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Comparison of efficacy of stereotactic body radiotherapy and thoracoscopic surgery in the treatment of early-stage non-small cell lung cancer.

PURPOSE
To observe and compare the efficacy and safety between stereotactic body radiotherapy and thoracoscopic surgery in the treatment of early-stage non-small cell lung cancer (NSCLC).


METHODS
The clinical data of 106 early-stage NSCLC patients admitted to the Thoracic Surgery Department of the hospital from February 2014 to February 2016 were retrospectively analyzed. Among these patients, 53 received stereotactic body radiotherapy (SBRT group), and 53 underwent video-assisted thoracoscopic surgery (VATS group). The clinical data of all patients were collected. The short-term response rate, Karnofsky performance status (KPS) score, changes in serum tumor marker levels before and after surgery and adverse reactions were compared between the two groups. Besides, all patients were followed up, and the overall survival (OS) and progression-free survival (PFS) were recorded.


RESULTS
The levels of serum carcinoembryonic antigen (CEA), cytokeratin 19 fragment (CYFRA21-1) and neurone specific enolase (NSE) were decreased in both groups after treatment, and the differences were not statistically significant between the two groups. The patients tolerated well with SBRT, without evident myelosuppression or adverse hematological effects. In SBRT group, there were 7 cases of radioactive skin reaction, 2 cases of grade I radiation esophagitis and 4 cases of radiation pneumonitis (including 3 cases of grade I radiation pneumonitis and 1 case of grade II radiation pneumonitis). In VATS group, there were 3 cases of incision infection, 2 cases of pulmonary infection, 5 cases of pulmonary atelectasis, 1 case of pulmonary leakage and 1 case of deep vein thrombosis of lower extremity. The 3- year OS and PFS were 79.2% (42/53) and 67.9% (36/53) and 83.0% (44/53) and 77.4% (41/53) in SBRT group and VATS group, respectively. Kaplan-Meier survival showed no statistically significant differences in the OS and PFS between the two groups (log-rank).


CONCLUSION
SBRT achieves better RR and DCR, similar OS and PFS to those of typical thoracoscopic surgery, and good patient tolerance in the treatment of early- stage NSCLC, which is a safe and effective treatment means.