title: Video-assisted thoracoscopic lobectomy versus stereotactic radiotherapy for stage I lung cancer.
abstract: BACKGROUND
  Previous comparative reports of stereotactic body radiotherapy (SBRT) and surgery for non-small cell lung cancer (NSCLC) suffered from short follow-up, mixed extents of resection and inclusion of benign lesion. We aimed to make comparisons of long-term outcomes between a pure series of video-assisted thoracoscopic surgery (VATS) lobectomy and SBRT for biopsy-proven clinical stage I NSCLC.
  
  
  METHODS
  We retrospectively compared overall survival (OS), cause-specific survival (CSS), recurrence-free survival (RFS), local control, regional lymph node (LN) control, and distant control between VATS lobectomy (n = 413) and SBRT (n = 104) for biopsy-proven clinical stage I NSCLC at our institution between 2003 and 2009. Propensity score matching was used to adjust the confounding effects in estimating treatment hazard ratios. Forty-one VATS lobectomy patients and 41 SBRT patients were matched blinded to outcome (1:1 ratio, caliper distance; 0.5).
  
  
  RESULTS
  After propensity score matching, the follow-up period of the whole cohort ranged from 5 to 120 months with a median of 48. After propensity score matching there were significant differences in OS (p = 0.0016), CSS (p = 0.0015), RFS (p < 0.0001), local control (p = 0.0019), and distant control (p < 0.0001) and no significant difference in regional LN control (p = 0.11). The VATS lobectomy patients and SBRT patients had 68.5% and 37.3% of 5-year OS, 83.5% and 56.7% of 5-year CSS, and 60.4% and 19.5% of 5-year RFS, respectively.
  
  
  CONCLUSIONS
  Our results suggest VATS lobectomy may offer significantly more favorable long-term outcomes than SBRT in potentially operable patients with biopsy-proven clinical stage I NSCLC.
authors: Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto.
authors: Masatsugu
authors: M
authors: Hamaji
authors: Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto.
authors: Fengshi
authors: F
authors: Chen
authors: Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto.
authors: Yukinori
authors: Y
authors: Matsuo
authors: Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto.
authors: Atsushi
authors: A
authors: Kawaguchi
authors: Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto.
authors: Satoshi
authors: S
authors: Morita
authors: Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto.
authors: Nami
authors: N
authors: Ueki
authors: Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto.
authors: Makoto
authors: M
authors: Sonobe
authors: Department of Radiation Oncology, Graduate School of Medicine, Hiroshima University, Hiroshima, Japan.
authors: Yasushi
authors: Y
authors: Nagata
authors: Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto.
authors: Masahiro
authors: M
authors: Hiraoka
authors: Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto. Electronic address: hdate@kuhp.kyoto-u.ac.jp.
authors: Hiroshi
authors: H
authors: Date
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D004502:Education, Medical, Continuing; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D007564:Japan; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods / Q000401:mortality; D016634:Radiosurgery / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome; D055815:Young Adult