Video-assisted Thoracoscopic Lobectomy Improves NSCLC Survival

by U.S. Medicine

November 9, 2017

HOUSTON—Should stereotactic body radiotherapy remain the standard treatment for medically inoperable early-Stage non-small cell lung cancer?

A study in the Journal of Thoracic and Cardiovascular Surgery supports the technique, which produces outcomes comparable to those of surgical resection in operable patients, but suggests the consideration of other options.1

Michael E. DeBakey VAMC-led researchers compared the outcomes of stereotactic body radiotherapy and video-assisted thoracoscopic lobectomy in veterans with early non-small cell lung cancer (NSCLC).

For the study, the team retrospectively reviewed data from 183 patients, almost all men, with clinical Stage I non-small cell lung cancer from 2009 to 2014. While 56 of them underwent stereotactic body radiotherapy, another 127 had video-assisted thoracoscopic lobectomy. Overall, patients who received stereotactic body radiotherapy were older than the patients who received video-assisted thoracoscopic lobectomy—median age, 79.5 vs. 64—and had more comorbidities.

Tumor control and overall, recurrence-free, and lung-cancer-specific survival were the primary endpoints.

Results indicated that, in the 37 propensity-matched pairs, the three-year actuarial tumor control rate was 54.3% after stereotactic body radiotherapy and 90.6% after video-assisted thoracoscopic lobectomy. Actuarial lung cancer-specific three-year survival was calculated to be 78.1% for stereotactic body radiotherapy vs. 93.6% for video-assisted thoracoscopic lobectomy.

Average survival rates also differed. Patients receiving stereotactic body radiotherapy had one-year survival rates of 89.2%, as well as three-year overall survival of 52.0% and three-year recurrence-free survival rate of 38.5%.

In comparison, the average one-year survival rate after video-assisted thoracoscopic lobectomy was 94.6%, and 85.7 and 82.8% for three-year overall and three-year recurrence-free survival, respectively.

“In multivariable analysis, stereotactic body radiotherapy independently predicted recurrence and poorer survival,” the study authors wrote.

The researchers noted that, for veteran patients with early-Stage non-small cell lung cancer, “video-assisted thoracoscopic lobectomy resulted in better disease control and survival than stereotactic body radiotherapy. Although prior reports suggest that stereotactic body radiotherapy is a suitable alternative to surgery in early-Stage lung cancer, a prospective randomized trial is needed. Nevertheless, stereotactic body radiotherapy remains a suitable option for medically inoperable patients.”

1 Cornwell LD, Echeverria AE, Samuelian J, Mayor J, et. cal.  Video-assisted thoracoscopic lobectomy is associated with greater recurrence-free survival than  stereotactic body radiotherapy for clinical Stage I lung cancer. J Thorac Cardiovasc Surg. 2017 Aug 16. pii: S0022-5223(17)31718-X. doi: 10.1016/j.jtcvs.2017.07.065. [Epub ahead of print] PubMed PMID: 28888379.

 


Related Articles

New Agents Extend Options for Increased Survival in Metastatic Prostate Cancer

Accounting for nearly a third of all cancer diagnoses, prostate cancer is the most frequently diagnosed cancer in the VHA, where past research has suggested that the malignancy is caught earlier than in other healthcare systems.

Personalized Medicine Brightens Outlook for Most Common Kidney Cancer

In the past five years, 10 new system therapies have been approved for renal cell carcinoma (RCC), the most common type of kidney cancer.


U.S. Medicine Recommends


More From oncology

Oncology

New Agents Extend Options for Increased Survival in Metastatic Prostate Cancer

Accounting for nearly a third of all cancer diagnoses, prostate cancer is the most frequently diagnosed cancer in the VHA, where past research has suggested that the malignancy is caught earlier than in other healthcare systems.

Oncology

Personalized Medicine Brightens Outlook for Most Common Kidney Cancer

In the past five years, 10 new system therapies have been approved for renal cell carcinoma (RCC), the most common type of kidney cancer.

Oncology

Targeted Therapies Transform RCC Treatment Over Last Decade

In the last decade, the development of multiple molecular-targeted therapies has dramatically altered the treatment landscape for advanced renal cell carcinoma (RCC).

Oncology

Liver Cancer Continues to Rise, Even as VA Declares Victory Over HCV Infection

In March, then-VA Secretary David Shulkin, MD, announced at the annual Wharton Health Care Business Conference that the VA will have eliminated hepatitis C infections among all patients willing and able to be treated by next spring.

Oncology

Undertreatment of Metastatic Pancreatic Cancer Treatment, Despite Guidelines

While many other cancers have seen dramatic improvement in outcomes in the past 20 years, pancreatic cancer remains one of the deadliest malignancies, regardless of stage at diagnosis, with an overall five-year survival rate of only 8%, according to the American Cancer Society.

Facebook Comment

Subscribe to U.S. Medicine Print Magazine

U.S. Medicine is mailed free each month to physicians, pharmacists, nurse practitioners, physician assistants and administrators working for Veterans Affairs, Department of Defense and U.S. Public Health Service.

Subscribe Now

Receive Our Email Newsletter

Stay informed about federal medical news, clinical updates and reports on government topics for the federal healthcare professional.

Sign Up