Stereotactic Radiation Comparable to Wedge Resection for High-Risk Lung Cancer Patients
Last Updated: 2010-01-11 18:58:42 -0400 (Reuters Health)
Dr. Inga S. Grills and associates at
The researchers analyzed data from two cohorts. One was comprised of 58 patients (95% of whom were medically inoperable) who had image-guided stereotactic radiation as part of a prospective phase II trial that began in 2005. The second cohort included 69 patients who underwent wedge resection; these subjects were identified by chart review going back to 2003. In all cases, lesions were technically resectable and no bigger than 5 cm.
Although patients in the stereotactic group were older and had more comorbidities, there was a trend toward reduced local recurrence with radiation compared to surgery (4% vs 20%, p = 0.07). Otherwise, there were no statistically significant differences between radiation and wedge resection in rates of regional recurrence (4% vs 18%), distant metastasis (19% vs 21%), or freedom from any failure (77% vs 65%).
When patients with T4 disease, presumed synchronous primary tumors or nonbiopsied tumors were excluded, rates of local and regional recurrence were significantly lower with radiation therapy.
While overall survival was better with wedge resection (87% vs 72%, p = 0.01), cause-specific survival was nearly identical (94% vs 93%, p = 0.53).
Multiple regression analysis indicated that squamous histology and presence of a synchronous primary tumor predicted distant metastasis after stereotactic radiation, whereas visceral pleural invasion, bronchoalveolar histology, and stage IB tumors predicted distant metastasis after surgery. For all patients, age over 70 predicted shorter overall survival.
The authors note that theirs is the only published study so far comparing wedge resection with stereotactic body radiotherapy, but that numerous ongoing trials will provide more definitive findings.
They conclude that "in medically inoperable/borderline operable patients, stereotactic body radiation therapy is an equivalent option to limited resection, with shorter recovery times and fewer significant complications."
But Dr. Nasser K. Altorki from
For one thing, he objects to the comparison of a controlled phase II study population with an historical uncontrolled cohort. Also, he points out, wedge resections for tumors > 1 cm are now done with iodine-125 brachytherapy, which substantially improves outcomes.
Furthermore, Dr. Altorki writes, "since treatment of the wedge group started at least 3 years before the initiation of the SBRT trial," the lower recurrence rate following radiation therapy may be due to the much shorter follow-up.
In the second editorial, Dr. Robert D. Timmerman from the University of Texas Southwestern Medical Center,
The best scenario, he suggests, is one in which the options of surgery, stereotactic body radiation therapy, or radiofrequency ablation will each have a role in local tumor eradication.
J Clin Oncol 2009.
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