Patient-reported Outcomes After the Treatment of Early Stage Non-small-cell Lung Cancer With Stereotactic Body Radiotherapy Compared With Surgery

Clin Lung Cancer. 2019 Sep;20(5):370-377.e3. doi: 10.1016/j.cllc.2019.04.001. Epub 2019 Apr 25.


Introduction: As there is increasing evidence for comparable survival after either stereotactic body radiotherapy (SBRT) or surgery for patients with stage I non-small-cell lung cancer (NSCLC), treatment impact on the quality of life (QoL) is essential for well-informed decision-making. Our previous work evaluated health utility between surgery and SBRT in stage I NSCLC. The aim of this secondary analysis is to directly compare QoL in the first year after SBRT and surgery.

Materials and methods: QoL was assessed at baseline and 3, 6, and 12 months after treatment. Two prospectively collected databases of patients with clinically proven stage I NSCLC, from 2 large hospitals in the Netherlands, were pooled (n = 306; 265 patients were treated with SBRT and 41 patients with surgery). To correct for confounding, propensity scores were calculated, to be selected for surgical treatment. A mixed model analysis was used to study differences in QoL between the 2 treatments.

Results: The 41 surgical patients were matched to 41 SBRT patients on propensity score with a 1:1 ratio. At baseline, patients in the surgery group report a lower QoL compared with patients in the SBRT group. However, during the first year after treatment, no clinical meaningful differences were observed, except for role functioning, between patients treated using either modality.

Conclusion: This study comparing a matched cohort revealed no clinically significant differences in QoL following either SBRT or surgery for early stage NSCLC. These results support the hypothesis that surgery and SBRT are comparable treatments.

Keywords: Lung resection; QoL; Quality of life; SABR; Shared decision.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Carcinoma, Non-Small-Cell Lung / epidemiology
  • Carcinoma, Non-Small-Cell Lung / radiotherapy*
  • Carcinoma, Non-Small-Cell Lung / surgery
  • Clinical Decision-Making
  • Cohort Studies
  • Female
  • Humans
  • Lung Neoplasms / epidemiology
  • Lung Neoplasms / radiotherapy*
  • Lung Neoplasms / surgery
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Netherlands / epidemiology
  • Patient Reported Outcome Measures*
  • Prospective Studies
  • Quality of Life