Sublobar resection with brachytherapy versus lobectomy for stage Ib nonsmall cell lung cancer

Thomas Birdas, Richard P M Koehler, Athanasios Colonias, Mark Trombetta, Richard H. Maley, Rodney J. Landreneau, Robert J. Keenan

Research output: Contribution to journalArticle

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Abstract

Background. We have previously shown that intraoperative brachytherapy decreases the local recurrences associated with sublobar resections for small stage Ia nonsmall-cell lung cancer (NSCLC). In this report, we present the outcomes of sublobar resection with brachytherapy compared with lobectomy in patients with stage Ib tumors. Methods. We retrospectively reviewed 167 stage Ib NSCLC patients: 126 underwent lobectomy and 41 sublobar resection with 125 I brachytherapy over the resection staple line. Endpoints were perioperative outcomes, incidence of recurrence, and disease-free and overall survival. Results. Patients undergoing sublobar resections had significantly worse preoperative pulmonary function. Hospital mortality, nonfatal complications, and median length of stay were similar in the two groups. Median follow-up was 25.1 months. Local recurrence in sublobar resection patients was 2 of 41 (4.8%), similar to the lobectomy group: 4 of 126 (3.2%; p = 0.6). At 4 years, both groups had equivalent disease-free survival (sublobar group, 43.0%; median, 37.7 months; and lobectomy group, 42.8%; median 41.8 months, p = 0.57) and overall survival (sublobar group, 54.1%; median, 50.2 months; and lobectomy group, 51.8%; median, 56.9 months; p = 0.38). Conclusions. Sublobar resection with brachytherapy reduced local recurrence rates to the equivalent of lobectomy in patients with stage Ib NSCLC, and resulted in similar perioperative outcomes and disease-free and overall survival, despite being used in patients with compromised lung function. We recommend the addition of intraoperative brachytherapy to sublobar resections in stage Ib patients who cannot tolerate a lobectomy.

Original languageEnglish (US)
Pages (from-to)434-439
Number of pages6
JournalAnnals of Thoracic Surgery
Volume81
Issue number2
DOIs
StatePublished - Feb 2006
Externally publishedYes

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Brachytherapy
Non-Small Cell Lung Carcinoma
Disease-Free Survival
Recurrence
Lung
Hospital Mortality
Length of Stay
Survival
Incidence
Neoplasms

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Birdas, T., Koehler, R. P. M., Colonias, A., Trombetta, M., Maley, R. H., Landreneau, R. J., & Keenan, R. J. (2006). Sublobar resection with brachytherapy versus lobectomy for stage Ib nonsmall cell lung cancer. Annals of Thoracic Surgery, 81(2), 434-439. https://doi.org/10.1016/j.athoracsur.2005.08.052

Sublobar resection with brachytherapy versus lobectomy for stage Ib nonsmall cell lung cancer. / Birdas, Thomas; Koehler, Richard P M; Colonias, Athanasios; Trombetta, Mark; Maley, Richard H.; Landreneau, Rodney J.; Keenan, Robert J.

In: Annals of Thoracic Surgery, Vol. 81, No. 2, 02.2006, p. 434-439.

Research output: Contribution to journalArticle

Birdas, T, Koehler, RPM, Colonias, A, Trombetta, M, Maley, RH, Landreneau, RJ & Keenan, RJ 2006, 'Sublobar resection with brachytherapy versus lobectomy for stage Ib nonsmall cell lung cancer', Annals of Thoracic Surgery, vol. 81, no. 2, pp. 434-439. https://doi.org/10.1016/j.athoracsur.2005.08.052
Birdas, Thomas ; Koehler, Richard P M ; Colonias, Athanasios ; Trombetta, Mark ; Maley, Richard H. ; Landreneau, Rodney J. ; Keenan, Robert J. / Sublobar resection with brachytherapy versus lobectomy for stage Ib nonsmall cell lung cancer. In: Annals of Thoracic Surgery. 2006 ; Vol. 81, No. 2. pp. 434-439.
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abstract = "Background. We have previously shown that intraoperative brachytherapy decreases the local recurrences associated with sublobar resections for small stage Ia nonsmall-cell lung cancer (NSCLC). In this report, we present the outcomes of sublobar resection with brachytherapy compared with lobectomy in patients with stage Ib tumors. Methods. We retrospectively reviewed 167 stage Ib NSCLC patients: 126 underwent lobectomy and 41 sublobar resection with 125 I brachytherapy over the resection staple line. Endpoints were perioperative outcomes, incidence of recurrence, and disease-free and overall survival. Results. Patients undergoing sublobar resections had significantly worse preoperative pulmonary function. Hospital mortality, nonfatal complications, and median length of stay were similar in the two groups. Median follow-up was 25.1 months. Local recurrence in sublobar resection patients was 2 of 41 (4.8{\%}), similar to the lobectomy group: 4 of 126 (3.2{\%}; p = 0.6). At 4 years, both groups had equivalent disease-free survival (sublobar group, 43.0{\%}; median, 37.7 months; and lobectomy group, 42.8{\%}; median 41.8 months, p = 0.57) and overall survival (sublobar group, 54.1{\%}; median, 50.2 months; and lobectomy group, 51.8{\%}; median, 56.9 months; p = 0.38). Conclusions. Sublobar resection with brachytherapy reduced local recurrence rates to the equivalent of lobectomy in patients with stage Ib NSCLC, and resulted in similar perioperative outcomes and disease-free and overall survival, despite being used in patients with compromised lung function. We recommend the addition of intraoperative brachytherapy to sublobar resections in stage Ib patients who cannot tolerate a lobectomy.",
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AU - Maley, Richard H.

AU - Landreneau, Rodney J.

AU - Keenan, Robert J.

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N2 - Background. We have previously shown that intraoperative brachytherapy decreases the local recurrences associated with sublobar resections for small stage Ia nonsmall-cell lung cancer (NSCLC). In this report, we present the outcomes of sublobar resection with brachytherapy compared with lobectomy in patients with stage Ib tumors. Methods. We retrospectively reviewed 167 stage Ib NSCLC patients: 126 underwent lobectomy and 41 sublobar resection with 125 I brachytherapy over the resection staple line. Endpoints were perioperative outcomes, incidence of recurrence, and disease-free and overall survival. Results. Patients undergoing sublobar resections had significantly worse preoperative pulmonary function. Hospital mortality, nonfatal complications, and median length of stay were similar in the two groups. Median follow-up was 25.1 months. Local recurrence in sublobar resection patients was 2 of 41 (4.8%), similar to the lobectomy group: 4 of 126 (3.2%; p = 0.6). At 4 years, both groups had equivalent disease-free survival (sublobar group, 43.0%; median, 37.7 months; and lobectomy group, 42.8%; median 41.8 months, p = 0.57) and overall survival (sublobar group, 54.1%; median, 50.2 months; and lobectomy group, 51.8%; median, 56.9 months; p = 0.38). Conclusions. Sublobar resection with brachytherapy reduced local recurrence rates to the equivalent of lobectomy in patients with stage Ib NSCLC, and resulted in similar perioperative outcomes and disease-free and overall survival, despite being used in patients with compromised lung function. We recommend the addition of intraoperative brachytherapy to sublobar resections in stage Ib patients who cannot tolerate a lobectomy.

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