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Stereotactic Body Radiotherapy Versus Delayed Surgery for Early-stage Non-small-cell Lung Cancer.
Mayne, Nicholas R; Lin, Belle K; Darling, Alice J; Raman, Vignesh; Patel, Deven C; Liou, Douglas Z; D'Amico, Thomas A; Yang, Chi-Fu Jeffrey.
  • Mayne NR; Department of Surgery, Duke University, Durham, North Carolina.
  • Lin BK; University of Arizona College of Medicine-Phoenix, Phoenix, Arizona.
  • Darling AJ; Department of Surgery, Duke University, Durham, North Carolina.
  • Raman V; Department of Surgery, Duke University, Durham, North Carolina.
  • Patel DC; Department of Cardiothoracic Surgery, Stanford University, Stanford, California.
  • Liou DZ; Department of Cardiothoracic Surgery, Stanford University, Stanford, California.
  • D'Amico TA; Stanford Health Care ValleyCare, Pleasanton, California.
  • Yang CJ; Department of Surgery, Duke University, Durham, North Carolina.
Ann Surg ; 272(6): 925-929, 2020 12.
Article in English | MEDLINE | ID: covidwho-873175
ABSTRACT

OBJECTIVE:

To evaluate the overall survival of patients with operable stage IA non-small-cell lung cancer (NSCLC) who undergo "early" SBRT (within 0-30 days after diagnosis) versus "delayed" surgery (90-120 days after diagnosis). SUMMARY OF BACKGROUND DATA During the COVID-19 pandemic, national guidelines have recommended patients with operable stage IA NSCLC to consider delaying surgery by at least 3 months or, alternatively, to undergo SBRT without delay. It is unknown which strategy is associated with better short- and long-term outcomes.

METHODS:

Multivariable Cox proportional hazards modeling and propensity score-matched analysis was used to compare the overall survival of patients with stage IA NSCLC in the National Cancer Data Base from 2004 to 2015 who underwent "early" SBRT (0-30 days after diagnosis) versus that of patients who underwent "delayed" wedge resection (90-120 days after diagnosis).

RESULTS:

During the study period, 570 (55%) patients underwent early SBRT and 475 (45%) underwent delayed wedge resection. In multivariable analysis, delayed resection was associated with improved survival [adjusted hazard ratio 0.61; (95% confidence interval (CI) 0.50-0.76)]. Propensity-score matching was used to create 2 groups of 279 patients each who received early SBRT or delayed resection that were well-matched with regard to baseline characteristics. The 5-year survival associated with delayed resection was 53% (95% CI 45%-61%) which was better than the 5-year survival associated with early SBRT (31% [95% CI 24%-37%]).

CONCLUSION:

In this national analysis, for patients with stage IA NSCLC, extended delay of surgery was associated with improved survival when compared to early treatment with SBRT.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Radiosurgery / Carcinoma, Non-Small-Cell Lung / Lung Neoplasms Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Variants Limits: Humans Language: English Journal: Ann Surg Year: 2020 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Radiosurgery / Carcinoma, Non-Small-Cell Lung / Lung Neoplasms Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Variants Limits: Humans Language: English Journal: Ann Surg Year: 2020 Document Type: Article