Stereotactic body radiotherapy compared with video‐assisted thoracic surgery after propensity‐score matching in elderly patients with pathologically‐proven early‐stage non‐small cell lung cancer

Abstract Objective Standard medical treatment for early non‐small cell lung cancer (NSCLC) is surgery; however, stereotactic body radiotherapy (SBRT) can be a viable substitute for elderly patients who can no longer tolerate or refuse surgery. The unsurpassed care for elderly patients with early NSCLC remains inconclusive. We conducted a propensity‐score matching analysis to compare the efficacy and side‐effects of SBRT and video‐assisted thoracic surgery (VATS) in elderly patients with pathologically‐proven early NSCLC. Methods This single‐institution retrospective study included 310 elderly patients who underwent VATS ( n = 180) or SBRT ( n = 130) from January 2011 to November 2018 at the Tianjin Medical University Cancer Institute and Hospital. Sex, performance status, pathology type, Charlson Comorbidity Index, and T‐stage according to the eighth tumor node metastasis classification were considered when performing propensity‐score matching. Results After propensity‐score matching, 71 patients were included in each group for analysis. A median follow‐up period of 53.5 months was observed for all patients; 72 and 53 months for patients undergoing VATS and SBRT, respectively. Overall survival ( p = 0.492), progression‐free survival ( p = 0.294), locoregional recurrence‐free survival ( p = 0.866), and distant metastasis‐free survival ( p = 0.452) did not differ significantly between the VATS and SBRT groups. Multivariate analysis showed a significant correlation between the T‐stage and overall survival. However, treatment‐related toxicity was lower in the SBRT group than in the VATS group. Conclusions SBRT is an option comparable with surgery for elderly patients with pathologically‐proven early‐stage NSCLC.