Abstract
Background
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.
Methods
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.
Results
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).
Conclusion
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.
Keywords
Abbreviations:
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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 01, 2022
Accepted:
October 19,
2022
Received in revised form:
October 15,
2022
Received:
July 5,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
