Lung Cancer

PV QA 4 - Poster Viewing Q&A 4

TU_26_3572 - Patient Outcomes Following SBRT Versus IR-based Procedures for Early Stage NSCLC

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

Patient Outcomes Following SBRT Versus IR-based Procedures for Early Stage NSCLC
R. L. Sleightholm1, M. Baine2, B. Clymer1, V. Verma3, and C. Lin2; 1University of Nebraska Medical Center, Omaha, NE, 2Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, 3Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA

Purpose/Objective(s): Treatment options for non-surgical candidates diagnosed with non-small cell lung cancer (NSCLC) include stereotactic body radiation therapy (SBRT) or interventional radiology (IR)-based procedures such as radiofrequency ablation, microwave ablation, and electroporation. Small retrospective studies have indicated that SBRT treatment have equivalent, if not improved, patient outcomes with similar to fewer adverse toxicities when compared to IR-based therapies. However, few large-volume assessments have been reported that substantiate these claims. Herein, we sought to provide clarity as to the comparative efficacy of SBRT versus IR-based procedures using the National Cancer Database (NCDB), the first such analysis to date.

Materials/Methods: Using NCDB, we identified early stage NSCLC patients who received SBRT (n=26,727) or IR-based procedures (n=1,009) for local control of their malignancy. Demographics were compared between cohorts, and multivariable logistic regression identified variables associated with receiving SBRT v IR. Propensity matching via a Greedy 8 to 1 matching algorithm was performed with patients matched in a 1:1 manner. Any match that resulted in a ≥2% difference in propensity score was excluded. Kaplan-Meier curves and log-rank testing was used to compare survival outcomes, particularly median overall survival (mOS).

Results: For the SBRT and IR unmatched groups, mOS was 37.7 and 33.5 mo., respectively (p<0.0001). Receiving SBRT over IR was associated increasing age, higher T-stage, and higher Charleson-Deyo Score. Using these to construct propensity scores, 984 pairs of patients were included in the final model. Comparisons of the matched cohort using logistic regression showed the groups were equivalent in terms of demographics and cancer characteristics. Overall, mOS was superior in the SBRT group, 40.4 vs 33.4 months (p<0.0001). Furthermore, OS at 1, 2, and 5 years between the SBRT and IR cohorts were 88.5% v 82.8%, 69.3% v 62.4%, and 33.5% v 26.0%, respectively (p<0.0001).

Conclusion: Despite having disproportionately more adverse characteristics, early stage NSCLC patients receiving SBRT demonstrated a greater mOS (37.7 v 33.5 mo., p<0.0001). After matching, the difference in mOS was even more profoundly in favor of SBRT (40.4 v 33.4, p<0.0001). Thus, our findings suggest that early stage NSCLC patients may benefit more by SBRT than IR-based procedures.

Author Disclosure: R.L. Sleightholm: None. M. Baine: None. B. Clymer: None. C. Lin: Research Grant; Eppley Cancer center at UNMC, DHHS/NIH/NCI. To purchase a research drug; Eppley Cancer center at UNMC. Focus is on translational studies that address basic and clinical issues of importance to improving outcome of patients with pancreatic cancer. Role: Project Leader Title of the project: Novel Target(s) in the Radiosensitization of Pancreatic Cancer; DHHS/NIH/NCI. Vice chair of Research; University of Nebraska Medical Center. Colorectal track leader; ASCO 2018 annual meeting.

Michael Baine, MD, PhD

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