Quality of Life Following Stereotactic Ablative Radiation Therapy Versus Surgery for Early-Stage Lung Cancer: Results From the ROSEL Randomized Controlled Trial and a Systematic Review

Purpose/Objective(s) One of the purported advantages of stereotactic ablative radiation therapy (SABR) as an alternative treatment option to surgery for early-stage non-small cell lung cancer (ES-NSCLC) is health-related quality of life (HRQOL). The objectives of this study are 1) to assess HRQOL and indirect costing outcomes from the ROSEL randomized trial comparing surgery and SABR for ES-NSCLC and 2) to perform a systematic review of HRQOL following SABR for ES-NSCLC. Materials/Methods In ROSEL, 22 patients with ES-NSCLC were randomized to either SABR or surgery before the trial closed due to poor accrual. HRQOL was evaluated at baseline, and then 3, 6, 12, 18, and 24 months posttreatment using the 30 item EORTC QLQ-C30, its corresponding 13-item lung cancer supplement, and the EuroQol disease-generic questionnaire. Indirect costs of productivity loss were evaluated using the short form health and labor questionnaire, which includes work absences, reduced efficiency at work, and substitution for unpaid work. Time to deterioration (TTD) in HRQOL was calculated from time to randomization to first appearance of clinically significant change. TTD was analyzed using Cox proportional hazard models. The Embase and MEDLINE databases were systematically reviewed to obtain English language articles investigating patient-reported HRQOL after SABR for ES-NSCLC up to August 1, 2015. Review articles, meta-analyses, and decision analyses were excluded. Relevant data regarding patient characteristics and study outcomes were abstracted and analyzed. Results In the ROSEL study, only TTD of global health status was significantly worse on univariable modeling for surgical patients compared to SABR (HR 0.19, P = 0.038). Indirect costing analysis revealed lower total productivity costs to society for SABR compared to surgery (€95 vs €3,513, P = 0.044). Patients reported a lower total degree of hindrance in paid and unpaid work for SABR compared to surgery (mean hindrance scores for SABR: 1.9, for surgery: 6.0, P = 0.010). In the SABR HRQOL systematic review, 9 out of 204 potential studies met all inclusion criteria and were analyzed. All studies were prospective in design. Overall, SABR appeared to be well-tolerated in a mostly medically inoperable patient population. Clinically and statistically significant deteriorations in fatigue and dyspnea were individually reported in two studies. An isolated report found clinically and statistically significant improvements in emotional functioning over time. Deterioration in dyspnea and physical functioning were noted in other studies, but were neither statistically nor clinically significant. Conclusion SABR is an overall well-tolerated modality in patients with ES-NSCLC who either declined surgery or were unfit. Exploratory results in operable ES-NSCLC suggest that SABR may be better tolerated than surgery and incur indirect costing savings. Future clinical trials comparing SABR and surgery would benefit from the inclusion of HRQOL metrics in study design