title: Analysis of stereotactic radiation vs. wedge resection vs. wedge resection plus Cesium-131 brachytherapy in early stage lung cancer.
abstract: OBJECTIVE
  The purpose of the study was to evaluate the outcomes for wedge resection (WR), WR plus brachytherapy (WRB), or stereotactic body radiation therapy (SBRT) for early stage non-small lung cancer.
  
  
  METHODS
  Retrospectively collected data of patients treated with WR, WRB, or SBRT (1993-2012). Cesium-131 (Cs131) used in WRB group in patients with close or positive margins based on surgical assessment. Kaplan-Meier survival analysis, log-rank test used to compare disease-free survival/overall survival between different groups. Multivariable analysis, using Cox proportional hazards regression analysis, was performed to evaluate the independent effect of age, gender, and treatment procedure on disease-free survival.
  
  
  RESULTS
  A total of 272 patients were included in the study (123 WR, 52 WR+Cs-131, 97 SBRT). Cs-131 was used with WRs that the surgeons deemed high risk. Local control (LC) was similar in the three groups and was achieved in 92.2% for WR group vs. 96.2% for WR+Cs-131 and 95.5% for SBRT (p = 0.60). On multivariate analysis, although females showed a higher LC, neither LC nor distant metastasis were associated with age or gender (p = 0.65 and p = 0.41, respectively). Five-year overall survival was 100% in the WR+B group, 97.7% in the WR group, and 89.6% in the SBRT group (p = 0.02). Toxicity was similar in the three groups.
  
  
  CONCLUSIONS
  WR, WR+ Cs-131, or SBRT are all excellent treatment options for patients with early stage non-small cell lung cancer that are not candidates for lobectomy. For high risk WRs, we favor use of Cesim-131 brachytherapy. Until a prospective randomized comparative study is done to evaluate the best treatment approach for early stage NSCLC, treatment selection should be based on a multidisciplinary team approach.
authors.affiliation: Department of Radiation Oncology, Weill Cornell Medical Center, New York. Electronic address: bup9001@med.cornell.edu.
authors.forename: Bhupesh
authors.initials: B
authors.lastname: Parashar
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medical Center, New York.
authors.forename: Jeffery
authors.initials: J
authors.lastname: Port
authors.affiliation: Department of Radiation Oncology, Weill Cornell Medical Center, New York.
authors.forename: Shruthi
authors.initials: S
authors.lastname: Arora
authors.affiliation: Department of Biostatistics, Weill Cornell Medical Center, New York.
authors.forename: Paul
authors.initials: P
authors.lastname: Christos
authors.affiliation: Department of Radiation Oncology, Weill Cornell Medical Center, New York.
authors.forename: Samuel
authors.initials: S
authors.lastname: Trichter
authors.affiliation: Department of Radiation Oncology, Weill Cornell Medical Center, New York.
authors.forename: Dattatreyudu
authors.initials: D
authors.lastname: Nori
authors.affiliation: Department of Radiation Oncology, Weill Cornell Medical Center, New York.
authors.forename: A Gabriella
authors.initials: AG
authors.lastname: Wernicke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D002289:Carcinoma, Non-Small-Cell Lung / Q000556:secondary / Q000628:therapy*; D002588:Cesium Radioisotopes / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011446:Prospective Studies; D016634:Radiosurgery; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012737:Sex Factors; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D002588:Cesium Radioisotopes
keywords: Brachytherapy; Cesium-131; Lung; SBRT; Wedge