1. Brachytherapy following sublobar resection (BSR) had no significant association with local NSCLC recurrence compared to sublobar resection (SR) alone.
2. Three-year overall survival rates were similar between BSR and SR.
Evidence rating level: 1 (Excellent)
Study Rundown: Compared to lobectomy, sublobar resection for non-small-cell lung cancer (NSCLC) is associated with greater risk for local recurrence. Adjuvant radiation therapy may reduce the risk of recurrence, and intraoperative brachytherapy offers greater patient adherence and minimal radiation injury compared to external-beam radiotherapy. At the conclusion of this prospective trial, the authors found that there was no relationship between adjuvant brachytherapy and rates of local recurrence. Though there was a trend towards reduced recurrence among patients with potentially compromised tumor margins who underwent brachytherapy, it was not statistically significant. Three year all-cause mortality also did not differ between the two treatment arms. Based on these findings, the authors suggested that adjuvant brachytherapy may be most beneficial only for patients with compromised margins following resection. It should be noted that this study was underpowered to detect smaller therapeutic benefits, and there was a lower rate of local recurrence in this trial compared to previous trials.
In-Depth [randomized controlled trial]: The authors randomized a total of 224 patients with high-risk operable non small cell lung cancer (NSCLC) <3cm to either sublobar resection alone or sublobar resection followed by brachytherapy. The primary outcome measured was time to local recurrence in the primary tumor lobe or in ipsilateral hilar nodes. This study was powered to detect large HR 0.315. Median follow-up was 4.38 years. A total of 222 patients were available for intention-to-treat analysis. There was no difference in time to local recurrence (HR, 1.01; 95% CI, 0.51 to 1.98, P = 0.98). There was a non-statistically significant trend to reduced local recurrence among patients with potentially compromised tumor margins following surgery (HR, 0.22; P = 0.24). Three year overall survival rates were similar between the two treatment arms (71% and 71%, P = 0.97).
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