title: Increase in the use of lung stereotactic body radiotherapy without a preceding biopsy in the United States.
abstract: BACKGROUND
  Stereotactic body radiotherapy (SBRT) is an efficacious treatment for early stage non-small cell lung cancer (NSCLC). Patients with clinically suspected NSCLC may have medical comorbidities that increase biopsy risks, making them more likely to receive SBRT without biopsy. This study characterizes the pervasiveness of this management approach nationally.
  
  
  METHODS
  Patients with stage I NSCLC who received SBRT from 2003 to 2011 were identified within National Cancer Database. Changes in the proportion treated without biopsy were compared by year of diagnosis using binomial logistic regression. Demographics were compared between patients with and without biopsy with Chi-square and t-tests. Multivariate logistic regression was used to determine factors independently associated with SBRT delivery without biopsy.
  
  
  RESULTS
  We identified 6960 patients. Most had biopsy before SBRT (95.5%). Over time the proportion treated without biopsy increased (OR 1.11, p=0.038). Univariate comparisons demonstrated that older, medically inoperable patients treated at academic centers located in the New England or Pacific regions were less likely to have biopsy before SBRT. Facility type and location (p<0.001), medical inoperability (p<0.001), and smaller tumor size (p=0.013) were associated with odds of SBRT without biopsy in multivariate analyses. A trend toward increased use of SBRT with a biopsy with later year of diagnosis (p=0.093) was observed in multivariate analysis.
  
  
  CONCLUSIONS
  The percentage of patients nationally undergoing SBRT without biopsy has increased over time. The reasons for this trend and ramifications of this approach on cost-effectiveness of care must be studied.
authors.affiliation: Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT 06510, United States. Electronic address: charles.rutter@yale.edu.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Rutter
authors.affiliation: Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT 06510, United States.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Corso
authors.affiliation: Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT 06510, United States.
authors.forename: Henry S
authors.initials: HS
authors.lastname: Park
authors.affiliation: Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT 06510, United States.
authors.forename: Brandon R
authors.initials: BR
authors.lastname: Mancini
authors.affiliation: Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT 06510, United States.
authors.forename: Debra N
authors.initials: DN
authors.lastname: Yeboa
authors.affiliation: Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT 06510, United States.
authors.forename: Nataniel H
authors.initials: NH
authors.lastname: Lester-Coll
authors.affiliation: Department of Thoracic Surgery, Yale School of Medicine, New Haven, CT 06510, United States.
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Kim
authors.affiliation: Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT 06510, United States.
authors.forename: Roy H
authors.initials: RH
authors.lastname: Decker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016634:Radiosurgery; D012307:Risk Factors; D047368:Tumor Burden; D014481:United States
keywords: Non-small cell; SBRT; Stereotactic