Surgery vs Radiation: Which Carries a Lower Mortality Risk for Lung Cancer?

Patients with a high risk of mortality may not choose first-line lung cancer treatment.

Determining the optimal cancer treatment is contingent on many factors, including disease type, stage, and patient characteristics. Treatment decisions may also depend on the provider.

A study recently published by the Journal of Clinical Oncology analyzed the risk of mortality for surgery or targeted radiation for early-stage lung cancer.

Included in the study were 76,623 patients who underwent surgery and 8216 patients who were treated with focused radiation for lung cancer.

The findings suggest that mortality rates were low for both therapies, with 2.1% of the surgery group and 0.7% of the focused radiation group dying within 30 days of treatment.

The authors noted that the post-treatment mortality rate varied by age. Approximately 3.9% of patients 80 years and older who received surgery died within 30 days compared with 0.9% of radiation-treated patients.

"When examining patients together across all age groups, there was slightly less post-treatment mortality with radiation than with surgery,” said first author William Stokes, MD. “But in older age groups, the differences became larger and potentially more meaningful for patients who are candidates for both therapies.”

The authors found that the 30-day morality rate for patients aged 71 to 75 years who underwent surgery was 1.87% higher compared with radiation, while the risk was 2.8% higher for those aged 76 to 80 years, according to the study. Patients older than 80 years who underwent surgery were found to have a 3.03% greater risk of mortality compared with radiation.

The researchers noted that a similar trend was seen at 90 days posttreatment.

Surgery is currently the recommended first choice of treatment for early-stage lung cancer, with targeted radiation as a second-line treatment.

The authors said that these findings suggest that targeted radiation may be the best treatment for patients whose recovery from surgery would be complicated, including older patients, according to the study.

Long-term studies are ongoing to evaluate which of the treatments is best overall, as surgery may carry increased short-term risks while reducing mortality more than radiation, according to the authors.

"For patients with early-stage lung cancer who are otherwise healthy and good surgical candidates, lobar resection remains the standard," said senior author Chad G. Rusthoven, MD. “However, the results of this study may be important to consider when discussing the treatment options for older patients who are thought to have a high risk of surgical complications.”

The authors said that these findings may help advise shared decision-making between patients and providers, meaning that patients with a high risk of mortality or with lifespan priorities may be able to make better treatment choices, according to the study.

"This analysis of patient outcomes from centers around the country showed low rates of post-treatment mortality with both surgery and radiation, which is very encouraging,” Dr Rusthoven said. “Larger differences in post-treatment mortality were observed among older patients, and this information may be helpful to the discussion of treatment options with our patients.”