Effect of Endoscopic Bronchial Ultrasound on Outcomes for Stage I Non-Small-Cell Lung Cancer Patients Receiving Hypofractionated Radiotherapy

In this study we retrospectively reviewed 92 clinical stage I nonesmall-cell lung cancer patients treated with hypofractionated radiotherapy and found no statistically significant differences in 2-year freedom from regional failure, disease-free survival, or overall survival for endoscopic bronchial ultrasound (EBUS)-staged versus noneEBUS-staged patients. These results might point to intrinsic limitations of EBUS, competing risks to failure and cancer-specific death, and effective salvage therapy in patients who had regional disease recurrence. Background: In this study we sought to determine if staging endoscopic bronchial ultrasound (EBUS) improves outcomes in stage I nonesmall-cell lung cancer (NSCLC) patients who received hypofractionated radiation therapy (HFRT). Patients and Methods: Patients with stage I NSCLC treated with HFRT from 2008 to 2015 were retrospectively identified from 3 affiliated institutions. All patients underwent positron emission tomography/computed tomography staging and a subset of patients received pretreatment EBUS. Patients with and without pre-radiation therapy EBUS were compared for baseline characteristics. The log rank test was used to compare KaplaneMeier estimates. Univariate analysis (UVA) and multivariable analysis (MVA) were used to analyze the effect of factors on disease-free survival (DFS) and overall survival (OS). Results: Ninety-two patients met study criteria. Median follow-up for the entire cohort was 21 months. Two-year DFS and OS were 63% and 81%, respectively. Two-year freedom from local, regional, and distant failure were 93%, 87%, and 87%, respectively. Thirty-seven of 92 patients (40%) received pretreatment EBUS. There were no statistically significant differences in 2-year freedom from regional failure rates, DFS, or OS for EBUS-staged versus noneEBUS-staged patients. On UVA, smaller tumor size (P = .03) and higher performance status (P = .05) were associated with improved OS. On MVA, tumor size retained significance for improved OS (hazard ratio [HR], 0.44; 95% confidence interval [CI], 0.19-0.97; P = .04) and higher performance status showed a trend toward improved OS (HR, 0.51; 95% CI, 0.23-1.11; P = .09). Conclusion: In this retrospective series, we did not detect a difference in regional failure or survival outcomes among stage I NSCLC patients who received invasive staging with EBUS before HFRT. (C) 2017 Elsevier Inc. All rights reserved.