Survival and recurrence rates following SBRT or surgery in medically operable Stage I NSCLC

• Published in: Lung cancer (Amsterdam, Netherlands) Netherlands), 2024-11, Vol.197, p.107962, Article 107962
• Main Authors: Snider, Michael, Salama, Joseph K., Boyer, Matthew
• Format: Article
• Language: English
• Subjects: Aged; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - radiotherapy; Carcinoma, Non-Small-Cell Lung - surgery; Early stage NSCLC; Female; Follow-Up Studies; Humans; Lobectomy; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - radiotherapy; Lung Neoplasms - surgery; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Pneumonectomy; Radiosurgery - methods; Retrospective Studies; SBRT; Sub-lobar resection; Surgical candidates; Survival Rate
• ISSN: 0169-5002; 1872-8332; 1872-8332
• DOI: 10.1016/j.lungcan.2024.107962

•Clinical findings alone are insufficient to identify surgical candidates who can have radiation.•Overall, lung cancer specific, and progression free survival worse with radiation.•Regional nodal recurrence rates higher with radiation compared to surgery.•Strategies to address regional recurrence after radiation are warranted. Surgery is the standard of care for early-stage non-small cell lung cancer (NSCLC), with SBRT reserved for patients who are not surgical candidates. We hypothesized overall survival (OS), lung cancer-specific survival (LCSS), progression free survival (PFS), and recurrence rates following SBRT or surgery in medically operable patients with Stage I NSCLC from the Veterans’ Health Care System (VAHS) would be equivalent. Medically operable patients diagnosed with Stage I NSCLC between 2000–2020 from the VAHS, determined by an FEV1 or DLCO > 60 % of predicted and Charlson comorbidity index (CCI) of 0 or 1, treated with SBRT or surgery were identified. SBRT patients were propensity score matched in a 1:1:1 ratio to those undergoing resection (SBRT:lobectomy:sub-lobar resection). OS, LCSS, and PFS and site of recurrence were determined. 103 patients were included in each cohort. With a median follow-up of 7.9 years 5-year OS for all patients was 51 % (95 % CI 46–57 %). After propensity score matching, OS (HR 2.08, 1.59), LCSS (HR 2.28, 1.97), and PFS (1.97, 1.45) were significantly worse with SBRT compared to either lobectomy or sub-lobar resection, respectively, (p  0.05) when compared to lobectomy or sub-lobar resection, respectively. In medically operable patients, OS, LCSS, and PFS following either lobectomy or sub-lobar resection were superior to that for SBRT for Stage I NSCLC, likely due in part to higher regional recurrence following SBRT. This suggests that pulmonary function test results and CCI alone are insufficient to define a cohort of medically operable patients suited for SBRT. These data support strategies to overcome regional recurrences seen with SBRT.