Mortality after radiotherapy or surgery in the treatment of early stage non-small-cell lung cancer: a population-based study on recent developments
Stereotactic body radiotherapy (SBRT) can achieve high tumour control with limited toxicity for inoperable early stage non-small-cell lung cancer (NSCLC) patients.
Patients and methods
The German Epidemiologic Cancer Registries from the Robert-Koch Institute were assessed. Periods according to the availability of SBRT were: (1) 2000–2003 (pre-SBRT); (2) 2004–2007 (interim); and (3) 2007–2014 (broad availability of SBRT). To assess the association of cancer-related parameters with mortality, hazard ratios (HR) from Cox proportional hazards models were computed. To evaluate the change of treatment-related mortality, we performed interaction analyses and the relative excess risk due to interaction (RERI, additive scale) was computed.
A total of 16,292 patients with UICC stage I NSCLC diagnosed between 2000 and 2014 were analysed. Radiotherapy utilization increased from 5% in pre-SBRT era to 8.8% after 2007. In univariate analyses, survival in the whole cohort improved only marginally when 2000–2003 is compared to 2004–2007 (HR 0.92, 95% CI 0.85–1.01) or 2008–2014 (HR 0.93, 95% CI 0.86–1.01). Comparing surgery/radiotherapy, mortality in the radiotherapy group started from a 3.5-fold risk in 2000–2003 to 2.6 after 2007. The interaction analysis revealed a stronger improvement for radiotherapy (multiplicative scale for 2000–2003 vs. > 2007: 0.74, 95% CI 0.58–0.94). On an additive scale, treatment × period interaction revealed an RERI for 2000–2003 vs. > 2007 of − 1.18 (95% CI − 1.8, − 0.55).
Using population-based data, we observed a survival improvement in stage I lung cancer over time. With an increasing utilization of radiotherapy, a stronger improvement occurred in patients treated with radiotherapy when compared to surgery.
KeywordsStereotactic body radiotherapy Lung cancer Stage I Non-small-cell lung cancer Radiotherapy Patterns of care Population-based analysis
Unité international contre le cancer
Non-small-cell lung cancer
Video-assisted thoracoscopic surgery
Stereotactic body radiotherapy
Small-cell lung cancer
Eastern Co-operative Oncology Group
We would like to thank the Robert Koch Institute (RKI), especially Dr. Klaus Kraywinkel, and the Epidemiologic Cancer Register in Germany for kindly providing the raw data for analysis.
No grant number is applicable.
Compliance with ethical standards
Conflict of interest
The authors have declared no conflicts of interest.
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