A retrospective comparison demonstrated that in persons with stage I non-small cell lung cancer (NSCLC), overall survival was superior among patients undergoing lobectomy or pneumonectomy compared with patients undergoing stereotactic body radiation therapy (SBRT), but cancer-specific survival rates were similar between the two groups.

As the researchers explained in Journal of Thoracic Oncology (2013;8[2]:192-201), they sought to compare patterns of failure (primary tumor control, local control, regional control, and distant control) between lobar resection (lobectomy or pneumonectomy) and SBRT for persons with clinical stage I NSCLC. They reviewed the records of 260 such patients who had lobar resection with lobectomy (237 subjects) or pneumonectomy (23 subjects), and 78 patients who received SBRT.

Four-year lobar local control was greater for lobar resection than for SBRT (98.7% vs 93.6%, respectively). However, the results for the other three measures were similar. Although overall survival was greater for lobar resection (63.5% vs 29.6%), cause-specific survival was similar for surgery and for radiation (81.3% vs 75.3%, respectively).

Compared with the SBRT participants, lobar resection patients were younger and healthier, and had better pulmonary function. The SBRT participants, however, had smaller tumors. Among 76 patients from each group who were matched based on tumor size, overall survival was better for the surgery patients, but no significant differences emerged between groups in terms of patterns of failure or cause-specific survival.

The investigators called for randomized trials to control for fundamental differences in comorbidity, which impact interpretation of both tumor control and survival.