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  • Jul 30, 2018
    Stereotactic Body Radiation Therapy for Operable Early-Stage Lung Cancer Findings from NRG Oncology RTOG 0618 Trial

    This trial evaluated the use of SBRT for early stage lung cancer patients who were operable, whereas historically SBRT was reserved for medically inoperable patients. The primary endpoint was local control, and survival, adverse events, and the incidence of surgical salvage, as secondary endpoints.

    With median follow up of 48.1 months, 26 of 33 enrolled patients were evaluable. Of those evaluable 23/26 were T1 and 3 were T2. The median FEV1 and DLCO were 72% (38-136) and 68% (22-96), respectively.

    One patient had primary tumor recurrence; 4 year local control 96%. OS and DFS at 4 years was 56% and 57%, respectively. LRC at 4 years was 88% (3 regional failures) and DM rate was 12% (5 patients). Grade 3 AE rate 14%, no grade 4.

    SBRT appears to have a high probability of tumor control, low morbidity, and little need for surgical salvage in patients with early-stage operable lung cancer.

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    Journal & Date: JAMA Oncol. 2018 May 31. doi: 10.1001/jamaoncol.2018.1251. [Epub ahead of print]
    Key Institution: UTSW, Dallas TX, USA
    Keywords: SBRT, SABR, early stage NSCLC, medically operable
  • Jul 30, 2018
    Post-Treatment Mortality After Surgery and Stereotactic Body Radiotherapy for Early-Stage Non–Small-Cell Lung Cancer

    This paper is a NCDB analysis of early-stage NSCLC that shows improved 30-day mortality with SABR vs. surgery. The authors identified 76,623 patients who were treated with surgery or SABR for early-stage NSCLC (T1-T2a N0 M0) and compared their 30-day and 90-day post-treatment

    Patients with SABR had significantly improved mortality at both 30-days and 90-days compared to patients who received surgery in both unmatched and propensity-matched analyses. Elder patients (>70 years) had greatest mortality benefit with SABR vs. surgery. Patients treated with pneumonectomy had worst absolute mortality as would be expected. These results strongly show that SABR may be safer than surgery especially in the peri-treatment period and for elderly patients, as we would intuitively expect. This is despite SABR patients typically being chosen because they are poor operative candidates, thus generally being frailer. This study has limitations as a retrospective NCDB analysis, with the cohorts not being perfectly matched, as shown in table 1 with nearly every pre-treatment treatment/site/stage/epidemiologic factor being significantly different between the surgery and SABR groups. Also, the authors limit the analysis to only T1-T2a patients and don’t include T2b N0 patients who are also generally strong candidates for both lobectomy and for SABR. In addition, there is no data on survival/mortality beyond the 90 day period; it would be interesting to see if any of the early mortality trends continued subsequently and if that also correlated with age. Still, despite these limitations, this paper is probably the largest and strongest to date showing that for older patients SABR may be strongly preferable to surgery to decrease risk of peri-treatment mortality. It is thus potentially practice-changing especially for older patients who are borderline surgical candidates, as physicians may be more likely to recommend SABR based on the results of this study.

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    Journal & Date: Journal of Clinical Oncology 36, 642-651, 2018
    Key Institution: National Cancer Database analysis
    Keywords: Surgery, SBRT, SABR, non-small cell lung cancer (NSCLC), mortality

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