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Wedge Resection vs Stereotactic Body Radiation Therapy for Stage 1 Non-Small Cell Lung Cancer in Octogenarians
Rolfy A Perez Holguin1, William G Wong1, Chan Shen2
1Division of Thoracic Surgery, Department of Surgery, Pennsylvania State University College of Medicine, Hershey, Pennsylvania.
Annals of Thoracic Surgery Short Reports
|April 24, 2026
Summary
For octogenarians with early-stage non-small cell lung cancer (NSCLC), wedge resection surgery offers improved survival compared to stereotactic body radiation therapy (SBRT). This study highlights surgery
Area of Science:
- Oncology
- Geriatric Medicine
- Thoracic Surgery
Background:
- Early-stage non-small cell lung cancer (NSCLC) is typically treated with surgical resection.
- Stereotactic body radiation therapy (SBRT) is an alternative for elderly patients to avoid surgical complications.
- Octogenarians present unique challenges for treatment decisions in NSCLC.
Purpose of the Study:
- To compare the efficacy of wedge resection versus SBRT in octogenarian patients (age ≥80) with early-stage NSCLC (clinical T1 N0 M0).
- To evaluate overall survival rates and treatment outcomes between the two modalities in this specific patient population.
Main Methods:
- Retrospective analysis of the National Cancer Database.
- Inclusion of patients aged ≥80 with clinical T1 N0 M0 NSCLC treated with wedge resection or SBRT.
- Exclusion of medically inoperable patients.
- Application of propensity score matching to create balanced cohorts.
- Kaplan-Meier method and multivariable Cox proportional hazards model for survival analysis.
Main Results:
- A cohort of 3938 patients was analyzed, with 137 matched pairs identified post-propensity score matching.
- Wedge resection demonstrated a significantly higher 5-year overall survival rate (44.5%) compared to SBRT (20.1%) (P < .001).
- Multivariable analysis confirmed wedge resection as associated with improved survival (HR, 0.516; P < .001).
- Pathologic examination after wedge resection led to upstaging in 23.7% of cases, with 1.7% having positive lymph nodes.
- There was an observed increase in SBRT use and a decrease in surgical treatment over the study period.
Conclusions:
- Wedge resection is associated with superior survival outcomes compared to SBRT for octogenarian patients with early-stage NSCLC.
- Surgical resection provides crucial pathological information and lymph node assessment, potentially leading to necessary treatment adjustments.
- Further research is needed to define the optimal role and utility of SBRT in this elderly demographic.
