Stereotactic Body Radiotherapy versus Non-Radiotherapeutic Ablative Procedures for Early Stage Non-Small Cell Lung Cancer
Year: 2019
Type: article
Study design: Observational Study
Abstract: Mentor: Chi Lin Program: Radiation Oncology Introduction: Despite the fact that stereotactic body radiation therapy (SBRT) is the only recommended first-line therapy for inoperable early stage NSCLC, several thermal ablative procedures (TAPs) are available. Outcomes from these procedures, and how they compare to SBRT, are scarce. We sought to evaluate the comparative efficacy of SBRT versus TAPs using the National Cancer Database (NCDB). Methods: The NCDB (2004–2014) was queried for early stage NSCLC patients who did not undergo surgical resection. Treatment-specific inclusion criteria were applied to select for patients as receiving either TAPs or SBRT. Univariate logistic regression, Cox proportional hazard modeling, and Kaplan-Meier (KM) curves were performed. Propensity matching was performed using a modified Greedy 8→n matching 1:1 algorithm. Results: 27,734 patients were analyzed; 26,725 underwent SBRT and 1,009 underwent IR-procedures. Patients who received SBRT were older and more likely to have clinical stage 1B disease. Despite this, SBRT was associated with longer median overall survival (OS) (37.7 vs 33.5 months, p=0.001) and 1, 2, and 5 year OS than the IR cohort at 86.7% vs 83.1%, 67.5% vs 62.7%, and 30.6% vs 26.9%, respectively (p=0.001). Upon propensity matching, the improved OS with SBRT remained with a median OS of 40.4 months vs 33.4 months and 1, 2, and 5 year OS of 89.0% vs 82.9%, 69.7% vs 62.7%, and 34.4% vs 26.4%, respectively (p=0.0033). Conclusions: Despite being associated with multiple poor prognostic features, SBRT was associated with higher OS over TAPs for treatment of non-operative patients diagnosed with early-stage NSCLC.
Institution: University of Nebraska Medical Center
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W2995367985