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Thomas J. Birdas
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Rodney J. Landreneau
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Ann Thorac Surg 2006;81:434-439
© 2006 The Society of Thoracic Surgeons

Original article: General thoracic

Sublobar Resection With Brachytherapy Versus Lobectomy for Stage Ib Nonsmall Cell Lung Cancer

Thomas J. Birdas, MD a , * , Richard P.M. Koehler, MD a , Athanasios Colonias, MD b , Mark Trombetta, MD b , Richard H. Maley, Jr, MD a , Rodney J. Landreneau, MD c , Robert J. Keenan, MD a

a Department of Cardiothoracic Surgery, Allegheny General Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
b Department of Radiation Oncology, Allegheny General Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
c Division of Thoracic and Foregut Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

Accepted for publication August 25, 2005.

* Address correspondence to Dr Birdas, The West Penn Center For Lung and Thoracic Disease, 4815 Liberty Ave, Ste 158, Pittsburgh, PA 15224 (Email: tbirdas1{at}aol.com).

Presented at the Forty-first Annual Meeting of The Society of Thoracic Surgeons, Tampa, FL, Jan 24–26, 2005.

BACKGROUND: We have previously shown that intraoperative brachytherapy decreases the local recurrences associated with sublobar resections for small stage Ia nonsmall-cell lung cancer (NSCLC). In this report, we present the outcomes of sublobar resection with brachytherapy compared with lobectomy in patients with stage Ib tumors.

METHODS: We retrospectively reviewed 167 stage Ib NSCLC patients: 126 underwent lobectomy and 41 sublobar resection with 125 I brachytherapy over the resection staple line. Endpoints were perioperative outcomes, incidence of recurrence, and disease-free and overall survival.

RESULTS: Patients undergoing sublobar resections had significantly worse preoperative pulmonary function. Hospital mortality, nonfatal complications, and median length of stay were similar in the two groups. Median follow-up was 25.1 months. Local recurrence in sublobar resection patients was 2 of 41 (4.8%), similar to the lobectomy group: 4 of 126 (3.2%; p = 0.6). At 4 years, both groups had equivalent disease-free survival (sublobar group, 43.0%; median, 37.7 months; and lobectomy group, 42.8%; median 41.8 months, p = 0.57) and overall survival (sublobar group, 54.1%; median, 50.2 months; and lobectomy group, 51.8%; median, 56.9 months; p = 0.38).

CONCLUSIONS: Sublobar resection with brachytherapy reduced local recurrence rates to the equivalent of lobectomy in patients with stage Ib NSCLC, and resulted in similar perioperative outcomes and disease-free and overall survival, despite being used in patients with compromised lung function. We recommend the addition of intraoperative brachytherapy to sublobar resections in stage Ib patients who cannot tolerate a lobectomy.




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