SURVIVAL AND QUALITY OF LIFE AFTER STEREOTACTIC OR 3D-CONFORMAL RADIOTHERAPY FOR INOPERABLE EARLY-STAGE LUNG CANCER

Purpose: To investigate survival and local recurrence after stereotactic ablative radiotherapy (SABR) or threedimensional conformal radiotherapy (3D-CRT) administered for early-stage primary lung cancer and to investigate longitudinal changes of health-related quality of life (HRQOL) parameters after either treatment.

Methods and Materials: Two prospective cohorts of inoperable patients with T1-2N0M0 primary lung tumors were analyzed. Patients received 70 Gy in 35 fractions with 3D-CRT or 60 Gy in three to eight fractions with SABR. Global quality of life (GQOL), physical functioning (PF), and patient-rated dyspnea were assessed using the respective dimensions of European Organization for Research and Treatment of Cancer Core Questionnaire-C30 and LC13. HRQOL was analyzed using multivariate linear mixed-effects modeling, survival and local control (LC) using the Kaplan-Meier method, Cox proportional hazards analysis, and Fine and Gray multivariate competing risk analysis as appropriate.

Results: Overall survival (OS) was better after SABR compared with 3D-CRT with a HR of 2.6 (95% confidence interval [CI]: 1.5-4.8; p <0.01). 3D-CRT conferred a subhazard ratio for LC of 5.0 (95% CI: 1.7-14.7; p <0.01) compared with SABR. GQOLand PF were stable after SABR(p= 0.21 andp = 0.62, respectively). Dyspnea increased afterSABRby 3.2 out of 100 points (95% CI: 1.0-5.3; p <0.01), which is clinically insignificant. At 1 year, PFdecreased by an excess of 8.7 out of 100 points (95% CI: 2.8-14.7; p <0.01) after 3D-CRT compared with SABR.

Conclusion: In this nonrandomized comparison of two prospective cohorts of medically inoperable patients with Stage I lung cancer, OS and LC were better after SABR. GQOL, PF, and patient-rated dyspnea were stable after SABR, whereas PF decreased after 3D-CRTapproaching clinical significance already at 1 year. (C) 2011 Elsevier Inc.