Searching for an alternative to surgery for early lung cancer

Patients with operable stage I non-small cell lung cancer (NSCLC) could achieve better overall survival rates if treated with Stereotactic Ablative Radiotherapy (SABR) rather than the current standard of care — invasive surgery — according to research from a phase III randomized international study fromMD Anderson Cancer Center.

The findings, published inThe Lancet Oncology, are from the first randomized clinical trials comparing SABR and surgery.

“For the first time, we can say that the two therapies are at least equally effective, and that SABR appears to be better tolerated and might lead to better survival outcomes for these patients,” said the first author and principal investigatorJoe Y. Chang, M.D., Ph.D., professor ofRadiation Oncology. “Stereotactic radiation treatment is a relatively new approach for operable early stage lung cancer, while surgery has been the standard for a century. This study can give physicians confidence to consider a non-invasive option.”

The researchers analyzed overall survival, recurrences and toxicity in 58 patients. Estimated three-year survival rates were 79% in the surgery group and 95% in the SABR group, while recurrence-free survival rates at three years were 80% and 86%, respectively. Six patients in the surgery group died versus one death within the SABR group. None of the patients treated with SABR had high-grade toxicity.

The authors suggest that the lower survival rate following surgery could be attributed to other simultaneous conditions that were worsened by the surgical reduction of lung function. As such, the findings support SABR as a non-invasive alternative, especially for elderly patients and for those with significant comorbidities.

According to the Centers for Disease Control and Prevention, lung cancer is the leading cancer killer in both men and women in the United States. The American Cancer Society reports that over half of people with lung cancer die within one year of being diagnosed, and, according to the National Cancer Institute, an estimated 158,040 Americans are expected to die from the disease in 2015.

“The findings of our study provide strong support for a large clinical trial to investigate the potential superiority of SABR for patients with early-stage disease,” said senior authorJack A. Roth, M.D., Professor and Bud Johnson Clinical Distinguished Chair Department of Thoracic & Cardiovascular Surgery. “While we wait for more data, physicians can consider SABR an effective treatment for these patients, especially for those whom surgery brings high risk.”

Read more about these findings on MD Anderson'swebsite.