Stereotactic Radiotherapy Reduces Treatment Cost While Improving Overall Survival and Local Control Over Standard Fractionated Radiation Therapy for Medically Inoperable Non-Small-Cell Lung Cancer

PURPOSE: Radiation therapy (RT) is the standard alternative curative treatment option for medically inoperable early stage non-small-cell lung cancer (NSCLC). Recently, stereotactic body radiotherapy (SBRT) has shown substantial promise to improve local control rates as compared with conventional fractionated RT external beam RT (EBRT). We compare treatment outcomes and costs between SBRT and EBRT in this patient population. MATERIALS AND METHODS: A total of 86 patients with Stage I (Tl-2 N0) NSCLC were treated with either EBRT (n=41) or SBRT (n=45) between January 2002 and April 2008. EBRT patients were treated to a median dose of 70 Gy with 3-dimensional conformal RT (n=39) or intensity-modulated radiation therapy (n=2). SBRT was delivered in 4 or 5 fractions to 48 (Tl, n=44) or 60 (T2, n=1) Gy. The actual cost was calculated using 2010 Medicare hospital-based Ambulatory Payment Classification and hospital-based physician fee screen reimbursement rates for both the technical and professional components. RESULTS: On the basis of a median number of fractions for this patient population, SBRT was significantly less expensive (13, 639 EBRT vs. 10, 616 SBRT, P < 0. 01). Survival analysis demonstrated superior 36-month overall survival using SBRT, 71% versus 42% for EBRT (P < 0. 05). SBRT also reduced local failure by nearly 3 times compared with EBRT (12% vs. 34%, P=0. 10). CONCLUSION: In this study of Stage I NSCLC patients, SBRT was found to be less expensive than standard fractionated EBRT, with the cost savings highly dependent on the number of SBRT fractions and EBRT technique (3-dimensional conformal RT vs. intensity-modulated radiation therapy). SBRT was also associated with superior local control and overall survival.