Multi-institutional analysis of stereotactic body radiation therapy for operable early-stage non-small cell lung carcinoma

Benjamin H Kann; Vivek Verma; John M Stahl; Rudi Ross; Arie P Dosoretz; Timothy D Shafman; Cary P Gross; Henry S Park; James B Yu; Roy H Decker

doi:10.1016/j.radonc.2019.01.027

Multi-institutional analysis of stereotactic body radiation therapy for operable early-stage non-small cell lung carcinoma

Radiother Oncol. 2019 May:134:44-49. doi: 10.1016/j.radonc.2019.01.027. Epub 2019 Feb 1.

Authors

Benjamin H Kann¹, Vivek Verma², John M Stahl³, Rudi Ross⁴, Arie P Dosoretz⁴, Timothy D Shafman⁴, Cary P Gross⁵, Henry S Park⁶, James B Yu⁶, Roy H Decker⁶

Affiliations

¹ Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, USA. Electronic address: benjamin.kann@yale.edu.
² Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, USA.
³ Department of Radiation Oncology, University of Alabama at Birmingham School of Medicine, Birmingham, USA.
⁴ 21st Century Oncology, Fort Myers, USA.
⁵ Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, USA.
⁶ Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, USA.

PMID: 31005223
DOI: 10.1016/j.radonc.2019.01.027

Abstract

Purpose: Although stereotactic body radiation therapy (SBRT) is the standard of care for inoperable early-stage non-small cell lung carcinoma (NSCLC), its role for medically operable patients remains controversial. To address this knowledge gap, we conducted a multi-institutional study to assess post-SBRT disease control and survival outcomes in medically operable patients.

Methods: We conducted a retrospective cohort study including patients with biopsy-proven cT1-2N0M0 NSCLC treated with definitive SBRT (2006-2015). Per patient charts, inoperability referred to documentation of poor surgical candidacy with a given rationale for lack of resection. Charts of operable patients contained documentation of patients refusing surgery or choosing SBRT, without a documented rationale for inoperability. Subjects were excluded in cases of ambiguity regarding the aforementioned definitions and/or lack of clearly documented operability status. Endpoints included local failure (LF) and regional-distant failure, both evaluated with Fine and Gray competing risks regression; Kaplan-Meier methodology analyzed overall survival (OS) and progression-free survival (PFS).

Results: Of 952 patients, 408 (42.9%) were operable, and 544 (57.1%) were inoperable. Median follow-up was 22 months. Two-year LF was 9.7% in operable patients and 8.2% in inoperable patients (p = 0.36). There was no statistical difference in regional-distant failure (p = 0.55) between cohorts. Operable patients experienced statistically higher OS (p = 0.04), but not PFS (p = 0.11). Respective 1-, 2-, and 3-year OS in operable patients were 85.4%, 66.2%, and 51.2%.

Conclusions: Although patients with operable NSCLC experience higher OS than their inoperable counterparts, disease-related outcomes are similar. These results may better inform shared decision-making between medically operable patients and their multidisciplinary providers.

Keywords: Lung cancer; Non-small cell lung carcinoma; Operable; Stereotactic ablative radiotherapy; Stereotactic body radiation therapy.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Carcinoma, Non-Small-Cell Lung / pathology
Carcinoma, Non-Small-Cell Lung / radiotherapy*
Carcinoma, Non-Small-Cell Lung / surgery
Cohort Studies
Female
Humans
Kaplan-Meier Estimate
Lung Neoplasms / pathology
Lung Neoplasms / radiotherapy*
Lung Neoplasms / surgery
Male
Neoplasm Staging
Progression-Free Survival
Radiosurgery / methods*
Retrospective Studies
Treatment Outcome