Top Line: It turns out patients don’t love a coin toss deciding whether they will undergo major surgery, so we have to turn to more creative strategies than a tried and true randomized trial to compare outcomes after surgery and ablative radiation for early-stage non-small cell lung cancer (NSCLC).
The Study: The only pooled prospective data we have on the subject suggests equipoise. Here we have more pooled prospective data drawing on 1115 patients receiving surgery (n=1003) or ablative radiation (n=112) per “shared decision-making” for cT1a-bN0 NSCLC prospectively enrolled in one of two cohort studies. Surgery consisted of lobectomy (56%) or sublobar resection (44%), primarily wedge resection. As expected, the surgical group was significantly younger with significantly fewer comorbidities. Nonetheless, lung cancer-specific survival was nearly identical: 94% after surgery versus 93% after radiation at 5 years and 90% versus 88% at 10 years. What’s more, overall survival was similar for 110 propensity matched pairs.
TBL: “This supports SBRT as an alternative treatment option for small, early NSCLCs [with treatment decisions] personalized based on the unique circumstances of each patient.” | Henschke, J Thorac Oncol 2023
The Study: The only pooled prospective data we have on the subject suggests equipoise. Here we have more pooled prospective data drawing on 1115 patients receiving surgery (n=1003) or ablative radiation (n=112) per “shared decision-making” for cT1a-bN0 NSCLC prospectively enrolled in one of two cohort studies. Surgery consisted of lobectomy (56%) or sublobar resection (44%), primarily wedge resection. As expected, the surgical group was significantly younger with significantly fewer comorbidities. Nonetheless, lung cancer-specific survival was nearly identical: 94% after surgery versus 93% after radiation at 5 years and 90% versus 88% at 10 years. What’s more, overall survival was similar for 110 propensity matched pairs.
TBL: “This supports SBRT as an alternative treatment option for small, early NSCLCs [with treatment decisions] personalized based on the unique circumstances of each patient.” | Henschke, J Thorac Oncol 2023