Surgery versus SABR for resectable non-small-cell lung cancer - Part 7 of 9

This is a letter in response to the article by Chang and colleagues. The authors begin by stating that the data from this study should be graded according to an internationally accepted system, GRADE. In terms of overall mortality, the study should be downgraded by two points to low quality, because the two trials had different results and the pooled estimate is inaccurate. Moreover, given the small sample size, it is likely that the two groups differed with regards to risk of mortality, perhaps with higher risk patients randomised to the surgical arm as evidenced by the unacceptably high mortality rate in that group. They also point out that only 27% of patients in the SABR arm of the ROSEL trial had biopsy proven NSCLC. In addition, Figure 2, A (overall survival) has a hazard ratio of 0.14 in favor of SABR, but the 95% CI (0.017-1.190) is discrepant with the p-value of 0.037. Lastly, the original article concluded that the two treatments were equally effective although the two trials were not designed as equivalence trials. The authors state that no conclusions can be drawn from the data of these trials.