Stereotactic body radiotherapy versus conventional radiotherapy for early-stage small cell lung cancer
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This study was designed to compare survival outcomes for non-surgically managed T1-T2N0M0 small cell lung cancer (SCLC) patients who received either stereotactic body radiation therapy (SBRT) or conventionally fractionated radiotherapy (CFRT) using the National Cancer Database (NCDB).
The NCDB was queried between 2004 and 2015 for patients with T1-T2N0M0 SCLC. Patients must have been treated with curative intent SBRT or CFRT (delivered daily or twice daily, 45–70 Gy) with or without chemotherapy. The primary outcome was overall survival (OS). A subset analysis of patients receiving chemotherapy was also performed. A propensity score matching (PSM) analysis was performed to compare OS among patients who received chemotherapy.
We evaluated 1378 patients in the general cohort. Multivariable Cox regression analysis (MVA) in the general cohort revealed that SBRT was significantly associated with improved survival (HR 0.68, p < 0.001) along with receipt of chemotherapy (HR 0.63, p < 0.001). SBRT patients were less likely to receive chemotherapy compared with CFRT patients (p < 0.01). In the chemotherapy subset of 1096 patients, on MVA, there was a trend in favor of the SBRT group (HR 0.73, p = 0.06). A 3:1 PSM analysis on the chemotherapy subset found similar results on MVA with a trend in favor of SBRT (p = 0.06).
Patients with T1-2N0M0 SCLC treated with SBRT regimens incorporating chemotherapy had comparable outcomes with those treated with concurrent chemoradiotherapy using standard fractionation. Treatment paradigms for T1-2N0M0 SCLC incorporating SBRT warrant further exploration and should incorporate chemotherapy.
KeywordsSmall cell lung cancer Stereotactic body radiotherapy Early-stage small cell lung cancer National Cancer Database
The authors also wish to acknowledge the Vanderbilt Institute for Clinical and Translational Research for their funding support.
Compliance with ethical standards
This study was funded by the National Center for Advancing Translational Sciences (CTSA award no. UL1 TR002243) and the Vanderbilt Institute for Clinical and Translational Research.
Conflict of interest
Neil B. Newman received a grant in order to support biostatistical analysis. All other authors declare that they have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
Statement of informed consent was not applicable since the manuscript does not contain any patient data.
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