The MISSILE trial boldly asked if neoadjuvant lung SBRT delivered prior to lobectomy or sublobar resection for early-stage non-small cell lung cancer could both increase the rates of R0 resection and possibly even improve systemic disease control by invigorating antitumor immunity. That’s a lot to ask of combining two local therapies that both result in excellent local control. You may remember the notorious complete pathologic response rate of 60% (n=21/35). Unfortunately, long term reporting confirms “five-year outcomes, including an overall survival of 67% and disease-free survival of 58%, are similar to those reported for either modality alone.” Indeed, the common sense strategy of combining either surgery or SBRT with immunotherapy has been more successful. | Tan, Int J Radiat Oncol BIol Phys 2024
