Stereotactic body radiotherapy (SBRT) provides better overall survival rates than surgery for lung cancer patients with severe chronic obstructive pulmonary disease (COPD), a disease commonly associated with lung cancer, according to a study in the upcoming March issue of the International Journal of Radiation Oncology•Biology•Physics.
Surgery has been the standard treatment for Stage I non-small-cell lung cancer patients, but when the patient has COPD the chances of postoperative complications increase. COPD is present in 50 to 70 percent of patients with lung cancer, so the researchers, including David Palma, MD, of the London Regional Cancer Program in London, Ontario, Canada, and colleagues wanted to examine outcomes of SBRT treatment in Stage I lung cancer patients with severe COPD.
Included in the study was a single-institution cohort of 176 patients with both COPD and Stage I non-small-cell lung cancer who were treated with SBRT. A systematic review of published literature also identified studies reporting outcomes after SBRT or surgery.
Results showed post-SBRT patients had a mean 30-day mortality of 0 percent compared with 10 percent for post-surgery patients. The overall survival rate post-SBRT was 79 to 95 percent at one year and 43 to 70 percent at three years. Post-surgery overall survival rates at one and three years were 45 to 86 percent and 31 to 66 percent, respectively.
“SBRT is a safe and effective less-invasive option for lung cancer patients with COPD that does not have the added risks of surgery-related mortality and prolonged hospitalization,” Palma said in a statement.
SBRT is associated with low risks of operative mortality, a favorable toxicity profile and rarely requires a hospital stay, according to the authors, but they noted that their review indicates published data on survival outcomes in patients with severe COPD and Stage I NSCLC are lacking.
“Comparisons of outcomes across studies can be biased by differences in baseline populations, and definitive conclusions cannot be made,” wrote the authors, who added that this patient population has a high risk of death from non-lung cancer causes, which means small differences in oncologic outcomes between surgery and SBRT are less important in determining survival.
While the study shows SBRT to be effective, the authors explained that surgery’s invasive nature confers advantages over SBRT. With surgery, a definitive pathological diagnosis can be made, and more complete nodal staging is also possible.
“All eligible patients should be evaluated in a multidisciplinary setting and afforded an informed decision of the risks and benefits of both surgery and SBRT,” said Palma.