Effectiveness of surgery and individualized high-dose hyperfractionated accelerated radiotherapy on survival in clinical stage I non-small cell lung cancer. A propensity score matched analysis.
OBJECTIVE
Surgery is considered the treatment of choice for early-stage non-small cell lung cancer (NSCLC). Patients with poor pulmonary function or other comorbidities are treated with radiotherapy. The objective of this investigation is to compare the 3-year survival of two early-stage NSCLC populations treated in two different hospitals, either by surgical resection (lobectomy) or by individualized high-dose accelerated radiotherapy, after matching patients by propensity scoring analysis.


METHODS
A retrospective comparative study has been performed on two series of consecutive patients with cytohistological diagnosis of NSCLC, clinically staged IA by means of PET-scan (radiotherapy group) and pathologically staged IA (surgery group).


RESULTS
A total of 157 cases were initially selected for the analysis (110 operated and 47 treated by radiotherapy). Patients in the radiotherapy group were older, with higher comorbidity and lower FEV1% with 3-years probability of survival for operated patients higher than that found for patients treated by radiotherapy. After matching by propensity scoring (using age and FEV1%), differences disappear and 3-years probability of survival had no statistical differences.


CONCLUSIONS
Although this is a non-randomized retrospective analysis, we have not found 3-years survival differences after matching cases between surgery and radiotherapy. Nevertheless, data presented here support the continuous investigation for non-surgical alternatives in this disease.
Jimenez
Marcelo F
MF
Thoracic Surgery Service, Salamanca University Hospital, Spain. mfjl@usal.es
van Baardwijk
Angela
A
Aerts
Hugo J W L
HJ
De Ruysscher
Dirk
D
Novoa
Nuria M
NM
Varela
Gonzalo
G
Lambin
Philippe
P
D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D011013:Pneumonectomy; D049268:Positron-Emission Tomography; D057216:Propensity Score; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal; D015996:Survival Rate; D014057:Tomography, X-Ray Computed