Long-term survival in NSCLC similar with stereotactic ablative radiotherapy or surgery

Reuters Health - 20/10/2021 - Long-term survival after stereotactic ablative radiotherapy is noninferior to surgery for operable stage 1 non-small-cell lung cancer, a U.S. study suggests.

Researchers examined data on 80 patients with early-stage non-small-cell lung cancer (NSCLC) who underwent stereotactic ablative radiotherapy at the University of Texas MD Anderson Cancer Center in Houston from Sept. 1, 2015, to Jan. 31, 2017. Outcomes were compared to a propensity matched cohort of patients with similar diagnoses and tumor characteristics who underwent surgical treatment at the same institution over the same time period.

The median follow-up period was 5.1 years and the primary endpoint was 3-year overall survival. Overall survival at three years was 91% in both the radiotherapy and the surgery cohorts. At five years, overall survival was similar for the two groups, at 87% with radiotherapy and 84% with surgery.

"It is the first report of long-term survival of early-stage lung cancer treated with stereotactic ablative radiotherapy," said senior study author Dr. Joe Y. Chang, director of Stereotactic Ablative Radiotherapy in the Department of Radiation Oncology at the MD Anderson Cancer Center.

"The result is a big surprise for the oncology community, because surgical resection has been the standard care of operable early-stage lung cancer for decades," Dr. Chang said by email. "In fact, most primary care physicians and lung cancer patients aren't aware that there is a non-invasive curative option for early-stage lung cancer."

The study also looked at progression free survival as a secondary endpoint, and found similar outcomes with both surgery and radiotherapy.

Three-year progression free survival was 80% with stereotactic ablative radiotherapy versus 88% with surgery. At three years, cancer-specific survival was also similar between the two intervention groups, at 95% with stereotactic ablative radiotherapy and 97% with surgery.

There were no significant differences in local recurrence rates or distant metastasis rates.

Stereotactic ablative radiotherapy was also well tolerated, researchers report in The Lancet Oncology. There were no serious adverse events or instances of grade 4-5 toxicity.

One limitation of the study is that the surgical patients were not treated under a fixed protocol, the authors point out. The results also might not be generalizable because longer intervals between PET-CT and initiation of stereotactic ablative radiotherapy that are common in community and rural facilities might result in different outcomes than those seen in the study population.

In general, patients who are young and have no significant comorbidities should consider having surgical resection because they can tolerate an invasive procedure better, Dr. Chang said.

However, for senior patients and those with significant co-morbidities, stereotactic ablative radiotherapy can significantly reduce side effects and complications and achieve similar long-term survival, Dr. Chang said.

"Multidisciplinary team discussion including surgeon, radiation oncologists, medical oncologist, pulmonary physicians, pathologist and diagnostic radiologist is critical to provide the optimal treatment option for these patients," Dr. Chang said.

SOURCE: https://bit.ly/3aVqCgr The Lancet Oncology, online September 13, 2021.

By Lisa Rapaport



Posted on 20 October 20212 November 2021