Surgery and Radiation May Have Similar Quality of Life Outcomes in Lung Cancer

For patients with early-stage lung cancer, surgery and radiation may have similar outcomes regarding quality of life.

Patients with high-risk early-stage lung cancer who underwent surgery via sublobar resection or received treatment with stereotactic body radiation therapy (SBRT) experienced similar quality of life a year after either procedure, researchers have found.

Sublobar resection is the surgical removal of part of a lung lobes. SBRT consists of treatment with focused beams of high-intensity radiation administered over relatively fewer sessions than older forms of radiation therapy, as Dr. Jeremy Mudd explained.

Mudd, a clinical fellow in pulmonary and critical care medicine at The Mount Sinai Hospital in New York, is the co-author of the study comparing quality of life following the two procedures, findings of which were published in Cancer.

Survival Outcomes Are Similar

“The big question that we wanted to answer in our study was, for patients who have early-stage lung cancer who are in a higher-risk population — meaning that they're older, more frail, have more medical problems, such that they're not eligible for lobectomy [the surgical removal of an entire section of a lung], which is the gold standard treatment for early stage lung cancer historically — how do these patients tolerate these other different options for treatment that are available to them?” Mudd said in an interview with CURE®.

“There's decent data out there about survival outcomes, at least in like the three-to-five-year range, showing that these two treatments, sublobar resection and SBRT, have pretty comparable survival outcomes. But what's really lacking in the literature is how do these treatments affect quality of life in this cohort, and these older patients, in particular?”

Comparing Quality of Life

Researchers enrolled 337 patients with stage 1 to 2A non-small cell lung cancer at high risk for lobectomy, 63% of whom received SBRT. Mudd and his colleagues then assessed patients’ quality of life via surveys completed before treatment and then at seven days, 30 days, six months and 12 months after treatment.

“Patients who underwent the sublobar resection seemed to have a slightly worse quality of life in the physical health and the lung cancer-specific quality of life domains at seven days [after treatment],” Mudd said. "But then, those patients basically returned to close to their baseline at all other time points, and there was no significant difference between the groups in each of the domains at all other points beyond seven days. Importantly, both groups were close to their baseline quality of life in all domains at the end of the 12 months.”

The physical health domain of quality of life, Mudd explained, was based on the Short Form-8, Physical Health Survey rating aspects of quality of life related to a patient’s physical health such as exercise capacity and the ability to complete daily tasks. Likewise, lung cancer-specific quality of life was determined via the Functional Assessment of Cancer Therapy for Lung Cancer survey, assessing aspects of quality of life in both the physical and mental health domain that have been particularly validated in lung cancer patients, Mudd said.

“These findings,” researchers wrote in the study, “suggest that sublobar resection and SBRT have a similar impact on the [quality of life] of patients with early-stage lung cancer deemed ineligible for lobectomy.”

In turn, this research can spark conversations between patients and their care teams regarding treatment options, as Mudd explained.

“Really, both treatment modalities seemed like they're pretty well-tolerated and neither group [of patients] really saw significant worsening of their quality of life, at least not in any kind of sustained way,” Mudd said. “So, it seems like this [question] could be up to patients and their providers to decide which modality makes more sense for them, knowing that both seemed to be pretty well tolerated and seem to have pretty good quality of life for the patients that undergo them.”

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