Aggressive Surgery Recommended for Early Stage Lung Cancer

Patients with early stage lung cancer live longer when they undergo a lobectomy rather than less extensive surgery or radiation treatment, according to a new study.

Researchers at the University of California, San Diego (UCSD, USA) conducted a study to evaluate the comparative effectiveness of open surgery and stereotactic body radiation therapy (SBRT) in treating lung cancer, using the Veteran’s Affairs (VA) infrastructure system in order to identify 4,069 veterans with biopsy-proven clinical stage I non-small cell lung cancer (NSCLC) diagnosed between 2006 and 2015. The researchers compared cancer-specific survival among patients receiving lobectomy, sub-lobar resection, or SBRT.

In all, 449 SBRT, 2,986 lobectomy, and 634 sub-lobar resection procedures were analyzed, revealing a higher immediate postprocedural mortality in the surgery groups compared with the SBRT group. On the other hand, the five-year incidence of cancer death was lowest in the lobectomy group at 23%, with the sub-lobar group at 32%, and SBRT patients at 45%; SBRT was also was associated with an overall 45% increased risk of cancer death, compared with lobectomy. The study was published on November 29, 2017, in Annals of Thoracic Surgery.

“Our data suggest that the higher operative risks of surgery are more than offset by improved survival in the months and years after treatment, particularly for lobectomy. The more aggressively we treat early lung cancer, the better the outcome,” said lead author Alex Bryant, BSc, of the UCSD School of Medicine. “This study is one of the best-powered and detailed analyses to date, and suggests that lobectomy is still the preferred treatment of this disease for most patients.”

Lobectomy is the removal of an entire lobe of the lung; sub-lobar resection is a less extensive operation that includes wedge and segmental resections; SBRT delivers very high doses of radiation over a short period of time (typically 1-2 weeks), precisely targeting the tumor. As of 2015, SBRT accounts for 19% of all NSCLC treatments, mainly for patients who are too sick to tolerate a major operation like lobectomy, which remains the standard treatment for early lung cancer in patients who can tolerate a major surgical procedure.

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