In a recent study entitled “Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-cell lung cancer: a pooled analysis of two randomized trials,” the authors show that stereotactic ablative radiotherapy may be an efficient treatment for patients with operable stage 1 non-small cell lung cancer. The study was published in the journal The LANCET Oncology.

Currently, the standard care treatment for patients with operable stage I non–small cell lung cancer (NSCLC) is a lobectomy, i.e., a surgical procedure where surgeons remove one of the lobes of the lungs, accompanied by mediastinal lymph node dissection (mediastinal nodes are a group of lymph nodes located in the thoracic cavity of the body). Previous studies reported that stereotactic ablative radiotherapy, a highly focused radiation treatment into the tumor area, yielded positive outcomes in patients with inoperable stage I NSCLC. The objective of two previous randomized phase 3 studies — entitled STARS and ROSEL – sought to determine if the same results could be achieved with operable stage I NSCLC, however, due to low patient enrollment, neither study was completed.

In this new study, the authors assessed overall survival for patients treated with for stereotactic ablative radiotherapy versus surgery by analyzing the pooled data from these previous trials. The team evaluated the data collected from 58 patients who were enrolled and randomly assigned to receive either stereotactic ablative radiotherapy (31 patients) or surgery (27 patients). Patients’ median follow-up was 40.2 months and 35.4 months for stereotactic ablative radiotherapy and surgery, respectively.

Six deaths were registered in the surgery group, while only one death was registered in the stereotactic ablative radiotherapy cohort. Additionally, it was estimated that patients treated with stereotactic ablative radiotherapy had a 3-year overall survival rate of 95% while surgery patients only had a 79%. Recurrence-free survival at 3 years was 86% and 80% for patients undergoing radiotherapy and surgery, respectively.

Although the authors recognized that the study has limitations (the clinical trails in which they based the analysis has a small sample size and were incomplete), their results suggest stereotactic ablative radiotherapy can be an efficient option for treating operable stage I NSCLC. However, additional studies with a larger sample size are needed to confirm these preliminary results.

Joe Y. Chang, MD, PhD, professor of radiation oncology at The University of Texas MD Anderson Cancer Center commented, “For the first time, we can say that the two therapies are at least equally effective, and that stereotactic ablative radiotherapy appears to be better tolerated and might lead to better survival outcomes for these patients.”

Tom Treasure, MD, of the members of the clinical operational research unit at University College London, Robert C. Rintoul, PhD, FCRP, of the department of thoracic oncology at Papworth Hospital in Cambridge, United Kingdom and Fergus Macbeth, MD, of the Wales Cancer Trials Unit added in an editorial piece accompanying the study, “The opportunity of a fair test should be given to less invasive treatments. Stereotactic ablative radiotherapy is not the only candidate procedure that might reduce the harms of lung cancer treatment without loss of effectiveness. The uptake of videothoracoscopy, for example, has been resisted by surgeons, but the accumulating case series and registry evidence suggest that oncological effectiveness is not sacrificed by moving away from thoracotomy.”