Stereotactic radiotherapy provides long-term survival outcomes comparable to surgery in NSCLC patients

Stereotactic radiotherapy provides long-term survival outcomes comparable to surgery in NSCLC patients

A new clinical trial report concludes that stereotactic radiation therapy provides long-term survival outcomes comparable to surgery in patients with early-stage small non-small cell lung cancer (NSCLC). Patients in the study who received radiation also reported fewer side effects after treatment.

The STARS study (NCT02357992) is the first to report 10-year clinical outcomes from a prospective comparison of stereotactic radiation and surgical resection for operable NSCLC. The results will be presented today at the annual meeting of the American Society for Radiation Oncology (ASTRO).

Our study, based on a decade of data, confirms that stereotactic radiotherapy is a strong alternative to surgery for most patients with operable stage I NSCLC. This highly targeted, non-invasive treatment achieved the same long-term overall survival as lobectomy while allowing many patients to have an easier recovery and potentially a better quality of life.”

Joe Y. Chang, MD, PhD, FASTRO, senior author of the study and professor of thoracic radiation oncology and director of stereotactic ablative radiation therapy, The University of Texas MD Anderson Cancer Center

Lung cancer is the leading cause of cancer death in the United States and worldwide, although survival rates have improved in recent years due to treatment advances and earlier detection through screening programs. NSCLC accounts for more than 85% of all lung cancers, including the estimated 226,650 adults in the United States who are expected to be newly diagnosed with the disease in 2025.

Stereotactic ablative radiation therapy (SABR), also known as stereotactic body radiation therapy (SBRT), delivers high doses of radiation at pinpoint accuracy over typically five or fewer treatment sessions. It is the standard of care for patients with early-stage NSCLC who cannot undergo surgery, and there is increasing evidence that it may provide survival benefits comparable to surgery even for patients who are eligible for surgery.

"Until now, surgery has been the only standard option for early-stage NSCLC, but more than 50% of patients experience moderate or severe side effects afterwards. And as many patients age, many patients can no longer tolerate surgery, so the demand for non-invasive options that provide durable local control is growing," said Dr. Chang.

"This study provides the clearest picture yet that radiation can also be an attractive option for appropriate surgical candidates. It included a larger patient population than previously published randomized trials, and we followed these patients for much longer."

In the Phase II trial, researchers recruited 80 patients with tumors smaller than 3 centimeters, no lymph node involvement, and no distant metastases to receive SABR in three or four sessions. The SABR group was compared to a surgical cohort of 80 patients who underwent video-assisted thoracoscopic (VATS) lobectomy with removal of mediastinal lymph nodes.

Surgical patients were selected from an institutional dataset of patients enrolled prospectively during the same time window and matched to the SABR cohort for age, gender, tumor size, and health status. All patients in the study were healthy enough to undergo either surgery or radiation and were treated at MD Anderson between 2015 and 2017. Researchers followed both groups for up to 10 years to track survival, recurrence, side effects, quality of life and financial impact.

After a median follow-up of 8.3 years, overall survival was nearly identical between groups: 69% of patients treated with SABR and 66% of patients treated with surgery were alive 10 years after treatment. The rates of lung cancer-specific survival (92% vs. 89%) and recurrence-free survival (57% vs. 65%) were also similar for both patient cohorts.

Dr. Chang and colleagues previously reported three- and five-year overall survival rates of 91% and 87%, respectively, after SABR. They also reported minimal side effects after radiation therapy, with no treatment-related hospitalizations or deaths and only three isolated cases of grade 2 to 3 side effects. Most patients who reported long-term results in the study maintained a good quality of life after treatment, he said.

Some patients with larger or more complex tumors remain better candidates for surgery, Dr. Chang. He also emphasized the importance of multidisciplinary collaboration between thoracic surgeons and radiation oncologists in the care of these patients and the need to carefully monitor patients receiving SABR over time for possible relapses.

Researchers are now exploring strategies to further reduce recurrence rates, including combining local therapies with immunotherapy and using artificial intelligence tools to predict hidden lymph node involvement before it shows up on PET/CT scans, Dr. Chang. "Although SABR provided excellent long-term results, up to a third of patients treated with local therapies still developed locoregional or distant recurrences of this aggressive cancer. Our goal is to find new ways to increase survival rates even further."

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