Surgery Shows Superior Outcomes Over SABR in Elderly NSCLC Patients, Study Finds
Key Insights
A retrospective study reveals surgery trends toward better overall survival and locoregional control compared to SABR in elderly NSCLC (search) patients, with 5-year OS rates of 47.3% versus 31.5% respectively.
Early mortality risk was higher with surgery (8.3%) compared to SABR (1.2%), highlighting the importance of careful patient selection for surgical intervention in elderly NSCLC (search) patients.
Researchers developed a novel therapeutic decision support tool considering factors like WHO status and respiratory function to help optimize treatment selection between surgery and SABR.
A new retrospective study published in Cancers demonstrates that surgical intervention tends to offer superior outcomes compared to stereotactic radiotherapy (SABR) for elderly patients with non-small cell lung cancer (NSCLC (search)), despite some important caveats regarding patient selection.
The single-center study, conducted at Marseille University Hospital (search) from 2012 to 2022, compared outcomes between surgery and SABR in patients aged 75 and older with stage IA to IIA NSCLC (search). After propensity score matching to ensure comparable groups, researchers analyzed 127 surgical patients against 85 who received SABR.
Survival Outcomes and Disease Control
The matched analysis revealed trending superiority for surgery in overall survival (OS) rates. At the 5-year mark, surgical patients showed a 47.30% survival rate (95% CI, 36.1%-62.0%) compared to 31.5% (95% CI, 19.9%-49.9%) in the SABR group. The difference approached but did not reach statistical significance (P = .068).
Locoregional recurrence rates also favored surgery, with 11.8% of surgical patients experiencing recurrence compared to 21.2% in the SABR group. The survival without locoregional recurrence at 3 years was notably higher in the surgery group (89.4%) versus the SABR group (64.7%).
Safety and Early Mortality Considerations
An important finding emerged regarding treatment-related mortality. The 90-day mortality rate was higher in the surgical group at 8.3% compared to just 1.2% in the SABR group, though this difference did not reach statistical significance (P = .063). Additionally, 8.7% of surgical patients required readmission for treatment-related complications.
Patient Selection and Decision Support
"We believe that the future challenge for this population lies in a more relevant therapeutic selection," stated Dr. Galdric Oliver from the Oncology Radiotherapy Department (search) at Marseille University Hospital (search). The research team developed a therapeutic decision support tool incorporating multiple factors including:
- WHO performance status
- Carbon monoxide diffusion capacity (DLCO)
- Comorbidity index
- Forced expiratory volume (FEV1)
- Gender
Treatment Protocols
Surgical approaches included thoracotomy, video-assisted thoracoscopy, and robot-assisted procedures. The SABR protocol evolved during the study period, initially utilizing TomoTherapy (search)® (60 Gy in 5 fractions) from 2012-2019, then switching to Cyberknife (search)® treatment from 2020-2022.
Clinical Implications
These findings suggest that while surgery may offer better long-term outcomes for elderly NSCLC (search) patients, careful patient selection is crucial. The higher early mortality risk with surgery emphasizes the need for thorough pre-operative assessment and risk stratification. The newly developed decision support tool may help clinicians better identify which elderly patients are most likely to benefit from surgery versus SABR.