title: Patterns of failure after stereotactic body radiation therapy or lobar resection for clinical stage I non-small-cell lung cancer.
abstract: BACKGROUND
  The purpose of this study was to compare patterns of failure between lobar resection (lobectomy or pneumonectomy) and stereotactic body radiation therapy (SBRT) for patients with clinical stage I non-small-cell lung cancer (NSCLC).
  
  
  METHODS
  From January 2004 to January 2008, 338 patients underwent definitive treatment for pathologically confirmed clinical stage I NSCLC with lobar resection (n = 260) or SBRT (n = 78). Most surgical patients underwent lobectomy (n = 237). SBRT patients received a biologically effective dose of at least 100 Gy10. Lobar resection patients were younger, healthier, and had superior pulmonary function, whereas most of the patients in the SBRT group had T1 tumors. Final pathology upstaged 32.7% of surgery patients, and 20.0% received adjuvant chemotherapy. No SBRT patients received adjuvant chemotherapy.
  
  
  RESULTS
  In an unmatched comparison, 4-year lobar local control (98.7% versus 93.6%, p = 0.015) was greater for lobar resection versus SBRT, respectively, though primary tumor (98.7% versus 95.3%, p = 0.088), regional (82.9% versus 78.1%, p = 0.912), and distant control (76.1% versus 54.0%, p = 0.152) were similar. Overall survival (OS, 63.5% versus 29.6%, p < 0.0001) was greater for lobar resection, though cause-specific survival (CSS, 81.3% versus 75.3%, p = 0.923) was similar. In a T-stage matched comparison of 152 patients, there was no significant difference in patterns of failure or CSS, whereas OS favored surgery.
  
  
  CONCLUSIONS
  Lobectomy/pneumonectomy or SBRT results in comparable patterns of failure for clinical stage I NSCLC. In this retrospective comparison, OS was superior for surgery, though CSS was similar. Randomized trials are necessary to control for fundamental differences in comorbidity, which impact interpretation of both tumor control and survival.
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri 3110, USA. crobinson@radonc.wustl.edu
authors.forename: Cliff G
authors.initials: CG
authors.lastname: Robinson
authors.forename: Todd A
authors.initials: TA
authors.lastname: DeWees
authors.forename: Issam M
authors.initials: IM
authors.lastname: El Naqa
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Creach
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Olsen
authors.forename: Traves D
authors.initials: TD
authors.lastname: Crabtree
authors.forename: Bryan F
authors.initials: BF
authors.lastname: Meyers
authors.forename: Varun
authors.initials: V
authors.lastname: Puri
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Bell
authors.forename: Parag J
authors.initials: PJ
authors.lastname: Parikh
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Bradley
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000401:mortality*; D016634:Radiosurgery / Q000401:mortality*; D012189:Retrospective Studies; D015996:Survival Rate; D017211:Treatment Failure