NSCLC: SABR yields similar CSS but worse OS than surgery

  • Spencer KL & al.
  • Eur Respir J
  • 11 Jan 2019

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • Stereotactic ablative radiotherapy (SABR) offered the same cancer-specific survival (CSS) as surgical resection for patients with stage I NSCLC, but worse 2-year OS.

Why this matters

  • Randomized controlled trials comparing surgery and SABR have struggled to recruit participants and other studies comparing the 2 often include selection bias and unobserved confounders.

Study design

  • Intention-to-treat analysis.
  • 468 patients with stage I NSCLC underwent surgical resection (n=316), SABR (n=99), or conventionally fractionated radiotherapy (n=53).
  • Funding: None disclosed.

Key results

  • Among surgical patients, 84.8% had lobectomy and 15.2% sub-lobar resection.
  • 2-year OS was better with surgery than SABR or CFRT (79.8% vs 58.6% and 54.7%, respectively).
  • After excluding patients with no confirmed malignancy before treatment, SABR and CFRT were associated with worse OS compared to surgery (SABR aHRs, 1.696; 95% CI, 1.130-2.545 and CFRT aHR, 2.232; 95% CI, 1.385-3.598).
  • After excluding patients with no confirmed pre-treatment malignancy, CSS (aHR, 2.281; 95% CI, 1.204-4.319) and cancer and treatment-related survival (CTRS aHR, 2.018; 95% CI, 1.004-4.055) were significantly worse with CFRT compared to surgery, but not with SABR.
  • SABR and CFRT were associated with significantly greater non-cancer mortality (subdistribution HR [SHR], 2.161; P<.001 and shr p=".027," respectively>

Limitations

  • Single-center, retrospective study.

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