Recurrence after Stereotactic Body Radiation Therapy versus Lobectomy for Non-Small Cell Lung Cancer

Lung Cancer

Sebastian N, et al. Ann Thorac Surg 2020.


BACKGROUND: Although lobectomy remains the standard of care for early-stage non-small cell lung cancer (NSCLC), several studies suggest equipoise between lobectomy and stereotactic body radiation therapy (SBRT). However, randomized evidence is lacking. We compared outcomes of early-stage NSCLC patients treated with lobectomy or SBRT.

METHODS: We included clinical T1-2N0 NSCLC treated with lobectomy or SBRT to a biologically effective dose (BED) of ≥ 100 Gy10. We used Cox proportional hazards and nearest-neighbor propensity score (2:1) matching to adjust for confounders. Kaplan-Meier curves were used to assess survival and recurrence.

RESULTS: We identified 554 patients treated with lobectomy (n = 389) or SBRT (n = 165) at our institution between 2008 and 2018. After propensity score matching, there were 132 and 85 lobectomy and SBRT patients, respectively. SBRT was associated with increased local recurrence (HR = 6.80; 95% CI 1.92- 24.10; p = 0.003) and regional nodal recurrence (HR = 2.58; 95% CI 1.17 - 5.68; p = 0.018), as well as worse overall survival (HR = 2.00; 95% CI 1.21 - 3.32; p = 0.007) and progression-free survival (HR = 2.34; 95% CI 1.50 - 3.67; p < 0.001).There was no difference in distant recurrence (HR = 1.19; 95% CI 0.57 - 2.52; p = 0.64).

CONCLUSIONS: We found superior outcomes in patients with early-stage NSCLC treated with lobectomy compared to SBRT, including locoregional control. These findings should be interpreted with caution, due to selection bias, but underscore the importance of robust randomized prospective data to clarify the relative efficacy of these modalities.