Stage I non-small cell lung cancer: results for surgery in a patterns-of-care study in Sydney and for high-dose concurrent end-phase boost accelerated radiotherapy

Abstract

Purpose: To review results of resection or radical radiotherapy in Sydney to inform patients contemplating treatment options for early-stage non-small cell lung cancer (NSCLC).

Methods and materials: Sixty-eight resected pathologic stage I patients were identified from a patterns-of-care (POC) study of all 1993 and 1996 NSCLC patients treated at the South Western Sydney Area Health Service and the Northern Sydney Area Health Service. These were compared with 39 clinical stage I patients treated by modern radiotherapy using an accelerated high-dose technique at St George Hospital (SGH).

Results: Resected POC patients achieved a median survival rate of 67 months and a 5-year survival rate of 54% (95% CI, 40-66%). SGH radiotherapy patients achieved a median survival rate of 43 months and a 5-year survival rate of 30% (95% CI, 13-48%). On multivariate analysis, the only significant factor is performance status, which may reflect comorbidity burden. Cancer-specific 5-year survival rates for surgery (59% [44-71%]) and for radiotherapy (53% [28-72%]) are not significantly different.

Conclusions: Modern radiotherapy is a reasonable option for patients to consider for stage I NSCLC and is recommended for medically inoperable patients rather than supportive care or observation.