title: Survival and quality of life after stereotactic or 3D-conformal radiotherapy for inoperable early-stage lung cancer.
abstract: OBJECTIVE
  To investigate survival and local recurrence after stereotactic ablative radiotherapy (SABR) or three-dimensional conformal radiotherapy (3D-CRT) administered for early-stage primary lung cancer and to investigate longitudinal changes of health-related quality of life (HRQOL) parameters after either treatment.
  
  
  METHODS
  Two prospective cohorts of inoperable patients with T1-2N0M0 primary lung tumors were analyzed. Patients received 70 Gy in 35 fractions with 3D-CRT or 60 Gy in three to eight fractions with SABR. Global quality of life (GQOL), physical functioning (PF), and patient-rated dyspnea were assessed using the respective dimensions of European Organization for Research and Treatment of Cancer Core Questionnaire-C30 and LC13. HRQOL was analyzed using multivariate linear mixed-effects modeling, survival and local control (LC) using the Kaplan-Meier method, Cox proportional hazards analysis, and Fine and Gray multivariate competing risk analysis as appropriate.
  
  
  RESULTS
  Overall survival (OS) was better after SABR compared with 3D-CRT with a HR of 2.6 (95% confidence interval [CI]: 1.5-4.8; p < 0.01). 3D-CRT conferred a subhazard ratio for LC of 5.0 (95% CI: 1.7-14.7; p < 0.01) compared with SABR. GQOL and PF were stable after SABR (p = 0.21 and p = 0.62, respectively). Dyspnea increased after SABR by 3.2 out of 100 points (95% CI: 1.0-5.3; p < 0.01), which is clinically insignificant. At 1 year, PF decreased by an excess of 8.7 out of 100 points (95% CI: 2.8-14.7; p < 0.01) after 3D-CRT compared with SABR.
  
  
  CONCLUSIONS
  In this nonrandomized comparison of two prospective cohorts of medically inoperable patients with Stage I lung cancer, OS and LC were better after SABR. GQOL, PF, and patient-rated dyspnea were stable after SABR, whereas PF decreased after 3D-CRT approaching clinical significance already at 1 year.
authors.affiliation: Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. j.widder@rt.umcg.nl
authors.forename: Joachim
authors.initials: J
authors.lastname: Widder
authors.forename: Douwe
authors.initials: D
authors.lastname: Postmus
authors.forename: Jan F
authors.initials: JF
authors.lastname: Ubbels
authors.forename: Erwin M
authors.initials: EM
authors.lastname: Wiegman
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Langendijk
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D016001:Confidence Intervals; D059026:Diagnostic Self Evaluation; D019583:Dose Fractionation, Radiation; D004417:Dyspnea / Q000175:diagnosis; D005260:Female; D006304:Health Status; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011446:Prospective Studies; D011788:Quality of Life; D016634:Radiosurgery / Q000379:methods / Q000401:mortality*; D020266:Radiotherapy, Conformal / Q000379:methods / Q000401:mortality*; D012044:Regression Analysis; D011795:Surveys and Questionnaires