Stereotactic body radiotherapy versus percutaneous local tumor ablation for early-stage non-small cell lung cancer.

Autor: Ager BJ; Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA., Wells SM; Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA., Gruhl JD; Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA., Stoddard GJ; Division of Epidemiology, School of Medicine, University of Utah, Salt Lake City, UT, USA., Tao R; Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA., Kokeny KE; Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA., Hitchcock YJ; Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA. Electronic address: Ying.Hitchcock@hci.utah.edu.
Jazyk: angličtina
Zdroj: Lung cancer (Amsterdam, Netherlands) [Lung Cancer] 2019 Dec; Vol. 138, pp. 6-12. Date of Electronic Publication: 2019 Sep 16.
DOI: 10.1016/j.lungcan.2019.09.009
Abstrakt: Objectives: To compare patterns of care and overall survival (OS) between stereotactic body radiotherapy (SBRT) and percutaneous local tumor ablation (LTA) for non-surgically managed early-stage non-small-cell lung cancer (NSCLC).
Materials and Methods: The National Cancer Database (NCDB) was queried from 2004 to 2014 for adults with non-metastatic, node-negative invasive adenocarcinoma or squamous cell carcinoma of the lung with primary tumor size ≤5.0 cm who did not undergo surgery or chemotherapy and received SBRT or LTA. Patterns of care were assessed with multivariate logistic regression. After propensity-score weighting with generalized boosted regression, OS was assessed with univariate and doubly-robust multivariate Cox regression.
Results: Of 15,792 patients, 14,651 (93%) received SBRT and 1141 (7%) received LTA. Increasing age (OR 1.01, p = .035), treatment at an academic institution (OR 2.94, p < .001), increasing tumor size (OR 1.05, p < .001), and more recent year of diagnosis (OR 1.43, p < .001) were predictive of treatment with SBRT, whereas comorbidities (OR 0.74, p = .003) and treatment at a high-volume facility (OR 0.05, p < .001) were predictive for LTA. At a median follow-up of 26.2 months, SBRT was associated with improved OS relative to LTA within a propensity-score weighted doubly-robust multivariate analysis (HR 0.71, p < .001). On weighted subgroup analyses, improved OS was observed with SBRT for tumor sizes >2.0 cm (HR 0.72, p < .001) and for those treated at high-volume facilities (HR 0.71, p < .001). No OS difference was found with SBRT or LTA in tumor sizes ≤2.0 cm (HR 0.90, p = .227).
Conclusion: Within the NCDB, SBRT was more commonly utilized and was associated with improved OS when compared to percutaneous LTA for patients with non-surgically managed early-stage NSCLC. Patients with small tumor volumes likely represent an appropriate population for future prospective randomized comparisons between SBRT and LTA.
(Copyright © 2019 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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