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Aggressive Treatment of Early Lung Cancer Improves Survival
The standard treatment for early-stage non-small-cell lung cancer has been to remove the entire lobe of the lung affected. A newer approach called stereotactic body radiation therapy (SBRT) has become increasingly popular, too. Which is better?
By Shari Roan
Medically Reviewed by Thomas Marron, MD, PhD
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Aggressive surgery for early-stage non-small-cell lung cancer results in longer survival than more moderate surgery and an increasingly popular radiation therapy approach, according to a study published online in November of 2019 in the journal The Annals of Thoracic Surgery.
Early-stage lung cancer is defined as cancer that is confined to part of a lung and has not spread elsewhere in the lungs or the body. Historically, a lobectomy, in which the entire lobe of the lung containing the tumor is removed, has been the preferred treatment for early-stage lung cancer. But over the past decade, stereotactic body radiation therapy (SBRT), in which the tumor is destroyed by applying precision, high-dose radiation during a one to two week period, has become more popular.
But which method is superior in terms of improving survival has not been clear, says the senior author of the study, James D. Murphy, MD, of the University of California San Diego School of Medicine. Previous studies have attempted to compare patient outcomes for each procedure but have produced mixed results.
In this study, one of the largest and most detailed analyses on early-stage lung cancer treatment to date, Dr. Murphy and his colleagues compared data taken from the Veterans Affairs Informatics and Computing Infrastructure to look at patient survival after either lobectomy, sublobar resection — a less-extensive operation that involves taking out just part of the lobe containing cancer — or SBRT. Of the 4,069 patients studied, the majority underwent lobectomy, while 16 percent had sublobar resection and 11 percent received SBRT. The researchers found that, five years after treatment, 23 percent of the patients in the lobectomy group had died compared with 32 percent of patients who had sublobar resection and 45 percent of the radiation therapy patients.
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“I think we should absolutely present this data to our patients,” Murphy says. “But, more so, this study really pushes us toward the need for a good clinical trial to compare these two modalities.”
Lobectomy is a common procedure that has become increasingly safe over the years, he says. It involves opening the patient’s chest and removing the lobe with the tumor (you have two lobes on the left side and three on the right). Some surgeons perform lobectomy using a minimally invasive technique to minimize the incision. Complications of lobectomy include the risk of infection and even a small risk of death. In the new study, the 30-day mortality was 1.9 percent for lobectomy, 1.7 percent for sublobar resection, and 0.5 percent for SBRT.
Stereotactic body radiation therapy involves no surgery and can be completed in just a few days. But ultimately, patients should think about which approach is more likely to cure cancer, Murphy says. Even early-stage lung cancer is a dangerous disease with a significant risk of cancer recurrence, he says. “When you look at the survival curve for these patients, it’s not that great. Even with just a single nodule in the lung, some patients will go on to develop advanced lung cancer.”
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Patients should explore their treatment options thoroughly, he advises.
“When you consider both surgery and radiation, the risks are going to be individual,” he says. “The location of tumor, the size of the tumor, and the patient’s medical history will feed into the potential risks and benefits for each procedure. Meet with the surgeon. Meet with the radiation oncologist, and have these conversations. Ask ‘If you look at me — my cancer — what are the risks? What are the benefits?’
“In the absence of a clinical trial, it becomes an individual patient decision. But I think our data show if a patient is truly undecided, people would probably lean toward surgery as long as the patient is a reasonable candidate for surgery.
“It’s been hard to say definitively which one is better,” he says. “For healthy people who can tolerate surgery, most people would say these patients should undergo surgery. If you can’t tolerate surgery, clearly radiation therapy is the best answer.
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