Role of Sublobar Resection in Early-Stage NSCLC Treatment

By: Amanda E. Ruffino, BA
Posted: Tuesday, May 7, 2024

Suresh Senan, MRCP, FRCR, PhD, of Cancer Center Amsterdam, and colleagues have illustrated the findings of two well-conducted trials, JCOG0802 and CALGB 140503, that randomized 1,803 patients with early-stage peripheral non–small cell lung cancer (NSCLC) measuring ≤ 2 cm. These findings have significantly impacted the treatment landscape by establishing sublobar resection as a new standard over lobar resection, the authors noted. The results, published in Radiotherapy and Oncology, have implications for clinical practice, particularly in guiding treatment decisions for patients with operable disease, including considerations of alternative modalities such as stereotactic ablative radiotherapy (SABR).

The JCOG0802 trial enrolled 979 patients, and the CALGB 140503 trial enrolled 824 patients, all of whom were randomly assigned to undergo either lobar or sublobar resection. The primary endpoint for both trials was overall survival, with secondary endpoints including disease-free survival and treatment-related complications.

Both trials demonstrated comparable low postoperative mortality rates, indicating the safety of both surgical procedures. However, there were notable differences in overall survival between the study populations, highlighting the influence of confounding factors such as smoking history and comorbidities on reported outcomes. For example, although the postoperative mortality rates were comparable between the two surgical procedures, the 5-year disease-free survival rate in CALGB 140503 was approximately 60% with either lobar or sublobar resection. Additionally, during follow-up, between 15% and 18% of patients in both trials developed other malignancies, underscoring the importance of comprehensive long-term monitoring in this patient population.

Of note, patients who underwent sublobar resections exhibited better long-term survival and were more likely to undergo additional curative treatments compared with those who underwent lobar resections. According to the authors, these results suggest that sublobar resection may offer advantages in terms of both survival outcomes and potential for further treatment options.

Disclosure: For full disclosures of the study authors, visit thegreenjournal.com.

Radiotherapy and Oncology

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