Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-cell lung cancer: a pooled analysis of two randomized controlled trials - Part 1 of 9

Thus far, only 3 randomized controlled trials (RCTs) have compared stereotactive ablative radiotherapy (SABR) versus surgery in patients with early stage NSCLC (STARS trial, ROSEL trial, and ACOSOG Z4099 trial). Unfortunately all 3 were unable to meet the accrual goals and were closed early. The current study is a pooled analysis of patients in the STARS trial and ROSEL trial (n=31 in SABR group and n=27 in surgery group). All patients had clinical stage I NSCLC (<4 cm) and were surgical candidates for lobectomy with a performance status of 0 to 2. Of note, patients in the STARS trial required histologic confirmation of NSCLC prior to randomization, but patients in the ROSEL trial did not. Overall 1 and 3-year survival was 100% and 95% in the SABR group and 88% and 79% in the surgery group. There was no significant difference in local, regional, or distant metastases or recurrence-free survival between the two groups. In terms of complications, in the SABR group, 3 (10%) patients had treatment related grade 3 adverse events. In the surgery group, one patient died of complications and 12 (44%) had postoperative grade 3-4 adverse events. The authors concluded that SABR is better tolerated and may lead to improved survival over surgery in patients with stage I NSCLC.