Comparing the Safety and Efficacy of Stereotactic Radiotherapy versus Surgery in Lung Cancer
San Francisco, CA—The use of stereotactic body radiotherapy (SBRT), also called stereotactic radiotherapy or radiosurgery, is an effective option for elderly patients with cancer who are inoperable or who decline surgery, but its safety and efficacy compared with surgery have not been investigated. James B. Yu, MD, MHS, Assistant Professor of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, and colleagues compared the survival and toxicity rates for patients with stage I non–small-cell lung cancer (NSCLC) who received SBRT with patients with NSCLC who underwent surgery. They presented their results at the 2014 American Society for Radiation Oncology meeting.
Using Medicare information from the Surveillance, Epidemiology, and End Results database, Yu and colleagues identified patients aged >67 years who had undergone SBRT or surgery for stage I NSCLC between 2007 and 2009. Poisson regression was used to compare the rates of overall mortality, lung cancer–specific mortality, and trends in toxicity.
Overall, 367 patients received SBRT and were matched to 711 patients who underwent surgery. The overall mortality rate was higher during months 1, 3, and 6 for patients in the surgery group compared with the SBRT group. Conversely, at 12 and 24 months, the overall mortality rate was higher with SBRT compared with surgery (Table 1).
Furthermore, after controlling for clinical and sociodemographic factors, overall mortality and lung cancer–specific mortality were higher with SBRT than with surgery. “The mortality data should be taken with a grain of salt. Patients who had surgery were healthier; they underwent surgical staging and were truly stage I, whereas it is likely that some of the patients who were clinically stage I and treated with radiosurgery actually had more disseminated disease,” Dr Yu told Value-Based Cancer Care. “What we found was basically that patients who have undergone surgery are likely to live longer compared with patients who have undergone radiosurgery for a variety of reasons, including differences in staging.”
Patients in the surgery group had significantly higher rates of toxicity (P <.001) compared with patients in the SBRT group at 0 to 3 months (Table 2).
Dr Yu and colleagues suggest that this may be attributed to the increased rate of surgery-related short-term infections and respiratory complications. However, at 24 months after treatment, the difference in toxicity between the 2 groups was significantly smaller.
Commenting on these results, Dr Yu said, “If you have a patient for whom you think having pneumonia, a respiratory complication, or a wound infection would be very dangerous, then those patients should get radiosurgery rather than surgery.” He added, “Our findings support clinical practice in that patients who are healthy enough to get surgery should get surgery, and patients for whom complications would be difficult to overcome should get radiosurgery.”