The study indicates that surgery remains the treatment most likely to improve survival rates for patients eligible for either intervention.
Why does surgery currently outperform SABR in patient survival?
The research, which utilized an emulated target trial design to analyze real-world data from England’s National Cancer Registry, provides a direct comparison between these two primary interventions. By applying the principles of a randomized controlled trial to existing hospital and radiotherapy records, investigators sought to bridge a significant evidence gap that has persisted due to previous randomized trials failing to recruit enough patients. Study authors characterized this evaluation as a groundbreaking, first-of-its-kind comparison of the 2 modalities utilizing this approach.
Richard Grieve, professor of health economics at LSHTM and a co-author of the study, emphasized the practical takeaway for clinicians.
For most patients with early-stage NSCLC who are eligible for surgery, our results provide reassurance that it remains the treatment most likely to improve survival rates.
While aligning with current NICE recommendations, this discovery additionally assists in defining scenarios where substitute options like SABR might enhance patient care quality and overall results.
How do outcomes shift for older patients?
One of the nuances of the study involves the treatment of patients aged 80 years and older. Within this specific cohort, the investigators observed no statistically significant variance regarding 3-year all-cause mortality between the 2 interventions. This suggests that SABR could offer an alternative treatment with curative intent for selected older populations. For individuals with early-stage NSCLC who either decline surgery or are deemed medically unfit for the procedure, SABR is presently advised as a curative-intent therapy.
The research additionally documented that average 3-year lung cancer–specific mortality estimations stood at 20.6% following SABR compared with 14.5% after surgery, alongside elevated recurrence projections for SABR relative to surgical intervention. However, these differences were not statistically significant. Approximately 2000 individuals diagnosed with early-stage lung cancer annually in England could potentially qualify for either surgery or SABR—with about 1 out of 5 currently undergoing SABR, a figure that has grown over recent years—making these statistics particularly pertinent to that region.
What are the implications for current clinical practice?
The research, supported by the National Institute for Health and Care Research Biomedical Research Centre in Manchester, does not advocate for the abandonment of radiotherapy. Instead, it helps clinicians identify where alternative treatments, such as SABR, may improve patient outcomes and their quality of care. Ultimately, the study team determined that surgery ought to stay the standard first-line approach for patients with early-stage NSCLC who are candidates for either surgery or SABR.
As the medical community continues to refine these pathways, the reliance on real-world evidence becomes vital. With ongoing studies yet to report their data, this analysis provides guidance for specialists balancing the risks of surgical intervention against alternative treatments.
