Stage I-II non-small-cell lung cancer treated usingeither stereotactic ablative radiotherapy (SABR) orlobectomy by video-assisted thoracoscopic surgery(VATS): Outcomes of a propensity score-matchedanalysis

Background: Video-assisted thoracoscopic surgery (VATS) lobectomy and stereotactic ablative radiotherapy (SABR)are both used for early-stage non-small-cell lung cancer. We carried out a propensity score-matched analysis tocompare locoregional control (LRC).Patients and methods: VATS lobectomy data from six hospitals were retrospectively accessed; SABR data wereobtained from a single institution database. Patients were matched using propensity scores based on cTNM stage,age, gender, Charlson comorbidity score, lung function and performance score. Eighty-six VATS and 527 SABRpatients were matched blinded to outcome (1:1 ratio, caliper distance 0.025). Locoregional failure was defined asrecurrence in/adjacent to the planning target volume/surgical margins, ipsilateral hilum or mediastinum. Recurrenceswere either biopsy-confirmed or had to be PET-positive and reviewed by a tumor board.Results: The matched cohort consisted of 64 SABR and 64 VATS patients with the median follow-up of 30 and 16months, respectively. Post-SABR LRC rates were superior at 1 and 3 years (96.8% and 93.3% versus 86.9% and82.6%, respectively, P = 0.04). Distant recurrences and overall survival (OS) were not significantly different.Conclusion: This retrospective analysis found a superior LRC after SABR compared with VATS lobectomy, but OSdid not differ. Our findings support the need to compare both treatments in a randomized, controlled trial.