Stereotactic Ablative Radiotherapy as an Alternative to Lobectomy in Patients With Medically Operable Stage I NSCLC: A Retrospective, Multicenter Analysis

Surgery or Stereotactic Body Radiotherapy for Early-stage Lung Cancer: What Is the Current Evidence?

“…Moreover, the disease for 3.2% of the patients in the surgery group had been pathologically upstaged. Finally, although Scotti et al 1 found that SBRT could yield comparable OS and PFS for operable patients, these results were significantly biased owing to the very small sample size of the SBRT group (only 30 operable patients could be included in the analysis) and the large sample size difference (30 patients vs. 94 patients), which could have significantly influenced the analytical power. Therefore, the significant bias present in their study has greatly limited the overall validity of their results.…”

“…They included a total of 187 patients with early-stage lung cancer and reported that SBRT yielded worse overall survival (OS; hazard ratio [HR], 2.27; P < .01) and a trend toward worse progressionfree survival (PFS; HR, 0.61; P ¼ .09) for all patients (including both operable and inoperable patients). 1 However, they reported comparable OS (HR, 1.68; 95% confidence interval [CI], 0.72-3.90) and PFS (HR, 1.57; 95% CI, 0.68-3.64) in operable patients who had undergone SBRT compared with those who had undergone lobectomy, which might justify to some degree the use of SBRT as an alternative to surgery in the treatment of early-stage lung cancer. 1 However, their results should be carefully interpreted.…”

“…1 However, they reported comparable OS (HR, 1.68; 95% confidence interval [CI], 0.72-3.90) and PFS (HR, 1.57; 95% CI, 0.68-3.64) in operable patients who had undergone SBRT compared with those who had undergone lobectomy, which might justify to some degree the use of SBRT as an alternative to surgery in the treatment of early-stage lung cancer. 1 However, their results should be carefully interpreted. 1 First, similar to previous studies, 2 a significant imbalance in the baseline characteristics between the surgery group and SBRT group were present in their study.…”

“…With great interest, we have read the study by Scotti et al 1 entitled "Stereotactic Ablative Radiotherapy as an Alternative to Lobectomy in Patients With Medically Operable Stage I NSCLC: A Retrospective, Multicenter Analysis." In their study, Scotti et al 1 conducted a multicenter analysis to compare the efficacies of stereotactic body radiotherapy (SBRT) with lobectomy in the treatment of patients with earlystage lung cancer.…”

“…1 However, their results should be carefully interpreted. 1 First, similar to previous studies, 2 a significant imbalance in the baseline characteristics between the surgery group and SBRT group were present in their study. 1 For example, the patients in the SBRT group were older and had had a worse performance status and worse global initiative for chronic obstructive lung disease scale scores compared with the patients in the surgery group (P < .001), which might have favored the survival of the surgery group.…”