title: Comparison of limited surgery and three-dimensional conformal radiation in high-risk patients with stage I non-small cell lung cancer.
abstract: BACKGROUND
  Anatomic resection is currently the standard of care for patients with stage I non-small cell lung cancer (NSCLC). Some stage I patients are unable to tolerate lobectomy because of limited lung function or prohibitive comorbidities. In this study, we retrospectively compared the outcome of patients treated with wedge resection or three-dimensional (3-D) conformal radiation therapy, the most common treatment modalities used for such high-risk patients.
  
  
  METHODS
  All patients with stage I NSCLC from 1988 to 2005 who were not considered candidates for anatomic surgical resection were reviewed. Univariate and multivariate analyses were performed to assess the influence of 3-D conformal radiation and surgery on overall survival and recurrence-free survival. Propensity score-matched analysis and cost assessments were performed to compare outcomes with both modalities. Propensity matching was performed for gender, histology, tumor size, performance status, and age.
  
  
  RESULTS
  Of 160 patients studied, 68 patients received limited resection and 92 patients received 3-D conformal radiation. Univariate and multivariate analyses suggested a trend toward improved outcome in limited resection. Propensity matching was performed with 34 matched pairs and demonstrated no statistically significant difference in overall survival or recurrence-free survival. The mean cost of radiation therapy ($32,735) was not statistically significantly different from surgery ($30,411).
  
  
  CONCLUSIONS
  In high-risk patients with NSCLC, limited resection has a tendency towards improved outcome. A propensity matched analysis did not show a clear benefit for limited resection, which may be due in part to an inadequate number of patients for analysis and/or increased comorbidities of patients treated with 3-D conformal radiation.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
authors.forename: Sai
authors.initials: S
authors.lastname: Yendamuri
authors.forename: Ritsuko R
authors.initials: RR
authors.lastname: Komaki
authors.forename: Arlene M
authors.initials: AM
authors.lastname: Correa
authors.forename: Pamela
authors.initials: P
authors.lastname: Allen
authors.forename: Bob
authors.initials: B
authors.lastname: Wynn
authors.forename: Shanda
authors.initials: S
authors.lastname: Blackmon
authors.forename: Wayne L
authors.initials: WL
authors.lastname: Hofstetter
authors.forename: David C
authors.initials: DC
authors.lastname: Rice
authors.forename: Jack A
authors.initials: JA
authors.lastname: Roth
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Swisher
authors.forename: Ara A
authors.initials: AA
authors.lastname: Vaporciyan
authors.forename: Garrett L
authors.initials: GL
authors.lastname: Walsh
authors.forename: Reza J
authors.initials: RJ
authors.lastname: Mehran
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D003365:Costs and Cost Analysis; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome