The use of stereotactic body radiotherapy (SBRT) for patients with non–small cell lung cancer (NSCLC) can reduce treatment disparities between White and Black patients, according to research presented by Ganesh et al at the International Association for the Study of Lung Cancer (IASLC) World Conference on Lung Cancer 2022 in Vienna (Abstract EP02.02).
Previous research has shown significant treatment disparities for Black patients who are less likely to receive curative therapy for early-stage lung cancer. Researchers led by Ashwin Ganesh, a medical student at the University of Illinois College of Medicine in Chicago sought to determine if increased use of stereotactic body radiation therapy (SBRT) has led to an increase in the proportion of patients receiving definitive treatment for early-stage NSCLC.
SBRT is a form of radiation therapy that allows the radiation to be focused more closely on the cancer tumor, thus sparing healthy tissue and allowing the clinician to use a stronger dose of radiation.
Study Details
The investigators used The National Cancer Database (NCDB) to determine the proportion of patients with NSCLC receiving surgical treatment, SBRT, or no definitive treatment (observation) for clinical stage T1–T2 N0M0 NSCLC from 2004 to 2017. The receipt of treatment for NSCLC was evaluated in terms of the overall population and by race.
From 2004 to 2017, the proportion of patients with early-stage NSCLC undergoing observation declined from 22% in 2004 to 10.5% in 2017 (P < .001). Meanwhile, the proportion receiving surgical treatment declined from 77% in 2004 to 68% in 2017 (P < .001), whereas the proportion receiving SBRT increased from 1% (95% confidence interval [CI] = 0.9%–1.3%) in 2004 to 22% (95% CI 21.4%–22.3%) in 2017 (P < .001).
Among White patients, the proportion undergoing observation decreased from 21% in 2004 to 10% in 2017 (P < .001). Among Black patients, the proportion undergoing observation decreased from 32% (95% CI = 29.0%–35.8%) in 2004 to 15% (95% CI = 13.4%–15.8%) in 2017 (P < .001).
The proportion of White patients receiving surgery declined from 78% to 68% from 2004–2017 (P < .001). In addition, the proportion receiving SBRT increased from 1% in 2004 to 22% (P < .001). The proportion of Black patients receiving surgery did not change significantly from 67% (95% CI = 63.2%–70.1%) in 2004 to 63% (95% CI = 61.6%–64.8%) in 2017 (P = .09). Meanwhile, the proportion receiving SBRT increased from 1% (95% CI = 0.3%–1.7%) in 2004 to 22% (95% CI = 20.8%–23.5%, P < .001). Between 2011 to 2017 the odds ratio of the likelihood of Black patients to receive curative therapy increased from 0.55 (95% CI = 0.48–0.64) to 0.70 (95% CI = 0.62–0.79, P < .001) when compared to White patients.
“Our analysis found that increased utilization of SBRT has significantly increased the proportion of patients who are able to receive curative therapy for early-stage NSCLC, and the use of SBRT has markedly reduced previously seen disparities seen in the receipt of treatment between White and Black patients,” said Mr. Ganesh.
