Stereotactic ablative radiotherapy shows long-term benefit in operable early NSCLC
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Stereotactic ablative radiotherapy appeared as effective as surgery among patients with operable early-stage non-small cell lung cancer, according to results published in The Lancet Oncology.
Researchers additionally observed minimal adverse events with stereotactic ablative radiotherapy (SABR).
“In 2015, we published a pooled randomized clinical study to compare SABR with surgical lobectomy for stage I NSCLC in The Lancet Oncology. Results of that study showed OS at 3 years was better with SABR compared with surgical resection due to surgery-related mortality and complications,” Joe Y. Chang, MD, PhD, FASTRO, Texas 4000 distinguished professor and director of stereotactic ablative radiotherapy in the department of radiation oncology at The University of Texas MD Anderson Cancer Center, told Healio. “However, major limitations of our previous study included the small patient numbers due to poor enrollment and short-term follow-up, and poor patient enrollment was due to treating physicians’ or patients’ biases favoring one or the other.”
For the current study, Chang and colleagues changed to a single-arm design with a prespecified comparison with more modern video-assisted thoracoscopic surgical lobectomy with mediastinal lymph node dissection.
The cohort included 80 patients who underwent SABR for early-stage NSCLC between Sept. 1, 2015, and Jan. 31, 2017. Researchers compared those patients with a cohort of propensity-matched patients undergoing surgery during the same period.
Median follow-up was 5.1 years (interquartile range, 3.9-5.8).
Results showed 3-year OS of 91% (95% CI, 85-98) among both the SABR and surgery cohorts and 5-year OS of 87% (95% CI, 79-95) with SABR and 84% (95% CI, 76-93) with surgery.
Multivariable analysis showed no significant differences in OS between the two cohorts (HR = 0.86; 95% CI, 0.45-1.65). The SABR and surgery cohorts also had similar rates of PFS at 3 years (80% vs. 88%) and at 5 years (77% vs. 80%).
Researchers observed only one case of grade 3 dyspnea and no grade 4 to grade 5 adverse events with SABR.
“Since both SABR and surgery achieved similar long-term survival, patients with operable early-stage NSCLC have two great treatment options. In general, patients who are young and have no significant comorbidities should consider having surgical resection because they can tolerate an invasive procedure much better than older patients,” Chang said. “For older-aged patients, particularly those with significant comorbidities, SABR may significantly reduce side effects and complications and achieve similar long-term survival. A multidisciplinary team discussion — including surgeons, radiation oncologists, medical oncologists, pulmonary physicians, pathologists and diagnostic radiologists — is critical to provide the optimal treatment option for these patients.”
Chang and colleagues are now conducting a randomized study to compare SABR alone vs. SABR plus the anti_PD-1 antibody nivolumab (Opdivo, Bristol Myers Squibb) among patients with early-stage NSCLC.
For more information:
Joe Y. Chang, MD, PhD, FASTRO, can be reached at The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030; email: jychang@mdanderson.org.
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Chang JY, et al. Lancet Oncol. 2021;doi:0.1016/S1470-2045(21)00401-0.
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