Stereotactic Ablative Radiotherapy as an Alternative to Lobectomy in Patients With Medically Operable Stage I NSCLC: A Retrospective, Multicenter Analysis.

Aged Aged, 80 and over Carcinoma, Non-Small-Cell Lung / mortality Cohort Studies Drug Combinations Estradiol / analogs & derivatives Female Humans Lung Neoplasms / mortality Male Middle Aged Neoplasm Staging Norethindrone Pneumonectomy Radiosurgery Retrospective Studies Survival Analysis Testosterone / analogs & derivatives

Ablative stereotactic body radiation therapy Lobectomy Medically operable Multicenter analysys Stage I NSCLC

Journal

Clinical lung cancer

ISSN: 1938-0690

Titre abrégé: Clin Lung Cancer

Pays: United States

ID NLM: 100893225

Informations de publication

Date de publication:
01 2019

Historique:

received: 14 05 2018

revised: 02 09 2018

accepted: 04 09 2018

pubmed: 24 10 2018

medline: 27 6 2019

entrez: 24 10 2018

Statut: ppublish

Résumé

Stereotactic ablative body radiation therapy (SBRT) has evolved as the standard treatment for patients with inoperable stage I non-small-cell lung cancer (NSCLC). We report the results of a retrospective analysis conducted on a large, well-controlled cohort of patients with stage I to II NSCLC who underwent lobectomy (LOB) or SBRT. One hundred eighty-seven patients with clinical-stage T1a-T2bNoMO NSCLC were treated in 2 academic hospitals between August 2008 and May 2015. Patients underwent LOB or SBRT; those undergoing SBRT were sub-classified as surgical candidates and nonsurgical candidates, according to the presence of surgical contraindications or comorbidities. In univariate analysis, no significant difference was found in local control between patients who underwent SBRT and LOB, with a trend in favor of surgery (hazard ratio [HR], 0.27; 95% confidence interval [CI], 0.07-1.01; P < .053). Univariate analysis showed that overall survival (OS) was significantly better in patients who underwent LOB (HR, 0.44; 95% CI, 0.23-0.85) with a 3-year OS of 73.4% versus 65.2% for surgery and radiation therapy patients, respectively (P < .01). However, no difference in OS was observed between operable patients undergoing SBRT and patients who underwent LOB (HR, 1.68; 95% CI, 0.72-3.90). Progression-free survival was comparable between patients who underwent LOB and SBRT (HR, 0.61; P = .09). SBRT is a valid therapeutic approach in early-stage NSCLC. Furthermore, SBRT seems to be very well-tolerated and might lead to the same optimal locoregional control provided by surgery for patients with either operable or inoperable early-stage NSCLC.

Sections du résumé

BACKGROUND

MATERIALS AND METHODS

One hundred eighty-seven patients with clinical-stage T1a-T2bNoMO NSCLC were treated in 2 academic hospitals between August 2008 and May 2015. Patients underwent LOB or SBRT; those undergoing SBRT were sub-classified as surgical candidates and nonsurgical candidates, according to the presence of surgical contraindications or comorbidities.

RESULTS

In univariate analysis, no significant difference was found in local control between patients who underwent SBRT and LOB, with a trend in favor of surgery (hazard ratio [HR], 0.27; 95% confidence interval [CI], 0.07-1.01; P < .053). Univariate analysis showed that overall survival (OS) was significantly better in patients who underwent LOB (HR, 0.44; 95% CI, 0.23-0.85) with a 3-year OS of 73.4% versus 65.2% for surgery and radiation therapy patients, respectively (P < .01). However, no difference in OS was observed between operable patients undergoing SBRT and patients who underwent LOB (HR, 1.68; 95% CI, 0.72-3.90). Progression-free survival was comparable between patients who underwent LOB and SBRT (HR, 0.61; P = .09).

CONCLUSION

SBRT is a valid therapeutic approach in early-stage NSCLC. Furthermore, SBRT seems to be very well-tolerated and might lead to the same optimal locoregional control provided by surgery for patients with either operable or inoperable early-stage NSCLC.

Identifiants

DOI: 10.1016/j.cllc.2018.09.003 PMID: 30348595

pubmed: 30348595

pii: S1525-7304(18)30236-5

doi: 10.1016/j.cllc.2018.09.003

pii:

doi:

Substances chimiques

Drug Combinations 0

estradiol, norethisterone, testosterone drug combination 0

Testosterone 3XMK78S47O

Estradiol 4TI98Z838E

Norethindrone T18F433X4S

Types de publication

Comparative Study Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

Pagination

e53-e61

Commentaires et corrections

Type : CommentIn