Top Line: Synchronous lung primaries are not uncommon and require upfront thoughtful multidisciplinary discussion.
The Study: An enlightening retrospective analysis of 835 veterans with synchronous stage I NSCLC treated between 2006 and 2024 examines trends and outcomes associated with surgery, stereotactic body radiotherapy (SBRT), or both. While the incidence of synchronous primaries remained stable at approximately 3% of stage I cases, SBRT utilization increased dramatically over time. The incorporation of SBRT as a component of treatment, to either one or both sites, increased from <20% of cases in 2008 to >60% in 2024. Adjusted 5-year overall survival improved across treatment groups, reaching 72% overall, though disease-free survival favored a surgery-only approach. Adjusted 5-year disease-free survival was 43% when SBRT was delivered to either both or one lesion versus 57% when surgery was performed on both. It is unclear if the disease-free survival discrepancy is due to selection bias of tumors amenable to surgery representing more biologically indolent disease versus a true difference in local control.
TBL:Multimodality treatment for synchronous early-stage NSCLC is rising with survival outcomes improving across all curative-intent approaches. | Brandt, Ann Thorac Surg 2025
The Study: An enlightening retrospective analysis of 835 veterans with synchronous stage I NSCLC treated between 2006 and 2024 examines trends and outcomes associated with surgery, stereotactic body radiotherapy (SBRT), or both. While the incidence of synchronous primaries remained stable at approximately 3% of stage I cases, SBRT utilization increased dramatically over time. The incorporation of SBRT as a component of treatment, to either one or both sites, increased from <20% of cases in 2008 to >60% in 2024. Adjusted 5-year overall survival improved across treatment groups, reaching 72% overall, though disease-free survival favored a surgery-only approach. Adjusted 5-year disease-free survival was 43% when SBRT was delivered to either both or one lesion versus 57% when surgery was performed on both. It is unclear if the disease-free survival discrepancy is due to selection bias of tumors amenable to surgery representing more biologically indolent disease versus a true difference in local control.
TBL:Multimodality treatment for synchronous early-stage NSCLC is rising with survival outcomes improving across all curative-intent approaches. | Brandt, Ann Thorac Surg 2025