• Dhruvin H Hirpara, Biniam Kidane, Alexander V Louie, Victoria Zuk, Gail Darling, Mathieu Rousseau, Tyler Chesney, Natalie Coburn, Julie Hallet, and REcovery After Surgical Therapy for Older adults REsearch—Cancer (RESTORE-C) Group.
• Department of Surgery, University of Toronto, Toronto, ON, Canada.
• Ann. Surg. 2023 Aug 1; 278 (2): e368e376e368-e376.

ObjectiveTo examine long-term healthcare dependency outcomes of stereotactic body radiation therapy (SBRT) to surgery for older adults with stage I non-small cell lung cancer (NSCLC).BackgroundSBRT is an emerging alternative to surgery in patients with early-stage lung cancer. There remains a paucity of prospective studies comparing these modalities, especially with respect to long-term dependency outcomes in older adults with lung cancer.MethodsAdults 70 years old and above with stage I NSCLC treated with surgery or SBRT from January 2010 to December 2017 were analyzed using 1:1 propensity score matching. Homecare use, days at home, and time spent alive and at home were compared. E-value methods assessed residual confounding.ResultsA total of 1129 and 2570 patients underwent SBRT and surgery, respectively. In all, 1016 per group were matched. SBRT was associated with a higher overall risk of homecare utilization [hazard ratio (HR)=1.75, 95% confidence interval (CI): 1.37-2.23] than surgery up to 5 years following treatment. While the hazards of death or nursing home admission were lower in the first 3 months after SBRT (HR=0.55, 95% CI: 0.36-0.85), they became consistently higher beyond this period and remained high up to 5 years compared with surgery (HR=2.13; 95% CI: 1.85-2.45). The above findings persisted in stratified analyses for frail patients and those with no pretreatment homecare. E-values indicated it was unlikely that the observed estimates could be explained by unmeasured confounders.ConclusionsSurgery offers robust long-term dependency outcomes compared with SBRT. These are important patient-centered endpoints which may be used for counseling and shared decision-making in older adults with stage I NSCLC.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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