Comparison of limited surgery and three-dimensional conformal radiation in high-risk patients with stage I non-small cell lung cancer

INTRODUCTION: Anatomic resection is currently the standard of care for patients with stage I non-small cell lung cancer (NSCLC). Some stage I patients are unable to tolerate lobectomy because of limited lung function or prohibitive comorbidities. In this study, we retrospectively compared the outcome of patients treated with wedge resection or three-dimensional (3-D) conformal radiation therapy, the most common treatment modalities used for such high-risk patients. METHODS: All patients with stage I NSCLC from 1988 to 2005 who were not considered candidates for anatomic surgical resection were reviewed. Univariate and multivariate analyses were performed to assess the influence of 3-D conformal radiation and surgery on overall survival and recurrence-free survival. Propensity score-matched analysis and cost assessments were performed to compare outcomes with both modalities. Propensity matching was performed for gender, histology, tumor size, performance status, and age. RESULTS: Of 160 patients studied, 68 patients received limited resection and 92 patients received 3-D conformal radiation. Univariate and multivariate analyses suggested a trend toward improved outcome in limited resection. Propensity matching was performed with 34 matched pairs and demonstrated no statistically significant difference in overall survival or recurrence-free survival. The mean cost of radiation therapy ($32,735) was not statistically significantly different from surgery ($30,411). CONCLUSION: In high-risk patients with NSCLC, limited resection has a tendency towards improved outcome. A propensity matched analysis did not show a clear benefit for limited resection, which may be due in part to an inadequate number of patients for analysis and/or increased comorbidities of patients treated with 3-D conformal radiation.