Decade-Long Study Shows Radiation Therapy Equal in Effectiveness to Surgery for Early-Stage Non-Small Cell Lung Cancer

A comprehensive 10-year clinical trial has demonstrated that stereotactic radiation therapy (SABR) provides survival outcomes comparable to surgical removal for patients diagnosed with small, early-stage non-small cell lung cancer (NSCLC). The study revealed that patients treated with radiation experienced fewer adverse effects compared to those undergoing surgery.

The trial, known as the STARS trial (NCT02357992), is the first to present long-term results from a prospective comparison of SABR versus surgical resection in operable NSCLC cases. Results were shared at the American Society for Radiation Oncology (ASTRO) Annual Meeting.

According to senior author Dr. Joe Y. Chang from the University of Texas MD Anderson Cancer Center, the data confirms that stereotactic radiotherapy is a formidable alternative to surgery for most patients with stage I NSCLC. The targeted, noninvasive treatment achieved nearly identical overall survival rates after ten years: 69% for the radiation group and 66% for the surgical group. Lung-cancer-specific survival was high in both groups, 92% and 89%, respectively, with recurrence-free survival also showing comparable figures.

Historically, surgery was the standard treatment for early-stage NSCLC. However, more than half of the patients often face significant side effects post-surgery, which can be especially challenging for older adults who may not tolerate invasive procedures. SABR, involving high doses of precisely delivered radiation over typically five or fewer sessions, has become standard care for those who cannot undergo surgery. Growing evidence suggests even suitable candidates for surgery may benefit similarly from this noninvasive approach.

The trial involved 80 patients with tumors less than 3 centimeters, no lymph node involvement, and no metastases. These patients received SABR in three or four sessions, matched against 80 patients who underwent minimally invasive lobectomy with lymph node removal. Both groups were treated at MD Anderson between 2015 and 2017 and followed for up to a decade.

Results showed that after a median follow-up of 8.3 years, survival rates were remarkably similar: 69% for SABR and 66% for surgery at ten years post-treatment. The rates of lung cancer-specific survival and recurrence-free survival also closely aligned. Side effects were minimal, with no hospitalizations or deaths related to treatment and only three cases of grade 2-3 side effects reported. Most patients maintained good quality of life long-term.

Dr. Chang emphasized that larger or complicated tumors might still warrant surgical intervention, highlighting the importance of multidisciplinary care involving thoracic surgeons and radiation oncologists. Ongoing research is exploring ways to further improve outcomes, including combining local therapies with immunotherapy and employing artificial intelligence to better detect lymph node involvement.

Ultimately, the study supports increasing use of SABR as a viable, effective, and less invasive treatment option for early-stage NSCLC patients, offering comparable survival with fewer side effects and better quality of life.

Source: https://medicalxpress.com/news/2025-09-year-clinical-trial-surgery-early.html