Related Experiment Video
Updated: Apr 25, 2026
Dynamic Lung Tumor Tracking for Stereotactic Ablative Body Radiation Therapy
Published on: June 7, 2015
Clinical, Quality, and Cost Outcomes of Patients With Early-Stage Non-Small Cell Lung Cancer Undergoing Surgery or
Sowmyanarayanan Thuppal1,2, Kanika Chawla1, Ryan Bowman1
1Division of Cardiothoracic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois.
Background:
We evaluated how National Surgical Quality Improvement Program (NSQIP) risk, frailty, and quality of life influence treatment selection between surgery and stereotactic body radiotherapy (SBRT) in early-stage non-small cell lung cancer (NSCLC).
Methods:
Prospectively collected data from treatment-naive adults with early-stage NSCLC included demographics, pulmonary function, NSQIP risk scores, and frailty (index ≥3). Quality of life was assessed by Quality of Life Questionnaire Core 30, Quality of Life Questionnaire Lung Cancer 13, and modified Medical Research Council Dyspnea Scale tools.
Results:
SBRT was more likely for frail patients (odds ratio [OR], 4.92), those needing assistance (OR, 5.01), and those with disability (OR, 3.48) or impaired mobility (OR, 4.04). Multivariate analysis found that higher NSQIP mortality risk (OR, 12.60), frailty (OR, 4.80), and lower forced expiratory volume in 1 second predicted SBRT selection. Complications were more frequent after surgery (41% vs 17%; P < .05). Unadjusted overall survival at 6 months, 1 year, and 2 years favored surgery (99.1%, 97.2%, 90.2%) over SBRT (95.7%, 86.5%, 79.2%; P < .05). Recurrence-free survival at 1 year and 2 years was also higher with surgery (95.1%, 82.3%) vs SBRT (87.6%, 63.5%; P < .05). Physical functioning, fatigue, and dyspnea worsened over time in both groups; at 2 years, quality of life was similar except for greater decline in role functioning in SBRT patients. Median 90-day treatment-related costs were lower for SBRT ($11,188 vs $15,018; P < .05) but similar when major complications were excluded.
Conclusions:
Frailty, NSQIP risk, and functional metrics help guide treatment selection in early-stage NSCLC. Surgery yields better survival and recurrence outcomes, whereas SBRT offers lower early morbidity and cost in selected patients.
