The following is a summary of the “Impact of stereotactic body radiation therapy volume on surgical patient selection, short-term survival, and long-term survival in early-stage non–small cell lung cancer,” published in the February 2023 issue of Thoracic and cardiovascular surgery by Till, et al.
The use of stereotactic body radiation therapy (SBRT) to treat non-small cell lung cancer has risen in recent years. The study’s overarching goal is to determine how a facility’s utilization of SBRT influences the selection of surgical patients and their subsequent chances of survival. From 2008-2017, the National Cancer Database was mined for information on patients with TI/T2N0M0 lesions and the characteristics of their treatment centers. A ratio of SBRT to surgery was found to improve short-term survival for patients treated surgically, and a threshold for surgical volume was used to stratify facilities. The methods of multiple regression analysis, Cox proportional-hazards regression, and the Kaplan-Meier log-rank test were utilized.
Overall, 182,610 patients participated. Over the course of the study, the number of centers with a high SBRT: surgery ratio (17%) rose from 118 (11.5%) to 558 (48.4%). Although there were statistically insignificant differences in age, race, and insurance status between patients undergoing surgery at high-SBRT and low-SBRT facilities, comorbidity scores and tumor sizes were comparable between the two groups. There was a significant reduction in both 30-day and 90-day mortality rates when patients from low-volume surgical facilities were treated at a high SBRT-using facility (1.8% vs. 1.4%, P< .001).
No variation was seen at high-throughput surgical centers. Patients undergoing resection at high-volume surgical centers had a better 5-year survival rate than those treated at high-volume SBRT centers (hazard ratio, 0.91; CI, 0.90-0.93 P< .001). Differences in short-term survival after resection at institutions with high-SBRT utilization are likely attributable to low surgical volume institutions. The utilization of SBRT at a facility does not correlate with the short-term or long-term survival of patients treated at high-volume surgical facilities.