Video-assisted Thoracoscopic Lobectomy Improves NSCLC Survival

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.


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