Longitudinal quality of life after sublobar resection and stereotactic body radiation therapy for early‐stage non–small cell lung cancer

• Published in: Cancer 2024-07, Vol.130 (14), p.2515-2527
• Main Authors: Wisnivesky, Juan P., Mudd, Jeremy, Stone, Kimberly, Slatore, Christopher G., Flores, Raja, Swanson, Scott, Blackstock, William, Smith, Cardinale B., Chidel, Mark, Rosenzweig, Kenneth, Henschke, Claudia, Kern, Jeffrey A.
• Format: Article
• Language: English
• Subjects: Cancer therapies; early‐stage lung cancer; Health care facilities; limited resection; Lung cancer; Mental health; Non-small cell lung carcinoma; non–small cell lung cancer; Patients; Quality of life; Radiation therapy; Robotic surgery; Small cell lung carcinoma; stereotactic body radiation therapy; Thoracic surgery; Thorax
• ISSN: 0008-543X; 1097-0142; 1097-0142
• DOI: 10.1002/cncr.35286

Background Many patients with early‐stage lung cancer are not candidates for lobectomy because of various factors, with treatment options including sublobar resection or stereotactic body radiation therapy (SBRT). Limited information exists regarding patient‐centered outcomes after these treatments. Methods Subjects with stage I–IIA non–small cell lung cancer (NSCLC) at high risk for lobectomy who underwent treatment with sublobar resection or SBRT were recruited from five medical centers. Quality of life (QOL) was compared with the Short Form 8 (SF‐8) for physical and mental health and Functional Assessment of Cancer Therapy–Lung (FACT‐L) surveys at baseline (pretreatment) and 7 days, 30 days, 6 months, and 12 months after treatment. Propensity score methods were used to control for confounders. Results Of 337 subjects enrolled before treatment, 63% received SBRT. Among patients undergoing resection, 89% underwent minimally invasive video‐assisted thoracic surgery or robot‐assisted resection. Adjusted analyses showed that SBRT‐treated patients had both higher physical health SF‐8 scores (difference in differences [DID], 6.42; p = .0008) and FACT‐L scores (DID, 2.47; p = .004) at 7 days posttreatment. Mental health SF‐8 scores were not different at 7 days (p = .06). There were no significant differences in QOL at other time points, and all QOL scores returned to baseline by 12 months for both groups. Conclusions SBRT is associated with better QOL immediately posttreatment compared with sublobar resection. However, both treatment groups reported similar QOL at later time points, with a return to baseline QOL. These findings suggest that sublobar resection and SBRT have a similar impact on the QOL of patients with early‐stage lung cancer deemed ineligible for lobectomy. Patients with early‐stage non–small cell lung cancer at high risk for lobectomy who were treated with stereotactic body radiation therapy or sublobar resection were followed for quality of life (QOL) measures at intervals up to 12 months after cancer treatment. Although patients treated with sublobar resection had worse QOL in the early postoperative period, there was no clinically significant difference in QOL outcomes at all other time points, with both groups returning to baseline QOL by 12 months.