title: Stereotactic radiotherapy reduces treatment cost while improving overall survival and local control over standard fractionated radiation therapy for medically inoperable non-small-cell lung cancer.
abstract: OBJECTIVE
  Radiation therapy (RT) is the standard alternative curative treatment option for medically inoperable early stage non-small-cell lung cancer (NSCLC). Recently, stereotactic body radiotherapy (SBRT) has shown substantial promise to improve local control rates as compared with conventional fractionated RT [external beam RT (EBRT)]. We compare treatment outcomes and costs between SBRT and EBRT in this patient population.
  
  
  METHODS
  A total of 86 patients with Stage I (Tl-2 N0) NSCLC were treated with either EBRT (n=41) or SBRT (n=45) between January 2002 and April 2008. EBRT patients were treated to a median dose of 70 Gy with 3-dimensional conformal RT (n=39) or intensity-modulated radiation therapy (n=2). SBRT was delivered in 4 or 5 fractions to 48 (Tl, n=44) or 60 (T2, n=1) Gy. The actual cost was calculated using 2010 Medicare hospital-based Ambulatory Payment Classification and hospital-based physician fee screen reimbursement rates for both the technical and professional components.
  
  
  RESULTS
  On the basis of a median number of fractions for this patient population, SBRT was significantly less expensive ($13,639 EBRT vs. $10,616 SBRT, P < 0.01). Survival analysis demonstrated superior 36-month overall survival using SBRT, 71% versus 42% for EBRT (P < 0.05). SBRT also reduced local failure by nearly 3 times compared with EBRT (12% vs. 34%, P=0.10).
  
  
  CONCLUSIONS
  In this study of Stage I NSCLC patients, SBRT was found to be less expensive than standard fractionated EBRT, with the cost savings highly dependent on the number of SBRT fractions and EBRT technique (3-dimensional conformal RT vs. intensity-modulated radiation therapy). SBRT was also associated with superior local control and overall survival.
authors.affiliation: Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI 48072, USA. Thomas.Lanni@beaumonthospitals.com
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Lanni
authors.forename: Inga S
authors.initials: IS
authors.lastname: Grills
authors.forename: Larry L
authors.initials: LL
authors.lastname: Kestin
authors.forename: John M
authors.initials: JM
authors.lastname: Robertson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000191:economics* / Q000401:mortality* / Q000628:therapy; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D008175:Lung Neoplasms / Q000191:economics / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery; D020266:Radiotherapy, Conformal; D050397:Radiotherapy, Intensity-Modulated; D055752:Small Cell Lung Carcinoma / Q000191:economics* / Q000401:mortality* / Q000628:therapy; D015996:Survival Rate; D016896:Treatment Outcome