Comparison of the outcomes of sublobar resection and stereotactic body radiotherapy for stage T1-2N0M0 non-small cell lung cancer with tumor size ≤ 5 cm: a propensity score matching analysis

Baiqiang Dong; Xuan Zhu; Jianan Jin; Yuanyuan Chen; Hangjie Ying; Yamei Chen; Fangxiao Lu; Wei Shen; Jin Wang; Ming Chen

doi:10.21037/jtd-20-2367

Comparison of the outcomes of sublobar resection and stereotactic body radiotherapy for stage T1-2N0M0 non-small cell lung cancer with tumor size ≤ 5 cm: a propensity score matching analysis

J Thorac Dis. 2020 Oct;12(10):5934-5954. doi: 10.21037/jtd-20-2367.

Authors

Baiqiang Dong^{1

2}, Xuan Zhu³, Jianan Jin^{1

2}, Yuanyuan Chen^{1

2}, Hangjie Ying^{1

2}, Yamei Chen^{1

2}, Fangxiao Lu⁴, Wei Shen⁵, Jin Wang^{1

2}, Ming Chen^{1

2}

Affiliations

¹ Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China.
² Department of Radiation Oncology, Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China.
³ Department of Radiation Oncology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
⁴ Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences; Department of X-ray, Cancer Hospital of the University of Chinese Academy of Sciences; Department of X-ray, Zhejiang Cancer Hospital, Cancer Hospital of the University of Chinese Academy of Sciences, Hangzhou, China.
⁵ Hangzhou YITU Healthcare Technology Co., Ltd., Hangzhou, China.

Abstract

Background: Surgery and stereotactic body radiotherapy (SBRT) are both suitable treatment options for early stage Non-small cell lung cancer (NSCLC), which accounts for the majority of lung cancer. This study compared the outcomes of sublobar resection (SLR) and SBRT in patients with stage T1-2N0M0 NSCLC with tumor size ≤5 cm.

Methods: Patients with T1-2N0M0 lung cancer who underwent SLR or SBRT between January, 2012 and December, 2016 were included in this retrospective study. The survival outcomes and toxicity of the SLR and SBRT cohorts were compared using Kaplan-Meier survival plots. In a second exploratory analysis, propensity score matching (PSM) was applied to reduce selection bias between the two groups of patients.

Results: A total of 121 SLR and 109 SBRT cases were included. The average follow-up was 49.4 months. Prior to PSM, the 5-year overall survival (OS) and cancer-specific survival (CSS) rates in the SLR group (82.8% and 89.0%, respectively) were superior to those in the SBRT group (67.0% and 75.3%; P=0.001 and P=0.013, respectively). There were no statistically significant differences in the five-year locoregional control and disease-free survival (DFS) rates between the groups. PSM identified 40 patients from each treatment group who shared similar characteristics. At 5 years, the OS rates in the SLR and SBRT groups were comparable (79.9% vs. 66.5%, respectively; P=0.154). After PSM, the rates of CSS, locoregional control, and DFS were also similar between the groups (P=0.458, 0.369, and 0.698, respectively). In the SBRT group, one patient developed grade 3 radioactive pneumonitis. No grade >3 toxicities or treatment-related deaths occurred in either group.

Conclusions: SBRT may be an alternative option to SLR for patients who cannot tolerate lobectomy because of medical comorbidities and has a similar level of effectiveness.

Keywords: Early-stage non-small cell lung cancer (early-stage NSCLC); adverse event; propensity score matching (PSM); stereotactic body radiotherapy; sublobar resection (SLR); treatment outcome.