Abstract:
Objective: To compare the effects of stereotactic body radiotherapy (SBRT) and sublobectomy for clinical stage Ⅰ non-small cell lung cancer (NSCLC).
Methods: A total of 298 patients with stage Ⅰ NSCLC who were treated at the Cancer Hospital of the University of Chinese Academy of Science from May 2015 to December 2017 were analyzed. Among them, 149 patients received SBRT, and 149 patients underwent sublobectomy. On computed tomography, lesions located in the outer one-third of the lung field were considered to be located on the outer side. Lesions in the remaining two-thirds of the lung field were considered to be located on the inner side. Propensity score matching was performed according to the treatment method, and differences in local tumor recurrence, disease specific survival (DSS), overall survival (OS), and treatment-related complications/adverse reactions were compared between the two groups.
Results: The average surgical margin distance in the operation group was (2.4±0.2) cm (0.4-5.2) cm. Propensity score matching analysis showed that relapse-free survival (RFS) was significantly longer in the operation group than in the SBRT group (P=0.014). There were no significant differences in OS (P=0.58) or DSS (P=0.88). Surgical treatment was significantly effective for large nodules with a diameter of >2.0 cm (P=0.035). There were no significant differences in OS, DSS, or RFS between the groups for nodules with a diameter of ≤ 2.0 cm (P>0.05). The recurrence rate of tumors was higher in the outer side group with SBRT, but no significant difference in the inner side group. The local recurrence rate was higher in the SBRT group (P=0.005). After SBRT, the rate of grade ≥ 2 radiation pneumonia was 6.1%. In total, 15 patients (10.1%) developed pneumothorax after surgery, and the rates of postoperative delirium, arrhythmia, and pneumonia were 5.3%, 6.1%, and 4.7%, respectively.
Conclusions: In patients with stage Ⅰ NSCLC with comorbidities, sublobectomy resulted in a longer RFS than SBRT; however, there were no significant differences in OS or DSS between the two treatments. The size and location of the tumor must be considered while developing the treatment plan.