Document Detail

Patterns of failure after stereotactic body radiation therapy or lobar resection for clinical stage I non-small-cell lung cancer.
MedLine Citation:
PMID:  23287852     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: The purpose of this study was to compare patterns of failure between lobar resection (lobectomy or pneumonectomy) and stereotactic body radiation therapy (SBRT) for patients with clinical stage I non-small-cell lung cancer (NSCLC).
METHODS: From January 2004 to January 2008, 338 patients underwent definitive treatment for pathologically confirmed clinical stage I NSCLC with lobar resection (n = 260) or SBRT (n = 78). Most surgical patients underwent lobectomy (n = 237). SBRT patients received a biologically effective dose of at least 100 Gy10. Lobar resection patients were younger, healthier, and had superior pulmonary function, whereas most of the patients in the SBRT group had T1 tumors. Final pathology upstaged 32.7% of surgery patients, and 20.0% received adjuvant chemotherapy. No SBRT patients received adjuvant chemotherapy.
RESULTS: In an unmatched comparison, 4-year lobar local control (98.7% versus 93.6%, p = 0.015) was greater for lobar resection versus SBRT, respectively, though primary tumor (98.7% versus 95.3%, p = 0.088), regional (82.9% versus 78.1%, p = 0.912), and distant control (76.1% versus 54.0%, p = 0.152) were similar. Overall survival (OS, 63.5% versus 29.6%, p < 0.0001) was greater for lobar resection, though cause-specific survival (CSS, 81.3% versus 75.3%, p = 0.923) was similar. In a T-stage matched comparison of 152 patients, there was no significant difference in patterns of failure or CSS, whereas OS favored surgery.
CONCLUSION: Lobectomy/pneumonectomy or SBRT results in comparable patterns of failure for clinical stage I NSCLC. In this retrospective comparison, OS was superior for surgery, though CSS was similar. Randomized trials are necessary to control for fundamental differences in comorbidity, which impact interpretation of both tumor control and survival.
Cliff G Robinson; Todd A DeWees; Issam M El Naqa; Kimberly M Creach; Jeffrey R Olsen; Traves D Crabtree; Bryan F Meyers; Varun Puri; Jennifer M Bell; Parag J Parikh; Jeffrey D Bradley
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer     Volume:  8     ISSN:  1556-1380     ISO Abbreviation:  J Thorac Oncol     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-18     Completed Date:  2013-07-18     Revised Date:  2014-01-11    
Medline Journal Info:
Nlm Unique ID:  101274235     Medline TA:  J Thorac Oncol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  192-201     Citation Subset:  IM    
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MeSH Terms
Adenocarcinoma / mortality*,  pathology,  surgery
Aged, 80 and over
Carcinoma, Non-Small-Cell Lung / mortality*,  pathology,  surgery
Carcinoma, Squamous Cell / mortality*,  pathology,  surgery
Follow-Up Studies
Lung Neoplasms / mortality*,  pathology,  surgery
Middle Aged
Neoplasm Staging
Pneumonectomy / mortality*
Radiosurgery / mortality*
Retrospective Studies
Survival Rate
Treatment Failure
Erratum In:
J Thorac Oncol. 2013 Oct;8(10):1343

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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