Stereotactic Body Radiation Therapy Versus Wedge Resection for Early-Stage Node-Negative Non-Small Cell Lung Cancer Tumors ≤8 mm: A National Analysis

Abstract

Background: Despite the significant advances in detecting pulmonary nodules, the management plan of small tumors with malignant potential remains controversial. The objective of this study was to evaluate the overall survival of patients with ≤8 mm non-small cell lung cancer (NSCLC) who undergo stereotactic body radiation therapy (SBRT) versus wedge resection. Methods: Kaplan-Meier analysis, multivariable Cox proportional hazards modeling, and propensity score-matched analysis were performed to evaluate the overall survival of patients with ≤8 mm NSCLC in the National Cancer Database (NCDB) from 2004-2017 who underwent SBRT versus patients who underwent wedge resection. The above-mentioned matched analyses were repeated for patients with no comorbidities. Patients who were coded in the NCDB as having undergone radiation because surgery was contraindicated due to patient risk factors (e.g., comorbid conditions, advance age, etc.) and those with a history of prior malignancy were excluded from analysis. Results: Of the 1,505 patients who had NSCLC ≤8 mm during the study period, 1,339 (89%) patients underwent wedge resection, and 166 (11%) patients underwent SBRT. In both unadjusted analysis and in multivariable Cox modeling and propensity score-matched analysis, wedge resection was associated with improved survival when compared to SBRT. These results were consistent in a sensitivity analysis limited to patients with no comorbidities. Conclusion: In this national analysis, patients with NSCLC ≤8 mm undergoing wedge resection experienced improved survival when compared to SBRT. This finding can be used to help inform the treatment decision-making process for tumors that are being discovered incidentally or through lung cancer screening.