Original article
General thoracic
Video-Assisted Thoracoscopic Lobectomy Versus Stereotactic Radiotherapy for Stage I Lung Cancer

https://doi.org/10.1016/j.athoracsur.2014.11.009Get rights and content

Background

Previous comparative reports of stereotactic body radiotherapy (SBRT) and surgery for non-small cell lung cancer (NSCLC) suffered from short follow-up, mixed extents of resection and inclusion of benign lesion. We aimed to make comparisons of long-term outcomes between a pure series of video-assisted thoracoscopic surgery (VATS) lobectomy and SBRT for biopsy-proven clinical stage I NSCLC.

Methods

We retrospectively compared overall survival (OS), cause-specific survival (CSS), recurrence-free survival (RFS), local control, regional lymph node (LN) control, and distant control between VATS lobectomy (n = 413) and SBRT (n = 104) for biopsy-proven clinical stage I NSCLC at our institution between 2003 and 2009. Propensity score matching was used to adjust the confounding effects in estimating treatment hazard ratios. Forty-one VATS lobectomy patients and 41 SBRT patients were matched blinded to outcome (1:1 ratio, caliper distance; 0.5).

Results

After propensity score matching, the follow-up period of the whole cohort ranged from 5 to 120 months with a median of 48. After propensity score matching there were significant differences in OS (p = 0.0016), CSS (p = 0.0015), RFS (p < 0.0001), local control (p = 0.0019), and distant control (p < 0.0001) and no significant difference in regional LN control (p = 0.11). The VATS lobectomy patients and SBRT patients had 68.5% and 37.3% of 5-year OS, 83.5% and 56.7% of 5-year CSS, and 60.4% and 19.5% of 5-year RFS, respectively.

Conclusions

Our results suggest VATS lobectomy may offer significantly more favorable long-term outcomes than SBRT in potentially operable patients with biopsy-proven clinical stage I NSCLC.

Section snippets

Patients and Methods

This study was approved by the Institutional Review Board of Kyoto University Hospital (reference number: E1993). The requirement for patient consent was waived. Retrospective chart review was performed on the prospectively maintained databases in the Department of Thoracic Surgery and Department of Radiation Oncology and Image-Applied Therapy at Kyoto University Hospital.

Included in this study were 413 Asian patients who underwent VATS lobectomy for a biopsy-proven, solitary, clinical stage I

Comparisons Before Propensity Score Matching

Hazard ratio (95% confidence interval) of VATS lobectomy to SBRT and p value for each endpoint were as follows, on the basis of a Cox proportional hazard model, adjusted for age, gender, tumor diameter, CCI, and % FEV1: OS, 0.58 (0.33 to 0.997) and p = 0.049; CSS, 0.483 (0.242 to 0.964) and p < 0.0001; RFS, 0.483 (0.294 to 0.80) and p = 0.00042; local control, 0.137 (0.045 to 0.41) and p = 0.0004; regional LN control, 0.489 (0.152 to 1.57) and p = 0.229; and distant control, 0.445 (0.228

Comment

Stereotactic body radiotherapy may be a reasonable alternative to surgical treatment for early-stage NSCLC in medically compromised or inoperable patients [1]. The role of SBRT in potentially operable patients has remained to be determined. Surgery has been recommended for operable patients with early-stage NSCLC because surgery is more diagnostic and enables nodal staging and adjuvant treatments for node-positive patients [1]. However, comparative studies on surgery versus SBRT in potentially

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Masatsugu Hamaji and Fengshi Chen contributed equally to this work.

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