1. Stage I Non Small Cell Lung Cancer (NSCLC): single centre comparison of outcome by treatment with surgery, conventional radiotherapy and stereotactic ablative radiotherapy
Dr Kamalram Thippu Jayaprakash, Dr David Gilligan and Dr Susan Harden
Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, United Kingdom
Introduction:
Surgery is the gold standard treatment for early stage non-small cell lung cancer (NSCLC). However radical radiotherapy (RT) using either conventionally fractionated 3-dimensional conformal RT (3D-CRT) or Stereotactic Ablative Body Radiotherapy (SABR) is a standard treatment option in medically inoperable patients. We performed a retrospective analysis to compare overall survival of stage I NSCLC patients treated with surgery, 3D-CRT and SABR in our institutes.
Methods:
Patients treated between September 2012 and January 2015 were identified from our institutional electronic databases. Data was collected and analysed using IBM SPSS® Version 22 statistical software. All cases were discussed at the Papworth and Addenbrooke’s thoracic multi disciplinary team meeting. Surgery was considered for all patients and RT was offered for medically inoperable patients or those who declined surgery. SABR (55 Gy/5#) was offered for all eligible patients with peripheral primaries and 3D-CRT (55Gy/20#) was used when SABR was not technically possible.
Yellow – Surgery; Blue – 3D –CRT; Green - SABR
SABR plan of a LUL tumour
Results:
A total of 91 stage I NSCLC patients were treated over this time; 49, 22 and 20 patients were treated with surgery, 3D-CRT and SABR respectively.
With 17 months median follow-up, there is no significant difference in one or two years overall survival (OS) between three patient groups by Kaplan-Meier survival analysis. In the surgical group 1 and 2 years OS are 89% & 84%, in the 3D-CRT group 80% & 80% and in the SABR cohort 82% & 82% respectively. Median survival has not been reached (graph).
Only 7/91 patients have progressed, with one local-regional recurrence after surgery and 6 patients developing distant metastases of which 3 were in the surgical, 1 in the 3DCRT and 2 in the SABR groups.
Histological confirmation rate for RT patients was 76%. In the surgical group, 84% were treated with lobectomy, 12% treated with wedge resection and 4% with bi-lobectomy.
Nearly one third of the patients (30%) have also been diagnosed with another malignancy, predominantly a smoking related solid malignancy.
Conclusions:
Our small series analysis shows very good overall survival with both 3D-CRT and SABR treatments for early stage NSCLC at 1 and 2 years. Although surgery remains gold standard treatment, RT may provide similar survival outcomes. A current UK trial is aiming to compare surgery with SABR (SABRTooth1). Although overall survival outcomes for 3D-CRT and SABR appear equivalent, SABR may still be preferable to 3D-CRT due to fewer treatments for patients and in reducing departmental workload.
1SABRTOOTH; A study to determine the feasibility and acceptability of conducting a phase III randomised controlled trial comparing stereotactic Ablative Radiotherapy (SABR) with surgery in patients with peripheral stage I non-small cell lung cancer (NSCLC) considered Higher risk of complications from surgical resection (ISRTCN No ).
Acknowledgements:
Physicists and Radiographers, Lung Team, Department of Radiation Physics, Cambridge University Hospitals NHS FT, Cambridge, CB2 0QQ, United Kingdom
Mr Aman Coonar, Mr Marco Scarci, Department of Thoracic Surgery, Papworth Hospital NHS FT, Papworth Everard, Cambridge, CB23 3RE, United Kingdom
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