- Patients with operable early-stage NSCLC who choose stereotactic body radiation therapy (SBRT) over recommended surgery have significantly worse survival than those who undergo recommended surgery.
Why this matters
- Prior studies have reported conflicting results regarding outcomes after SBRT vs surgery for early-stage NSCLC.
- 138,143 patients with stage I-II NSCLC who were candidates for surgical resection.
- Funding: None disclosed.
- 1359 (0.98%) chose SBRT instead of recommended surgery.
- Rate of SBRT among those recommended for surgery increased steadily during the study period, from 0.1% in 2004 to a peak of 1.7% in 2016 (P<.01>
- After propensity matching, 1-year OS was similar between the groups.
- But 5-year OS was significantly better in the surgery group:
- 57.2% vs 38.1% (P<.01>
- SBRT was associated with significantly higher mortality:
- Adjusted HR, 1.69 (P<.01>
- Surgery yielded better outcomes than SBRT in subgroups according to wedge resection, age, and T1 tumor stage.
- After multivariable analysis:
- SBRT was more likely in older patients, black patients, and Medicaid recipients.
- Surgery was more common for patients with private insurance, those with ≥1 comorbidity, and those with a higher T stage.
- Retrospective study.