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Targeted radiation reduces mortality for early-stage lung cancer

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February 20, 2018

William Stokes

Stereotactic body radiation therapy conferred lower 30-day and 90-day mortality rates than surgery among patients with early-stage non-small cell lung cancer, according to study results.

The difference appeared more prominent among patients aged older than 70 years,

Several randomized trials comparing surgery with SBRT for operable early-stage NSCLC have been launched, but most have closed early because of poor accrual,” William Stokes, MD, senior resident in the department of radiation oncology at University of Colorado School of Medicine, and colleagues wrote. “In the single available comparison of randomized data, the finding of improved 3-year survival with SBRT over surgery is provocative; however, this analysis was limited by factors including the pooling of data from two separate trials, small patient numbers and low utilization rates of minimally invasive surgical techniques.”

Stokes and colleagues used data from the National Cancer Data Base to compare 30- and 90-day mortality among 76,623 patients with NSCLC who underwent surgery and 8,216 who received SBRT.

Researchers found surgery was more common among patients who were younger and in earlier years of diagnosis; had private insurance, T2 tumors, right-sided tumors or adenocarcinoma; lived in higher income areas; and received treatment in nonacademic facilities and those with lower patient volume.

Seventy-eight percent of surgery patients underwent lobectomy, 20.3% underwent sublobar resection and 2% had pneumonectomy.

At 30 days, patients who received SBRT had lower rates of mortality than those who had surgery (0.73% vs. 2.07%). At 90 days, the difference shrunk but remained significant (2.93% vs. 3.59%; P < .001 for both).

After propensity score matching, the differences in mortality between SBRT and surgery increased at 30 days (0.79% vs. 2.41%) and at 90 days (2.82% vs. 4.23%; P < .001 for both).

The differences in mortality increased:

  • Among patients aged 71 to 75 years — those who underwent surgery had a 1.87 percentage point increase in mortality at 30 days and a 2.02 percentage point increase at 90 days;
  • Among patients aged 76 to 80 years — those who underwent surgery had a 2.8 percentage point increase in mortality at 30 days and a 2.59 percentage point increase at 90 days; and
  • Among patients aged older than 80 years — those who underwent surgery had a 3.03 percentage point increase in mortality at 30 days and a 3.67 percentage point increase in mortality at 90 days.

“When examining patients together across all age groups, there was slightly less posttreatment mortality with radiation than with surgery,” Stokes said in a press release. “But, in older age groups, the differences became larger and potentially more meaningful for patients who are candidates for both therapies.”

Mortality rates were higher with increased extent of resection among patients who underwent surgery compared with SBRT at 30 days (sublobar resection, HR = 2.85; 95% CI, 2.14-3.79; lobectomy, HR = 3.65; 95% CI, 2.8-4.76; pneumonectomy, HR = 14.5; 95% CI, 10.3-20.2) and at 90 days (sublobar resection, HR = 1.37; 95% CI, 1.17-1.61; lobectomy, HR = 1.6; 95% CI, 1.39-1.84; pneumonectomy, HR = 5.66; 95% CI, 4.53-7.05).

The limitations of the study include the retrospective study design and lack of data on disease control, DFS, cause of death and comorbidities.

“Although surgery was associated with only moderate increases in absolute mortality overall, the most clinically meaningful observations from this analysis are likely related to the significant interaction between older age and increasing posttreatment mortality differences between surgery and SBRT,” the researchers wrote. “In particular, the increasing absolute and relative mortality rates with surgery compared [with] SBRT among patients 71[to] 75, 76 [to] 80, and [greater than] 80 years of age may have direct implications on shared decision-making for elderly patients who are considered higher risk surgical candidates.”– by Cassie Homer

Disclosures: Stokes reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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