Stereotactic body radiotherapy versus percutaneous local tumor ablation for early-stage non-small cell lung cancer.
OBJECTIVES
To compare patterns of care and overall survival (OS) between stereotactic body radiotherapy (SBRT) and percutaneous local tumor ablation (LTA) for non-surgically managed early-stage non-small-cell lung cancer (NSCLC).


MATERIALS AND METHODS
The National Cancer Database (NCDB) was queried from 2004 to 2014 for adults with non-metastatic, node-negative invasive adenocarcinoma or squamous cell carcinoma of the lung with primary tumor size ≤5.0 cm who did not undergo surgery or chemotherapy and received SBRT or LTA. Patterns of care were assessed with multivariate logistic regression. After propensity-score weighting with generalized boosted regression, OS was assessed with univariate and doubly-robust multivariate Cox regression.


RESULTS
Of 15,792 patients, 14,651 (93%) received SBRT and 1141 (7%) received LTA. Increasing age (OR 1.01, p = .035), treatment at an academic institution (OR 2.94, p < .001), increasing tumor size (OR 1.05, p < .001), and more recent year of diagnosis (OR 1.43, p < .001) were predictive of treatment with SBRT, whereas comorbidities (OR 0.74, p = .003) and treatment at a high-volume facility (OR 0.05, p < .001) were predictive for LTA. At a median follow-up of 26.2 months, SBRT was associated with improved OS relative to LTA within a propensity-score weighted doubly-robust multivariate analysis (HR 0.71, p < .001). On weighted subgroup analyses, improved OS was observed with SBRT for tumor sizes >2.0 cm (HR 0.72, p < .001) and for those treated at high-volume facilities (HR 0.71, p < .001). No OS difference was found with SBRT or LTA in tumor sizes ≤2.0 cm (HR 0.90, p = .227).


CONCLUSION
Within the NCDB, SBRT was more commonly utilized and was associated with improved OS when compared to percutaneous LTA for patients with non-surgically managed early-stage NSCLC. Patients with small tumor volumes likely represent an appropriate population for future prospective randomized comparisons between SBRT and LTA.
['Ager|Bryan J|BJ|', 'Wells|Stacey M|SM|', 'Gruhl|Joshua D|JD|', 'Stoddard|Gregory J|GJ|', 'Tao|Randa|R|', 'Kokeny|Kristine E|KE|', 'Hitchcock|Ying J|YJ|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D002289:Carcinoma, Non-Small-Cell Lung D016208:Databases, Factual D005260:Female D005500:Follow-Up Studies D006801:Humans D008175:Lung Neoplasms D008297:Male D008875:Middle Aged D009367:Neoplasm Staging D000078703:Radiofrequency Ablation D016634:Radiosurgery D012189:Retrospective Studies D015996:Survival Rate
Stereotactic body radiotherapy NSCLC Microwave ablation Percutaneous ablation Radiofrequency ablation