Surgery or radiotherapy for stage I lung cancer? An intention to treat analysis
Introduction:Â 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:Â 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:Â 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 1.32â€“2.57)) but there was no difference in CSS (HR for SABR 1.47 (95% CI 0.80â€“2.69) or CTRS (HR for SABR 1.27 (95% CI 0.74â€“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 0.59â€“1.81)). Non-cancer death was significantly higher in SABR than surgery (sub-distribution hazard 2.16 (95% CI 1.41â€“3.32)).
Conclusion:Â 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.
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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.
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