Bryan J Ager1, Stacey M Wells1, Joshua D Gruhl1, Gregory J Stoddard2, Randa Tao1, Kristine E Kokeny1, Ying J Hitchcock3. 1. Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA. 2. Division of Epidemiology, School of Medicine, University of Utah, Salt Lake City, UT, USA. 3. Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA. Electronic address: Ying.Hitchcock@hci.utah.edu.
Abstract
OBJECTIVES: To compare patterns of care and overall survival (OS) between stereotactic body radiotherapy (SBRT) and percutaneous local tumor ablation (LTA) for non-surgically managed early-stage non-small-cell lung cancer (NSCLC). MATERIALS AND METHODS: The National Cancer Database (NCDB) was queried from 2004 to 2014 for adults with non-metastatic, node-negative invasive adenocarcinoma or squamous cell carcinoma of the lung with primary tumor size ≤5.0 cm who did not undergo surgery or chemotherapy and received SBRT or LTA. Patterns of care were assessed with multivariate logistic regression. After propensity-score weighting with generalized boosted regression, OS was assessed with univariate and doubly-robust multivariate Cox regression. RESULTS: Of 15,792 patients, 14,651 (93%) received SBRT and 1141 (7%) received LTA. Increasing age (OR 1.01, p = .035), treatment at an academic institution (OR 2.94, p < .001), increasing tumor size (OR 1.05, p < .001), and more recent year of diagnosis (OR 1.43, p < .001) were predictive of treatment with SBRT, whereas comorbidities (OR 0.74, p = .003) and treatment at a high-volume facility (OR 0.05, p < .001) were predictive for LTA. At a median follow-up of 26.2 months, SBRT was associated with improved OS relative to LTA within a propensity-score weighted doubly-robust multivariate analysis (HR 0.71, p < .001). On weighted subgroup analyses, improved OS was observed with SBRT for tumor sizes >2.0 cm (HR 0.72, p < .001) and for those treated at high-volume facilities (HR 0.71, p < .001). No OS difference was found with SBRT or LTA in tumor sizes ≤2.0 cm (HR 0.90, p = .227). CONCLUSION: Within the NCDB, SBRT was more commonly utilized and was associated with improved OS when compared to percutaneous LTA for patients with non-surgically managed early-stage NSCLC. Patients with small tumor volumes likely represent an appropriate population for future prospective randomized comparisons between SBRT and LTA.
OBJECTIVES: To compare patterns of care and overall survival (OS) between stereotactic body radiotherapy (SBRT) and percutaneous local tumor ablation (LTA) for non-surgically managed early-stage non-small-cell lung cancer (NSCLC). MATERIALS AND METHODS: The National Cancer Database (NCDB) was queried from 2004 to 2014 for adults with non-metastatic, node-negative invasive adenocarcinoma or squamous cell carcinoma of the lung with primary tumor size ≤5.0 cm who did not undergo surgery or chemotherapy and received SBRT or LTA. Patterns of care were assessed with multivariate logistic regression. After propensity-score weighting with generalized boosted regression, OS was assessed with univariate and doubly-robust multivariate Cox regression. RESULTS: Of 15,792 patients, 14,651 (93%) received SBRT and 1141 (7%) received LTA. Increasing age (OR 1.01, p = .035), treatment at an academic institution (OR 2.94, p < .001), increasing tumor size (OR 1.05, p < .001), and more recent year of diagnosis (OR 1.43, p < .001) were predictive of treatment with SBRT, whereas comorbidities (OR 0.74, p = .003) and treatment at a high-volume facility (OR 0.05, p < .001) were predictive for LTA. At a median follow-up of 26.2 months, SBRT was associated with improved OS relative to LTA within a propensity-score weighted doubly-robust multivariate analysis (HR 0.71, p < .001). On weighted subgroup analyses, improved OS was observed with SBRT for tumor sizes >2.0 cm (HR 0.72, p < .001) and for those treated at high-volume facilities (HR 0.71, p < .001). No OS difference was found with SBRT or LTA in tumor sizes ≤2.0 cm (HR 0.90, p = .227). CONCLUSION: Within the NCDB, SBRT was more commonly utilized and was associated with improved OS when compared to percutaneous LTA for patients with non-surgically managed early-stage NSCLC. Patients with small tumor volumes likely represent an appropriate population for future prospective randomized comparisons between SBRT and LTA.
Authors: Achilles J Fakiris; Ronald C McGarry; Constantin T Yiannoutsos; Lech Papiez; Mark Williams; Mark A Henderson; Robert Timmerman Journal: Int J Radiat Oncol Biol Phys Date: 2009-02-27 Impact factor: 7.038
Authors: Bryan J Schneider; Megan E Daly; Erin B Kennedy; Mara B Antonoff; Stephen Broderick; Jill Feldman; Shruti Jolly; Bryan Meyers; Gaetano Rocco; Chad Rusthoven; Ben J Slotman; Daniel H Sterman; Brendon M Stiles Journal: J Clin Oncol Date: 2017-11-06 Impact factor: 44.544
Authors: Henry S Park; Frank C Detterbeck; David C Madoff; Brett C Bade; Ulas Kumbasar; Vincent J Mase; Andrew X Li; Justin D Blasberg; Gavitt A Woodard; Whitney S Brandt; Roy H Decker Journal: J Thorac Dis Date: 2022-06 Impact factor: 3.005
Authors: Julie K Jang; Scott M Atay; Li Ding; Elizabeth A David; Sean C Wightman; Anthony W Kim; Jason C Ye Journal: Am J Clin Oncol Date: 2022-04-01 Impact factor: 2.339
Authors: Angel Cilleruelo-Ramos; Esther Cladellas-Gutiérrez; Carolina de la Pinta; Laura Quintana-Cortés; Paloma Sosa-Fajardo; Felipe Couñago; Xabier Mielgo-Rubio; Juan Carlos Trujillo-Reyes Journal: World J Clin Oncol Date: 2021-12-24
Authors: Valentina Vespro; Maria Chiara Bonanno; Maria Carmela Andrisani; Anna Maria Ierardi; Alice Phillips; Davide Tosi; Paolo Mendogni; Sara Franzi; Gianpaolo Carrafiello Journal: Tomography Date: 2022-03-01