Comparative analysis of clinical efficacy between stereotactic ablative radiotherapy and surgery for early-stage non-small cell lung cancer
Cui Yingying,Fan Chengcheng,Sun Yanan,Luo Hui,Zheng Xiaoli,Yang Chengliang,Ye Ke,Ge Hong
Department of Radiation Oncology,Henan Cancer Hospital,Affiliated Tumor Hospital of Zhengzhou University,Zhengzhou 450008,China (Cui YY,Fan CC,Sun YN,Zheng XL,Yang CL,Ye K,Ge H);Zhengzhou University Second Clinical College,Zhengzhou 450016,China (Luo H)
Abstract： Objective To compare the clinical efficacy and safety between stereotactic ablative radiotherapy (SABR) and surgery in the treatment of early-stage non-small cell lung cancer (NSCLC). Methods A total of 227 patients who were initially diagnosed with early-stage NSCLC and with complete clinical data admitted to Henan Cancer Hospital between June 2012 and December 2016 were recruited and assigned into the SABR (n=73) and surgery groups (n=154).Kaplan-Meier method was used to calculate survival rate and survival comparison was performed using the log-rank test. Chi-square test was adopted to compare the baseline data between two groups. Results All patients completed corresponding treatment. The samples of SABR group and operation group were 74 and 155 cases respectively. The 1-year and 3-year overall survival (OS) rates in the SABR and surgery groups were 97.2%, 81.9% and 96.5%, 78.2%(P=0.603),respectively. The 1-year and 3-year progression-free survival (PFS) rates in the SABR and surgery groups were 90.1%,66.9% and 89.2%,66.9%(P=0.565),respectively. The 1-year and 3-year locoregional recurrence-free survival rates in the SABR and surgery groups were 92.8%,84.0% and 96.5%,90.8%(P=0.133),respectively. The 1-year and 3-year distant metastasis-free survival rates in the SABR and surgery groups were 97.2%,75.4% and 89.2%,69.8%(P=0.095),respectively. Conclusions SABR and surgery yield similar OS,PFS,locoregional recurrence-free and distant metastasis-free survival rates in the treatment of early-stage NSCLC. Therefore, SABR is an alternative treatment for patients with early-stage NSCLC.
Cui Yingying,Fan Chengcheng,Sun Yanan et al. Comparative analysis of clinical efficacy between stereotactic ablative radiotherapy and surgery for early-stage non-small cell lung cancer[J]. Chinese Journal of Radiation Oncology, 2018, 27(4): 365-369.
[1] Chen W,Zheng R,Zhang S,et al. Cancer incidence and mortality in China,2013[J].Cancer Lett,2017,401:63-71.DOI:10.1016/j.canlet.2017.04.024. [2] Solda F,Lodge M,Ashley S,et al. Stereotactic radiotherapy (SABR) for the treatment of primary non-small cell lung cancer;systematic review and comparison with a surgical cohort[J].Radiother Oncol,2013,109(1):1-7.DOI:10.1016/j.radonc.2013.09.006. [3] Shirvani SM,Jiang J,Chang JY,et al. Lobectomy,sublobar resection,and stereotactic ablative radiotherapy for early-stage non-small cell lung cancers in the elderly[J].JAMA Surg,2014,149(12):1244-1253.DOI:10.1001/jamasurg.2014.556. [4] Sun B,Brooks ED,Komaki RU,et al.7-year follow-up after stereotactic ablative radiotherapy for patients with stage Ⅰ non-small cell lung cancer:Results of a phase 2 clinical trial[J].Cancer,2017,123(16):3031-3039.DOI:10.1002/cncr.30693. [5] Chang JY,Senan S,Paul MA,et al. Stereotactic ablative radiotherapy versus lobectomy for operable stage Ⅰ non-small-cell lung cancer:a pooled analysis of two randomised trials[J].Lancet Oncol,2015,16(6):630-637.DOI:10.1016/S1470-2045(15)70168-3. [6] Wang P,Zhang D,Guo XG,et al. A propensity-matched analysis of surgery and stereotactic body radiotherapy for early stage non-small cell lung cancer in the elderly[J].Medicine (Baltimore),2016,95(52):e5723.DOI:10.1097/MD.0000000000005723. [7] Ge H,Cai J,Kelsey CR,et al. Quantification and minimization of uncertainties of internal target volume for stereotactic body radiation therapy of lung cancer[J].Int J Radiat Oncol Biol Phys,2013,85(2):438-443.DOI:10.1016/j.ijrobp.2012.04.032. [8] Timmerman R,Paulus R,Galvin J,et al. Stereotactic body radiation therapy for inoperable early stage lung cancer[J].JAMA,2010,303(11):1070-1076.DOI:10.1001/jama.2010.261. [9] Ettinger DS,Wood DE,Akerley W,et al. Non-small cell lung cancer,version 1.2015[J].J Natl Compr Canc Netw,2014,12(12):1738-1761. [10] Grills IS,Mangona VS,Welsh R,et al. Outcomes after stereotactic lung radiotherapy or wedge resection for stage Ⅰ non-small-cell lung cancer[J].J Clin Oncol,2010,28(6):928-935.DOI:10.1200/JCO.2009.25.0928. [11] Palma D,Visser O,Lagerwaard FJ,et al. Treatment of stage Ⅰ NSCLC in elderly patients:a population-based matched-pair comparison of stereotactic radiotherapy versus surgery[J].Radiother Oncol,2011,101(2):240-244.DOI:10.1016/j.radonc.2011.06.029. [12] Robinson CG,DeWees TA,El Naqa IM,et al. Patterns of failure after stereotactic body radiation therapy or lobar resection for clinical stage Ⅰ non-small-cell lung cancer[J].J Thorac Oncol,2013,8(2):192-201.DOI:10.1097/JTO.0b013e31827ce361. [13] Varlotto J,Fakiris A,Flickinger J,et al. Matched-pair and propensity score comparisons of outcomes of patients with clinical stage Ⅰ non-small cell lung cancer treated with resection or stereotactic radiosurgery[J].Cancer,2013,119(15):2683-2691.DOI:10.1002/cncr.28100. [14] Verstegen NE,Oosterhuis JW,Palma DA,et al. Stage Ⅰ-Ⅱ non-small-cell lung cancer treated using either stereotactic ablative radiotherapy (SABR) or lobectomy by video-assisted thoracoscopic surgery (VATS):outcomes of a propensity score-matched analysis[J].Ann Oncol,2013,24(6):1543-1548.DOI:10.1093/annonc/mdt026. [15] Nakagawa T,Negoro Y,Matsuoka T,et al. Comparison of the outcomes of stereotactic body radiotherapy and surgery in elderly patients with cT1-2N0M0 non-small cell lung cancer[J].Respir Investig,2014,52(4):221-226.DOI:10.1016/j.resinv.2014.01.002. [16] Hamaji M,Chen F,Matsuo Y,et al. Video-assisted thoracoscopic lobectomy versus stereotactic radiotherapy for stage Ⅰ lung cancer[J].Ann Thorac Surg,2015,99(4):1122-1129.DOI:10.1016/j.athoracsur.2014.11.009. [17] Rosenzweig K.Stereotactic body radiation therapy as an alternative to surgery in early-stage non-small-cell lung cancer[J].Oncology (Williston Park),2017,31(6):492-498. [18] Giraud P,Antoine M,Larrouy A,et al. Evaluation of microscopic tumor extension in non-small-cell lung cancer for three-dimensional conformal radiotherapy planning[J].Int J Radiat Oncol Biol Phys,2000,48(4):1015-1024. [19] Lee Y,Auh SL,Wang Y,et al. Therapeutic effects of ablative radiation on local tumor require CD8+ T cells:changing strategies for cancer treatment[J].Blood,2009,114(3):589-595.DOI:10.1182/blood-2009-02-206870.
2018, Vol. 27 
