Brachytherapy With Sublobar Resection Fails to Improve NSCLC Recurrence Rates

Brachytherapy did not reduce rates of local recurrence after sublobar resection in patients with non–small-cell lung cancer, according to results of a new study.

Brachytherapy did not reduce rates of local recurrence after sublobar resection in patients with non–small-cell lung cancer (NSCLC), according to results of a new randomized phase III study.

Previous work has suggested an association between sublobar resection and higher locoregional recurrence rates compared with lobectomy; as a result, the procedure is usually reserved for high-risk patients considered ineligible for lobectomy. Investigators led by Hiran C. Fernando, MD, of Boston Medical Center, tested whether adding brachytherapy to resection lowered recurrence rates in patients with operable NSCLC tumors sized 3 cm or less. Results were published online ahead of print in the Journal of Clinical Oncology on June 30.

The study included 222 patients randomized to either resection only or resection along with brachytherapy. After a median follow-up of 4.38 years, there was no difference in time to local recurrence (P = .98) or in the types of recurrence.

“In this patient group-small stage 1 tumors, 3 cm or less-brachytherapy has no significant effect,” Fernando said in an email. He noted that the overall local recurrence rates were less than what is typically reported: Local progression occurred in only 17 patients (7.7%). Local recurrence rates after 2 and 3 years were 12.3% and 12.3% in the resection only group, compared with 9.3% and 12.0% in the brachytherapy group; neither of these time points were significantly different.

The 5-year overall survival rates were also similar between the groups, at 61.4% for the resection only group and 55.6% for brachytherapy patients (P = .38).

“There was a trend for an impact with brachytherapy when margins were close, as assessed by staple line cytology,” Fernando said. “However, only 14 patients had positive staple line cytology, suggesting that surgeons in the study were paying close attention to the margins.”

He added that more information is still needed on whether brachytherapy might be beneficial for patients with larger tumors, when sublobar resection is performed as a compromise operation. Also, this study provides “good benchmark data on the expected results of sublobar resection in high-risk patients, which is helpful for treatment discussions, especially in light of other therapies that are becoming available.”

Study details

The median age of patients in the study was 71 years, and slightly more than half of each cohort was female. There were no differences between groups with regard to any baseline characteristic, including performance status, tumor stage, clinical nodule size, and others.