A national analysis of wedge resection versus stereotactic body radiation therapy for stage IA non–small cell lung cancer

Abstract Objective Lobectomy is considered optimal therapy for early-stage non–small cell lung cancer, but sublobar wedge resection and stereotactic body radiation therapy are alternative treatments. This study compared outcomes between wedge resection and stereotactic body radiotherapy. Methods Ove...

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Bibliographic Details
Published in:The Journal of thoracic and cardiovascular surgery 2017-08, Vol.154 (2), p.675-686.e4
Main Authors: Yerokun, Babatunde A., MD, Yang, Chi-Fu Jeffrey, MD, Gulack, Brian C., MD, Li, Xuechan, MS, Mulvihill, Michael S., MD, Gu, Lin, MS, Wang, Xiaofei, PhD, Harpole, David H., MD, D'Amico, Thomas A., MD, Berry, Mark F., MD, Hartwig, Matthew G., MD
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Carcinoma, Non-Small-Cell Lung - mortality
Carcinoma, Non-Small-Cell Lung - pathology
Carcinoma, Non-Small-Cell Lung - radiotherapy
Carcinoma, Non-Small-Cell Lung - surgery
Cardiothoracic Surgery
Female
Humans
Kaplan-Meier Estimate
Lung - surgery
lung cancer
Lung Neoplasms - mortality
Lung Neoplasms - pathology
Lung Neoplasms - radiotherapy
Lung Neoplasms - surgery
Male
Middle Aged
NSCLC
overall survival
Pneumonectomy
Propensity Score
Radiosurgery - methods
Retrospective Studies
stereotactic body radiotherapy
sublobar resection
Survival Analysis
wedge resection
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Summary:Abstract Objective Lobectomy is considered optimal therapy for early-stage non–small cell lung cancer, but sublobar wedge resection and stereotactic body radiation therapy are alternative treatments. This study compared outcomes between wedge resection and stereotactic body radiotherapy. Methods Overall survival of patients with cT1N0 and tumors ≤2 cm who underwent stereotactic body radiotherapy or wedge resection in the National Cancer Data Base from 2008 to 2011 was assessed via a Kaplan-Meier and propensity score–matched analysis. A center-level sensitivity analysis that used observed/expected mortality ratios was conducted to identify an association between center use of stereotactic body radiotherapy and mortality. Results Of the 6295 patients included, 1778 (28.2%) underwent stereotactic body radiotherapy, and 4517 (71.8%) underwent wedge resection. Stereotactic body radiotherapy was associated with significantly reduced 5-year survival compared with wedge resection in both unmatched analysis (30.9% vs 55.2%, P  
ISSN:0022-5223
1097-685X
DOI:10.1016/j.jtcvs.2017.02.065