275. Surgery Versus Stereotactic Body Radiotherapy for Early-Stage Lung Cancer in Healthy Patients who Refused a Recommended Surgery
The Icahn School of Medicine at Mount Sinai
New York, NY
United States - Contact Me
Andrea Wolf is Director of the NY Mesothelioma Program and Associate Professor of Thoracic Surgery at the Icahn School of Medicine at Mount Sinai. She graduated Cum Laude from Princeton and earned highest honors at Harvard Medical School. She served as Chief Resident in Surgery at the MGH and Cardiothoracic Surgery at the Brigham and Women’s Hospital, where she completed a Thoracic Oncology Research Fellowship while earning her MPH at the Harvard School of Public Health. She has expertise in surgery for pleural mesothelioma and VATS lobectomy, and research interests in mesothelioma, health care disparities, and lung cancer. She and her team at the NY Mesothelioma Program received the 2020 International Association for the Study of Lung Cancer Care Team Award and she was honored with the 2022 Absestos Disease Awareness Organization Irving J. Selikoff Award. She has presented at numerous national and international meetings, is co-editor of the third edition of Sugarbaker’s Adult Chest Surgery and has published extensively on pleural mesothelioma and lung cancer. She loves to run and has one son, who is a superhero.
Yale-New Haven Hospital
North Haven, CT
United States - Contact Me
Dr. Udelsman is currently a traditional fellow in the Yale University CT Surgery program in New Haven, CT. He completed his general surgery residency at MGH and is general surgery board-certified. He earned his medical degree and master’s in health sciences at Yale University School of Medicine after graduating cum laude from Williams College with a B.A. in English Literature and Chemistry.
Dr. Udelsman’s research work has evolved alongside his interests and career plans; as a result, he has experience in a diverse array of clinical research topics and techniques, from bench side vascular tissue engineering to large database analysis. During residency, he focused on clinical research in Thoracic Surgery and Surgical Palliative Care. He is now continuing this work in fellowship and plans to continue to do so as an academic thoracic surgeon.
Abstract
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.