Comparative Effectiveness of SBRT and Standard Fractionated Radiation While Treating Early Stage Non-Small Cell Lung Cancer (NSCLC) Patients

Abstract

Stereotactic body radiation therapy (SBRT) is an advanced treatment modality and currently is the standard of care for treatment of medically inoperable early stage NSCLC cancer. However, SBRT may not be available in many clinics, especially in small or community-based practices. In this study, we aim to evaluate the pattern of practice in the United States and compare the efficacy of SBRT versus standard fractionated external beam radiation therapy (SF-EBRT) using a large database. We have analyzed the National Cancer Database (NCDB) between 2004 and 2015 of NSCLC patients (n=38,494) with clinical stage T1-T1c who were non-operable and received no chemotherapy; all these patients were treated only with radiation. For SF-EBRT, patients with radiation dose of 60-70Gy with 1.8-2Gy per fraction and for SBRT, radiation dose of 45-60Gy in 3-5 fractions were only included. Overall survival (OS) was calculated from the date of diagnosis until the date of death or last follow up. Kaplan-Meier analysis was performed for determining overall survival (OS). IBM software was used for statistical analysis; p-value < 0.05 was considered statistically significant. Of the 38,494 patients, the median age of the patients was 75 years (range: 26-90); 47.2% male, 89.6% white, 8.3% black. The median follow-up was 25.9 months. During 2004-2015 about 30.6% (n=11,763) patients were treated with SF-EBRT while 69.4% (n=26,731) patients were treated with the SBRT. There was a clear trend of increasing use of SBRT in more recent years (<1,000 in 2006 vs >9,500 in 2015). The mean and median OS of the patients treated with SBRT were significantly higher (about 11months higher; Table 1) as compared to the patients in SF-EBRT group. One-year, three-year and five-year OS are also significantly better in SBRT group. This study indicates that for early stage inoperable NSCLC, SBRT is the preferred method of treatment. SBRT provides significantly improved overall survival over SF-EBRT. Therefore, every effort should be made to treat the eligible early stage NSCLC patients with SBRT. Further analysis using multivariable risk model is underway.Abstract 3142; Table 1OS of early stage NSCLC patients treated with either SF-EBRT or SBRTTreatment modalitySF-EBRTSBRTp-valueMean OS (months)37.248.2<0.001Median OS (months)37.949.0<0.0011-year OS (%)79.086.9<0.053-year OS (%)40.658.2<0.055-year OS (%)27.348.1<0.05 Open table in a new tab