SBRT vs Minimally Invasive Surgery in NSCLC: Clinical Model May Help in Selection Process

By: Chris Schimpf, MSW
Posted: Friday, November 1, 2024

Citing current challenges in choosing between stereotactic body radiotherapy (SBRT) and minimally invasive surgery to treat patients with early-stage non–small cell lung cancer (NSCLC), Gaetano Rocco, MD, of Memorial Sloan Kettering Cancer Center, New York, and colleagues set out to study the many factors influencing the decision-making process among this patient population. Their findings, published in Annals of Surgery, suggest that providers’ clinical expertise may be used to create a predictive model that categorizes these patients into three distinct risk groups, and patients in the intermediate-risk group may benefit most from a multidisciplinary decision-making process.

“Our study… is the first to identify a comprehensive array of clinical factors, including age, reduced performance status, previous pulmonary resection, the Memorial Sloan Kettering Frailty score, forced expiratory volume in 1 second, and diffusing capacity of the lungs for carbon monoxide, independently associated with the referral SBRT,” the investigators stated. “[These factors are] likely already routinely collected by a significant proportion of thoracic surgeons or pulmonologists worldwide. This suggests a straightforward implementation of our model into clinical practice.”

A total of 1,291 patients with stage I NSCLC were included in the study, of whom 1,116 underwent minimally invasive surgery, and 175 underwent SBRT between January 2020 and July 2023. Using multivariable logistic regression analysis, the investigators created the prediction model described above, which they reported demonstrated an AUC of 0.908 (95% confidence interval [CI] = 0.876–0.938). Based on probability scores, they stratified participants into low-risk, intermediate-risk, and high-risk categories, observing that treatment modality was not associated with overall survival (hazard ratio for SBRT = 1.67; 95% CI = 0.80–3.48; P = .20).

“The lack of significant prognostic effect of the treatment modality on overall survival in our study further supports the performance and validity of the prediction model, mimicking the decision-making of the surgeons in our group,” the researchers added.

Disclosure: For full disclosures of the study authors, visit journals.lww.com.

Annals of Surgery

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