Comparison of stereotactic body radiation therapy versus surgery for multiple primary lung cancers after prior radical resection: A multicenter retrospective study

Baiqiang Dong; Runzhe Chen; Xuan Zhu; Qing Wu; Jia'nan Jin; Wenqing Wang; Yujia Zhu; Hui Jiang; Nan Bi; Xu Wang; Xiaofang Xu; Yujin Xu; Ming Chen

doi:10.1016/j.ctro.2023.100601

Comparison of stereotactic body radiation therapy versus surgery for multiple primary lung cancers after prior radical resection: A multicenter retrospective study

Clin Transl Radiat Oncol. 2023 Feb 15:40:100601. doi: 10.1016/j.ctro.2023.100601. eCollection 2023 May.

Authors

Baiqiang Dong^{1

2}, Runzhe Chen¹, Xuan Zhu³, Qing Wu^{2

4}, Jia'nan Jin², Wenqing Wang⁵, Yujia Zhu¹, Hui Jiang¹, Nan Bi⁵, Xu Wang⁶, Xiaofang Xu⁷, Yujin Xu², Ming Chen^{1

2}

Affiliations

¹ Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University, Guangzhou, China.
² Department of Thoracic Radiotherapy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China.
³ Department of Radiation Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
⁴ The Second Clinical Medical College of Zhejiang Chinese Medicine University, Hangzhou, China.
⁵ Department of Radiation Oncology, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China.
⁶ Department of Radiology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China.
⁷ Department of Thoracic Oncology Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China.

Abstract

Background: Patients who previously underwent surgical resection of initial primary lung cancer are at a high risk of developing multiple primary lung cancers (MPLCs). The purpose of this study was to compare the efficacy and safety between stereotactic body radiation therapy (SBRT) and surgery for MPLCs patients after prior radical resection for the first lung cancers.

Methods: In this multicenter retrospective study, eligible MPLC patients with tumor diameter of 5.0 cm or less at N0M0 who underwent SBRT or reoperation between January 2013 and August 2020 were enrolled. The primary endpoint was the 3-year locoregional recurrence and treatment-related toxicity. Kaplan-Meier method was used to calculate survival rates. The χ² test was adapted to assess the difference of categorical variables between the two subgroup patients.

Results: A total of 203 (73 in the SBRT group and 130 in the surgery group) patients from three academic cancer centers were evaluated with a median follow-up of 38.3 months. The cumulative 1-, 2-, and 3-year incidences of locoregional recurrence were 5.6 %, 7.0 % and 13.1 % in the SBRT group versus 3.2 %, 4.8 % and 7.4 % in the surgery group, respectively [hazard ratio (HR), 1.97; 95 % confidence interval (CI), 0.74-5.24; P = 0.14]. The cancer-specific survival rates were 95.9 %, 94.5 % and 88.1 % versus 96.9 %, 94.6 % and 93.8 % in the SBRT and surgery groups respectively (HR, 1.72; 95 % CI, 0.67-4.44; P = 0.23). In the SBRT group, two patients (2.7 %) suffered from grade 3 radiation pneumonitis, while in the surgery group, grade 3 complications occurred in four (3.1 %) patients, and four cases were expired due to pneumonia or pulmonary heart disease within 90 days after surgery.

Conclusions: SBRT is an effective therapeutic option with limited toxicity compared to surgery for patients with MPLCs after prior radical surgical resection, and it could be considered as an alternative treatment for those patients.

Keywords: BED, biological effective dose; CCI, Charlson comorbidity index; CSS, cancer-specific survival; CT, computed tomography; DM, distant metastasis; FEV1, forced expiratory volume in the first second; FVC, forced vital capacity; ITV, internal target volume; KPS, Karnofsky performance status; LRR, locoregional recurrence; Locoregional recurrence; MPLC, multiple primary lung cancer; Multiple primary lung cancers; NSCLC, non-small cell lung cancer; OS, overall survival; PET/CT, positron emission tomography/computed tomography; PTV, planning target volume; Radical resection; SBRT, stereotactic body radiation therapy; Stereotactic body radiation therapy; TTP, time to progression; Toxicity; VATS, video-assisted thoracoscopic surgery.