Elsevier

Radiotherapy and Oncology

Volume 114, Issue 2, February 2015, Pages 148-154
Radiotherapy and Oncology

SBRT of lung cancer
Stereotactic body radiotherapy and treatment at a high volume facility is associated with improved survival in patients with inoperable stage I non-small cell lung cancer

https://doi.org/10.1016/j.radonc.2014.12.004Get rights and content

Abstract

Background

This study examined the comparative effectiveness of no treatment (NoTx), conventional fractionated radiotherapy (ConvRT), and stereotactic body radiotherapy (SBRT) in patients with inoperable stage I non-small cell lung cancer. This population based cohort also allowed us to examine what facility level characteristics contributed to improved outcomes.

Methods

We included patients in the National Cancer Database from 2003 to 2006 with T1-T2N0M0 inoperable lung cancer (n = 13,036). Overall survival (OS) was estimated using Kaplan–Meier methods and Cox proportional hazard regression.

Results

The median follow up was 68 months (interquartile range: 35–83 months) in surviving patients. Among the cohort, 52% received NoTx, 41% received ConvRT and 6% received SBRT. The 3-year OS was 28% for NoTx, 36% for ConvRT radiotherapy, and 48% for the SBRT cohort (p < 0.0001). On multivariate analysis, the hazard ratio for SBRT and ConvRT were 0.67 and 0.77, respectively, as compared to NoTx (1.0 ref) (p < 0.0001). Patients treated at a high volume facility vs. low volume facility had a hazard ratio of 0.94 vs. 1.0 (p = 0.01).

Conclusions

Patients with early stage inoperable lung cancer treated with SBRT and at a high volume facility had a survival benefit compared to patients treated with ConvRT or NoTx or to those treated at a low volume facility.

Section snippets

Database

The National Cancer Database (NCDB) is a hospital-based cancer registry that collects data from the American College of Surgeons (ACoS)-Commission on Cancer (CoC) accredited facilities [17]. The requirements for CoC accreditation include the cancer program meeting 34 CoC quality care standards, the facility undergoing an onsite survey every 3 years, and maintaining levels of excellence in the delivery of patient centered care. ACoS and the American Cancer Society sponsor the database. The

Results

From 2003 to 2006, there were 13,036 patients who met eligibility criteria for the study. The study included 1196 different treatment facilities, of which 153 performed SBRT. Of the cohort, 52% (n = 6888) received no therapy, 41% (n = 5375) received conventional radiation therapy and 6% (n = 773) received stereotactic body radiotherapy. Patient characteristics are shown in Table 1.

The median follow up was 21 months (interquartile range 11–43 months) in all patients and 68 months (interquartile range

Discussion

This study reveals meaningful survival gains with the use of SBRT over both conventional radiotherapy as well as observation, results that suggest a broad societal benefit to this modern radiotherapy technology. This analysis therefore provides significant support to the hypothesis that curative radiotherapy – and in particular, SBRT – improves overall survival in this vulnerable population, and it is one of the first studies to show population-level effectiveness gains from stereotactic

Funding

None.

Conflict of interest statement

The authors state that they have no relationships, conditions or circumstances that present potential conflicts of interest with this study.

References (31)

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