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MINI 18 - Radiation Topics in Localized NSCLC (ID 139)
- Event: WCLC 2015
- Type: Mini Oral
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
MINI18.13 - Can Stereotactic Ablative Radiotherapy (SABR) Improve Patient Selection for Lung Cancer Surgery and Reduce Perioperative Mortality? (ID 779)
16:45 - 18:15 | Author(s): S. Szentpetery
Comparative effectiveness research has demonstrated similar rates of disease control and overall survival (OS) for patients with stage I non-small cell lung carcinoma (NSCLC) who are treated with either surgery or SABR. It was therefore hypothesized that the introduction of SABR might improve patient selection for surgery, lead to the referral of high operable risk patients for SABR, and consequently reduce the lung cancer surgery perioperative mortality rate.
Cancer registry data identified all patients with stage I NSCLC who underwent surgery or SABR between 1993-2014 at a Veterans Affairs medical center. Mortality rates from the pre-SABR and post-SABR (after 2007) eras were compared. Clinical records in the Computerized Patient Record System were queried to analyze rates of disease control and overall survival (OS).
A total of 284 patients underwent surgery for stage I NSCLC in the pre-SABR (n=171) and post-SABR (n=113) eras. The majority of patients were male (96.6%) and the median follow-up was 4.1 years. Operative procedures included a pneumonectomy (n=10), lobectomy (n=206), or wedge resection (n=68). The 90-day mortality rate was 3.2%, whereas the 6-month mortality rate was 7.0%. Comparing mortality rates in the pre-SABR to post-SABR eras, there were no declines at 90-days (3.5% vs. 2.7%, p=0.47), or 6-months (7.0% vs. 7.1%, p=0.36). Patients referred for SABR have included 27 medically inoperable patients and 0 operable patients. The mortality rate after SABR was 0% at both 90-days and 6 months. Comparing SABR and surgery, the rate of disease progression was similar (p=0.47); found in 18.5% after SABR (1 distant, 4 regional), 23.4% after lobectomy (9 regional, 2 regional and distant, 11 distant), 33.3% after wedge (3 local, 3 distant), and 0% after pneumonectomy. Two-year OS was numerically superior with SABR (69.4% vs. 63.1%), although this was not statistically significant (p=0.52).
The introduction of SABR neither influenced patient selection for surgery, nor reduced the perioperative mortality rate for patients with stage I NSCLC. These data suggest comparative effectiveness research alone may be insufficient to improve outcomes for this disease. Efforts to complete a prospective randomized trial of surgery vs. SABR should not be abandoned.
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