A new study, performed by a team from the University of Texas MD Anderson Cancer Center, entitled “Lobectomy, Sublobar Resection, and Stereotactic Ablative Radiotherapy for Early-Stage Non–Small Cell Lung Cancers in the Elderly” published in the October issue of JAMA journal reports better outcomes of total removal of the lung lobe when compared to partial removal in patients with early-stage non-small cell lung cancer (NSCLC).

The incidence of early-stage non–small cell lung cancer (NSCLC) in an increasingly elderly population is on the rise. Frequently associated co-morbidities are chronic obstructive pulmonary disease (COPD), coronary artery disease, and renal failure. Three different treatments are available for NSCLC patients, however, differences in clinical characteristics and survival outcomes have not been the subject of a comprehensive study.

Here, the authors compared the three most commonly used therapies for elderly patients with early-stage NSCLC – lobectomy (removal of a lung lobe), sublobar resection (partial removal of affected lung), and stereotactic ablative radiotherapy (SABR).

Shervin M. Shirvani, M.D., study’s first author, attending radiation oncologist at Banner MD Anderson Cancer Center in Arizona and an adjunct professor at MD Anderson, commented, “Currently, lung cancer is one of the most common and fatal cancers, and for the foreseeable future, it will be one of the major health epidemics our country faces. Yet we don’t have strong evidence-based guidelines for how to best treat the disease — especially when it’s discovered early.”

This is the most comprehensive population-based study evaluating current treatments for early-stage NSCLC. Accordingly, Shirvani noted, “In the absence of clinical trials, it was important to analyze observational data from a very large database to compare these three modalities. We wanted to compare lobectomy, the treatment generally thought to be the standard of care, to both the smaller surgery and stereotactic ablative radiotherapy, which does not carry a surgical risk, and understand, which may be best for this elderly patient population with extensive concurrent illnesses.”

In the study, the authors analyzed the Surveillance, Epidemiology and End Results (SEER) Medicare database and identified 9,093 patients with NSCLC treated with either of the following treatments — lobectomy (7,215 patients), sub lobar resection (1,496 patients), and SABR (382 patients).

In summary, the authors found lobectomy associated with better lung-specific survival when compared to sublobar resection. Shirvani added, “The assumption was that for an elderly patient with a number of co-morbidities, the smaller surgery would be better than a whole lobectomy because there would be fewer surgical complications. Yet, it appears that the ability to eradicate the cancer with the bigger surgery may be more important than minimizing surgical risk.”

When they compared lobectomy with SABR, both groups of patients exhibited the same lung-specific survival. Thus, the authors suggest that SABR is a potential therapeutic strategy for elderly patients with multiple comorbidities.

Benjamin Smith, M.D., associate professor, Radiation Oncology at MD Anderson, commented, “Clearly, the incidence of early-stage lung cancer will increase dramatically in the next few years, and we need to be prepared to treat patients in the right way — balancing the effectiveness versus risk of treatment in an elderly population. Observational studies like ours give us insight into what the right treatment strategy should be, and hopefully will encourage both physicians and patients who prospective clinical trials are worth pursuing.”