Effectiveness of Thermal Ablation and Stereotactic Radiotherapy based on Stage I Lung Cancer Histology.

Abstract

PURPOSE\nTo assess whether the effectiveness of thermal ablation (TA) and stereotactic body radiotherapy (SBRT) as initial treatment for stage I lung cancer vary depending on the histological subtype.\n\n\nMATERIAL AND METHODS\nThe 2004-2016 National Cancer Database was queried for patients with American Joint Committee on Cancer (AJCC) stage I lung cancer treated with TA or SBRT. Patients < 18 yo, those treated with surgery or chemotherapy, or with unknown survival and follow-up were excluded. TA and SBRT patients were 1:5 propensity score matched separately for each histological subtype to adjust for confounders. Overall survival (OS) was assessed using Cox models.\n\n\nRESULTS\n28,425patients were included (SBRT n=27,478; TA n=947). TA was more likely to be utilized in Caucasian patients, those with more comorbidities, smaller neuroendocrine tumors of the lower lobe, and treatment in the northeastern United states. After propensity score matching, a cohort with n=4,085 SBRT and n=817 TA patients with balanced confounders was obtained. In this cohort, overall survival for TA and SBRT was comparable (HR=1.07, 95% CI:0.98-1.18, p=0.13), but varied by histological subtypes: higher OS for TA was observed for patients with non-small-cell neuroendocrine tumors (vs. SBRT HR=0.48, 95% CI:0.24-0.95, p=0.04) No significant OS differences between TA and SBRT were evident for adenocarcinomas, squamous cell carcinomas, small-cell carcinomas, and non-neuroendocrine large cell carcinomas (p>0.1 each).\n\n\nCONCLUSIONS\nOverall survival following TA and SBRT for stage 1 lung cancer is comparable for most histological subtypes, except for longer OS following TA in non-small-cell neuroendocrine tumors.