Comparative Analysis Of Clinical Efficacy Between Stereotactic Ablative Radiotherapy And Surgery For Early-stage Non-small Cell Lung Cancer

Objective To investigate the effectiveness and toxicity of stereotactic ablative radiotherapy and surgery for early stage non-small cell lung cancer.To analysis the relationship between tumor size and efficacy of stereotactic ablation radiotherapy.Methods Treatment details and outcomes were retrospectively analyzed in our institution.Between June 2012 and December 2016,227 patients underwent SABR or surgery for early stage non-small cell lung cancer.Of these,73 received SABR,154 underwent surgery.Clinical stage was performed according to the seventh edition of the UICC standard.Staging examinations included chest and upper abdomen CT,brain MRI,bone ECT,and PET-CT,if necessary(patients without pathological confirmation must perform whole-body PET-CT).Every 3 to 6 months after the treatment,patients had been through routine examination.Two years after the treatment,patients were reviewed by telephone,letter or email follow-up.Routine examinations include chest CT,abdomen CT,brain MRI,bone ECT,and PET-CT if feasible.Kaplan-Meier method was used to calculate survival rate and survival comparison was performed using the log-rank test.Chi-squared test was used to compare the baseline characteristics of patients between the two groups.P<0.05 was considered statistically significant.Results All 227 patients were successfully treated.All patients returned to the hospital for review and evaluation after treatment.The overall follow-up time was 5to 64 months.The median follow-up time was 30 months.The follow-up rate was97%.The one year,two year and three year overall survival(OS)rates of SABR group and surgery group were 97.2%,90.4%,81.9% and 96.5%,88.9%,78.2%(P=0.603),respectively.The one year,two year and three year progression free survival(PFS)rates of SABR group and surgery group were 90.1%,77.9%,66.9% and89.2%,81.5%,66.9%(P=0.565),respectively.The one year,two year and three year free from locoregional(FFLR)rates of SABR group and surgery group were92.8%,90.6%,84.0% and 96.5%,94.5%,90.8%(P=0.133),respectively.The one year,two year and three year free from distant metastasis(FFDM)rates of SABR group and surgery group were 97.2%,84.6%,75.4% and 89.2%,82.2%,69.8%(P=0.095),respectively.According to tumor size,subgroup analysis of stereotactic ablation radiotherapy group was performed: There was no statistical difference between tumor diameter ?30mm(T1 in seventh edition UICC standard)and tumor diameter>30mm group in OS,PFS,cancer-specific survival(CSS).No tumor-induced death was observed in 25 patients with tumor diameter <20 mm.Three months after treatment,the incidence of respiratory complications in the stereotactic ablation radiotherapy group was 9%,and the surgery group was 27%;the incidence of cardiovascular complications in the stereotactic ablation radiotherapy group was 0%,and the surgery group was 3.5%.Only 3% of patients in the SABR group developed radiation pneumonia.No patients with hemoptysis or radiation esophagitis were seen.Conclusions For early stage non-small cell lung cancer patients,there is no significantly statistical difference in OS?PFS?FFLR and FFDM between patients who underwent SABR or surgery.And the former one is non-invasive,has a short hospital stay time and has little adverse reactions.Therefore,SABR might be an alternative treatment for the early stage non-small cell lung cancer patients.