Neil B Newman1, Alexander D Sherry2, Daniel W Byrne3, Evan C Osmundson1. 1. Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN. 2. Vanderbilt University School of Medicine, Nashville, TN. 3. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN.
Abstract
PURPOSE: This study was designed to compare survival outcomes for non-surgically managed T1-T2N0M0 small cell lung cancer (SCLC) who received either stereotactic body radiation therapy (SBRT) or conventionally fractionated radiotherapy (CFRT) using the National Cancer Data Base (NCDB). METHODS: The was queried between 2004-2015 for patients with T1-T2N0M0 SCLC. Patients must have been treated with curative intent SBRT or CFRT (delivered daily or twice daily, 45-70 Gy) with or without chemotherapy. The primary outcome was overall survival (OS). A subset analysis of patient receiving chemotherapy was also performed. A propensity score matched (PSM) analysis was performed to compare OS among patients who received chemotherapy. RESULTS: We evaluated 1378 patients in the general cohort. Multivariable Cox regression analysis(MVA) in the general cohort revealed that SBRT was significantly associated with improved survival (HR 0.68, p<0.001) along with receipt of chemotherapy (HR 0.63, p <0.001). SBRT patients were less likely to receive chemotherapy compared to CFRT patients (p<0.01). In the chemotherapy subset, of 1096 patients, on MVA, there was a trend in favor of the SBRT group (HR 0.73; p=0.06). A 3:1 PSM analysis on the chemotherapy subset found similar results on MVA with a trend in favor of SBRT (p=0.06). CONCLUSION: Patients with T1-2N0M0 SCLC treated with SBRT regimens incorporating chemotherapy had comparable outcomes to concurrent chemoradiotherapy using standard fractionation. Treatment paradigms for T1-2N0M0 SCLC incorporating SBRT warrant further exploration and should incorporate chemotherapy.
PURPOSE: This study was designed to compare survival outcomes for non-surgically managed T1-T2N0M0 small cell lung cancer (SCLC) who received either stereotactic body radiation therapy (SBRT) or conventionally fractionated radiotherapy (CFRT) using the National Cancer Data Base (NCDB). METHODS: The was queried between 2004-2015 for patients with T1-T2N0M0 SCLC. Patients must have been treated with curative intent SBRT or CFRT (delivered daily or twice daily, 45-70 Gy) with or without chemotherapy. The primary outcome was overall survival (OS). A subset analysis of patient receiving chemotherapy was also performed. A propensity score matched (PSM) analysis was performed to compare OS among patients who received chemotherapy. RESULTS: We evaluated 1378 patients in the general cohort. Multivariable Cox regression analysis(MVA) in the general cohort revealed that SBRT was significantly associated with improved survival (HR 0.68, p<0.001) along with receipt of chemotherapy (HR 0.63, p <0.001). SBRT patients were less likely to receive chemotherapy compared to CFRT patients (p<0.01). In the chemotherapy subset, of 1096 patients, on MVA, there was a trend in favor of the SBRT group (HR 0.73; p=0.06). A 3:1 PSM analysis on the chemotherapy subset found similar results on MVA with a trend in favor of SBRT (p=0.06). CONCLUSION: Patients with T1-2N0M0 SCLC treated with SBRT regimens incorporating chemotherapy had comparable outcomes to concurrent chemoradiotherapy using standard fractionation. Treatment paradigms for T1-2N0M0 SCLC incorporating SBRT warrant further exploration and should incorporate chemotherapy.
Entities:
Keywords:
early stage small cell lung cancer; national cancer database; small cell lung cancer; stereotactic body radiotherapy
Authors: A Aupérin; R Arriagada; J P Pignon; C Le Péchoux; A Gregor; R J Stephens; P E Kristjansen; B E Johnson; H Ueoka; H Wagner; J Aisner Journal: N Engl J Med Date: 1999-08-12 Impact factor: 91.245
Authors: Shideng Bao; Qiulian Wu; Roger E McLendon; Yueling Hao; Qing Shi; Anita B Hjelmeland; Mark W Dewhirst; Darell D Bigner; Jeremy N Rich Journal: Nature Date: 2006-10-18 Impact factor: 49.962
Authors: Ramaswamy Govindan; Nathan Page; Daniel Morgensztern; William Read; Ryan Tierney; Anna Vlahiotis; Edward L Spitznagel; Jay Piccirillo Journal: J Clin Oncol Date: 2006-10-01 Impact factor: 44.544
Authors: Youjin Lee; Sogyong L Auh; Yugang Wang; Byron Burnette; Yang Wang; Yuru Meng; Michael Beckett; Rohit Sharma; Robert Chin; Tony Tu; Ralph R Weichselbaum; Yang-Xin Fu Journal: Blood Date: 2009-04-06 Impact factor: 22.113
Authors: P Wheatley-Price; C Ma; L F Ashcroft; M Nankivell; R J Stephens; S C White; P Lorigan; N Thatcher; F H Blackhall; F A Shepherd Journal: Ann Oncol Date: 2009-08-12 Impact factor: 32.976
Authors: Long Liang; Taiyu Chen; Tao Ren; Mian Mao; Keli Wang; Chunhan Tang; Juan Xiao; Hongyuan Jia; Wenli Chen; Qifeng Wang; Tao Li Journal: Cancer Manag Res Date: 2022-01-06 Impact factor: 3.989
Authors: Cristina Pangua; Jacobo Rogado; Gloria Serrano-Montero; José Belda-Sanchís; Beatriz Álvarez Rodríguez; Laura Torrado; Nuria Rodríguez De Dios; Xabier Mielgo-Rubio; Juan Carlos Trujillo; Felipe Couñago Journal: World J Clin Oncol Date: 2022-06-24