TY - JOUR
T1 - Treatment of stage I non–small cell lung cancer
T2 - What's trending?
AU - McMurry, Timothy L.
AU - Shah, Puja M.
AU - Samson, Pamela
AU - Robinson, Clifford G.
AU - Kozower, Benjamin D.
N1 - Publisher Copyright:
© 2017 The American Association for Thoracic Surgery
PY - 2017/9
Y1 - 2017/9
N2 - Objectives Stage I non–small cell lung cancer traditionally is treated with lobectomy. Sublobar resection and stereotactic body radiation therapy provide alternative treatments for higher-risk groups. The purpose of this study was to determine the national treatment trends for stage I lung cancer. Methods The National Cancer Database was queried for patients with clinical stage I non–small cell lung cancer between 1998 and 2012. Patients were compared across treatment groups, and trends in treatment and disease were evaluated over the 15-year time period. Results The National Cancer Database contained 369,931 patients with clinical stage I non–small cell lung cancer. After removing patients who received chemotherapy as a first course of treatment and patients with pathologic stage IV, 357,490 patients were analyzed. The first recorded cases of stereotactic body radiation therapy are in 2003 and rapidly increased to 6.6% (2063) of all patients treated in 2012. The number of diagnoses of stage I non–small cell lung cancer steadily increased over the 15-year period, whereas the rate of lobectomy decreased from 55% in 1998 to 50% in 2012 (P <.001). Most of the decrease in lobectomy can be explained by the increase in the rate of sublobar resection from 12% to 17% (P <.001). The percentage of untreated patients remained stable at approximately 7% (P =.283). Conclusions Although the number of stage I non–small cell lung cancer cases continues to increase, lobectomy rates are decreasing while sublobar resection and stereotactic body radiation therapy rates are increasing. Although the increasing popularity of alternative therapies to lobectomy for treatment of stage I non–small cell lung cancer should allow more patients to undergo treatment, we did not observe this trend in the data.
AB - Objectives Stage I non–small cell lung cancer traditionally is treated with lobectomy. Sublobar resection and stereotactic body radiation therapy provide alternative treatments for higher-risk groups. The purpose of this study was to determine the national treatment trends for stage I lung cancer. Methods The National Cancer Database was queried for patients with clinical stage I non–small cell lung cancer between 1998 and 2012. Patients were compared across treatment groups, and trends in treatment and disease were evaluated over the 15-year time period. Results The National Cancer Database contained 369,931 patients with clinical stage I non–small cell lung cancer. After removing patients who received chemotherapy as a first course of treatment and patients with pathologic stage IV, 357,490 patients were analyzed. The first recorded cases of stereotactic body radiation therapy are in 2003 and rapidly increased to 6.6% (2063) of all patients treated in 2012. The number of diagnoses of stage I non–small cell lung cancer steadily increased over the 15-year period, whereas the rate of lobectomy decreased from 55% in 1998 to 50% in 2012 (P <.001). Most of the decrease in lobectomy can be explained by the increase in the rate of sublobar resection from 12% to 17% (P <.001). The percentage of untreated patients remained stable at approximately 7% (P =.283). Conclusions Although the number of stage I non–small cell lung cancer cases continues to increase, lobectomy rates are decreasing while sublobar resection and stereotactic body radiation therapy rates are increasing. Although the increasing popularity of alternative therapies to lobectomy for treatment of stage I non–small cell lung cancer should allow more patients to undergo treatment, we did not observe this trend in the data.
KW - Non–small cell lung cancer
KW - lobectomy
KW - national trends
KW - stereotactic body radiation therapy
UR - http://www.scopus.com/inward/record.url?scp=85018414908&partnerID=8YFLogxK
U2 - 10.1016/j.jtcvs.2017.03.122
DO - 10.1016/j.jtcvs.2017.03.122
M3 - Article
C2 - 28476421
AN - SCOPUS:85018414908
SN - 0022-5223
VL - 154
SP - 1080
EP - 1087
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 3
ER -