Elsevier

Radiotherapy and Oncology

Volume 155, February 2021, Pages 254-260
Radiotherapy and Oncology

Original Article
The impact of stereotactic body radiation therapy on the overall survival of patients diagnosed with early-stage non-small cell lung cancer

https://doi.org/10.1016/j.radonc.2020.10.028Get rights and content

Highlights

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    SBRT was associated with improved OS compared to observation in cT1cN0cM0, cT2cN0cM0, and cT3cN0cM0 stage NSCLC patients.

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    The impact of SBRT on OS increased in more recent treatment eras and higher T stages.

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    The impact of SBRT on OS improved with an increase in the age at diagnosis and an increase in the comorbidity score.

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    Our study results support current practice with SBRT as a feasible alternative for those who are unable to perform surgery in various populations.

Abstract

Background and purpose

Stereotactic Body Radiotherapy (SBRT) has emerged as a standard treatment for inoperable early-stage non-small cell lung cancer (NSCLC) with remarkable local control. However, it is not clear if this local control translates to overall survival (OS). The objective of this study is to investigate the impact of SBRT on the OS of early-stage NSCLC patients and examine if the extent of this impact changes with the era of diagnosis, T stage, age, and comorbidity status.

Materials and methods

Using the National Cancer Database, we compared the OS of cT1–3 cN0 cM0 NSCLC patients with SBRT or observation. Multivariable analyses were adjusted for age, race, sex, income, education, place of living, hospital type, insurance status, comorbidity score, histology types, and diagnosis year.

Results

Among 50,819 patients, 27,027 (53.18%) received SBRT and 23,792 (46.82%) were observed. Multivariable Cox Proportional-Hazards analysis demonstrated SBRT was associated with an improved OS compared to observation (HR:0.56, p < 0.001). Subset multivariable Cox Proportional-Hazards analyses stratified by T stage, year of diagnosis, age, or Charlson Score revealed that HRs of SBRT vs. observation decrease from cT1 to cT3 (0.73–0.68), from 2004 to 2015 (0.65–0.51), from <50 to ≥80 years old (1.04–0.58) and from a Charlson Score 0 to 2 (0.69–0.58).

Conclusion

SBRT was associated with improved OS compared to no treatment in early-stage NSCLC. The magnitude of the impact of SBRT on OS increases in patients with advanced age, higher T stages, higher comorbidity scores and more recent treatment eras.

Section snippets

Data source

We extracted the data from the NCDB database, a nationwide oncology outcomes database for more than 1500 Commission-accredited cancer programs in the United States and Puerto Rico, capturing 70% or more newly diagnosed malignancies in the United States.

Study population

Patients with cT1–3 cN0 cM0 NSCLC diagnosed between 2004 and 2016, ages ≥18 at the time of diagnosis, were included. Patients who received surgery, chemotherapy, immunotherapy, hormone therapy, conventional radiation therapy, and patients who

Patient characteristics

Among 50,819 patients who were diagnosed with NSCLC between 2004 and 2016, 27,027 (53.18%) received SBRT, and 23,792 (46.82%) were observed. Clinical T stage were as follows, 33,305 (65.54%) with T1, 14,897 (29.31%) with T2, and 2617 (5.15%) with T3. The median age of the entire cohort was 75.0 (range 18–90), while the median age of the SBRT cohort was 75.0 years (range 26.0–90.0), and 75 years for those who were observed (range 18.0–90.0). The baseline characteristics of the entire cohort are

Discussion

In the current analysis, we found that SBRT was associated with significantly improved OS compared to observation, Which is consistent with the results of others [18], [19]. More importantly, our study demonstrated that the impact of SBRT on OS increased with a higher T stage, an older patient, patients diagnosed in a more recent year, and patients with higher comorbidity scores. Our findings are critical as it indicates that the local control of SBRT reported in various studies may translate

Financial support/funding statement

There are no sources of financial support or funding.

Conflicts of interest notification

There are no conflicts of interest.

Acknowledgment

There are no acknowledgments.

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