Longitudinal quality of life after sublobar resection and stereotactic body radiation therapy for early-stage non-small cell lung cancer.

Journal: Cancer

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Affiliated Institutions:  Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Division of Pulmonary & Critical Care Medicine, Department of Medicine, and Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA. Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA. Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA. Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Department of Radiation Oncology, Colorado Permanente Medical Group, Denver, Colorado, USA. Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Division of Medical Oncology, Department of Medicine, National Jewish Health, Denver, Colorado, USA.

Abstract summary 

Many patients with early-stage lung cancer are not candidates for lobectomy because of various factors, with treatment options including sublobar resection or stereotactic body radiation therapy (SBRT). Limited information exists regarding patient-centered outcomes after these treatments.Subjects with stage I-IIA non-small cell lung cancer (NSCLC) at high risk for lobectomy who underwent treatment with sublobar resection or SBRT were recruited from five medical centers. Quality of life (QOL) was compared with the Short Form 8 (SF-8) for physical and mental health and Functional Assessment of Cancer Therapy-Lung (FACT-L) surveys at baseline (pretreatment) and 7 days, 30 days, 6 months, and 12 months after treatment. Propensity score methods were used to control for confounders.Of 337 subjects enrolled before treatment, 63% received SBRT. Among patients undergoing resection, 89% underwent minimally invasive video-assisted thoracic surgery or robot-assisted resection. Adjusted analyses showed that SBRT-treated patients had both higher physical health SF-8 scores (difference in differences [DID], 6.42; p = .0008) and FACT-L scores (DID, 2.47; p = .004) at 7 days posttreatment. Mental health SF-8 scores were not different at 7 days (p = .06). There were no significant differences in QOL at other time points, and all QOL scores returned to baseline by 12 months for both groups.SBRT is associated with better QOL immediately posttreatment compared with sublobar resection. However, both treatment groups reported similar QOL at later time points, with a return to baseline QOL. These findings suggest that sublobar resection and SBRT have a similar impact on the QOL of patients with early-stage lung cancer deemed ineligible for lobectomy.

Authors & Co-authors:  Wisnivesky Mudd Stone Slatore Flores Swanson Blackstock Smith Chidel Rosenzweig Henschke Kern

Study Outcome 

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Citations :  Brunelli A, Kim AW, Berger KI, Addrizzo‐Harris DJ. Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians evidence‐based clinical practice guidelines. Chest. 2013;143(suppl 5):e166S‐e190S. doi:10.1378/chest.12‐2395
Authors :  12
Identifiers
Doi : 10.1002/cncr.35286
SSN : 1097-0142
Study Population
Male,Female
Mesh Terms
Other Terms
early‐stage lung cancer;limited resection;non–small cell lung cancer;quality of life;stereotactic body radiation therapy
Study Design
Study Approach
Country of Study
Publication Country
United States