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Posted by on Oct 24, 2021 in Lung cancer | 0 comments

In a nutshell

This study evaluated the long-term outcomes of stereotactic ablative radiation therapy (SABR) and video-assisted thoracic surgery (VATS) for the treatment of patients with early-stage non-small cell lung cancer (NSCLC). The data showed that both SABR and VATS led to similar long-term survival outcomes.

Some background

Surgery to remove tumors is usually the first option for patients with early-stage NSCLC. Video-assisted thoracic surgery lobectomy (VATS-L) is a minimally invasive surgical method that involves the surgical removal of a portion of the lung called a lobe through small cuts in the chest. VATS-L involves using a small camera that is inserted into the patients’ chest via a scope. Because cancer can spread to other areas of the body, it is important to check other sites such as the lymph nodes. The lymph nodes nearest the lung are called mediastinal lymph nodes. Mediastinal lymph node dissection (MLND) is the complete removal of the mediastinal lymph nodes. 

Stereotactic ablative radiation therapy (SABR) is the standard treatment to treat early-stage NSCLC. It uses a high dose of radiation and targets a specific area from different angles. SABR has been shown to improve survival in patients with operable early-stage NSCLC compared to surgery. However, findings from many of those studies are unreliable because of selection biases, small sample size, short follow-up, and differences between study protocols. There are few studies evaluating the long-term outcomes of SABR and VATS for the treatment of patients with early-stage NSCLC.

Methods & findings

This study involved patients with early-stage NSCLC. 80 patients were treated with SABR. 352 patients were treated with VATS-L-MLND. The average follow-up time was 5.1 years.

In the SABR group, the overall survival rate was 91% after 3 years, and 87% after 5 years. The survival without cancer worsening rate was 80% after 3 years, and 77% after 5 years. No serious side effects occurred in patients treated with SABR.

In the VATS-L-MLND group, the overall survival rate was 91% after 3 years, and 84% after 5 years. The survival without cancer progression rate was 88% after 3 years, and 80% after 5 years.

There was no significant difference in terms of overall survival and survival without cancer worsening between the SABR and VATS-L-MLND groups.

The bottom line

This study concluded that both SABR and VATS-L-MLND led to similar long-term survival outcomes in patients with early-stage NSCLC.

The fine print

This study was not randomized. The VATS-L-MLND group was not treated under a fixed protocol. More randomized controlled trials directly comparing the two techniques are still essential to fully evaluate the value of SABR and VATS-L-MLND for NSCLC.

Published By :

The Lancet. Oncology

Date :

Sep 13, 2021

Original Title :

Stereotactic ablative radiotherapy for operable stage I non-small-cell lung cancer (revised STARS): long-term results of a single-arm, prospective trial with prespecified comparison to surgery.

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