***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES Guideline -specified curative therapies for a clinical stage I non-small cell lung cancer ( NSCLC ) are either lobectomy or Stereotactic Ablative Radiotherapy ( SABR ) . As outcomes of prospect i ve r and omized clinical trials comparing these modalities are unavailable , we performed a propensity-score matched analysis to create two similar groups in order to compare clinical outcomes . METHODS We selected 577 patients , 96 VATS or open lobectomy were treated at Erasmus University Medical Center Rotterdam and 481 SABR patients were treated at VU University Medical Center Amsterdam with clinical stage I NSCLC . RESULTS Matching of patients according to propensity score result ed in a cohort that consisted of 73 patients in the surgery group and of 73 patients in the SABR group . Median follow-up in the surgery and SABR group was 49 months and 28 months , respectively . Overall survival of patients who underwent surgery was 95 % and 80 % at 12 and 60 months , respectively . For the SABR group this was 94 % at 12 months and 53 % at 60 months . No statistical significant difference ( p=0.089 ) in survival was found between these groups . CONCLUSIONS In this study we found no significant differences in overall survival in propensity matched patients diagnosed with stage I NSCLC treated either surgically or with SABR . After 3 years there seems to be a trend toward improved survival in patients who were treated surgically OBJECTIVE Our objective was to investigate the surgical management of primary lung cancer by board-certified thoracic surgeons participating in the general thoracic surgery portion of The Society of Thoracic Surgeons data base . METHODS We identified all pulmonary resections recorded in the general thoracic surgery prospect i ve data base from 1999 to 2006 . Among the 49,029 recorded operations , 9033 pulmonary resections for primary lung cancer were analyzed . RESULTS There were 4539 men and 4494 women with a median age of 67 years ( range 20 - 94 years ) . Comorbidity affected 79 % of patients and included hypertension in 66 % , coronary artery disease in 26 % , body mass index of 30 kg/m2 or more in 25.7 % , and diabetes mellitus in 13 % . The type of resection was a wedge resection in 1649 ( 18.1 % ) , segmentectomy in 394 ( 4.4 % ) , lobectomy in 6042 ( 67 % ) , bilobectomy in 357 ( 4.0 % ) , and pneumonectomy in 591 ( 6.5 % ) . Mediastinal lymph nodes were evaluated in 5879 ( 65 % ) patients ; via mediastinoscopy in 1928 ( 21 % ) , nodal dissection 3722 ( 41 % ) , nodal sampling in 1124 ( 12.4 % ) , and nodal biopsy in 729 ( 8 % ) . Median length of stay was 5 days ( range 0 - 277 days ) . Operative mortality was 2.5 % ( 179 patients ) . One or more postoperative events occurred in 2911 ( 32 % ) patients . CONCLUSION The patients in the general thoracic surgery data base are elderly , gender balanced , and afflicted by multiple comorbid conditions .  Mediastinal lymph node evaluation is common and the pneumonectomy rate is low . The length of stay is short and operative mortality is low , despite frequent postoperative events BACKGROUND Video-assisted thoracoscopic surgery ( VATS ) lobectomy and stereotactic ablative radiotherapy ( SABR ) are both used for early-stage non-small-cell lung cancer . We carried out a propensity score-matched analysis to compare locoregional control ( LRC ) . PATIENTS AND METHODS  VATS lobectomy data from six hospitals were retrospectively accessed ; SABR data were obtained from a single institution data base . Patients were matched using propensity scores based on cTNM stage , age , gender , Charlson comorbidity score , lung function and performance score . Eighty-six VATS and 527 SABR patients were matched blinded to outcome ( 1:1 ratio , caliper distance 0.025 ) . Locoregional failure was defined as recurrence in/adjacent to the planning target volume/surgical margins , ipsilateral hilum or mediastinum . Recurrences were either biopsy-confirmed or had to be PET-positive and review ed by a tumor board . RESULTS The matched cohort consisted of 64 SABR and 64 VATS patients with the median follow-up of 30 and 16 months , respectively . Post-SABR LRC rates were superior at 1 and 3 years ( 96.8 % and 93.3 % versus 86.9 % and 82.6 % , respectively , P = 0.04 ) . Distant recurrences and overall survival ( OS ) were not significantly different . CONCLUSION This retrospective analysis found a superior LRC after SABR compared with VATS lobectomy , but OS did not differ . Our findings support the need to compare both treatments in a r and omized , controlled trial Introduction : The purpose of this study was to compare patterns of failure between lobar resection ( lobectomy or pneumonectomy ) and stereotactic body radiation therapy ( SBRT ) for patients with clinical stage I non – small-cell lung cancer ( NSCLC ) . Methods : From January 2004 to January 2008 , 338 patients underwent definitive treatment for pathologically confirmed clinical stage I NSCLC with lobar resection ( n = 260 ) or SBRT ( n = 78 ) . Most surgical patients underwent  lobectomy ( n = 237 ) . SBRT patients received a biologically effective dose of at least 100 Gy10 . Lobar resection patients were younger , healthier , and had superior pulmonary function , whereas most of the patients in the SBRT group had T1 tumors . Final pathology upstaged 32.7 % of surgery patients , and 20.0 % received adjuvant chemotherapy . No SBRT patients received adjuvant chemotherapy . Results : In an unmatched comparison , 4-year lobar local control ( 98.7 % versus 93.6 % , p = 0.015 ) was greater for lobar resection versus SBRT , respectively , though primary tumor ( 98.7 % versus 95.3 % , p = 0.088 ) , regional ( 82.9 % versus 78.1 % , p = 0.912 ) , and distant control ( 76.1 % versus 54.0 % , p = 0.152 ) were similar . Overall survival ( OS , 63.5 % versus 29.6 % , p < 0.0001 ) was greater for lobar resection , though cause-specific survival ( CSS , 81.3 % versus 75.3 % , p = 0.923 ) was similar . In a T-stage matched comparison of 152 patients , there was no significant difference in patterns of failure or CSS , whereas OS favored surgery . Conclusion : Lobectomy/pneumonectomy or SBRT results in comparable patterns of failure for clinical stage I NSCLC . In this retrospective comparison , OS was superior for surgery , though CSS was similar . R and omized trials are necessary to control for fundamental differences in comorbidity , which impact interpretation of both tumor control and survival PURPOSE The incidence of early-stage non-small cell lung cancer ( NSCLC ) among older adults is expected to increase because of demographic trends and computed tomography-based screening ; yet , optimal treatment in the elderly remains controversial . Using the Surveillance , Epidemiology , and End Results (SEER)-Medicare cohort spanning 2001 - 2007 , we compared survival outcomes associated with 5 strategies used in contemporary practice : lobectomy , sublobar resection , conventional radiation therapy , stereotactic ablative radiation therapy ( SABR ) , and observation . METHODS AND MATERIAL S Treatment strategy and covariates were determined in 10,923 patients aged ≥ 66 years with stage IA-IB NSCLC . Cox regression , adjusted for patient and tumor factors , compared overall and disease-specific survival for the 5 strategies . In a second exploratory analysis , propensity-score matching was used for comparison of SABR with other options . RESULTS The median age was 75 years , and 29 % had moderate to severe comorbidities . Treatment distribution was lobectomy ( 59 % ) , sublobar resection ( 11.7 % ) , conventional radiation ( 14.8 % ) , observation ( 12.6 % ) , and SABR ( 1.1 % ) . In Cox regression analysis with a median follow-up time of 3.2 years , SABR was associated with the lowest risk of death within 6 months of diagnosis ( hazard ratio [ HR ] 0.48 ; 95 % confidence interval [ CI ] 0.38 - 0.63 ; referent is lobectomy ) . After 6 months , lobectomy was associated with the best overall and disease-specific survival . In the propensity-score matched analysis , survival after SABR was similar to that after lobectomy ( HR 0.71 ; 95 % CI 0.45 - 1.12 ; referent is SABR ) . Conventional radiation and observation were associated with poor outcomes in all analyses . CONCLUSIONS In this population -based experience , lobectomy was associated with the best long-term outcomes in fit elderly patients with early-stage NSCLC . Exploratory analysis of SABR early adopters suggests efficacy comparable with that of surgery in select population s. Evaluation of these therapies in r and omized trials is urgently needed PURPOSE To compare outcomes between lung stereotactic radiotherapy ( SBRT ) and wedge resection for stage I non-small-cell lung cancer ( NSCLC ) . PATIENTS AND METHODS One hundred twenty-four patients with T1 - 2N0 NSCLC underwent wedge resection ( n = 69 ) or image-guided lung SBRT ( n = 58 ) from February 2003 through August 2008 . All were ineligible for anatomic lobectomy ; of those receiving SBRT  , 95 % were medically inoperable , with 5 % refusing surgery . Mean forced expiratory volume in 1 second and diffusing capacity of lung for carbon monoxide were 1.39 L and 12.0 mL/min/mmHg for wedge versus 1.31 L and 10.14 mL/min/mmHg for SBRT ( P = not significant ) . Mean Charlson comorbidity index and median age were 3 and 74 years for wedge versus 4 and 78 years for SBRT ( P < .01 , P = .04 ) . SBRT was volumetrically prescribed as 48 ( T1 ) or 60 ( T2 ) Gy in four to five fractions . Results Median potential follow-up is 2.5 years . At 30 months , no significant differences were identified in regional recurrence ( RR ) , locoregional recurrence ( LRR ) , distant metastasis ( DM ) , or freedom from any failure ( FFF ) between the two groups ( P > .16 ) . SBRT reduced the risk of local recurrence ( LR ) , 4 % versus 20 % for wedge ( P = .07 ) . Overall survival ( OS ) was higher with wedge but cause-specific survival ( CSS ) was identical . Results excluding synchronous primaries , nonbiopsied tumors , or pathologic T4 disease ( wedge satellite lesion ) showed reduced LR ( 5 % v 24 % , P = .05 ) , RR ( 0 % v 18 % , P = .07 ) , and LRR ( 5 % v 29 % , P = .03 ) with SBRT . There were no differences in DM , FFF , or CSS , but OS was higher with wedge . CONCLUSION Both lung SBRT and wedge resection are reasonable treatment options for stage I NSCLC patients ineligible for anatomic lobectomy .  SBRT  reduced LR , RR , and LRR . In this nonr and omized population of patients selected for surgery versus SBRT ( medically inoperable ) at physician discretion , OS was higher in surgical patients . SBRT and surgery , however , had identical CSS BACKGROUND The st and ard of care for operable , stage I , non-small-cell lung cancer ( NSCLC ) is lobectomy with mediastinal lymph node dissection or sampling . Stereotactic ablative radiotherapy ( SABR ) for inoperable stage I NSCLC has shown promising results , but two independent , r and omised , phase 3 trials of SABR in patients with operable stage I NSCLC ( STARS and ROSEL ) closed early due to slow accrual . We aim ed to assess overall survival for SABR versus surgery by pooling data from these trials . METHODS Eligible patients in the STARS and ROSEL studies were those with clinical T1 - 2a ( < 4 cm ) , N0M0 , operable NSCLC . Patients were r and omly assigned in a 1:1 ratio to SABR or lobectomy with mediastinal lymph node dissection or sampling . We did a pooled analysis in the intention-to-treat population using overall survival as the primary endpoint . Both trials are registered with Clinical Trials.gov ( 
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In addition , lobectomy demonstrated a beneficial trend in one-year RFS , five-year RFS , and CSS .
Meta-analyses of current evidence suggested that lobectomy provides better long-term survival outcomes for stage I NSCLC patients