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• W2017411862 abstract "Purpose/Objective(s)VATS-lobectomy is increasingly seen as a preferred procedure in early-stage NSCLC. High local control rates are also seen after stereotactic ablative radiation therapy (SABR) in these patients. We performed a propensity score-matched analysis to compare loco-regional control after both procedures.Materials/MethodsPatients with stage I-II NSCLC treated at 6 hospitals with VATS lobectomy were eligible. Details of SABR patients were obtained from a single-institutional database. Patients were matched using propensity scores based on cTNM, age, gender, Charlson comorbidity score, lung function and performance score. Matching was performed blinded to all outcomes. Excluded were: synchronous/prior lung tumors or COPD GOLD IV. In total 86 VATS- and 527 SABR patients were eligible for matching (1:1 ratio, caliper distance 0.025). Loco-regional failure was defined as recurrence in/adjacent to the planning target volume or surgical margins, ipsilateral hilum or mediastinum. Recurrences were biopsy-confirmed or PET-positive and reviewed by a multidisciplinary tumor board. Patients upstaged during VATS or developing recurrence were treated according to Dutch guidelines.ResultsThe matched cohort consisted of patients with cT1-3N0 NSCLC following SABR (n = 64) or VATS-lobectomy (n = 64). Mean age of SABR and VATS patients were 71 and 68 years, and median follow-up was 30 and 16 months, respectively. Pre-treatment histological confirmation of stage I NSCLC was available in 53% of SABR patients and 50% of VATS patients. Three planned VATS resections (4.7%) were converted into an open lobectomy, all due to hemorrhage that was difficult to control. The median number of dissected lymph node stations was 4 (range 1-6). Median number of dissected lymph nodes was 8.5 (range 1-24), and 71.9% of patients had 6 or more individual nodes dissected. Unsuspected nodal disease was detected during surgery in 12 (18.8%) patients. Of these, 4 patients (6.3%) had N1-disease and 8 patients (12.5%) had unsuspected N2 disease. Upstaging during surgery was not scored as a recurrence. SABR patients had a better loco-regional control rates at 1- and 3-years (96.8% and 93.3% vs. 86.9% and 82.6%, respectively, p = 0.03). Three-year progression-free survival did not significantly differ between groups (79.3% vs. 63.2%, p = 0.09). The rates of distant recurrence and overall survival did not differ significantly.ConclusionsThe 3-year progression-free survival and overall survival were similar after SABR and VATS-lobectomy. However, loco-regional control was superior after SABR. These findings support accrual in randomized controlled trials evaluating both treatments. Purpose/Objective(s)VATS-lobectomy is increasingly seen as a preferred procedure in early-stage NSCLC. High local control rates are also seen after stereotactic ablative radiation therapy (SABR) in these patients. We performed a propensity score-matched analysis to compare loco-regional control after both procedures. VATS-lobectomy is increasingly seen as a preferred procedure in early-stage NSCLC. High local control rates are also seen after stereotactic ablative radiation therapy (SABR) in these patients. We performed a propensity score-matched analysis to compare loco-regional control after both procedures. Materials/MethodsPatients with stage I-II NSCLC treated at 6 hospitals with VATS lobectomy were eligible. Details of SABR patients were obtained from a single-institutional database. Patients were matched using propensity scores based on cTNM, age, gender, Charlson comorbidity score, lung function and performance score. Matching was performed blinded to all outcomes. Excluded were: synchronous/prior lung tumors or COPD GOLD IV. In total 86 VATS- and 527 SABR patients were eligible for matching (1:1 ratio, caliper distance 0.025). Loco-regional failure was defined as recurrence in/adjacent to the planning target volume or surgical margins, ipsilateral hilum or mediastinum. Recurrences were biopsy-confirmed or PET-positive and reviewed by a multidisciplinary tumor board. Patients upstaged during VATS or developing recurrence were treated according to Dutch guidelines. Patients with stage I-II NSCLC treated at 6 hospitals with VATS lobectomy were eligible. Details of SABR patients were obtained from a single-institutional database. Patients were matched using propensity scores based on cTNM, age, gender, Charlson comorbidity score, lung function and performance score. Matching was performed blinded to all outcomes. Excluded were: synchronous/prior lung tumors or COPD GOLD IV. In total 86 VATS- and 527 SABR patients were eligible for matching (1:1 ratio, caliper distance 0.025). Loco-regional failure was defined as recurrence in/adjacent to the planning target volume or surgical margins, ipsilateral hilum or mediastinum. Recurrences were biopsy-confirmed or PET-positive and reviewed by a multidisciplinary tumor board. Patients upstaged during VATS or developing recurrence were treated according to Dutch guidelines. ResultsThe matched cohort consisted of patients with cT1-3N0 NSCLC following SABR (n = 64) or VATS-lobectomy (n = 64). Mean age of SABR and VATS patients were 71 and 68 years, and median follow-up was 30 and 16 months, respectively. Pre-treatment histological confirmation of stage I NSCLC was available in 53% of SABR patients and 50% of VATS patients. Three planned VATS resections (4.7%) were converted into an open lobectomy, all due to hemorrhage that was difficult to control. The median number of dissected lymph node stations was 4 (range 1-6). Median number of dissected lymph nodes was 8.5 (range 1-24), and 71.9% of patients had 6 or more individual nodes dissected. Unsuspected nodal disease was detected during surgery in 12 (18.8%) patients. Of these, 4 patients (6.3%) had N1-disease and 8 patients (12.5%) had unsuspected N2 disease. Upstaging during surgery was not scored as a recurrence. SABR patients had a better loco-regional control rates at 1- and 3-years (96.8% and 93.3% vs. 86.9% and 82.6%, respectively, p = 0.03). Three-year progression-free survival did not significantly differ between groups (79.3% vs. 63.2%, p = 0.09). The rates of distant recurrence and overall survival did not differ significantly. The matched cohort consisted of patients with cT1-3N0 NSCLC following SABR (n = 64) or VATS-lobectomy (n = 64). Mean age of SABR and VATS patients were 71 and 68 years, and median follow-up was 30 and 16 months, respectively. Pre-treatment histological confirmation of stage I NSCLC was available in 53% of SABR patients and 50% of VATS patients. Three planned VATS resections (4.7%) were converted into an open lobectomy, all due to hemorrhage that was difficult to control. The median number of dissected lymph node stations was 4 (range 1-6). Median number of dissected lymph nodes was 8.5 (range 1-24), and 71.9% of patients had 6 or more individual nodes dissected. Unsuspected nodal disease was detected during surgery in 12 (18.8%) patients. Of these, 4 patients (6.3%) had N1-disease and 8 patients (12.5%) had unsuspected N2 disease. Upstaging during surgery was not scored as a recurrence. SABR patients had a better loco-regional control rates at 1- and 3-years (96.8% and 93.3% vs. 86.9% and 82.6%, respectively, p = 0.03). Three-year progression-free survival did not significantly differ between groups (79.3% vs. 63.2%, p = 0.09). The rates of distant recurrence and overall survival did not differ significantly. ConclusionsThe 3-year progression-free survival and overall survival were similar after SABR and VATS-lobectomy. However, loco-regional control was superior after SABR. These findings support accrual in randomized controlled trials evaluating both treatments. The 3-year progression-free survival and overall survival were similar after SABR and VATS-lobectomy. However, loco-regional control was superior after SABR. These findings support accrual in randomized controlled trials evaluating both treatments." @default.
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• W2017411862 title "Patterns of Disease Recurrence Following Either Stereotactic Ablative Radiation Therapy (SABR) or Lobectomy by Video-assisted Thoracoscopic Surgery (VATS) in Stage I-II Non-small Cell Lung Cancer: Outcomes of a Propensity Score-matched Analysis" @default.
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