Comparative analysis of treatment options for stage T1–2N 0M0 non-small cell lung cancer

   Background. The standard treatment for localized non-small cell lung cancer (NSCLC) is surgery. However, for inoperable patients or patients who refuse surgical treatment, radiation therapy in different fractionation regimens remains an alternative to surgery. Traditional radiation therapy does not provide treatment results similar to those after surgical treatment, but the use of stereotactic body radiation therapy (SBRT) changes this paradigm, allowing results comparable to surgical treatment.

   Purpose. To compare the results of treatment of patients with T1–2N 0M0 stages of NSCLC depending on the treatment performed – surgery, radiation therapy in the traditional fractionation mode, stereotactic radiation therapy, combined treatment.

   Materials and methods. From 2015 to 2021 on the basis of the Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine, 195 patients with non-small cell lung cancer stages T1–2N 0M0 were treated. 79 patients underwent surgical treatment, 81 patients underwent radiation therapy, and the combined treatment group included 35 patients. The operation was more often performed as a lobectomy (62 people), atypical resection was performed in 17 cases. Traditional radiation therapy was performed in 66 patients, stereotactic radiation therapy in 15 patients. In the combination treatment group, radiotherapy was given after atypical resection.

   Results. Overall survival (OS), regardless of treatment option, was 102 months. OS rates were high in the surgical and combined treatment groups, while median OS was not reached in the surgery group. In the radiation therapy group, OS was 54 months. Progression-free survival (PFS) was 83 months among all patients. PFS rates are highest with surgical treatment (1-year PFS 96 %), in the radiation therapy group the 1-year PFS was 78 %, in the combined treatment group – 80 %. There was no significant difference in OS and PFS depending on the histological subtype of the tumor. The 1-year OS rates in the radiation therapy (RT) group were comparable: after a radical course of RT in the traditional fractionation regimen – 90 %, after SBRT – 93 %. The 5-year OS rates were significantly different: 41 and 60 %, respectively. In a subgroup analysis of surgical treatment, there was a trend towards increased OS in the atypical resection group compared with lobectomy patients: 5-year OS was 80 and 77 %, respectively.

   Conclusions. Surgical treatment of stages T1–2N 0M0 non-small cell lung cancer should be the main treatment method. For inoperable patients who refuse surgical treatment, SBRT should be preferred to traditional RT.

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