Is focused radiotherapy better than minimally invasive surgery?

This study compared the efficacy of video-assisted thoracoscopic surgery (VATS) versus stereotactic ablative radiotherapy (SABR) in reducing the risk of local recurrence (return of the cancer close to the primary site) in patients with early stage non-small-cell lung cancer (NSCLC).

In patients with early stage NSCLC, lobectomy (surgical removal of a lobe of the lung) is the current treatment of choice. A newer, minimally invasive procedure is video-assisted thoracoscopic surgery (VATS), in which the surgeon makes very small cuts into the patient's body. VATS uses an instrument called a thoracoscope, which is a thin, tube-like instrument, with a small video camera at the end. This camera feeds video images to a screen and allows the surgeon to see and operate inside the chest and lungs. Stereotactic ablative radiotherapy (SABR) is an alternative treatment to conventional radiotherapy. The radiation doses are delivered with high precision, focusing on destroying the cancer cells only, while causing as little damage as possible to the near-by normal tissues. Both techniques usually involve shorter recovery times and hospital stays compared with conventional open lobectomy. This study aimed to compare the efficacy of VATS and SABR in patients with early stage NSCLC.

A total of 128 patients with NSCLC were evaluated in this study. Half (64) of these patients were treated with VATS, while the other half (64 patients) were treated with SABR. The main parameter evaluated was locoregional control or LRC (defined as the percentage of patients who did not experience a local recurrence a certain time after treatment). Researchers found that at 1 and 3 years after treatment, LRC rates were 96.8% and 93.8% respectively for patients treated with SABR. On the other hand, in patients treated with VATS, LRC rates were 86.9% at 1 year and 82.6% at 3 years after the procedure. There was no difference in survival rates between the 2 groups of patients. Side effects were more frequent in VATS-treated patients compared to patients in the SABR group.

In summary, the study showed that survival rates were similar for SABR compared to VATS treatment for patients with early stage NSCLC. However, LRC was significantly higher in patients treated with SABR than in patients in the VATS group.

This study included a small number of patients, who were followed up for a relatively short period of time. Larger trials are needed to confirm these encouraging results for SABR in early lung cancer treatment.

Consult with your physician regarding the most appropriate treatment in your situation.