Abstract 99P
Background
The standard treatment for operable patients with stage I non-small cell lung cancer (NSCLC) is a minimally invasive lobectomy (MIL). However, stereotactic ablative radiotherapy (SABR) is increasingly being used. The ESLUNG study compares the outcome of MIL and SABR in operable patients.
Methods
In this retrospective cohort study with 38 participating centres, patients with clinical stage I NSCLC (TNM7), treated in 2014–2016 with MIL or SABR, were included. Recurrence rates 5-year recurrence-free survival (RFS), overall survival (OS) and lung-cancer-specific mortality (LCSM) were calculated. RFS and OS were compared after adjusting for confounding by propensity score (PS) weighting.
Results
In total, 2183 patients (1211 MIL and 972 SABR) were included. SABR patients were significantly older, had more comorbidities and poorer lung function and performance status. Postoperative nodal upstaging occurred in 12.1% of operated patients. 30-day mortality was 1.0% after MIL and 0.2% after SABR. SABR patients developed significantly more regional recurrences (18.1 versus 14.2%) and/or distant metastases (26.2 versus 20.2%) with a similar local recurrence rate (13.1 versus 12.1%). Unadjusted 5-year RFS and OS were 58.0 versus 25.1% and 70.2 versus 40.3% after MIL and SABR, respectively. 5-year LCSM was 17.4% after MIL and 24.0% after SABR (HR 0.74, 95% CI 0.61–0.90). PS-weighted analyses showed – in patients considered operable – better RFS after MIL (HR 0.70, 95% CI 0.49–0.99), but no significant difference in OS (HR 0.80, 95% CI 0.53–1.21).
Conclusions
In operable patients with stage I NSCLC, MIL leads to fewer regional recurrences and distant metastases than SABR. However, OS did not differ significantly. Future studies should focus on optimization of patient selection for MIL or SABR to further reduce postoperative mortality after MIL and nodal failures after SABR.
Legal entity responsible for the study
K.J. Hartemink.
Funding
Dutch Cancer Society (KWF Kankerbestrijding).
Disclosure
All authors have declared no conflicts of interest.