New Techniques Improved Survival for Veterans with Stage 1 NSCLC

by U.S. Medicine

November 9, 2017

DURHAM, NC—Improved radiation and surgical techniques boosted overall survival in veterans diagnosed with Stage I non-small cell lung cancer (NSCLC) from 2001 to 2010.

According to a study published in the Journal of Thoracic Oncology, a study team led by researchers from the Durham, NC, VAMC and Duke University sought to comprehensively assess the combined impact of advances in diagnosis and treatment of Stage I NSCLC.1

The researchers queried the VA Central Cancer Registry, a database of U.S. veterans diagnosed at the VHA, from 2001-2010, identifying patients with Stage 1 NSCLC who had been treated with either surgery or radiation. Researchers then determined overall and lung cancer-specific survival in the 11,997 patients identified.

Results indicated that the four-year overall survival rate increased from 38.9% to 53.2% from 2001 to 2010 for all patients.

Positron Emission Tomography (PET) and Endobronchial Ultrasound Bronchoscopy (EBUS) were not found to improve overall survival.

At the same time, survival of radiated patients improved from 12.7% to 28.5%.

One factor was the introduction of stereotactic body radiation therapy (SBRT), which significantly improved overall for a hazard ratio of 0.60, and lung cancer-specific survival, with a hazard ration of 0.39, compared to conventionally fractionated radiation.

Surgery improved four-year survival rates from 51.5% to 66.5%, according to the study, which pointed out that the trend was linked to the use of adjuvant chemotherapy, increased video-assisted thorascopic surgery procedures and decreased pneumonectomy rates, with similar survival between open and VATS procedures.

The study also found that overall survival following lobectomy was superior to sublobar resection, with HR of 0.82.

“In the era of available SBRT (2008-2010), four-year overall survival was not significantly different following sublobar resection or lobectomy for medically unfit patients (CCI=2) (55.4% and 58.1%, p=0.69) but was significantly worse for fit patients (CCI=0-1) undergoing sublobar resection (55.5% and 68.0%, p<0.001),” the study authors noted.

Overall survival, HR 0.36, and lung cancer-specific survival (HR 0.31) were improved following surgery, however, as compared to radiation, with maintained improvement on matched comparison of lobectomy and SBRT, the results indicated.

1: Boyer MJ, Williams CD, Harpole DH, Onaitis MW, Kelley MJ, Salama JK. Improved Survival of Stage I Non-Small Cell Lung Cancer: A VA Central Cancer Registry Analysis. J Thorac Oncol. 2017 Sep 23. pii: S1556-0864(17)32706-5. doi: 10.1016/j.jtho.2017.09.1952. [Epub ahead of print] PubMed PMID: 28951090.


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