• Clinical lung cancer · Jan 2019

    Multicenter Study Comparative Study

    Stereotactic Ablative Radiotherapy as an Alternative to Lobectomy in Patients With Medically Operable Stage I NSCLC: A Retrospective, Multicenter Analysis.

    • Vieri Scotti, Alessio Bruni, Giulio Francolini, Marco Perna, Polina Vasilyeva, Mauro Loi, Gabriele Simontacchi, Domenico Viggiano, Biancaluisa Lanfranchi, Alessandro Gonfiotti, Juljana Topulli, Emanuela Olmetto, Virginia Maragna, Katia Ferrari, Viola Bonti, Camilla Comin, Sara Balduzzi, Roberto D'Amico, Frank Lohr, Luca Voltolini, and Lorenzo Livi.
    • Department of Oncology, Radiation Therapy Unit, Careggi University Hospital, Florence, Italy.
    • Clin Lung Cancer. 2019 Jan 1; 20 (1): e53-e61.

    BackgroundStereotactic ablative body radiation therapy (SBRT) has evolved as the standard treatment for patients with inoperable stage I non-small-cell lung cancer (NSCLC). We report the results of a retrospective analysis conducted on a large, well-controlled cohort of patients with stage I to II NSCLC who underwent lobectomy (LOB) or SBRT.Materials And MethodsOne hundred eighty-seven patients with clinical-stage T1a-T2bNoMO NSCLC were treated in 2 academic hospitals between August 2008 and May 2015. Patients underwent LOB or SBRT; those undergoing SBRT were sub-classified as surgical candidates and nonsurgical candidates, according to the presence of surgical contraindications or comorbidities.ResultsIn univariate analysis, no significant difference was found in local control between patients who underwent SBRT and LOB, with a trend in favor of surgery (hazard ratio [HR], 0.27; 95% confidence interval [CI], 0.07-1.01; P < .053). Univariate analysis showed that overall survival (OS) was significantly better in patients who underwent LOB (HR, 0.44; 95% CI, 0.23-0.85) with a 3-year OS of 73.4% versus 65.2% for surgery and radiation therapy patients, respectively (P < .01). However, no difference in OS was observed between operable patients undergoing SBRT and patients who underwent LOB (HR, 1.68; 95% CI, 0.72-3.90). Progression-free survival was comparable between patients who underwent LOB and SBRT (HR, 0.61; P = .09).ConclusionSBRT is a valid therapeutic approach in early-stage NSCLC. Furthermore, SBRT seems to be very well-tolerated and might lead to the same optimal locoregional control provided by surgery for patients with either operable or inoperable early-stage NSCLC.Copyright © 2018 Elsevier Inc. All rights reserved.

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