A recent clinical trial found that a highly targeted form of radiation therapy works just as well as surgery to treat early-stage non-small cell lung cancer (NSCLC), even 10 years after treatment. These findings could expand treatment options for people who are newly diagnosed with NSCLC and who may not be good candidates for surgery.

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“Our study confirms, based on a decade of data, that stereotactic radiotherapy is a strong alternative to surgery for most patients with operable stage 1 NSCLC,” said Dr. Joe Y. Chang, senior author of the study. Dr. Chang is also professor of thoracic radiation oncology and director of stereotactic ablative radiotherapy at the University of Texas MD Anderson Cancer Center. “This highly targeted, noninvasive treatment achieved the same long-term overall survival as lobectomy, while offering many patients an easier recovery and potentially better quality of life.”

A lobectomy is surgery to remove the lobe of the lung affected by cancer. This procedure is commonly recommended for stage 1 lung cancer.

What Did the Study Find?

The study, known as the revised STARS trial, compared two treatment approaches for early-stage NSCLC — a type of radiation therapy and a type of lobectomy surgery:

• Stereotactic ablative radiotherapy (SABR) — This noninvasive radiation treatment (it doesn’t require cuts or incisions) delivers precise, high-dose radiation, usually in just a few sessions. SABR is also called stereotactic body radiation therapy (SBRT).
• Video-assisted thoracoscopic (VATS) lobectomy with mediastinal lymph node removal — This is the standard surgery for NSCLC. VATS lobectomy removes the tumor and nearby lymph nodes.

The study followed 160 people (80 in each group) for a median of just over eight years. All participants had tumors smaller than 3 centimeters, had no cancer in their lymph nodes, and were healthy enough to have either treatment.

After 10 years, the researchers found these key results:

• The two groups had nearly the same overall survival rate, which reflects how many people were still alive, regardless of the cause of death. About 69 percent of people treated with SABR and 66 percent of those who had surgery were alive after 10 years.
• Lung cancer-specific survival was also similar, at 92 percent for those who received SABR and 89 percent for those who had VATS surgery.
• Recurrence-free survival rates — the percentage of people alive without their cancer returning after treatment — were 57 percent with SABR and 65 percent with surgery.
• Fewer short-term side effects were seen with radiation. No one treated with SABR was hospitalized or died due to treatment, and only a few had moderate side effects.

What Does This Mean for People Living With Lung Cancer?

Surgery has long been considered the best treatment for early-stage NSCLC, especially for people healthy enough for an operation. However, not everyone is a good candidate for surgery due to other health issues or personal choice. This new study provides strong, long-term evidence that SABR may be an effective alternative for people with small, early-stage lung tumors.

It’s important to know that these findings apply to people with small tumors (less than 3 centimeters) and no lymph node involvement. People with larger or more complex tumors may still benefit more from surgery. Your doctor may also recommend additional treatment after surgery or radiation to lower the risk of the cancer coming back.

Talk with your doctor about what these findings could mean for you, and ask about both surgical and radiation therapy options for early-stage lung cancer.

Join the Conversation

On MyLungCancerTeam, people share their experiences with lung cancer, get advice, and find support from others who understand.

Have you or a loved one been offered a choice between radiation therapy and surgery for early-stage lung cancer? Let others know in the comments below.