Multicenter prospective study of factors associated with provider decision-making of SBRT versus sublobar resection for stage I NSCLC

Treatment decision-making for early-stage non-small cell lung cancer in patients with high-operative risk is complex. In a multicenter prospective study, patients with stage I NSCLC at high surgical risk were treated with either stereotactic body radiotherapy (SBRT) or sublobar resection. Before treatment, the primary physician rated each patient’s candidacy for SBRT versus sublobar resection. Among 331 patients, 62% received SBRT. Older age and chronic obstructive pulmonary disease were associated with higher likelihood of SBRT candidacy. In contrast, higher forced expiratory volume, larger tumor size, and better functional scores decreased the likelihood or being considered for SBRT. The authors conclude that in patients with early-stage NSCLC at high surgical risk, treatment decisions are influenced by age, comorbidities, lung function, and tumor features.