Stereotactic ablative radiation therapy (SABR) for stage I non–small cell lung cancer (NSCLC) achieved a higher rate of overall survival than did invasive surgery, according to a combined analysis of two clinical trials.
The two randomized controlled trials, a multicenter study from the Netherlands and a multinational study conducted at The University of Texas MD Anderson Cancer Center and elsewhere, were the first to compare SABR and surgery head-to-head in NSCLC patients. In both trials, patients with operable stage I NSCLC were randomly assigned to undergo SABR or the standard of care, which is lobectomy with mediastinal lymph node dissection or sampling.
Thirty-one patients underwent SABR, and 27 underwent surgery. The median follow-up time was 40.2 months. The estimated 3-year overall survival rates were 79% for the surgery group and 95% for the SABR group (p = .037). No significant difference was seen in recurrence-free survival.
Three patients who underwent SABR experienced grade 3 adverse events, whereas 12 patients who underwent surgery experienced grade 3 or 4 adverse events. One patient died of surgical complications.
“For the first time, we can say that the two therapies are at least equally effective and that SABR appears to be better tolerated and might lead to better survival outcomes for these patients,” said Joe Y. Chang, M.D., Ph.D., a professor in the Department of Radiation Oncology and lead author of the study’s report. However, he said that the study’s findings should be interpreted with caution because of its small patient sample size and limited follow-up time.
Dr. Chang added that two larger trials comparing SABR and surgery for patients with NSCLC are scheduled to open later this year, one in the United States and one in the United Kingdom.
The study’s report was published in May in The Lancet Oncology.
OncoLog, August 2015, Volume 60, Issue 8