title: Microsimulation model predicts survival benefit of radiofrequency ablation and stereotactic body radiotherapy versus radiotherapy for treating inoperable stage I non-small cell lung cancer.
abstract: OBJECTIVE
  A subset of patients with stage IA and IB non-small cell lung cancer (NSCLC) is ineligible for surgical resection and undergoes radiation therapy. Radiofrequency ablation (RFA) and stereotactic body radiotherapy are newer potentially attractive alternative therapies.
  
  
  METHODS
  We added RFA and stereotactic body radiotherapy treatment modules to a microsimulation model that simulates lung cancer's natural history, detection, and treatment. Natural history parameters were previously estimated via calibration against tumor registry data and cohort studies; the model was validated with screening study and cohort data. RFA model parameters were calibrated against 2-year survival from the Radiofrequency Ablation of Pulmonary Tumor Response Evaluation (RAPTURE) study, and stereotactic body radiotherapy model parameters were calibrated against 3-year survival from a phase 2 prospective trial. We simulated lifetime histories of identical patients with early-stage NSCLC who were ineligible for resection, who were treated with radiation therapy, RFA, or stereotactic body radiotherapy under a range of scenarios. From 5,000,000 simulated individuals, we selected a cohort of patients with stage I medically inoperable cancer for analysis (n = 2056 per treatment scenario). Main outcomes were life expectancy gains.
  
  
  RESULTS
  RFA or stereotactic body radiotherapy treatment in patients with peripheral stage IA or IB NSCLC who were nonoperative candidates resulted in life expectancy gains of 1.71 and 1.46 life-years, respectively, compared with universal radiation therapy. A strategy where patients with central tumors underwent stereotactic body radiotherapy and those with peripheral tumors underwent RFA resulted in a gain of 2.02 life-years compared with universal radiation therapy. Findings were robust with respect to changes in model parameters.
  
  
  CONCLUSIONS
  Microsimulation modeling results suggest that RFA and stereotactic body radiotherapy could provide life expectancy gains to patients with stage IA or IB NSCLC who are ineligible for resection.
authors.affiliation: Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Angela C
authors.initials: AC
authors.lastname: Tramontano
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Cipriano
authors.forename: Chung Yin
authors.initials: CY
authors.lastname: Kong
authors.forename: Jo-Anne O
authors.initials: JA
authors.lastname: Shepard
authors.forename: Michael
authors.initials: M
authors.lastname: Lanuti
authors.forename: G Scott
authors.initials: GS
authors.lastname: Gazelle
authors.forename: Pamela M
authors.initials: PM
authors.lastname: McMahon
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000628:therapy*; D017115:Catheter Ablation / Q000401:mortality* / Q000706:statistics & numerical data; D003131:Combined Modality Therapy / Q000401:mortality; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D011013:Pneumonectomy / Q000401:mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D016634:Radiosurgery / Q000401:mortality* / Q000706:statistics & numerical data; D018570:Risk Assessment / Q000379:methods; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome