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Surgery or radiotherapy for stage I lung cancer? An intention to treat analysis

Katie L. Spencer, Martyn P.T. Kennedy, Katie L. Lummis, Deborah A.B. Ellames, Michael Snee, Alessandro Brunelli, Kevin Franks, Matthew E.J. Callister
European Respiratory Journal 2019; DOI: 10.1183/13993003.01568-2018


Introduction: Surgery is the standard of care for early stage lung cancer, with stereotactic ablative radiotherapy (SABR) a lower morbidity alternative for patients with limited physiological reserve. Comparisons of outcomes between these treatment options are limited by competing co-morbidities and differences in pre-treatment pathological information. This study aims to address both issues by assessing both overall and cancer-specific survival for presumed stage I lung cancer on an intention-to-treat basis.

Methods: This retrospective intention to treat analysis identified all patients treated for presumed stage I lung cancer within a single large UK centre. Overall survival (OS), cancer-specific survival (CSS) and combined cancer and treatment-related survival (CTRS) were assessed with adjustment for confounding variables using cox proportional hazards and Fine and Gray competing risks analyses.

Results: 468 patients (including 316 surgery, 99 SABR) were included in the study population. Compared to surgery, SABR was associated with inferior OS on multivariable Cox modelling (SABR HR 1.84 (95% CI 1.32–2.57)) but there was no difference in CSS (HR for SABR 1.47 (95% CI 0.80–2.69) or CTRS (HR for SABR 1.27 (95% CI 0.74–2.17)). Cancer and treatment related death was no different between SABR and surgery on Fine and Gray competing risks multivariable modelling (sub-distribution hazard 1.03 (95% CI 0.59–1.81)). Non-cancer death was significantly higher in SABR than surgery (sub-distribution hazard 2.16 (95% CI 1.41–3.32)).

Conclusion: In this analysis, no difference in cancer-specific survival was observed between SABR and surgery. Further work is needed to define predictors of outcome and help inform treatment decisions.


This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.

Conflict of interest: Dr. Spencer has nothing to disclose.

Conflict of interest: Dr. Kennedy has nothing to disclose.

Conflict of interest: Dr. Lummis has nothing to disclose.

Conflict of interest: Dr. Ellames has nothing to disclose.

Conflict of interest: Dr. Snee has nothing to disclose.

Conflict of interest: Dr. BRUNELLI has nothing to disclose.

Conflict of interest: Dr. Franks reports personal fees from Pfizer , personal fees from Astra-Zeneca, non-financial support from Astra-Zeneca, personal fees from Boerrhinger-Ingelheim, non-financial support from Boerrhinger-Ingelheim, personal fees from BMS, outside the submitted work.

Conflict of interest: Dr. Callister has nothing to disclose.

sumber : https://erj.ersjournals.com/content/early/2019/01/02/13993003.01568-2018


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