Patient reported outcomes after the treatment of early stage non-small cell lung cancer by stereotactic body radiotherapy compared to surgery

Abstract

Background: As survival seems to be equal after either stereotactic body radiotherapy (SBRT) or surgery for patients with stage I non-small cell lung cancer (NSCLC), treatment impact on the quality of life (QoL) after is essential for well-informed decision making. After a surgical resection, deterioration of QoL is often observed in the early post-treatment period, whereas QoL is reported to be maintained after SBRT. The aim of this study is to compare QoL in the first year after SBRT and surgery. Methods: QoL was assessed by using the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30) and the lung cancer-specific supplementary questionnaire (QLQ-LC13) at baseline and 3, 6 and 12 months after treatment. Two prospectively collected databases of patients with clinically proven stage I NSCLC, from two large hospitals in the Netherlands, were pooled (n=306; 256 patients were treated with SBRT and 41 patients with surgery). This observational study design is susceptible to selection bias. To correct for confounding, propensity-scores were calculated using forward stepwise logistic regression, to be selected for surgical treatment. For the final model, age, dichotomized ECOG score and FEV1% predicted scores were selected. Results: The 41 surgical patients were matched to 41 SBRT patients on propensity score with a 1:1 ratio. At baseline, patients in the surgery group report a lower health related- QoL compared to patients in the SBRT group. However, during the first year after treatment, no clinical meaningful differences in social-, role, physical, emotional and cognitive domains were observed between patients treated using either modality. Furthermore, no clinical meaningful differences in QLQ-LC13 scores (dyspnea, pain, fatigue) after treatment were observed. Conclusions: This study comparing a matched cohort, revealed no clinical significant differences in QoL following either SBRT or surgery for an early stage NSCLC.