Patterns of recurrence and survival after surgery or stereotactic radiotherapy for early stage NSCLC
Menée à partir de données portant sur 340 patients atteints d'un cancer du poumon non à petites cellules de stade I traité entre 2007 et 2010 par chirurgie ou radiothérapie ablative stéréotaxique, cette étude évalue la survie globale des patients en fonction du traitement reçu, analyse les formes de récidive, puis identifie les facteurs associés à cette récidive
Introduction : Surgery is the standard treatment for early stage non-small-cell lung cancer (NSCLC). For medically inoperable patients, stereotactic ablative radiotherapy (SABR) has emerged as widely used standard treatment. The aim of this study was to analyze survival and patterns of tumor recurrence in patients with clinical stage I NSCLC treated with surgery or SABR. Methods : Clinical data from all subsequent FDG-PET/CT-based stage I NSCLC patients (cT1-T2aN0M0) treated with surgery or SABR at our center between 2007 and 2010 were collected. Primary endpoints were overall survival and tumor recurrences/new primary lung tumors. Treatment groups were compared using multivariable Cox regression and competing risk analyses. Results : Three-hundred-forty patients treated with surgery (n=143) or SABR (n=197) were included. Surgical patients were younger, had a better WHO performance status and less comorbidities. After adjustment for prognostic covariables, treatment did not influence overall survival (adjusted hazard ratio [HR], SABR vs. surgery 1.07; 95% CI, 0.74 to 1.54; P= .73). Local control and distant recurrence were equal, while locoregional recurrences were significantly more frequent after SABR compared with surgery (adjusted subhazard ratio 2.51; 95% CI, 1.10 to 5.70; P=.028). Nodal failure (HR 2.16; 95% CI, 1.34 to 3.48) and distant metastases (HR 2.12; 95% CI, 1.52 to 2.97), but not local failure (HR 1.00; 95% CI, 0.53 to 1.89) predicted overall survival. Conclusions : In patients with FDG-PET-CT-based stage I NSCLC, SABR confers worse locoregional tumor control due to more nodal failures compared to surgery, stressing the need to improve mediastinal and hilar staging.