As survival seems to be equal after either stereotactic body radiotherapy (SBRT) or surgery for patients with stage I non-small cell lung cancer (NSCLC), treatment impact on the quality of life (QoL) after is essential for well-informed decision making. After a surgical resection, deterioration of QoL is often observed in the early post-treatment period, whereas QoL is reported to be maintained after SBRT. The aim of this study is to compare QoL in the first year after SBRT and surgery.
QoL was assessed by using the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30) and the lung cancer-specific supplementary questionnaire (QLQ-LC13) at baseline and 3, 6 and 12 months after treatment. Two prospectively collected databases of patients with clinically proven stage I NSCLC, from two large hospitals in the Netherlands, were pooled (n = 306; 256 patients were treated with SBRT and 41 patients with surgery). This observational study design is susceptible to selection bias. To correct for confounding, propensity-scores were calculated using forward stepwise logistic regression, to be selected for surgical treatment. For the final model, age, dichotomized ECOG score and FEV1% predicted scores were selected.
The 41 surgical patients were matched to 41 SBRT patients on propensity score with a 1:1 ratio. At baseline, patients in the surgery group report a lower health related-QoL compared to patients in the SBRT group. However, during the first year after treatment, no clinical meaningful differences in social-, role, physical, emotional and cognitive domains were observed between patients treated using either modality. Furthermore, no clinical meaningful differences in QLQ-LC13 scores (dyspnea, pain, fatigue) after treatment were observed.
This study comparing a matched cohort, revealed no clinical significant differences in QoL following either SBRT or surgery for an early stage NSCLC.
Clinical trial identification
Legal entity responsible for the study
Leonie Alberts and Harold Wolff.
Has not received any funding.
H.B. Wolff, V.M.H. Coupe: Research funding: Novartis. Novartis Pharma B.V. was not involved in the data collection, data analysis, or reporting. F.J. Lagerwaard: Honoraria, Speaker's bureau: Viewray inc USA. S. Senan: Honoraria, Consulting/advisory role company: Lilly Oncology, AstraZeneca; Research funding: Varian Medical systems. All other authors have declared no conflicts of interest.