Stereotactic body radiotherapy versus surgery in older adults with NSCLC - a population-based, matched analysis of long-term dependency outcomes

• Published in: Canadian Journal of Surgery Vol. 64; pp. S108 - S109
• Main Authors: Hirpara, D, Kidane, B, Louie, A, Zuk, V, Darling, G, Rousseau, M, Chesney, T, Coburn, N, Hallet, J
• Format: Journal Article
• Language: English
• Published: Ottawa CMA Impact, Inc 01.12.2021
• Subjects: Lung cancer; Older people; Radiation therapy; Surgery
• ISSN: 0008-428X; 1488-2310

Background: This study aimed to examine functional and longterm health care dependency outcomes of stereotactic body radiotherapy (SBRT) to surgery for older adults with stage I non-small cell lung cancer (NSCLC). Methods: We conducted a propensity-score matched analysis of adults older than 70 years of age with stage I NSCLC treated with surgery or SBRT from January 2010 to December 2017. Home care utilization, probability of being alive and at home, and 1-year days at home were compared using Andersen-Gill, piecewise Cox and negative binomial regression models, respectively. E-value methods assessed presence of residual confounding. Results: Of 3699 included patients, 1129 had SBRT and 2570 had surgery (72% videoassisted thoracoscopic surgery, 71% lobectomy). A total of 1016 per group were matched. Median follow-up was 38 months (interquartile range [IQR] 20-61 mo). SBRT was associated with a higher risk of home care utilization (hazard ratio [HR] 1.75, 95% confidence interval [CI] 1.37-2.23) than surgery, with a consistently greater proportion of SBRT patients requiring home care in the 6 months to 5 years following treatment. Surgery was associated with a higher probability of being alive and at home within 6-12 months (HR 1.87, 95% CI 1.33-2.64), 2-3 years (HR 2.31, 95% CI 1.64-3.24) and 4-5 years (HR 1.79, 95% CI I.11-2.91) after treatment, on piecewise regression. SBRT patients had statistically fewer days at home (median 352 d, IQR 346-355 d) than those with surgery (median 358 d, IQR 351-360 d) over 1 year following treatment (rate ratio 1.01, 95% CI 1.01-1.02). The findings persisted in stratified analyses for frail and nonfrail patients, although the association was smaller in frail patients. E-values indicated it was unlikely that the observed estimates could be explained by unmeasured confounders. Conclusion: SBRT was associated with higher home care utilization and a lower probability of being alive and at home than surgery for older adults with stage I NSCLC. These are important patient-centred outcomes for counselling and shared decision-making for older adults with early lung cancer.