SBRT vs surgery yields worse survival in early stage NSCLC

  • Khorfan R & al.
  • Ann Thorac Surg
  • 5 Mar 2020

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • 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.

Study design

  • 138,143 patients with stage I-II NSCLC who were candidates for surgical resection.
  • Funding: None disclosed.

Key results

  • 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.

Limitations

  • Retrospective study.