Measuring the Integration of Stereotactic Ablative Radiotherapy Plus Surgery for Early-Stage Non-Small Cell Lung Cancer: Long-Term Clinical Outcomes.

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For early-stage non-small cell lung cancer, surgery is the preferred approach in operable patients, whereas SABR is preferred for patients who are medically inoperable. The combination of neoadjuvant SABR followed by surgery was tested in the Measuring the Integration of Stereotactic Ablative Radiotherapy Plus Surgery for Early-Stage Non-Small Cell Lung Cancer (MISSILE) phase 2 trial. We report long-term outcomes beyond 5 years of follow-up. Patients diagnosed with T1-2N0M0 non-small cell lung cancer with good performance status and adequate lung function were enrolled. Patients underwent neoadjuvant SABR followed by lobectomy/wedge resection. Forty enrolled patients received SABR, of which 36 patients proceeded to surgery. The pathologic and major complete response rates were 60% and 63%, respectively. Median follow-up was 6.6 years following surgery. Five-year overall, disease-free, and cancer-specific survival were 66.7% (95% CI, 48.8%-79.5%), 58.3% (95% CI, 40.7%-72.4%), and 76.4% (95% CI, 58.2%-87.4%), respectively. Five-year local, regional, and distant control were 93.5% (95% CI, 76.3%-98.4%), 80.1% (95% CI, 62.7%-90.0%), and 82.4% (95% CI, 64.9%-91.7%), respectively. After SABR and surgery, 16.7% (n = 6) of patients experienced related grade ≥3 adverse events, and there were no grade 5 events. The combined approach of SABR and surgery was safe and demonstrated reasonable long-term clinical outcomes, but similar to surgery alone.