A national analysis of wedge resection versus stereotactic body radiation therapy for stage IA non-small cell lung cancer

Objective: Lobectomy is considered optimal therapy for early-stage non-small cell lung cancer, but sublobar wedge resection and stereotactic body radiation therapy are alternative treatments. This study compared outcomes between wedge resection and stereotactic body radiotherapy. Methods: Overall survival of patients with cT1N0 and tumors <= 2 cm who underwent stereotactic body radiotherapy or wedge resection in the National Cancer Data Base from 2008 to 2011 was assessed via a Kaplan-Meier and propensity score-matched analysis. A center-level sensitivity analysis that used observed/expected mortality ratios was conducted to identify an association between center use of stereotactic body radiotherapy and mortality. Results: Of the 6295 patients included, 1778 (28.2%) underwent stereotactic body radiotherapy, and 4517 (71.8%) underwent wedge resection. Stereotactic body radiotherapy was associated with significantly reduced 5-year survival compared with wedge resection in both unmatched analysis (30.9% vs 55.2%, P<.001) and after adjustment for covariates (31.0% vs 49.9%, P<.001). Stereotactic body radiotherapy also was associated with worse overall survival than wedge resection after 2 subgroup analyses of propensity-matched patients (P<.05 for both). Centers that used stereotactic body radiotherapy more often as opposed to surgery for patients with cT1N0 patients with tumors < 2 cm were more likely to have an observed/expected mortality ratio> 1 for 3-year mortality (P = .034). Conclusions: In this national analysis, wedge resection was associated with better survival for stage IA non-small cell lung cancer than stereotactic body radiotherapy.