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David S. Ettinger, MD, FACP, FCCP


STS 2022: Surgical Wedge Resection Versus Stereotactic Radiation Therapy for in Situ NSCLC

By: Vanessa A. Carter, BS
Posted: Thursday, February 10, 2022

Rolfy A. Perez Holguin, MD, of Penn State Health Milton S. Hershey Medical Center, and colleagues aimed to compare survival outcomes in patients with in situ non–small cell lung cancer (NSCLC) who underwent stereotactic body radiation therapy or surgical wedge resection. Presented during the 2022 Annual Meeting of The Society of Thoracic Surgeons (STS), these results demonstrated improved survival among patients undergoing wedge resection.

Surgical resection also allows for pathologic evaluation and lymph node sampling, which can result in pathologic upstaging,” the investigators noted.

This trial obtained data on 658 patients with clinical Tis N0 M0 NSCLC who underwent stereotactic body radiation therapy (n = 290) or wedge resection (n = 368). Chi-square analysis was performed to distinguish differences among subgroups by treatment. Kaplan-Meier method and Cox proportional hazard model were used to compare overall survival by treatment type.

Patients with a tumor size less than 3 cm and who were at least 75 years old were less likely to be treated with surgery compared with those who had tumors 3 cm or larger (P < .001) and who were younger (P = .002). Interestingly, female patients were more likely to undergo surgical resection than their male counterparts (P < .001). Lymph node sampling was performed in 42% of individuals treated with wedge resection, one of whom was found to have positive regional lymph nodes.

Ultimately, 45 participants who were treated with wedge resection underwent tumor upstaging upon final pathology. Kaplan-Meier analysis demonstrated an improved 5-year overall survival among patients treated with wedge resection compared with those treated with stereotactic body radiation therapy (P < .001). Of note, multivariate survival analysis further solidified that wedge resection was associated with improved overall survival (P < .001).

Disclosure: For disclosures of the study authors, visit

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