Original Study| Volume 24, ISSUE 1, e9-e18, January 2023

Outcomes Following SBRT vs. IMRT and 3DCRT for Older Patients with Stage IIA Node-Negative Non-Small Cell Lung Cancer > 5 cm

Published:November 01, 2022DOI:



      To describe outcomes and compare the effectiveness of stereotactic body radiotherapy (SBRT) versus 3-dimensional conformal radiotherapy (3DCRT) or intensity-modulated radiotherapy (IMRT) in patients with stage IIA lymph node-negative (N0) non-small cell lung cancer (NSCLC) tumors > 5 cm.


      We used the SEER-Medicare database (2005-2015) to identify patients > 65 years with stage IIA (AJCC TNM7) N0 NSCLC > 5 cm tumors who were treated with SBRT, IMRT, and 3DCRT. We used propensity score methods with inverse probability weighting to compare lung cancer-specific survival (LCSS), overall survival (OS), and toxicity.


      Of 584 patients, 88 (15%), 140 (24%), and 356 (61%) underwent SBRT, IMRT, and 3DCRT, respectively. The SBRT group was older (P = .004), had more comorbidities (P = .02), smaller tumors (P = .03), and more adenocarcinomas (P < .0001). We found a trend towards higher median unadjusted OS with SBRT compared to IMRT and 3DCRT (19 vs. 13 and 14 months, respectively, P = .37). In our propensity score-adjusted analyses, SBRT was significantly associated with better OS and LCSS compared to IMRT (HROS: 0.78, 95% CI: 0.68-0.89, HRLCSS: 0.70, 95% CI: 0.60-0.81) and 3DCRT (HROS: 0.81, 95% CI: 0.72-0.93, HRLCSS: 0.80, 95% CI: 0.68-0.93). SBRT-treated patients also had lower overall adjusted complication rates compared to IMRT (OR: 0.74, 95% CI: 0.55-0.99) and 3DCRT (OR: 0.53, 95% CI: 0.40-0.71).


      For patients with NSCLC tumors > 5 cm, SBRT trends towards fewer toxicities and improved survival compared to other forms of radiotherapy. Our findings support SBRT as an appropriate treatment strategy for older patients with larger inoperable NSCLC tumors.



      3DCRT (3-dimensional conformal radiotherapy), ARD (absolute risk difference), CI (confidence interval), CPT-4 (Current Procedural Terminology, 4th edition), EBRT (external beam radiation treatment), HR (hazard ratio), ICD-9 (International Classification of Diseases, 9th revision), ICD-O (International Classification of Diseases for Oncology), IMRT (intensity-modulated radiotherapy), IPW (inverse probability weighting), LCSS (lung cancer-specific survival), N0 (node-negative), NCI (National Cancer Institute), NSCLC (non-small cell lung cancer), OR (odds ratio), OS (overall survival), PET (positron emission tomography), RCT (randomized controlled trial), SBRT (stereotactic body radiotherapy), RT (radiotherapy), RTOG (Radiation Therapy Oncology Group), SEER (Surveillance, Epidemiology and End Results), SPACE (Scandinavian Stereotactic Precision and Conventional Radiotherapy Evaluation), US (United States)
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