Abstract
Purpose
The purpose of the study was to evaluate the outcomes for wedge resection (WR), WR
plus brachytherapy (WRB), or stereotactic body radiation therapy (SBRT) for early
stage non-small lung cancer.
Methods and Materials
Retrospectively collected data of patients treated with WR, WRB, or SBRT (1993–2012).
Cesium-131 (Cs131) used in WRB group in patients with close or positive margins based
on surgical assessment. Kaplan–Meier survival analysis, log-rank test used to compare
disease-free survival/overall survival between different groups. Multivariable analysis,
using Cox proportional hazards regression analysis, was performed to evaluate the
independent effect of age, gender, and treatment procedure on disease-free survival.
Results
A total of 272 patients were included in the study (123 WR, 52 WR+Cs-131, 97 SBRT).
Cs-131 was used with WRs that the surgeons deemed high risk. Local control (LC) was
similar in the three groups and was achieved in 92.2% for WR group vs. 96.2% for WR+Cs-131
and 95.5% for SBRT (p = 0.60). On multivariate analysis, although females showed a higher LC, neither LC
nor distant metastasis were associated with age or gender (p = 0.65 and p = 0.41, respectively). Five-year overall survival was 100% in the WR+B group, 97.7%
in the WR group, and 89.6% in the SBRT group (p = 0.02). Toxicity was similar in the three groups.
Conclusion
WR, WR+ Cs-131, or SBRT are all excellent treatment options for patients with early
stage non-small cell lung cancer that are not candidates for lobectomy. For high risk
WRs, we favor use of Cesim-131 brachytherapy. Until a prospective randomized comparative
study is done to evaluate the best treatment approach for early stage NSCLC, treatment
selection should be based on a multidisciplinary team approach.
Keywords
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Article Info
Publication History
Published online: May 19, 2015
Accepted:
April 1,
2015
Received in revised form:
March 15,
2015
Received:
November 5,
2014
Footnotes
Funding: Isoray to Bhupesh Parashar, MD.
Other authors: There are no financial disclosures, conflicts of interest, and/or acknowledgments for the authors.
Identification
Copyright
© 2015 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.
