Patterns of failure after stereotactic body radiation therapy or lobar resection for clinical stage i non-small-cell lung cancer

Cliff G. Robinson, Todd DeWees, Issam M. El Naqa, Kimberly M. Creach, Jeffrey R. Olsen, Traves D. Crabtree, Bryan F. Meyers, Varun Puri, Jennifer M. Bell, Parag J. Parikh, Jeffrey D. Bradley

Research output: Contribution to journalArticle

67 Citations (Scopus)

Abstract

INTRODUCTION: The purpose of this study was to compare patterns of failure between lobar resection (lobectomy or pneumonectomy) and stereotactic body radiation therapy (SBRT) for patients with clinical stage I non-small-cell lung cancer (NSCLC). METHODS: From January 2004 to January 2008, 338 patients underwent definitive treatment for pathologically confirmed clinical stage I NSCLC with lobar resection (n = 260) or SBRT (n = 78). Most surgical patients underwent lobectomy (n = 237). SBRT patients received a biologically effective dose of at least 100 Gy10. Lobar resection patients were younger, healthier, and had superior pulmonary function, whereas most of the patients in the SBRT group had T1 tumors. Final pathology upstaged 32.7% of surgery patients, and 20.0% received adjuvant chemotherapy. No SBRT patients received adjuvant chemotherapy. RESULTS: In an unmatched comparison, 4-year lobar local control (98.7% versus 93.6%, p = 0.015) was greater for lobar resection versus SBRT, respectively, though primary tumor (98.7% versus 95.3%, p = 0.088), regional (82.9% versus 78.1%, p = 0.912), and distant control (76.1% versus 54.0%, p = 0.152) were similar. Overall survival (OS, 63.5% versus 29.6%, p < 0.0001) was greater for lobar resection, though cause-specific survival (CSS, 81.3% versus 75.3%, p = 0.923) was similar. In a T-stage matched comparison of 152 patients, there was no significant difference in patterns of failure or CSS, whereas OS favored surgery. CONCLUSION: Lobectomy/pneumonectomy or SBRT results in comparable patterns of failure for clinical stage I NSCLC. In this retrospective comparison, OS was superior for surgery, though CSS was similar. Randomized trials are necessary to control for fundamental differences in comorbidity, which impact interpretation of both tumor control and survival.

Original languageEnglish (US)
Pages (from-to)192-201
Number of pages10
JournalJournal of Thoracic Oncology
Volume8
Issue number2
DOIs
StatePublished - Jan 1 2013
Externally publishedYes

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Non-Small Cell Lung Carcinoma
Radiotherapy
Pneumonectomy
Adjuvant Chemotherapy
Survival
Neoplasms
Comorbidity
Pathology
Lung

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine

Cite this

Patterns of failure after stereotactic body radiation therapy or lobar resection for clinical stage i non-small-cell lung cancer. / Robinson, Cliff G.; DeWees, Todd; El Naqa, Issam M.; Creach, Kimberly M.; Olsen, Jeffrey R.; Crabtree, Traves D.; Meyers, Bryan F.; Puri, Varun; Bell, Jennifer M.; Parikh, Parag J.; Bradley, Jeffrey D.

In: Journal of Thoracic Oncology, Vol. 8, No. 2, 01.01.2013, p. 192-201.

Research output: Contribution to journalArticle

Robinson, CG, DeWees, T, El Naqa, IM, Creach, KM, Olsen, JR, Crabtree, TD, Meyers, BF, Puri, V, Bell, JM, Parikh, PJ & Bradley, JD 2013, 'Patterns of failure after stereotactic body radiation therapy or lobar resection for clinical stage i non-small-cell lung cancer', Journal of Thoracic Oncology, vol. 8, no. 2, pp. 192-201. https://doi.org/10.1097/JTO.0b013e31827ce361
Robinson, Cliff G. ; DeWees, Todd ; El Naqa, Issam M. ; Creach, Kimberly M. ; Olsen, Jeffrey R. ; Crabtree, Traves D. ; Meyers, Bryan F. ; Puri, Varun ; Bell, Jennifer M. ; Parikh, Parag J. ; Bradley, Jeffrey D. / Patterns of failure after stereotactic body radiation therapy or lobar resection for clinical stage i non-small-cell lung cancer. In: Journal of Thoracic Oncology. 2013 ; Vol. 8, No. 2. pp. 192-201.
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T1 - Patterns of failure after stereotactic body radiation therapy or lobar resection for clinical stage i non-small-cell lung cancer

AU - Robinson, Cliff G.

AU - DeWees, Todd

AU - El Naqa, Issam M.

AU - Creach, Kimberly M.

AU - Olsen, Jeffrey R.

AU - Crabtree, Traves D.

AU - Meyers, Bryan F.

AU - Puri, Varun

AU - Bell, Jennifer M.

AU - Parikh, Parag J.

AU - Bradley, Jeffrey D.

PY - 2013/1/1

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N2 - INTRODUCTION: The purpose of this study was to compare patterns of failure between lobar resection (lobectomy or pneumonectomy) and stereotactic body radiation therapy (SBRT) for patients with clinical stage I non-small-cell lung cancer (NSCLC). METHODS: From January 2004 to January 2008, 338 patients underwent definitive treatment for pathologically confirmed clinical stage I NSCLC with lobar resection (n = 260) or SBRT (n = 78). Most surgical patients underwent lobectomy (n = 237). SBRT patients received a biologically effective dose of at least 100 Gy10. Lobar resection patients were younger, healthier, and had superior pulmonary function, whereas most of the patients in the SBRT group had T1 tumors. Final pathology upstaged 32.7% of surgery patients, and 20.0% received adjuvant chemotherapy. No SBRT patients received adjuvant chemotherapy. RESULTS: In an unmatched comparison, 4-year lobar local control (98.7% versus 93.6%, p = 0.015) was greater for lobar resection versus SBRT, respectively, though primary tumor (98.7% versus 95.3%, p = 0.088), regional (82.9% versus 78.1%, p = 0.912), and distant control (76.1% versus 54.0%, p = 0.152) were similar. Overall survival (OS, 63.5% versus 29.6%, p < 0.0001) was greater for lobar resection, though cause-specific survival (CSS, 81.3% versus 75.3%, p = 0.923) was similar. In a T-stage matched comparison of 152 patients, there was no significant difference in patterns of failure or CSS, whereas OS favored surgery. CONCLUSION: Lobectomy/pneumonectomy or SBRT results in comparable patterns of failure for clinical stage I NSCLC. In this retrospective comparison, OS was superior for surgery, though CSS was similar. Randomized trials are necessary to control for fundamental differences in comorbidity, which impact interpretation of both tumor control and survival.

AB - INTRODUCTION: The purpose of this study was to compare patterns of failure between lobar resection (lobectomy or pneumonectomy) and stereotactic body radiation therapy (SBRT) for patients with clinical stage I non-small-cell lung cancer (NSCLC). METHODS: From January 2004 to January 2008, 338 patients underwent definitive treatment for pathologically confirmed clinical stage I NSCLC with lobar resection (n = 260) or SBRT (n = 78). Most surgical patients underwent lobectomy (n = 237). SBRT patients received a biologically effective dose of at least 100 Gy10. Lobar resection patients were younger, healthier, and had superior pulmonary function, whereas most of the patients in the SBRT group had T1 tumors. Final pathology upstaged 32.7% of surgery patients, and 20.0% received adjuvant chemotherapy. No SBRT patients received adjuvant chemotherapy. RESULTS: In an unmatched comparison, 4-year lobar local control (98.7% versus 93.6%, p = 0.015) was greater for lobar resection versus SBRT, respectively, though primary tumor (98.7% versus 95.3%, p = 0.088), regional (82.9% versus 78.1%, p = 0.912), and distant control (76.1% versus 54.0%, p = 0.152) were similar. Overall survival (OS, 63.5% versus 29.6%, p < 0.0001) was greater for lobar resection, though cause-specific survival (CSS, 81.3% versus 75.3%, p = 0.923) was similar. In a T-stage matched comparison of 152 patients, there was no significant difference in patterns of failure or CSS, whereas OS favored surgery. CONCLUSION: Lobectomy/pneumonectomy or SBRT results in comparable patterns of failure for clinical stage I NSCLC. In this retrospective comparison, OS was superior for surgery, though CSS was similar. Randomized trials are necessary to control for fundamental differences in comorbidity, which impact interpretation of both tumor control and survival.

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