title: Outcomes after Stereotactic Body Radiotherapy versus Limited Resection in Older Patients with Early-Stage Lung Cancer.
abstract: BACKGROUND
  Limited resection and stereotactic body radiotherapy (SBRT) have emerged as treatment options for older patients with early-stage non-small-cell lung cancer (NSCLC), who are not good candidates for lobectomy.
  
  
  METHODS
  We used the Surveillance, Epidemiology and End Results-Medicare registry to identify patients older than 65 years with stage I to II NSCLC and negative lymph nodes treated with SBRT versus limited resection. We fitted a propensity score model predicting the use of SBRT and compared adjusted overall survival of patients treated with SBRT versus limited resection. Secondary analyses stratified the sample by type of limited resection (wedge versus segmentectomy), age (≤75 versus >75 years), and tumor size (<3 versus ≥3 cm). We also compared rates of surgical complications and SBRT-related toxicity in the two groups.
  
  
  RESULTS
  We identified 2243 patients of which 362 (16%) patients received SBRT. SBRT-treated patients were older, had higher comorbidity scores, and had larger tumors (p < 0.001 for all comparisons). Adjusted analyses showed no differences in survival (hazard ratio [HR], 1.19; 95% confidence interval [CI], 0.97-1.47) among patients treated with SBRT versus limited resection. Although survival of patients who underwent SBRT versus wedge resection was not different (HR, 1.22; 95% CI, 0.98-1.52), SBRT was associated with worse outcomes when compared with segmentectomy (HR, 1.55; 95% CI, 1.18-2.03). Adverse events were most often respiratory and more frequent in the patients treated with limited resection (28% versus 14%, p < 0.001).
  
  
  CONCLUSIONS
  SBRT is better tolerated and associated with similar survival when compared with wedge resection but not with segmentectomy in older patients with node-negative NSCLC.
authors.affiliation: *Department of Medicine, Respiratory Division and Respiratory Epidemiology and Clinical Research Unit, McGill University, Montreal, Canada; and †Division of General Internal Medicine, ‡Department of Radiation Oncology, and §Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Nicole
authors.initials: N
authors.lastname: Ezer
authors.forename: Rajwanth R
authors.initials: RR
authors.lastname: Veluswamy
authors.forename: Grace
authors.initials: G
authors.lastname: Mhango
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Rosenzweig
authors.forename: Charles A
authors.initials: CA
authors.lastname: Powell
authors.forename: Juan P
authors.initials: JP
authors.lastname: Wisnivesky
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods; D057216:Propensity Score; D016634:Radiosurgery / Q000009:adverse effects; D018426:SEER Program; D015996:Survival Rate; D047368:Tumor Burden