A comparative effectiveness study determined the optimal treatment strategy for increasing long-term survival in patients with early-stage lung cancer, published in The Annals of Thoracic Surgery (online November 29, 2017; doi:10.1016/j.ahtoracsur.2017.07.048).
Stereotactic body radiation therapy (SBRT) is often considered a potential alternative to surgery for early-stage lung cancer. However, prospective randomized data comparing these two treatment strategies are lacing, and existing studies are comprised of incomplete information and potential confounding variables.
James D Murphy, MD, MS, department of radiation medicine and applied sciences, University of California San Diego, and colleagues conducted a study to compare lobectomy with SBRT in lung cancer treatment. Researchers used a large, extensively detailed database from the Veteran’s Affairs system to sample 4069 patients, 449 of whom underwent SBRT, 2986 of whom underwent lobectomy, and 634 of whom underwent sublobar resection.
Researchers used univariable and multivariable competing risk analyses, the latter of which was adjusted for confounders including preoperative pulmonary function, smoking status, comorbidities, and staging workup procedures.
Results of the unadjusted analysis showed higher immediate post-procedural mortality in both surgery groups compared with the SBRT groups. However, the multivariable analysis—which considered long-term survival—showed higher cancer-specific mortality for patients in the SBRT group compared with those in the lobectomy group (sub-distribution HR, 1.45; 95% CI, 1.09-1.94; P = .01). No survival difference was observed between patients in the SBRT group and the sublobar resection group (sub-distribution HR, 1.25; 95% CI, 0.93-1.68; P = .15).
Researchers concluded that lobectomy improves long-term survival compared with SBRT in patients with early-stage lung cancer. “Our data suggest that the more aggressively we treat early lung cancer, the better the outcome,” stated co-author Alex K Bryant, BS, University of California at San Diego, in a press release (November 30, 2017). “This study is one of the best-powered and detailed analyses to date and suggests that lobectomy is still the preferred treatment of this disease for most patients.”
Researchers acknowledged that the potential for unmeasured confounding variables remains, and prospective randomized trials are needed to better compare these treatment strategies.—Zachary Bessette