Outcomes of stereotactic body radiotherapy versus lobectomy for stage I non-small cell lung cancer: a propensity score matching analysis

BMC Pulmonary Medicine

Yaping Xu¹  Qingren Lin¹  Yuezhen Wang¹  Zhun Wang¹  Xiaojiang Sun¹  Ning Zhou² 

[1] 0000 0004 1808 0985, grid.417397.f, Department of Radiation Oncology, Zhejiang Cancer Hospital, 1 Banshan dong Road, Hangzhou, People’s Republic of China;0000 0004 1808 0985, grid.417397.f, Department of Radiation Oncology, Zhejiang Cancer Hospital, 1 Banshan dong Road, Hangzhou, People’s Republic of China;0000 0001 2218 4662, grid.6363.0, Comprehensive Cancer Center, Charité Universitätsmedizin Berlin, Charitéplatz 1, D-10117, Berlin, Germany;

关键词: Non-small cell lung cancer;    Stereotactic body radiotherapy;    Lobectomy;    Propensity score match;   

DOI  :  10.1186/s12890-019-0858-y

来源: publisher

【 摘 要 】

BackgroundLobectomy is the standard treatment for patients with stage I non-small cell lung cancer (NSCLC). Recent studies have shown promising results of stereotactic body radiation therapy (SBRT) in these patients. We retrospectively compared the outcomes of lobectomy and SBRT in these patients from our therapeutic center.MethodsPatients who underwent lobectomy or SBRT for clinical T1–2a (T size≤5 cm), N0 M0, NSCLC between December 2011 and August 2016 were reviewed. Patient characteristics, treatment-related outcomes and toxicities were analyzed. Propensity score matching (PSM) was performed to improve comparability between the two groups.ResultsMedian follow-up period in the lobectomy (n = 246) and SBRT (n = 70) group was 31.4 months and 24.9 months, respectively. Three-year local recurrence-free survival (LRFS) was comparable in the two groups (97% vs. 91.7%, respectively; P = 0.768). Recurrence-free survival (RFS) at 3-year in the lobectomy and SBRT groups was 85.4 and 69.5%, respectively (P = 0.014). Three-year overall survival (OS) after lobectomy and SBRT was 88.2 and 79.7%, respectively (P = 0.027), while 3-year cancer-specific survival (CSS) was 91.3 and 82.5% (P = 0.022). After PSM (45 matched patients in each group), there was no significant between-group difference with respect to 3-year LRFS (89.6% vs. 87.5%, P = 0.635), RFS (77.6% vs. 67.3%, P = 0.446), OS (78.5% vs. 79.5%, P = 0.915) or CSS (86.4 and 79.5%, P = 0.551). In matched subgroup, 30-day mortality after lobectomy was 2.2%, and no treatment-related death occurred after SBRT.ConclusionsTreatment-related outcomes of SBRT and lobectomy were comparable. SBRT was well tolerated and had a very low toxicity profile in our study. SBRT is a promising alternative treatment option for stage I NSCLC patients. This study indicates that matching these disparate cohorts of patients is challenging. Clinical trials are essential to define the indications and relative efficacy of lobectomy and SBRT in a selected population.

【 授权许可】

CC BY