Long-Term Study Reveals Radiation Therapy Matches Surgery for Early-Stage Lung Cancer

A recent clinical trial has demonstrated that stereotactic radiation therapy can provide long-term survival rates comparable to surgical options for patients with early-stage non-small cell lung cancer (NSCLC). The findings indicate that patients who underwent radiation treatment experienced fewer side effects compared to those who opted for surgery.

The STARS trial, which is the first of its kind to present a decade's worth of clinical data comparing stereotactic radiation with surgical resection in operable cases of NSCLC, was unveiled at the American Society for Radiation Oncology (ASTRO) Annual Meeting. The lead researcher emphasized the significance of the study, noting that stereotactic radiotherapy is a viable alternative for most patients diagnosed with operable stage I NSCLC.

According to the research, this non-invasive treatment achieved similar long-term survival outcomes to those of lobectomy surgery, while also facilitating a smoother recovery process and potentially enhancing the patients' quality of life.

Lung cancer remains the leading cause of cancer-related mortality globally. However, survival rates have improved due to advancements in treatment methods and earlier detection through screening initiatives. NSCLC constitutes over 85% of all lung cancer cases, with an estimated 226,650 new diagnoses anticipated in the United States in 2025.

Stereotactic ablative radiotherapy (SABR), also referred to as stereotactic body radiation therapy (SBRT), involves administering high doses of radiation with exceptional precision, typically across five sessions or fewer. It is the standard treatment for early-stage NSCLC patients who cannot undergo surgical procedures. Growing evidence suggests that SABR may even provide survival benefits on par with surgical interventions for those who are eligible for surgery.

Historically, surgery was the sole standard treatment option for early-stage NSCLC; however, over 50% of patients report moderate to severe side effects post-operation. As the population ages, many individuals may not be in a position to endure surgical procedures, leading to an increasing demand for non-invasive treatments that ensure durable local control of cancer.

The study enrolled 80 patients with tumors measuring less than 3 centimeters, no lymph node involvement, and no distant metastases to receive SABR in three or four sessions. These patients were matched with a surgical group also comprising 80 patients who underwent video-assisted thoracoscopic (VATS) lobectomy along with mediastinal lymph node removal.

Both patient cohorts were selected from an institutional database during the same timeframe and matched based on factors such as age, gender, tumor size, and overall health status. All participants were fit enough to undergo either treatment modality and were treated at MD Anderson from 2015 to 2017. The researchers monitored both groups for up to ten years, analyzing survival rates, recurrence, side effects, quality of life, and financial implications.

After a median follow-up period of 8.3 years, overall survival rates were nearly identical between the two groups: 69% of patients treated with SABR and 66% of those who underwent surgery were alive after ten years. Additionally, lung cancer-specific survival rates were 92% for the SABR group compared to 89% for the surgical cohort, while recurrence-free survival rates were reported at 57% and 65%, respectively.

Previous reports from the research team indicated three- and five-year overall survival rates of 91% and 87% following SABR treatment. The study also noted minimal side effects associated with radiation therapy, with no treatment-related hospitalizations or fatalities and only three isolated cases of more severe side effects. Most patients who reported long-term outcomes maintained a good quality of life post-treatment.

However, the researchers acknowledged that some patients with larger or more complex tumors may still be better suited for surgical intervention. They underscored the importance of collaboration between thoracic surgeons and radiation oncologists to ensure optimal care for these patients and the necessity of ongoing monitoring for those receiving SABR to detect potential recurrences.

Current research efforts are focused on strategies to further minimize recurrence rates, including combining local therapies with immunotherapy and utilizing artificial intelligence to predict hidden lymph node involvement before it becomes evident on PET/CT scans. The ongoing goal is to enhance survival rates even further for patients dealing with this aggressive form of cancer.