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A SUVmax-based propensity matched analysis of stereotactic body radiotherapy versus surgery in stage I non-small cell lung cancer: unveiling the role of 18F-FDG PET/CT in clinical decision-making

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Abstract

Background

The value of maximum standard uptake value (SUVmax) was overlooked in current studies comparing stereotactic body radiotherapy (SBRT) versus surgery for stage I non-small cell lung cancer (NSCLC). Herein, we aimed to compare the 3-year outcomes based on patients for whom SUVmax were available, and to explore the role of SUVmax in clinical decision-making.

Methods

From January 2010 to June 2016, data of eligible patients were collected. Patient variables and clinical outcomes were compared in both unmatched and matched groups using propensity score matching (PSM). Multivariate analysis was performed for predictors of poor outcome. The relationship between treatment approach and survival outcome was also evaluated in subgroup patients stratified by SUVmax level.

Results

A total of 425 patients treated with either surgery (325) or SBRT (100) were included. Patients receiving SBRT were significantly older, had a higher level of SUVmax and were more likely to have tumor of centrally located. Multivariate analysis showed that SUVmax and tumor size were significant predictors for 3-year OS, LRC, and PFS, while better PFS was also related to peripheral tumor and surgery. The result of PSM analysis also showed that compared to SBRT, surgery could only achieve better PFS. Subgroup analysis indicated that surgery had added advantage of 3-year LRC and PFS for patients in high SUVmax group (SUVmax > 8), but not in low SUVmax group.

Conclusions

The study found a superior PFS after surgery while OS and LRC did not differ between SBRT and surgery. Surgery should be recommended for tumor of high SUVmax.

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References

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics. CA Cancer J Clin. 2017;67:7–30.

    Article  PubMed  Google Scholar 

  2. Onishi H, Shirato H, Nagata Y, Hiraoka M, Fujino M, Gomi K, et al. Stereotactic body radiotherapy (SBRT) for operable stage I non-small-cell lung cancer: can SBRT be comparable to surgery? Int J Radiat Oncol Biol Phys. 2011;81:1352–8.

    Article  PubMed  Google Scholar 

  3. Chang JY, Senan S, Paul MA, Mehran RJ, Louie AV, Balter P, et al. Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-cell lung cancer: a pooled analysis of two randomised trials. Lancet Oncol. 2015;16:630–7.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Falkson CB, Vella ET, Yu E, El-Mallah M, Mackenzie R, Ellis PM, et al. Radiotherapy with curative intent in patients with early-stage, medically inoperable, non-small-cell lung cancer: a systematic review. Clini Lung Cancer. 2017;18:105.

    Article  Google Scholar 

  5. Sun B, Brooks ED, Komaki RU, Liao Z, Jeter MD, McAleer MF, et al. 7-year follow-up after stereotactic ablative radiotherapy for patients with stage I non-small cell lung cancer: results of a phase 2 clinical trial. Cancer. 2017. https://doi.org/10.1002/cncr.30693 (Epub ahead of print).

    Article  PubMed Central  PubMed  Google Scholar 

  6. Verstegen NE, Oosterhuis JWA, Palma DA, Rodrigues G, Lagerwaard FJ, van der Elst A, et al. Stage I–II non-small-cell lung cancer treated using either stereotactic ablative radiotherapy (SABR) or lobectomy by video-assisted thoracoscopic surgery (VATS): outcomes of a propensity score-matched analysis. Ann Oncol. 2013;24:1543–8.

    Article  PubMed  CAS  Google Scholar 

  7. Robinson CG, DeWees TA, El NI, Creach KM, Olsen JR, Crabtree TD, et al. Patterns of failure after stereotactic body radiation therapy or lobar resection for clinical stage I non-small-cell lung cancer. J Thorac Oncol. 2013;8:192–201.

    Article  PubMed  Google Scholar 

  8. Kastelijn EA, El SS, Hofman FN, Van Putte BP, Monninkhof EM, Van Vulpen M, et al. Clinical outcomes in early-stage NSCLC treated with stereotactic body radiotherapy versus surgical resection. Anticancer Res. 2015;35:5607–14.

    PubMed  CAS  Google Scholar 

  9. Van den Berg LL, Klinkenberg TJ, Groen HJ, Widder J. Patterns of recurrence and survival after surgery or stereotactic radiotherapy for early stage NSCLC. J Thorac Oncol. 2015;10:826–31.

    Article  PubMed  Google Scholar 

  10. Zhang B, Zhu F, Ma X, Tian Y, Cao D, Luo S, et al. Matched-pair comparisons of stereotactic body radiotherapy (SBRT) versus surgery for the treatment of early stage non-small cell lung cancer: a systematic review and meta-analysis. Radiother Oncol. 2014;112:250–5.

    Article  PubMed  Google Scholar 

  11. Puri V, Crabtree TD, Bell JM, Broderick SR, Morgensztern D, Colditz GA, et al. Treatment outcomes in stage I lung cancer: a comparison of surgery and stereotactic body radiation therapy. J Thorac Oncol. 2015;10:1776–84.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kohutek ZA, Wu AJ, Zhang Z, Foster A, Din SU, Yorke ED, et al. FDG-PET maximum standardized uptake value is prognostic for recurrence and survival after stereotactic body radiotherapy for non-small cell lung cancer. Lung Cancer. 2015;89:115–20.

    Article  PubMed  Google Scholar 

  13. Liu J, Dong M, Sun X, Li W, Xing L, Yu J. Prognostic value of 18F-FDG PET/CT in surgical non-small cell lung cancer: a meta-analysis. PLoS One. 2016;11:e146195.

    Google Scholar 

  14. Loganadane G, Martinetti F, Mercier O, Krhili S, Riet FG, Mbagui R, et al. Stereotactic ablative radiotherapy for early stage non-small cell lung cancer: a critical literature review of predictive factors of relapse. Cancer Treat Rev. 2016;50:240–6.

    Article  PubMed  Google Scholar 

  15. He J, Huang Y, Shi S, Hu Y, Zeng Z. Comparison of effects between central and peripheral stage I lung cancer using image-guided stereotactic body radiotherapy via helical tomotherapy. Technol Cancer Res Treat. 2015;14:701–7.

    Article  PubMed  CAS  Google Scholar 

  16. Sherman RE, Anderson SA, Dal Pan GJ, Gray GW, Gross T, Hunter NL, et al. Real-world evidence-what is it and what can it tell us? N Engl J Med. 2016;375:2293–7.

    Article  PubMed  Google Scholar 

  17. Pan Y, Zheng D, Li Y, Cai X, Zheng Z, Jin Y, et al. Unique distribution of programmed death ligand 1 (PD-L1) expression in East Asian non-small cell lung cancer. J Thorac Dis. 2017;9:2579–86.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Shirvani SM, Jiang J, Chang JY, Welsh J, Likhacheva A, Buchholz TA, et al. Lobectomy, sublobar resection, and stereotactic ablative radiotherapy for early-stage non-small cell lung cancers in the elderly. JAMA Surg. 2014;149:1244–53.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Varlotto J, Fakiris A, Flickinger J, Medford-Davis L, Liss A, Shelkey J, et al. Matched-pair and propensity score comparisons of outcomes of patients with clinical stage I non-small cell lung cancer treated with resection or stereotactic radiosurgery. Cancer. 2013;119:2683–91.

    Article  PubMed  Google Scholar 

  20. Mokhles S, Verstegen N, Maat AP, Birim O, Bogers AJ, Mokhles MM, et al. Comparison of clinical outcome of stage I non-small cell lung cancer treated surgically or with stereotactic radiotherapy: results from propensity score analysis. Lung Cancer. 2015;87:283–9.

    Article  PubMed  Google Scholar 

  21. Nair VJ, MacRae R, Sirisegaram A, Pantarotto JR. Pretreatment [18F]-fluoro-2-deoxy-glucose positron emission tomography maximum standardized uptake value as predictor of distant metastasis in early-stage non-small cell lung cancer treated with definitive radiation therapy: rethinking the role of positron emission tomography in personalizing treatment based on risk status. Int J Radiat Oncol Biol Phys. 2014;88:312–8.

    Article  PubMed  Google Scholar 

  22. Cerfolio RJ, Bryant AS. Survival of patients with true pathologic stage I non-small cell lung cancer. Ann Thorac Surg. 2009;88:917–23.

    Article  PubMed  Google Scholar 

  23. Kim DH, Song BI, Hong CM, Jeong SY, Lee SW, Lee J, et al. Metabolic parameters using (18)F-FDG PET/CT correlate with occult lymph node metastasis in squamous cell lung carcinoma. Eur J Nucl Med Mol Imaging. 2014;41:2051–7.

    Article  PubMed  CAS  Google Scholar 

  24. Ettinger DS, Wood DE, Aisner DL, Akerley W, Bauman J, Chirieac LR, et al. Non-small cell lung cancer. J Natl Compr Canc Netw. 2010;8:740–801.

    Article  PubMed  CAS  Google Scholar 

  25. Burdett, S, Pignon, JP, Tierney J, Tribodet H, Stewart L, & Le Pechoux C, et al. Adjuvant chemotherapy for resected early-stage non-small cell lung cancer. Cochrane Database Syst Rev. 2015;3: D11430.

  26. Jumeau R, Bahig H, Filion E, Campeau MP, Lambert L, Roberge D, et al. Assessing the need for adjuvant chemotherapy after stereotactic body radiation therapy in early-stage non-small cell lung carcinoma. Cureus. 2016;8:e901.

    PubMed  PubMed Central  Google Scholar 

  27. Chen Y, Guo W, Lu Y, Zou B. Dose-individualized stereotactic body radiotherapy for T1-3N0 non-small cell lung cancer: long-term results and efficacy of adjuvant chemotherapy. Radiother Oncol. 2008;88:351–8.

    Article  PubMed  CAS  Google Scholar 

  28. Hamaji M, Chen F, Matsuo Y, Kawaguchi A, Morita S, Ueki N, et al. Video-assisted thoracoscopic lobectomy versus stereotactic radiotherapy for stage I lung cancer. Ann Thorac Surg. 2015;99:1122–9.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

All authors have contributed significantly, and that all authors are in agreement with the content of the manuscript. This work was supported by the Medical Guidance Program of the Science and Technology Commission of Shanghai Municipality (No. 14411970100).

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Author notes

  1. L. Ye and F. Xu contributed equally to this work.

Authors and Affiliations

  1. Department of Radiation Oncology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People’s Republic of China

    L. Ye, S. Shi, Z. Zeng, Y. Huang & J. He

  2. Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People’s Republic of China

    F. Xu, C. Lu, J. Gu & D. Ge

  3. Department of Epidemiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People’s Republic of China

    X. Jin

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  1. L. Ye
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Correspondence to D. Ge or J. He.

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Ethical approval

All procedures conducted in studies involving human participants were in accordance with the ethical standards of the ethical committee of Zhongshan Hospital, Fudan University, and with the principle of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Ye, L., Xu, F., Shi, S. et al. A SUVmax-based propensity matched analysis of stereotactic body radiotherapy versus surgery in stage I non-small cell lung cancer: unveiling the role of 18F-FDG PET/CT in clinical decision-making. Clin Transl Oncol 20, 1026–1034 (2018). https://doi.org/10.1007/s12094-017-1819-7

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