Treatment of stage I non–small cell lung cancer: What's trending?

Abstract

Objectives Stage I non–small cell lung cancer traditionally is treated with lobectomy. Sublobar resection and stereotactic body radiation therapy provide alternative treatments for higher-risk groups. The purpose of this study was to determine the national treatment trends for stage I lung cancer. Methods The National Cancer Database was queried for patients with clinical stage I non–small cell lung cancer between 1998 and 2012. Patients were compared across treatment groups, and trends in treatment and disease were evaluated over the 15-year time period. Results The National Cancer Database contained 369,931 patients with clinical stage I non–small cell lung cancer. After removing patients who received chemotherapy as a first course of treatment and patients with pathologic stage IV, 357,490 patients were analyzed. The first recorded cases of stereotactic body radiation therapy are in 2003 and rapidly increased to 6.6% (2063) of all patients treated in 2012. The number of diagnoses of stage I non–small cell lung cancer steadily increased over the 15-year period, whereas the rate of lobectomy decreased from 55% in 1998 to 50% in 2012 (P