Increase in the use of lung stereotactic body radiotherapy without a preceding biopsy in the United States

• Lung SBRT is an effective non-surgical treatment for early stage NSCLC.
• Patients with early stage NSCLC have comorbidities that augment biopsy risks.
• We assessed the rate of SBRT without a biopsy in the National Cancer Database.
• Over 10 years, the rate of SBRT without a biopsy increased.
• These findings have important implications on cost effectiveness of care for a growing population.

BackgroundStereotactic body radiotherapy (SBRT) is an efficacious treatment for early stage non-small cell lung cancer (NSCLC). Patients with clinically suspected NSCLC may have medical comorbidities that increase biopsy risks, making them more likely to receive SBRT without biopsy. This study characterizes the pervasiveness of this management approach nationally.MethodsPatients with stage I NSCLC who received SBRT from 2003 to 2011 were identified within National Cancer Database. Changes in the proportion treated without biopsy were compared by year of diagnosis using binomial logistic regression. Demographics were compared between patients with and without biopsy with Chi-square and t-tests. Multivariate logistic regression was used to determine factors independently associated with SBRT delivery without biopsy.ResultsWe identified 6960 patients. Most had biopsy before SBRT (95.5%). Over time the proportion treated without biopsy increased (OR 1.11, p = 0.038). Univariate comparisons demonstrated that older, medically inoperable patients treated at academic centers located in the New England or Pacific regions were less likely to have biopsy before SBRT. Facility type and location (p < 0.001), medical inoperability (p < 0.001), and smaller tumor size (p = 0.013) were associated with odds of SBRT without biopsy in multivariate analyses. A trend toward increased use of SBRT with a biopsy with later year of diagnosis (p = 0.093) was observed in multivariate analysis.ConclusionsThe percentage of patients nationally undergoing SBRT without biopsy has increased over time. The reasons for this trend and ramifications of this approach on cost-effectiveness of care must be studied.