The following is the summary of “Outcomes Following SBRT vs. IMRT and 3DCRT for Older Patients with Stage IIA Node-Negative Non-Small Cell Lung Cancer > 5 cm” published in the January 2023 issue of Clinical Lung Cancer by Tran, et al.
To describe the outcomes of stereotactic body radiotherapy (SBRT) for patients with stage IIA non-small cell lung cancer (NSCLC) tumors more than 5 cm and compare its efficacy to that of 3D conformal radiation (3DCRT) and intensity-modulated radiotherapy (IMRT) in treating these patients. Patients over the age of 65 with stage IIA (AJCC TNM7) N0 non-small cell lung cancer (NSCLC) more than 5 cm tumors treated with SBRT, IMRT, or 3DCRT were identified using the SEER-Medicare database (2005-2015). In order to evaluate the differences in overall survival (OS), lung cancer-specific survival (LCSS), and toxicity, researchers used propensity score approaches with inverse probability weighting.
Of the 584 patients treated, 88 (15%) had SBRT, 140 (24%) had IMRT, and 356 (61%) had 3DCRT. Patients in the SBRT group were older (P=.004), sicker (P=.02), had smaller tumors (P=.03), and had a higher incidence of adenocarcinomas (P<.0001). Median unadjusted OS was higher for SBRT (19 months) than with IMRT (13 months) and 3DCRT (14 months), although the difference was not statistically significant (P=.37). Compared to IMRT and 3DCRT, SBRT was substantially related with improved OS and LCSS in our propensity score-adjusted analyses (HROS: 0.78, 95% CI: 0.68-0.89, HRLCSS: 0.70, 95% CI: 0.60-0.81) and 3DCRT (HROS: 0.81, 95% CI: 0.72-0.93, HRLCSS: 0.80, 95% CI: 0.68-0.93).
Relative to IMRT (OR: 0.74, 95% CI: 0.55-0.99) and 3DCRT (OR: 0.53, 95% CI: 0.40-0.71), the overall adjusted complication rate for SBRT-treated patients was lower. SBRT tends to have less toxicities and better survival for patients with NSCLC tumors more than 5 cm compared to other kinds of radiation. Their results indicate that SBRT is a viable option for treating big, inoperable NSCLC tumors in elderly patients.