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Stereotactic body radiotherapy versus conventional radiotherapy for early-stage small cell lung cancer

  • Original Research
  • Published:
Journal of Radiation Oncology

Abstract

Purpose

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).

Methods

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.

Results

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).

Conclusion

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.

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Acknowledgments

The authors also wish to acknowledge the Vanderbilt Institute for Clinical and Translational Research for their funding support.

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Authors and Affiliations

  1. Department of Radiation Oncology, Vanderbilt University Medical Center, Preston Cancer Research Building, 2220 Pierce Ave, Nashville, TN, 37232, USA

    Neil B. Newman & Evan C. Osmundson

  2. Vanderbilt University School of Medicine, Nashville, TN, USA

    Alexander D. Sherry

  3. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA

    Daniel W. Byrne

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  1. Neil B. Newman
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  4. Evan C. Osmundson
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Correspondence to Neil B. Newman.

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Funding

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.

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Neil B. Newman received a grant in order to support biostatistical analysis. All other authors declare that they have no conflict of interest.

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Newman, N.B., Sherry, A.D., Byrne, D.W. et al. Stereotactic body radiotherapy versus conventional radiotherapy for early-stage small cell lung cancer. J Radiat Oncol 8, 239–248 (2019). https://doi.org/10.1007/s13566-019-00395-x

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