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Updated: Jun 19, 2026
Stereotactic Radiosurgery for Gynecologic Cancer
Published on: April 17, 2012
Real-world Decision-making Process for Stereotactic Body Radiotherapy Versus Minimally Invasive Surgery in
Stijn Vanstraelen1, Kay See Tan2, Prasad S Adusumilli1
1Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Objective:
To generate a prediction model for the selection of treatment modality for early-stage non-small cell lung cancer (NSCLC).
Background:
Stereotactic body radiotherapy (SBRT) and minimally invasive surgery (MIS) are used in the local treatment of early-stage NSCLC. However, the selection of patients for either SBRT or MIS remains challenging due to the multitude of factors influencing the decision-making process.
Methods:
We analyzed 1291 patients with clinical stage I NSCLC treated with intended MIS or SBRT from January 2020 to July 2023. A prediction model for selection for SBRT was created based on multivariable logistic regression analysis. The receiver operating characteristic curve analysis stratified the cohort into 3 treatment-related risk categories. Postprocedural outcomes, recurrence, and overall survival (OS) were investigated to assess the model's performance.
Results:
In total, 1116 patients underwent MIS and 175 SBRT. The prediction model included age, performance status, previous pulmonary resection, MSK-Frailty score, FEV1 and DLCO, and demonstrated an area-under-the-curve of 0.908 (95% CI: 0.876-0.938). Based on the probability scores (n=1197), patients were stratified into a low-risk (MIS, n=970 and SBRT, n=28), intermediate-risk (MIS, n=96 and SBRT, n=53), and high-risk category (MIS, n=10 and SBRT, n=40). Treatment modality was not associated with OS [HR of SBRT, 1.67 (95% CI: 0.80-3.48); P =0.20].
Conclusions:
Clinical expertise can be translated into a robust predictive model, guiding the selection of stage I NSCLC patients for MIS versus SBRT and effectively categorizing them into 3 distinct risk groups. Patients in the intermediate category could benefit most from multidisciplinary evaluation.
