Surgery versus Stereotactic Body Radiotherapy for Early-Stage Lung Cancer in Healthy Patients who Refused a Recommended Surgery.
Presented During:
Monday, May 8, 2023: 4:30PM - 4:45PM
Los Angeles Convention Center
Posted Room Name:
408B
Abstract No:
275
Submission Type:
Abstract Submission
Authors:
Brooks Udelsman (1), Maureen E. Canavan (2), Peter Zhan (3), Sora Ely (3), Daniel Boffa (4)
Institutions:
(1) Yale-New Haven Hospital, New Haven CT, (2) Cancer Outcomes Public Policy and Effectiveness Research Center, Yale University School of Medicine, New Haven, CT, (3) Department of Surgery, Yale University School of Medicine, New Haven, CT, (4) Yale New Haven, New Haven, CT
Submitting Author:
Brooks Udelsman
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Yale-New Haven Hospital
Yale-New Haven Hospital
Co-Author(s):
Maureen E. Canavan
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Cancer Outcomes Public Policy and Effectiveness Research Center, Yale University School of Medicine
Cancer Outcomes Public Policy and Effectiveness Research Center, Yale University School of Medicine
Peter Zhan
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Department of Surgery, Yale University School of Medicine
Department of Surgery, Yale University School of Medicine
Sora Ely
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Department of Surgery, Yale University School of Medicine
Department of Surgery, Yale University School of Medicine
*Daniel Boffa
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Yale New Haven
Yale New Haven
Presenting Author:
Brooks Udelsman
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Yale-New Haven Hospital
Yale-New Haven Hospital
Abstract:
Objective: To evaluate trends in the utilization of stereotactic body radiotherapy (SBRT) and the long-term survival of SBRT versus surgery in healthy patients with early-stage non-small cell lung cancer (NSCLC).
Methods: The National Cancer Database was queried for patients without documented comorbidities, who underwent surgical resection (lobectomy, segmentectomy, or wedge resection) or SBRT for clinical stage I NSCLC between 2012 and 2018. In the SBRT cohort, patients who were coded as not being offered surgery secondary to health or advanced age, were excluded. Perioperative mortality and 5-year survival were compared among propensity matched cohorts of patients who received SBRT vs. surgery, and repeated for the subset of SBRT patients who had documented refusal a recommended surgery.
Results: Overall 30,658 patients were identified, including 24,729 (80.7%) who underwent surgery and 5,929 (19.3%) treated with SBRT. Between 2012 and 2018 the proportion of patients receiving SBRT increased from 15.9% to 26.0% (p<0.001). In logistic regression, increasing age (odds ratio [OR] 1.09; 95% confidence interval [95%-CI] 1.09-1.10; p<0.001) and squamous histology (OR 1.25; 95%-CI 1.17-1.34; p<0.001) were associated with receiving SBRT. The 30-day and 90-day mortality were higher among patients undergoing surgical resection versus SBRT (1.7% vs. 0.3%, p<0.001; 2.8% vs. 1.7%, p<0.001). The unadjusted 5-year survival was greater in surgically managed patients (75.8% vs. 40.5% SBRT; p<0.001). In Kaplan Meier of propensity matched patients, the long-term survival favored SBRT for the first several months, but separated after one year, and by year two, significantly favored surgical management (5-year survival 61.9% for surgery vs 30.3% for SBRT; p<0.001) (Figure 1a). The propensity-matched analysis was repeated to only include SBRT patients who had documented refusal of a recommended surgery, again demonstrating superior survival with surgical management (5-year survival 63.5% with surgery vs 42.8% SBRT; p<0.001) (Figure 1b).
Conclusions
Over the past decade, SBRT has been increasingly used to treat early-stage lung cancer in comorbidity- free patients. Among patients that are eligible for either treatment, the long-term survival appears to favor surgical management over SBRT, particularly for patients with a health-related life expectancy exceeds two years.
Methods: The National Cancer Database was queried for patients without documented comorbidities, who underwent surgical resection (lobectomy, segmentectomy, or wedge resection) or SBRT for clinical stage I NSCLC between 2012 and 2018. In the SBRT cohort, patients who were coded as not being offered surgery secondary to health or advanced age, were excluded. Perioperative mortality and 5-year survival were compared among propensity matched cohorts of patients who received SBRT vs. surgery, and repeated for the subset of SBRT patients who had documented refusal a recommended surgery.
Results: Overall 30,658 patients were identified, including 24,729 (80.7%) who underwent surgery and 5,929 (19.3%) treated with SBRT. Between 2012 and 2018 the proportion of patients receiving SBRT increased from 15.9% to 26.0% (p<0.001). In logistic regression, increasing age (odds ratio [OR] 1.09; 95% confidence interval [95%-CI] 1.09-1.10; p<0.001) and squamous histology (OR 1.25; 95%-CI 1.17-1.34; p<0.001) were associated with receiving SBRT. The 30-day and 90-day mortality were higher among patients undergoing surgical resection versus SBRT (1.7% vs. 0.3%, p<0.001; 2.8% vs. 1.7%, p<0.001). The unadjusted 5-year survival was greater in surgically managed patients (75.8% vs. 40.5% SBRT; p<0.001). In Kaplan Meier of propensity matched patients, the long-term survival favored SBRT for the first several months, but separated after one year, and by year two, significantly favored surgical management (5-year survival 61.9% for surgery vs 30.3% for SBRT; p<0.001) (Figure 1a). The propensity-matched analysis was repeated to only include SBRT patients who had documented refusal of a recommended surgery, again demonstrating superior survival with surgical management (5-year survival 63.5% with surgery vs 42.8% SBRT; p<0.001) (Figure 1b).
Conclusions
Over the past decade, SBRT has been increasingly used to treat early-stage lung cancer in comorbidity- free patients. Among patients that are eligible for either treatment, the long-term survival appears to favor surgical management over SBRT, particularly for patients with a health-related life expectancy exceeds two years.
Categories:
Lung Cancer
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