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Original Article | Open Access

Stereotactic body radiotherapy compared with video-assisted thoracic surgery after propensity-score matching in elderly patients with pathologically-proven early-stage non-small cell lung cancer

Xiao-ye Liu1,2, Miao-Miao Gao1, Ze-yuan Cheng1, Zheng-Kun Cai1, Lu Yu1, Geng-Min Niu1, Jun-Yi Li1, Yu Bai1, Shu-Zhou Zhao1, Yong-Chun Song1, Xiao-Guang Wang1, Yang Dong1, Xu-yao Yu1, Zhen Tao1( ), Zhi-Yong Yuan1( )
Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
Department of Radiotherapy, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, China

Xiaoye Liu and Miao-Miao Gao are coauthors.

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Abstract

Objective

Standard medical treatment for early non-small cell lung cancer (NSCLC) is surgery; however, stereotactic body radiotherapy (SBRT) can be a viable substitute for elderly patients who can no longer tolerate or refuse surgery. The unsurpassed care for elderly patients with early NSCLC remains inconclusive.

We conducted a propensity-score matching analysis to compare the efficacy and side-effects of SBRT and video-assisted thoracic surgery (VATS) in elderly patients with pathologically-proven early NSCLC.

Methods

This single-institution retrospective study included 310 elderly patients who underwent VATS (n = 180) or SBRT (n = 130) from January 2011 to November 2018 at the Tianjin Medical University Cancer Institute and Hospital. Sex, performance status, pathology type, Charlson Comorbidity Index, and T-stage according to the eighth tumor node metastasis classification were considered when performing propensity-score matching.

Results

After propensity-score matching, 71 patients were included in each group for analysis. A median follow-up period of 53.5 months was observed for all patients; 72 and 53 months for patients undergoing VATS and SBRT, respectively. Overall survival (p = 0.492), progression-free survival (p = 0.294), locoregional recurrence-free survival (p = 0.866), and distant metastasis-free survival (p = 0.452) did not differ significantly between the VATS and SBRT groups. Multivariate analysis showed a significant correlation between the T-stage and overall survival. However, treatment-related toxicity was lower in the SBRT group than in the VATS group.

Conclusions

SBRT is an option comparable with surgery for elderly patients with pathologically-proven early-stage NSCLC.

Keywords

surgeryelderlyearly-stagenon-small cell lung cancerstereotactic body radiotherapy

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Precision Radiation Oncology
Volume 6 Issue 4,
December 2022
Pages 279-288
DOI: 10.1002/pro6.1175
Cite this article:
Liu X-y, Gao M-M, Cheng Z-y, et al. Stereotactic body radiotherapy compared with video-assisted thoracic surgery after propensity-score matching in elderly patients with pathologically-proven early-stage non-small cell lung cancer. Precision Radiation Oncology, 2022, 6(4): 279-288. https://doi.org/10.1002/pro6.1175

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Received: 26 August 2022
Revised: 23 October 2022
Accepted: 13 September 2022
Published: 16 December 2022
© 2022 The Authors. Precision Radiation Oncology published by John Wiley & Sons Australia, Ltd on behalf of Shandong Cancer Hospital & Institute.

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
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