Surgery versus SABR for early-stage lung cancer-time to call it a draw?

Abstract

Randomised controlled trials comparing surgery with non-surgical treatment for cancer have been notoriously difficult to complete, owing to challenges in both equipoise and preference in patients and providers alike. 1 Nguyen TK Nguyen EK Warner A Louie AV Palma DA Failed randomized clinical trials in radiation oncology: what can we learn?. Int J Radiat Oncol Biol Phys. 2018; 101: 1018-1024 Summary Full Text Full Text PDF PubMed Scopus (20) Google Scholar Debate on the relative merit of stereotactic ablative radiotherapy (SABR) versus surgery for early-stage non-small-cell lung cancer (NSCLC) is no exception. Prospective randomised controlled trials designed to identify a so-called winner between surgery and SABR have not been able to accrue, and the pooled analysis from the prematurely closed original STARS and ROSEL studies has been a lightning rod for discussion among thoracic oncologists. 2 Jones DR Do we know bad science when we see it?. J Thorac Cardiovasc Surg. 2015; 150: 472-473 Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar Even with other comparative effectiveness studies attempting to adjust for confounding, inherent limitations engender polarising opinions. 3 Chen H Laba JM Boldt RG et al. Stereotactic ablative radiation therapy versus surgery in early lung cancer: a meta-analysis of propensity score studies. Int J Radiat Oncol Biol Phys. 2018; 101: 186-194 Summary Full Text Full Text PDF PubMed Scopus (50) Google Scholar 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 surgeryLong-term survival after SABR is non-inferior to VATS L-MLND for operable stage IA NSCLC. SABR remains promising for such cases but multidisciplinary management is strongly recommended. Full-Text PDF