Search

To date, no published randomized trials have shown stereotactic body radiation therapy (SBRT) to offer superior outcomes to conventionally fractionated radiation therapy (CFRT) for early-stage non-small cell lung cancer (NSCLC). The largest study to date, this investigation of a contemporary national database sought to evaluate practice patterns and survival between CFRT and SBRT.The National Cancer Database was queried (2004-2015) for histologically-confirmed cT1-2aN0M0 NSCLC undergoing definitive CFRT or SBRT. Multivariable logistic regression ascertained factors associated with SBRT administration. Kaplan-Meier analysis evaluated overall survival (OS) before and following propensity matching. Cox proportional hazards modeling determined variables associated with OS.Of 23,088 patients, 2286 (10%) patients received CFRT and 20,802 (90%) SBRT. SBRT was less often delivered in African-Americans, patients with lower incomes, urban location, greater comorbidities, at non-academic centers, in larger tumors, and squamous histology (p 0.05 for all). Patients treated with SBRT had a higher median OS (38.8 months vs. 28.1 months, p 0.001). At median follow-up of 44.6 months, the median OS for the SBRT group was 38.8 months, versus 28.1 months for CFRT (p 0.001). These findings persisted following propensity matching. Subgroup analyses demonstrated improved OS in multiple subcohorts (T2, Charlson comorbidity score 2-3, squamous histology). SBRT was also independently associated with OS on Cox multivariate analysis (p 0.001).The largest such study to date (comprising of over 23,000 patients), this investigation demonstrates the survival benefit to ablative radiotherapy for early-stage NSCLC. Maturation of comparative prospective trials is eagerly awaited.

Patients with cT1-2N0M0 rectal cancer are often treated with up-front surgical resection, with adjuvant treatment reserved for patients upstaged with pathologic node-positive (pN+) disease at surgery. This study evaluates practice patterns and clinical outcomes when comparing different forms of adjuvant treatment for this patient population.The National Cancer Data Base was queried for cT1-2N0M0 rectal cancer patients between 2004 and 2015 with postoperative pN+ disease treated without neoadjuvant treatment. Patients were divided into groups receiving observation, chemotherapy, or chemoradiotherapy (CRT). Multivariable logistic regression determined factors associated with receipt of adjuvant treatment. Kaplan-Meier curves compared overall survival (OS), and Cox regression determined patient factors associated with OS.Altogether, 1466 patients met the inclusion criteria; 536 patients (36.6%) received adjuvant chemotherapy, 413 (28.2%) received adjuvant CRT, and 517 (35.3%) were observed postoperatively. Use of adjuvant treatment was associated with superior median OS (124.1 vs. 51.1 months, P .001), persisting after propensity score matching (124.0 vs. 61.9 months, P .001), but not between adjuvant CRT versus chemotherapy on subset analysis. Patients with positive surgical margins receiving adjuvant CRT showed a trend toward OS improvement compared to patients managed with chemotherapy (54.9 vs. 47.4 months, P = .10). Increased age, pN2 status, positive margin status, and observation were associated with poorer OS.Most patients found to have pN+ disease after up-front surgery for cT1-2N0 rectal cancer receive adjuvant treatment, which is associated with improved OS. Chemotherapy or CRT are appropriate options, although there was a trend toward higher OS for patients with positive surgical margins receiving CRT.