title: Stage I-II non-small-cell lung cancer treated using either stereotactic ablative radiotherapy (SABR) or lobectomy by video-assisted thoracoscopic surgery (VATS): outcomes of a propensity score-matched analysis.
abstract: BACKGROUND
  Video-assisted thoracoscopic surgery (VATS) lobectomy and stereotactic ablative radiotherapy (SABR) are both used for early-stage non-small-cell lung cancer. We carried out a propensity score-matched analysis to compare locoregional control (LRC).
  
  
  METHODS
  VATS lobectomy data from six hospitals were retrospectively accessed; SABR data were obtained from a single institution database. Patients were matched using propensity scores based on cTNM stage, age, gender, Charlson comorbidity score, lung function and performance score. Eighty-six VATS and 527 SABR patients were matched blinded to outcome (1:1 ratio, caliper distance 0.025). Locoregional failure was defined as recurrence in/adjacent to the planning target volume/surgical margins, ipsilateral hilum or mediastinum. Recurrences were either biopsy-confirmed or had to be PET-positive and reviewed by a tumor board.
  
  
  RESULTS
  The matched cohort consisted of 64 SABR and 64 VATS patients with the median follow-up of 30 and 16 months, respectively. Post-SABR LRC rates were superior at 1 and 3 years (96.8% and 93.3% versus 86.9% and 82.6%, respectively, P = 0.04). Distant recurrences and overall survival (OS) were not significantly different.
  
  
  CONCLUSIONS
  This retrospective analysis found a superior LRC after SABR compared with VATS lobectomy, but OS did not differ. Our findings support the need to compare both treatments in a randomized, controlled trial.
authors: Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands. n.verstegen@vumc.nl
authors: N E
authors: NE
authors: Verstegen
authors: J W A
authors: JW
authors: Oosterhuis
authors: D A
authors: DA
authors: Palma
authors: G
authors: G
authors: Rodrigues
authors: F J
authors: FJ
authors: Lagerwaard
authors: A
authors: A
authors: van der Elst
authors: R
authors: R
authors: Mollema
authors: W F
authors: WF
authors: van Tets
authors: A
authors: A
authors: Warner
authors: J J A
authors: JJ
authors: Joosten
authors: M I
authors: MI
authors: Amir
authors: C J A
authors: CJ
authors: Haasbeek
authors: E F
authors: EF
authors: Smit
authors: B J
authors: BJ
authors: Slotman
authors: S
authors: S
authors: Senan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods*; D057216:Propensity Score; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D016896:Treatment Outcome
keywords: SABR; VATS; early stage; lobectomy; non-small-cell lung cancer; stereotactic radiotherapy