The optimal treatment for patients with stage I non-small cell lung cancer: minimally invasive lobectomy versus stereotactic ablative radiotherapy – a nationwide cohort study

•Outcomes after minimally invasive lobectomy (MIL) and stereotactic ablative radiotherapy (SABR) for stage I NSCLC were compared after propensity score weighting.•Overall survival was not significantly different (HR 0.89, 95 % CI 0.65–1.20)•Recurrence-free survival was better after MIL (HR 0.70, 95 ...

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Published in:Lung cancer (Amsterdam, Netherlands) Netherlands), 2024-05, Vol.191, p.107792, Article 107792
Main Authors: de Ruiter, Julianne Cynthia, van der Noort, Vincent, van Diessen, Judi Nani Annet, Smit, Egbert Frederik, Damhuis, Ronald Alphons Maria, Hartemink, Koen Johan
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
Female
Humans
Lobectomy
Lung Neoplasms - mortality
Lung Neoplasms - pathology
Lung Neoplasms - radiotherapy
Lung Neoplasms - surgery
Male
Middle Aged
Minimally Invasive Surgical Procedures - methods
Neoplasm Recurrence, Local
Neoplasm Staging
Non-small cell lung cancer
Pneumonectomy - methods
Radiosurgery - methods
Retrospective Studies
Stage I
Stereotactic ablative radiotherapy
Stereotactic body radiotherapy
Treatment Outcome
Video-assisted thoracoscopic surgery
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Summary:•Outcomes after minimally invasive lobectomy (MIL) and stereotactic ablative radiotherapy (SABR) for stage I NSCLC were compared after propensity score weighting.•Overall survival was not significantly different (HR 0.89, 95 % CI 0.65–1.20)•Recurrence-free survival was better after MIL (HR 0.70, 95 % CI 0.49–0.99)•After MIL, less patients developed regional recurrence or distant metastasis.•Future studies should focus on optimization of patient selection for MIL or SABR. The aim of the Early-Stage LUNG cancer (ESLUNG) study was to compare outcomes after minimally invasive lobectomy (MIL) and stereotactic ablative radiotherapy (SABR) in patients with stage I non-small cell lung cancer (NSCLC). In this retrospective cohort study, patients with clinical stage I NSCLC (according to TNM7), treated in 2014–2016 with MIL or SABR, were included. 5-year overall survival (OS) and recurrence-free survival (RFS) were calculated and compared between patients treated with MIL and a propensity score (PS)-weighted SABR population with characteristics comparable to those of the MIL group. 1211 MIL and 972 SABR patients were included. Nodal upstaging occurred in 13.0 % of operated patients. 30-day mortality was 1.0 % after MIL and 0.2 % after SABR. After SABR, the 5-year regional recurrence rate (18.1 versus 14.2 %; HR 0.74, 95 % CI 0.58–0.94) and distant metastasis rate (26.2 versus 20.2 %; HR 0.72, 95 % CI 0.59–0.88) were significantly higher than after MIL, with similar local recurrence rate (13.1 versus 12.1 %; HR 0.90, 95 % CI 0.68–1.19). Unadjusted 5-year OS and RFS were 70.2 versus 40.3 % and 58.0 versus 25.1 % after MIL and SABR, respectively. PS-weighted, multivariable analyses showed no significant difference in OS (HR 0.89, 95 % CI 0.65–1.20) and better RFS after MIL (HR 0.70, 95 % CI 0.49–0.99). OS was not significantly different between stage I NSCLC patients treated with MIL and the PS-weighted population of patients treated with SABR. For operable patients with stage I NSCLC, SABR could therefore be an alternative treatment option with comparable OS outcome. However, RFS was better after MIL due to fewer regional recurrences and distant metastases. Future studies should focus on optimization of patient selection for MIL or SABR to further reduce postoperative mortality and morbidity after MIL and nodal failures after SABR.
ISSN:0169-5002
1872-8332
1872-8332
DOI:10.1016/j.lungcan.2024.107792