Resection, Cs131, SBRT All Strong Options for Early-Stage Lung Cancer

An analysis of treatment possibilities for early-stage non–small-cell lung cancer (NSCLC) found that wedge resection (WR), WR with Cesium-131 (Cs131) brachytherapy, and stereotactic body radiation therapy (SBRT) are all “excellent options.” In higher-risk WRs, the study found that the additional use of Cs131 may be beneficial.

“If a patient cannot undergo lobectomy as the primary treatment, it has been suggested that WR should be combined with brachytherapy to achieve results equivalent to lobectomy,” wrote study authors led by Bhupesh Parashar, MD, of Weill Cornell Medical College in New York. Parashar reported receiving funding support from IsoRay, which makes the Cs131 brachytherapy isotope.

The study was a retrospective analysis of 272 patients treated with WR alone (123 patients), WR and Cs131 brachytherapy (52 patients), or SBRT (97 patients); all were treated between 1993 and 2012. Cs131 was used when surgeons deemed the WR procedure “high risk,” such as for those with close or positive margins. Results of the study were published in Brachytherapy.

The rates of local control were similar, at 92.2% for WR, 96.2% for WR and Cs131, and 95.5% for SBRT (P = .60). There were also no differences when each individual group was compared to one other group.

Disease-free survival rates at 5 years were also not significantly different, at 50.5% for WR alone, 50.7% for WR and Cs131, and 46.9% for SBRT (P = .28).

Overall survival rates, however, were different. The median overall survival at 5 years was 100% in the WR and Cs131 group, compared with 97.7% in the WR alone group and 89.6% in the SBRT group (P = .02). The authors noted, though, that the lower survival in the SBRT group could be a result of selection bias, with those with more comorbidities being selected to receive that treatment.

They also wrote that though the similarity in result with WR alone and with Cs131 brachytherapy suggests no benefit by adding Cs131, “this may not be the case since brachytherapy was added to high-risk resections.” Those patients are generally at higher risk for local recurrence with no additional treatment.

The authors stressed that definitive answers will require a randomized prospective trial, but these results show that all three treatments are good options for early-stage lung cancer when lobectomy is not an option. Adding Cs131 brachytherapy to WR is recommended when the resection is deemed to be high risk by a surgeon.