Older NSCLC patients with smaller tumours prefer SBRT over lobectomy

Both surgery and use of stereotactic body radiation therapy (SBRT) result in a decrease in the mean tumour size of early-stage nonsmall cell lung cancer (NSCLC), a recent study has shown.

In addition, SBRT use has increased, particularly among older patients with smaller tumours and Charlson-Deyo scores ≥3. This increase contributed to the significant decline in patients with no therapy.

“As SBRT becomes widely available for early-stage NSCLC, there may be concerns in the surgical community that SBRT is being offered for patients with operable tumours, even though surgery is standard of care,” the authors said.

Trends in SBRT and surgery for NSCLC patients were assessed over time. The authors probed the National Cancer Database for those with node-negative NSCLC ≤5 cm from 2004 to 2016. They also examined the associations between definitive local treatment modalities and year using a multinomial regression model while controlling for other covariates.

A total of 202,367 patients met the inclusion criteria. Over the study period, a steady decrease from 2.44 cm to 2.55 cm was observed in mean tumour size in all treatment modalities.

The multinomial model showed a slight decrease in the likelihood of receiving lobectomy from 58 percent in 2004 to 53 percent in 2016. In contrast, SBRT use rose from 1 percent to 20 percent, while patients receiving no therapy dropped from 27 percent to 16 percent. The prospect of undergoing SBRT vs lobectomy increased with year of diagnosis (p<0.0001) and decreasing tumour size (p<0.0001).

Notably, the following factors correlated with treatment modality: age, race, income, facility, and Charlson-Deyo score.