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How Does Stereotactic Ablative Radiotherapy Measure Up Against Surgery in Stage I NSCLC?

By: Joseph Fanelli
Posted: Thursday, November 4, 2021

Updated results of the STARS trial, presented in The Lancet Oncology, demonstrated that long-term survival for patients with operable stage IA non–small cell lung cancer (NSCLC) who were treated with stereotactic ablative radiotherapy (SABR) was “noninferior” when compared with treatment with video-assisted thoracoscopic surgical lobectomy with mediastinal lymph node dissection (VATS L-MLND). Joe Y. Chang, MD, PhD, of the MD Anderson Cancer Center, Houston, and colleagues noted that this noninvasive procedure may prove to be an alternative to surgery for some patients, although multidisciplinary management is recommended.

“Considering much lower treatment-related side effects and complications as compared with surgery, noninvasive SABR can offer patients a much better quality of life, particularly for senior patients or those with comorbidities,” said Dr. Chang in an MD Anderson press release.

This trial generated updated long-term results from the single-arm prospective STARS trial. The authors enrolled 80 patients with newly diagnosed and histologically confirmed NSCLC with a Zubrod performance status of 0 to 2 and a tumor diameter up to 3 cm. This trial did not include patients from the previous pooled analysis. The patients received SABR dosing of 54 Gy in three factions or 50 Gy in four fractions.

The overall survival rate of those treated with SABR was 91% at 3 years and 87% at 5 years. Treatment with SABR was reported to be well tolerated, with no grade 4 or 5 toxicities. There was one case each of grade 3 dyspnea, grade 2 pneumonitis, and grade 2 lung fibrosis. No patients reported serious adverse events.

In the propensity-matched group of patients treated with VATS L-MLND, overall survival was 91% at 3 years and 84% at 5 years. The authors claimed noninferiority because the 3-year overall survival for those treated with SABR was not lower than that for those treated with VATS L-MLND. The investigators found no significant difference in overall survival between the two patient groups following a multivariable analysis.

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



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