Posttreatment Mortality With Stereotactic Body Radiotherapy vs Surgery in NSCLC

Key Points

  • SBRT was associated with lower 30- and 90-day mortality rates vs surgery.
  • The difference was most pronounced among patients aged > 70 years.

In a study reported in the Journal of Clinical Oncology, Stokes and colleagues found lower posttreatment mortality rates with stereotactic body radiotherapy (SBRT) vs surgery in early-stage non–small cell lung cancer (NSCLC), with the difference in rates increasing as a function of age.

Study Details

The study involved National Cancer Database data on patients with cT1­–T2a, N0, M0 NSCLC diagnosed between 2004 and 2013 who underwent surgery (n = 76,623; 78% lobectomy, 20% sublobar resection, 2% pneumonectomy) or SBRT (n = 8,216). Posttreatment mortality rates at 30 and 90 days were calculated and compared using Cox regression and propensity score–matched analyses.

30- and 90-Day Mortality

In the unmatched analysis, mortality rates were 2.07% with surgery vs 0.73% with SBRT at 30 days (P < .001) and 3.59% vs 2.93% at 90 days (P < .001). Among the 27,200 propensity score–matched patients, mortality rates were 2.41% vs 0.79% at 30 days (P < .001) and 4.23% vs 2.82% at 90 days (P < .001).

Differences in mortality for surgery vs SBRT increased with age, with P < .001 for interaction at both 30 days and 90 days. Absolute differences in rates favoring SBRT were 1.87% at 30 days and 2.02% at 90 days among patients aged 71 to 75 years; 2.80% and 2.59% among those aged 76 to 80 years old; and 3.03% and 3.67% among those aged > 80 years.

Compared with SBRT, surgical mortality rates were higher with increased extent of resection, with 30- and 90-day multivariate hazard ratios for mortality of 2.85 and 1.37 for sublobar resection, 3.65 and 1.60 for lobectomy, and 14.5 and 5.66 for pneumonectomy (all P < .001).

The investigators concluded, “Differences in 30- and 90-day posttreatment mortality between surgery and SBRT increased as a function of age, with the largest differences in favor of SBRT observed among patients older than 70 years. These representative mortality data may inform shared decision-making among patients with early-stage NSCLC who are eligible for both interventions.”

The study was supported in part by the Department of Surgery Outcomes and Applied Research program at the University of Colorado.

Chad G. Rusthoven, MD, of the Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, is the corresponding author for the Journal of Clinical Oncology article. 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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