Wedge Resection vs Stereotactic Body Radiation Therapy for Stage 1 Non-Small Cell Lung Cancer in Octogenarians

Background: Surgical resection is the mainstay of treatment for early-stage non-small cell lung cancer (NSCLC). Stereotactic body radiation therapy (SBRT) has been proposed as an alternative for older adult patients to avoid the morbidity associated with surgery. The aim of this study was to evaluate the 2 treatment modalities in octogenarians. Methods: The National Cancer Database was used to identify patients aged ≥80 years with clinical T1 N0 M0 NSCLC who underwent wedge resection or SBRT. Patients identified as medically inoperable were excluded. Propensity score matching was used to create a matched cohort. The Kaplan-Meier method and the multivariable Cox proportional hazards model were used to evaluate overall survival. Results: A total of 3938 patients met inclusion criteria. Propensity score matching yielded 137 well-balanced matched pairs. The unadjusted 5-year overall survival for the matched wedge resection group was 44.5%, compared with 20.1% for the SBRT group (P < .001). On multivariable analysis, wedge resection was associated with improved survival vs SBRT (hazard ratio, 0.516; P < .001). In patients treated with wedge resection, 23.7% were upstaged on the final pathology report, and 1.7% were found to have positive lymph nodes. The proportion of patients treated with SBRT increased during the study period, whereas treatment with surgery decreased. Conclusions: Compared with SBRT, wedge resection is associated with improved survival in octogenarian patients with clinical T1 N0 M0 NSCLC. Surgical resection allows for pathologic examination and lymph node sampling, which can lead to upstaging. Further investigation is warranted to identify the utility of SBRT for octogenarian patients.