Early-stage NSCLC: sublobar resection tops SBRT for RFS

  • Tamura M & al.
  • Ann Thorac Surg
  • 17 Nov 2018

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • Sublobar resection (SLR) offers better overall recurrence-free survival (RFS) than stereotactic body radiation therapy (SBRT) in patients with stage I NSCLC with tumors that are >2.0 cm and located internally.

Why this matters

  • Tumor size and location should be considerations when choosing between SBRT or sublobar resection for early-stage NSCLC.

Study design

  • Patients with stage I NSCLC underwent SBRT (n=106) or SLR (n=141).
  • Propensity score matching (PSM) of 78 patient pairs.
  • Funding: None disclosed.

Key results

  • PSM: At 5 years, RFS favored surgery over SBRT (69.7% vs 50.2%; P=.036), but there was no significant difference between groups in OS (75.2% vs 70.2%; P=.40) or disease-specific survival (DSS: 89.5% vs 76.0%; P=.78).
  • In patients with nodules >2.0 cm in diameter, surgery yielded significantly better 5-year RFS (69.0% vs 32.9%; P=.042), but 5-year DSS benefit failed to achieve significance (85.4% vs 48.5%; P=.064).
  • No differences in OS, DSS, or RFS between groups for patients with nodules ≤2.0 cm in diameter.
  • Patients with tumors located in the outer third of the lung field had a higher 5-year RFS with SBRT (72.1% vs 42.2%; P=.002), but also had a higher local recurrence rate (P=.0082).

Limitations

  • Retrospective study with small sample size.

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