Real-world decision-making process for stereotactic body radiotherapy versus minimally invasive surgery in early-stage lung cancer patients Journal Article
| Authors: | Vanstraelen, S.; Tan, K. S.; Adusumilli, P. S.; Bains, M. S.; Bott, M. J.; Downey, R. J.; Gomez, D. R.; Gray, K. D.; Huang, J.; Isbell, J. M.; Molena, D.; Park, B. J.; Rimner, A.; Rusch, V. W.; Shaverdian, N.; Sihag, S.; Wu, A. J.; Jones, D. R.; Rocco, G. |
| Article Title: | Real-world decision-making process for stereotactic body radiotherapy versus minimally invasive surgery in early-stage lung cancer patients |
| Abstract: | Objective: To generate a prediction model for selection of treatment modality for early-stage non-small cell lung cancer (NSCLC). Summary Background Data: Stereotactic body radiotherapy (SBRT) and minimally invasive surgery (MIS) are used in the local treatment of early-stage NSCLC. However, selection of patients for either SBRT or MIS remains challenging, due to the multitude of factors influencing the decision-making process. Methods: We analyzed 1291 patients with clinical stage I NSCLC treated with intended MIS or SBRT from January 2020 to July 2023. A prediction model for selection for SBRT was created based on multivariable logistic regression analysis. The receiver operating characteristic curve analysis stratified the cohort into 3 treatment-related risk categories. Post-procedural outcomes, recurrence and overall survival (OS) were investigated to assess the performance of the model. Results: In total, 1116 patients underwent MIS and 175 SBRT. The prediction model included age, performance status, previous pulmonary resection, MSK-Frailty score, FEV1 and DLCO, and demonstrated an area-under-the-curve of 0.908 (95%CI, 0.876–0.938). Based on the probability scores (n=1197), patients were stratified into a low-risk (MIS, n=970 and SBRT, n=28), intermediate-risk (MIS, n=96 and SBRT, n=53) and high-risk category (MIS, n=10 and SBRT, n=40). Treatment modality was not associated with OS (HR of SBRT, 1.67 [95%CI: 0.80-3.48]; p=0.20). Conclusion: Clinical expertise can be translated into a robust predictive model, guiding the selection of stage I NSCLC patients for MIS versus SBRT and effectively categorizing them into three distinct risk groups. Patients in the intermediate category could benefit most from multidisciplinary evaluation. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved. |
| Keywords: | lung cancer; recurrence; minimally invasive surgery; stereotactic body radiotherapy; outcomes; early-stage |
| Journal Title: | Annals of Surgery |
| ISSN: | 0003-4932 |
| Publisher: | Lippincott Williams & Wilkins |
| Publication status: | Online ahead of print |
| Date Published: | 2024-10-01 |
| Online Publication Date: | 2024-10-01 |
| Language: | English |
| DOI: | 10.1097/sla.0000000000006552 |
| PUBMED: | 39351678 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PDF -- MSK corresponding author is Gaetano Rocco -- Source: Scopus |
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