Researchers at The University of Texas MD Anderson Cancer Center have found that removing the entire lobe of lung can provide patients with early-stage lung cancer a better overall survival, when compared with partial resection. Furthermore, in some patients, stereotactic ablative radiotherapy (SABR) can be as efficient as a lobectomy to provide a survival benefit.
The study titled “Lobectomy, Sublobar Resection, and Stereotactic Ablative Radiotherapy for Early-Stage Non–Small Cell Lung Cancers in the Elderly”, published in the JAMA Surgery journal, is the biggest population-based study assessing modern treatment modalities for early-stage lung cancer.
By the end of 2014, an impressive 224,210 people in the U.S. are going to be diagnosed with lung cancer, according to the American Cancer Society. According to the study first author, Shervin M. Shirvani, M.D., attending radiation oncologist at Banner MD Anderson Cancer Center in Arizona and an adjunct professor at MD Anderson, the number of diagnosed lung cancer cases is expected to increase considerably in the upcoming future, partially due to the aging population and increased CT screening to diagnose lung cancer.
Currently, there are three treatment options available for patients diagnosed in the early-stages of the disease: lobectomy (removal of the entire lobe of lung), sublobar resection (removal of the area of the lung containing the tumor), and SABR (a precise form of radiation therapy).
“Currently, lung cancer is one of the most common and fatal cancers, and for the foreseeable future it will be one of the major health epidemics our country faces. Yet we don’t have strong evidence-based guidelines for how to best treat the disease – especially when it’s discovered early,” Dr. Shirvani said in a MD Anderson news release. “In the absence of clinical trials, it was important to analyze observational data from a very large database to compare these three modalities. We wanted to compare lobectomy, the treatment generally thought to be the standard of care, to both the smaller surgery and stereotactic ablative radiotherapy, which does not carry surgical risk, and understand which may be best for this elderly patient population with extensive concurrent illnesses,” he added.
To define the clinical characteristics and survival outcomes associated with the 3 commonly used definitive therapies for early-stage non-small cell lung cancer (NSCLC), the research team used the Surveillance, Epidemiology, and End Results database linked to Medicare, to analyze data concerning 9093 patients with early-stage, node-negative NSCLC who underwent lobectomy (79.3%), sublobar resection (16.5%), or SABR (4.2%), from January 2003, through December 2009.
The results demonstrated that lobectomy was associated with a better overall and lung-specific survival, when compared to sublobar resection.
“The assumption was that for an elderly patient with a number of co-morbidities, the smaller surgery would be better than a whole lobectomy because there would be fewer surgical complications. Yet, it appears that the ability to eradicate the cancer with the bigger surgery may be more important than minimizing surgical risk,” Dr. Shirvani explained.
Additionally, the results showed that when comparing patients treated with lobectomy and SABR, a similar overall survival and lung-cancer specific was observed, suggesting SABR as a viable option to surgery for elderly patients and/or patients with several medical problems.
“Clearly, the incidence of early-stage lung cancer will increase dramatically in the next few years, and we need to be prepared to treat patients in the right way – balancing the effectiveness versus risk of treatment in an elderly population,” explained Benjamin Smith, M.D., associate professor, Radiation Oncology at MD Anderson and study’s senior author. “Observational studies like ours give us insight into what the right treatment strategy should be, and hopefully will encourage both physicians and patients that prospective clinical trials are worth pursuing.”