Abstract
PurposeStereotactic body radiotherapy (SBRT) has been increasingly regarded as a reasonable option for early-stage lung cancer patients without pretreatment pathologic results, but the efficacy and safety in a Chinese population remains unclear. The aim of this study was to compare survival outcomes and toxicities between patients with clinically diagnosed early-stage lung cancer or biopsy-proven early-stage non-small cell lung cancer and to demonstrate the rationality of this treatment.Material and MethodsFrom May 2012 to December 2018, 56 patients with clinically diagnosed early-stage lung cancer and 60 patients with early-stage biopsy-proven were selected into non-pathological group and pathological group, respectively. Propensity score matching (PSM) was performed to reduce patient selection bias. Survival analysis with log-rank test was used to assess the differences of treatment outcomes, which included local control (LC), progression-free survival (PFS), and overall survival (OS).ResultsThe median age was 76 (range 47–93) years, and the median follow-up time was 58.3 (range 4.3–95.1) months in the cohort without pathologic results. The median age was 74 (range 57–88) years, and the median follow-up time was 56.3 (range 2.6–94) months in the cohort with pathologic results. 45 matched-pair were analyzed. The 5-year LC, PFS, and OS rates in matched-pair patients with or without pathologic biopsy were 85.5% and 89.8%, 40.6% and 70.9%, and 63.2% and 76.1%, respectively. On Kaplan-Meier survival analysis after PSM analysis, there was no significant difference between patients with pathologic results versus patients with no pathologic results in terms of LC (P= 0.498) and OS (P=0.141). Of the matched-pair patients treated with SBRT, only 1 patient experienced grade 3 or above radiation pneumonitis.ConclusionFor early-stage lung cancer patients with medically inoperable or not suitable for invasive diagnosis, SBRT may be a good local treatment.
Highlights
Primary lung cancer, one of the most common neoplasms, is the leading cause of cancer-related deaths worldwide [1]
56 patients with clinically diagnosed stage I lung cancer and 60 patients with pathological confirmation were recruited into this study
Before the PSM analysis, Kaplan-Meier survival analysis showed that there was no significant difference between patients with pathologic results versus patients with no pathologic results in terms of Local control (LC) (P= 0.456) (Figure 2A) and overall survival (OS) (P= 0.249) (Figure 2C)
Summary
One of the most common neoplasms, is the leading cause of cancer-related deaths worldwide [1]. Surgical resection remains to the gold standard in the treatment of suitable patients with early stage NSCLC [3] As for those patients unsuited for surgery, stereotactic body radiotherapy (SBRT), a high-dose and precisely conformal radiation approach, can achieve superb local control and a sharp dose fall-off to surrounding crucial normal structures [4, 5], and has been proven to have comparable treatment results to lung resection in both its therapeutic and adverse effects [6]. Pathological results before radiation are considered difficult to obtain especially in those elderly patients who are unwilling to have any invasive operation For these patients without pathological biopsy, SBRT may possibly be regarded as an excessive medical treatment due to the possibility of benign nodules, but patients with untreated earlystage NSCLC have a relatively poor survival with a median survival time of 10 months, and a 5-year survival rate of only 2% [8]. SBRT, a precise, noninvasive therapy, seems to be a reasonable solution for the empirical treatment of patients who cannot acquire pretreatment assurance of pathology
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