Stereotactic Body Radiotherapy versus Surgery for Medically Operable Stage I NSCLC: A Markov Model Based Decision Analysis

Abstract

Purpose/Objective(s)To compare the quality-adjusted life expectancy and overall survival in patients with stage I non-small cell lung cancer (NSCLC) treated with either stereotactic body radiation (SBRT) or surgery.Materials/MethodsWe constructed a Markov model to describe health states after either SBRT or lobectomy for stage I NSCLC for a 5-year timeframe. Rates of recurrence and Markov state utilities, consistent with the four stages of the AJCC staging system, were extracted and adapted from the literature. We report various treatment strategy survival outcomes stratified by age, sex, and pack-year history of smoking and compared these to an external outcome prediction tool (Adjuvant! Online).ResultsOverall survival, cancer specific survival, and other causes of death as predicted by our model correlated closely with those predicted by the external prediction tool. Mean quality-adjusted life expectancy ranged from 3.28 to 3.78 years after surgery and 3.35 to 3.87 years for SBRT. The utility threshold for preferring SBRT over surgery was 0.90. Outcomes were sensitive to quality of life, the proportion of local and regional recurrences treated with standard versus palliative treatments, and the surgical and SBRT treatment related mortalities.ConclusionsThe role of SBRT in the medically operable patient is yet to be defined. Our model indicates that SBRT may offer comparable overall survival and quality adjusted life expectancy as compared to surgical resection. Well powered prospective studies comparing surgery versus SBRT in early lung cancer are warranted to further investigate the relative survival, quality of life and cost characteristics of both treatment paradigms. Purpose/Objective(s)To compare the quality-adjusted life expectancy and overall survival in patients with stage I non-small cell lung cancer (NSCLC) treated with either stereotactic body radiation (SBRT) or surgery. To compare the quality-adjusted life expectancy and overall survival in patients with stage I non-small cell lung cancer (NSCLC) treated with either stereotactic body radiation (SBRT) or surgery. Materials/MethodsWe constructed a Markov model to describe health states after either SBRT or lobectomy for stage I NSCLC for a 5-year timeframe. Rates of recurrence and Markov state utilities, consistent with the four stages of the AJCC staging system, were extracted and adapted from the literature. We report various treatment strategy survival outcomes stratified by age, sex, and pack-year history of smoking and compared these to an external outcome prediction tool (Adjuvant! Online). We constructed a Markov model to describe health states after either SBRT or lobectomy for stage I NSCLC for a 5-year timeframe. Rates of recurrence and Markov state utilities, consistent with the four stages of the AJCC staging system, were extracted and adapted from the literature. We report various treatment strategy survival outcomes stratified by age, sex, and pack-year history of smoking and compared these to an external outcome prediction tool (Adjuvant! Online). ResultsOverall survival, cancer specific survival, and other causes of death as predicted by our model correlated closely with those predicted by the external prediction tool. Mean quality-adjusted life expectancy ranged from 3.28 to 3.78 years after surgery and 3.35 to 3.87 years for SBRT. The utility threshold for preferring SBRT over surgery was 0.90. Outcomes were sensitive to quality of life, the proportion of local and regional recurrences treated with standard versus palliative treatments, and the surgical and SBRT treatment related mortalities. Overall survival, cancer specific survival, and other causes of death as predicted by our model correlated closely with those predicted by the external prediction tool. Mean quality-adjusted life expectancy ranged from 3.28 to 3.78 years after surgery and 3.35 to 3.87 years for SBRT. The utility threshold for preferring SBRT over surgery was 0.90. Outcomes were sensitive to quality of life, the proportion of local and regional recurrences treated with standard versus palliative treatments, and the surgical and SBRT treatment related mortalities. ConclusionsThe role of SBRT in the medically operable patient is yet to be defined. Our model indicates that SBRT may offer comparable overall survival and quality adjusted life expectancy as compared to surgical resection. Well powered prospective studies comparing surgery versus SBRT in early lung cancer are warranted to further investigate the relative survival, quality of life and cost characteristics of both treatment paradigms. The role of SBRT in the medically operable patient is yet to be defined. Our model indicates that SBRT may offer comparable overall survival and quality adjusted life expectancy as compared to surgical resection. Well powered prospective studies comparing surgery versus SBRT in early lung cancer are warranted to further investigate the relative survival, quality of life and cost characteristics of both treatment paradigms.