Boston - American Association for Thoracic Surgery

AMERICAN ASSOCIATION FOR THORACIC SURGERY16. Propensity Matched Comparison of Surgery Versus StereotacticBody Radiation Therapy in Early Stage Lung CancerChadrick Denlinger, Jeffrey D. Bradley, Issam M. El Naqa, Jennifer B. Zoole,Bryan F. Meyers, * Alec Patterson, * Daniel Kreisel, Alexander S. Krupnick, †Traves CrabtreeCardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO, USAInvited Discussant: James D. LuketichOBJECTIVE: Stereotactic body radiation therapy (SBRT) has been proposed asan alternative local treatment option for high-risk patients with early stage lungcancer. A direct comparison of outcomes between SBRT and surgical resection hasnot been reported. This study compares short term outcomes between SBRT andsurgical treatment of non-small cell lung cancer (NSCLC).MONDAYAfternoonMETHODS: We compared all patients treated with surgery (1/2000–12/2006) orSBRT (2/2004–5/2007) with IA/B NSCLC clinically staged by CT and PET.Comorbidity scores were recorded prospectively using the Adult Co-MorbidityEvaluation (ACE-27) scoring system. Charts were reviewed to determine localtumor recurrence, disease-specific and overall survival. A multivariable Cox proportionalhazard model was utilized to adjust estimated treatment hazard ratios forconfounding effects of patient age, comorbidity index, and clinical stage.Propensity Cox Regression Analysis of Treatment Modality (Surgery vs. SBRT)EndpointSurgeryEventsSBRTEventsHazard-Ratio*(95% Confidence Interval) P-valueLocal tumor control 22 5 0.479(0.164–1.406)Cause-specific survival 85 12 0.776(0.401–1.482)Overall survival 172 41 0.637(0.433–0.923)0.1820.4480.020*Adjusted for Age, Comorbidity score, and T-stage.RESULTS: There were 462 surgery patients and 79 SBRT patients. Overall, surgicalpatients were older (p < 0.001), had lower co-morbidity scores (p < 0.001), andbetter pulmonary function (FEV1 and DLCO) (p < 0.001). Among the surgical andSBRT groups, 62.6% (291/462) and 75.9% (60/79) were clinical stage IA, respectively.Final pathology upstaged 35% (62/462) of the surgery patients. In an unmatchedcomparison, overall 5-year survival was 55% with surgery, and the 3-year survivalwas 32% with SBRT. In clinical stage IA patients, 3-year local tumor control was89% with SBRT and 96% with surgery (p = 0.051). There was no difference in local* AATS Member† Norman E. Shumway Research Scholarship 200899