Treatment of Stage I Non-Small Cell Lung Cancer: What’s Trending?

Abstract Objectives Stage I non-small cell lung cancer (NSCLC) is traditionally treated with lobectomy. Sub-lobar resection (SLR) and Stereotactic body radiation therapy (SBRT) provide alternative treatments for higher-risk groups. The purpose of this study was to determine the national treatment trends for stage I lung cancer. Methods The National Cancer Data Base (NCDB) was queried for clinical stage I NSCLC patients between 1998 and 2012. Patients were compared across treatment groups, and trends in treatment and disease were evaluated over the 15 year time period. Results The NCDB contained 369,931 clinical stage I NSCLC patients. After removing patients who received chemotherapy as a first course of treatment and pathologic stage IV patients, 357,490 patients were analyzed. The first recorded cases of SBRT are in 2003 and rapidly increased to 6.6% (2,063) of all patients treated in 2012. The number of diagnoses of stage I NSCLC steadily increased over the 15 year period, while the rate of lobectomy decreased from 55% in 1998 to 50% in 2012 (p < 0.001). Most of the decrease in lobectomy can be explained by the increase in the rate of sublobar resection from 12% to 17% (p < 0.001). The percentage of untreated patients remained stable at around 7% (p = 0.283). Conclusion Although the number of Stage I NSCLC cases continues to rise, lobectomy rates are decreasing while SLR and SBRT rates are increasing. Although the rising popularity of alternative therapies to lobectomy for treatment of Stage I NSCLC should allow more patients to undergo treatment, we did not observe this trend in the data.