A Population-Based Study of the Effectiveness of Stereotactic Ablative Radiotherapy Versus Conventional Fractionated Radiotherapy for Clinical Stage I Non-Small Cell Lung Cancer Patients
Background: Stereotactic ablative radiotherapy (SABR) is a promising option for non-operated early-stage non-small cell lung cancer (NSCLC) compared to conventional fractionated radiotherapy (CFRT). However, results from conclusive randomized controlled trials are not yet available. The aim of our study was to explore the effectiveness of SABR versus CFRT for non-operated early-stage NSCLC.
Methods: We used a comprehensive population-based database to identify clinical stage I non-operated NSCLC patients in Taiwan diagnosed from 2007 to 2013 who were treated with either SABR or CFRT. We used inverse probability weighting (IPW) and the propensity score (PS) as the primary form of analysis to address the nonrandomization of treatment. In the supplementary analyses (SA), we constructed subgroups based on PS matching to compare survival between patients treated with SABR versus CFRT.
Results: We identified 238 patients in our primary analysis. A good balance of covariates was achieved using PS weighting. Overall survival (OS) was not significantly different between those treated with SABR versus CFRT (SABR vs. CFRT: IPW adjusted hazard ratio [HR] 0.586, 95% confidence interval 0.264–1.101, p = 0.102). However, SABR was significantly favored in supplementary analyses.
Conclusions: In this population-based propensity-score adjusted analysis, we found that OS was not significantly different between those treated with SABR versus CFRT in the primary analysis, although significance was observed in the supplementary analyses. Our results should be interpreted with caution given the database (i.e., nonrandomized) approach used in our study. Overall, further studies are required to explore these issues.