Comparative effectiveness of surgery and radiosurgery for stage I XXXX .

@entity1 @entity137 @entity5 @entity1149 @entity2
BACKGROUND: Although surgery is the standard treatment for early-stage @entity1149 ( @entity1149 ), stereotactic body radiotherapy (SBRT) has been disseminated as an alternative therapy. The comparative mortalities and @entity137 of these treatments for @entity1 of different life expectancies are unknown. METHODS: The Surveillance, Epidemiology, and End Results-Medicare linked database was used to identify @entity1 who were 67 years old or older and underwent SBRT or surgery for stage I @entity1149 from 2007 to 2009. Matched @entity1 were stratified into short life expectancies (<5 years) and long life expectancies (>= 5 years). Mortality and complication rates were compared with Poisson regression. RESULTS: Overall, 367 SBRT @entity1 and 711 surgery @entity1 were matched. Acute @entity137 (0-1 month) was lower from SBRT versus surgery (7.9% vs 54.9%, P   <   .001). At 24 months after treatment, there was no difference (69.7% vs 73.9%, P   =   .31). The incidence rate ratio (IRR) for @entity137 from SBRT versus surgery was 0.74 (95% confidence interval [CI], 0.64-0.87). Overall mortality was lower with SBRT versus surgery at 3 months (2.2% vs 6.1%, P   =   .005), but by 24 months, overall mortality was higher with SBRT (40.1% vs 22.3%, P   <   .001). For @entity1 with short life expectancies, there was no difference in @entity2 mortality (IRR, 1.01; 95% CI, 0.40-2.56). However, for @entity1 with long life expectancies, there was greater overall mortality (IRR, 1.49; 95% CI, 1.11-2.01) as well as a trend toward greater @entity2 mortality (IRR, 1.63; 95% CI, 0.95-2.79) with SBRT versus surgery. CONCLUSIONS: SBRT was associated with lower immediate mortality and @entity137 in comparison with surgery. However, for @entity1 with long life expectancies, there appears to be a relative benefit from surgery versus SBRT. @entity5 2015;121:2341-2349.    2015 American @entity5 Society.
