Long-term benefit of SABR for operable early-stage NSCLC shown in new
study

Date:
September 14, 2021
Source:
University of Texas M. D. Anderson Cancer Center
Summary:
A new study showed that stereotactic ablative radiotherapy (SABR)
was as effective as surgery at providing long-term benefits to
patients with operable early-stage non-small cell lung cancer
(NSCLC) and generated minimal side effects. The study is the first
of its kind to compare long- term results of SABR against surgical
treatment in patients with operable early-stage NSCLC.



FULL STORY ==========================================================================
A new study from researchers at The University of Texas MD Anderson
Cancer Center showed that stereotactic ablative radiotherapy (SABR) was
as effective as surgery at providing long-term benefits to patients with operable early- stage non-small cell lung cancer (NSCLC) and generated
minimal side effects.

The study is the first of its kind to compare long-term results of SABR
against surgical treatment in patients with operable early-stage NSCLC.


==========================================================================
The findings from the single-arm, non-randomized STARS trial -- led by
Joe Chang, M.D., Ph.D., professor of Radiation Oncology, and Jack Roth,
M.D., professor of Thoracic and Cardiovascular Surgery -- were published
today in The Lancet Oncology.

SABR is treatment that concentrates intense doses of radiation on a
specific tumor site without damaging surrounding healthy tissue. It is
used as standard treatment for inoperable early-stage NSCLC. Due to its effectiveness, convenience and noninvasiveness, there is growing interest
in exploring SABR as a treatment for patients with operable diseases.

"After surgical resection, recovery may be prolonged and there can
be significant loss of lung function depending on the amount of lung
removed," Chang said. "However, SABR functions as a non-invasive 'knife'
to eliminate cancer with minimal side effects. Patients are treated in
30 minutes as an outpatient procedure, and they can return home or even
work the same day after therapy is delivered. Lung function is preserved."
The study builds on the pooled analyses of two randomized studies (STARS
and ROSEL trials), published in 2015, that investigated the advantages
of SABR versus a surgical procedure called video-assisted thoracoscopic surgical lobectomy with mediastinal lymph node dissection (VATS L-MLND).

For the current study, the researchers enrolled 80 newly diagnosed
patients with early-stage NSCLC with tumor sizes 3 cm or smaller from
Sept. 1, 2015, through Jan. 31, 2017, and compared their results to propensity-matched patients undergoing surgery during the same time
period. The final follow-up was Sept. 30, 2020, with a median follow-up
of 5.1 years.



==========================================================================
The results showed that the overall survival (OS) rates of the SABR and surgical cohorts were not significantly different. The SABR and surgical cohorts both achieved a three-year OS rate of 91%. The five-year OS rate
was 87% in the SABR arm versus 84% in the surgical arm.

The progression-free survival (PFS) rates also were similar. The
three-year PFS rate was 80% for the SABR group versus 88% for the surgical group, while the five-year PFS rate was 77% versus 80%, respectively. SABR
was well-tolerated, with no grade 4-5 toxicity. Only one case (1.3%)
of grade 3 dyspnea was reported.

Overall, these findings illustrate that SABR and VATS L-MLND surgery
achieved similar outcomes, Chang said. Both were effective in extending OS
and PFS, but SABR is a less invasive procedure and may be more beneficial
for certain patients.

"While surgical resection provides additional information about
mediastinal lymph node involvement, the procedure is associated with significant side effects and complications," Chang said. "Considering
much lower treatment- related side effects and complications as compared
with surgery, non-invasive SABR can offer patients a much better quality
of life, particularly for senior patients or those with co-morbidities."
While SABR remains a promising treatment option for patients with operable early-stage NSCLC, multidisciplinary management is strongly recommended.

"Further study is needed to better understand who benefits most from
surgery versus SABR, because both treatment options achieve local control
in early- stage lung cancer," Chang said. "The future question is how
to further reduce lymph node and distant recurrence for these patients."
Chang and his team currently are working on a randomized study to compare
SABR with SABR and anti-PD-1 immunotherapy (I-SABR study) combined, particularly for patients with larger tumors, isolated recurrences or multi-primary lung cancer.

========================================================================== Story Source: Materials provided by University_of_Texas_M._D._Anderson_Cancer_Center.

Original written by Shanley Chien. Note: Content may be edited for style
and length.


========================================================================== Journal Reference:
1. Joe Y Chang, Reza J Mehran, Lei Feng, Vivek Verma, Zhongxing
Liao, James
W Welsh, Steven H Lin, Michael S O'Reilly, Melenda D Jeter,
Peter A Balter, Stephen E McRae, Donald Berry, John V Heymach,
Jack A Roth, Mara Antonoff, Wayne Hofstetter, Ravi Rajaram, David
Rice, Boris Sepesi, Stephen Swisher, Ara Vaporciyan, Garrett
Walsh, Craig DeGraaf, Arlene Correa, Aileen Chen, Saumil Gandhi,
Ritsuko Komaki, Percy Lee, Quynh-Nhu Nguyen, Matthew Ning, Song
Gao, Julianne Pollard-Larkin, Paige Nitsch, Ramaswamy Sadagopan,
Xiaochun Wang. Stereotactic ablative radiotherapy for operable stage
I non-small-cell lung cancer (revised STARS): long- term results
of a single-arm, prospective trial with prespecified comparison
to surgery. The Lancet Oncology, 2021; DOI: 10.1016/S1470-2045
(21)00401-0 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2021/09/210914100059.htm

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