About 234,000 people will be diagnosed
with lung cancer in the U.S. this year,
according to the American Cancer
Society. About 16 percent of patients will
have early-stage tumors; these patients
have a 55 percent chance of being alive
five years after their cancer diagnosis.
Stereotactic body radiation therapy
(SBRT), also known as stereotactic
ablative body radiation (SABR), uses
more precise, higher doses of radiation
than conventional radiation therapy and
is delivered over a shorter period of time.
It’s now used to treat select patients with
distant metastases. Over the last decade,
SBRT has slowly been integrated into
treatment for early-stage cancers.
Ideally, doctors make treatment
recommendations based on results
from large, randomized clinical trials.
“Unfortunately, we don’t have those” data
to compare SBRT to surgery in early-stage lung cancer, says James Murphy, a
radiation oncologist at the University of
California, San Diego School of Medicine.
Not for a lack of trying. Since 2008,
three phase III trials comparing SBRT
with surgery have closed early due to low
patient enrollment. An analysis of pooled
data from two of those studies, which
included 58 patients, found that three
years out from treatment, the patients
who had received SBRT were more likely
to be alive than those who had surgery.
In addition, the patients who received
SBRT experienced fewer treatment-
related complications. But the limited data
prevent researchers from drawing solid
conclusions. As a result, says Murphy,
“We don’t have a really clear idea about
the best form of treatment.”
To gain new insights, Murphy reviewed
data from more than 4,000 veterans
diagnosed with early-stage NSCLC
between 2006 and 2015 at Veterans Affairs
hospitals. The majority— 3,620 patients—
had surgery to remove all or part of a lobe;
449 were treated with SBRT. Murphy’s
study, published in the February 2018
Annals of Thoracic Surgery, found that
long-term survival was better in the
surgery group. (Some patients died from
surgical complications.) Deaths from lung
cancer were more likely in the SBRT group.
Five years after treatment, 45 percent of
the patients treated with SBRT had died
from cancer, compared with 23 percent of
those who had surgery to remove an entire
lobe. Murphy says these findings suggest
that for most patients who are healthy
enough to be eligible, surgery remains the
best treatment option.
Even so, because SBRT carries few
immediate risks, it may be the best option
for certain patients. To identify who those
patients are, in July 2015 researchers
launched a clinical trial called Stablemates
to compare SBRT to surgery in patients
who, based on criteria such as lung
function or age, would be considered at
high risk for surgical complications. The
study is currently enrolling patients at
“We want to tease out the characteris-
tics of patients that make one treatment
work better than the other,” says Robert
Timmerman, a radiation oncologist at the
University of Texas Southwestern Medical
Center in Dallas who is co-leading the
Stablemates trial. (Timmerman led one
of the previous studies that closed early.)
“We want to give patients more choices
based on good information from a ran-
domized trial.” —S TEPHEN ORNES
EFFORTS UNDERWAY TO DEFINE ROLE OF
Surgery is the standard-of-care treatment for early-stage non–small cell lung cancer (NSCLC). In the late 1990s, early results from clinical trials suggested a new type of high-dose
radiation might be as effective as surgery for some patients. But
who those patients might be still is not clear.
For stage III non–small cell lung cancer (NSCLC), the standard of care is concurrent
chemotherapy and radiation therapy. An analysis of 12,641 patients 80 and over with
stage III NSCLC found that nearly 63 percent of these patients received no cancer-directed
treatment. Yet, the study also found that the patients who were treated had better overall
survival. The researchers say their findings underscore the need to focus attention on
addressing treatment disparities that can affect elderly adults.
LEARN MORE IN THE ONLINE FIRS T JAN. 8, 2018, CANCER.
If you have early-stage non–small cell lung
cancer (NSCLC), you should ask your doctors
• Have you considered all possible treatment
options? Surgery is the standard of care, but
you may have other options.
• Am I at high risk for complications from
surgery because of other health conditions
I have? If you are, then SBRT may be an option,
says Robert Timmerman, a radiation oncologist
at the University of Texas Southwestern Medical
Center in Dallas.
• What clinical trials am I eligible for?
Researchers need patients with early-stage
NSCLC who will consider enrolling in a clinical
trial. To find trials that might be right for you,
clinicaltrials.gov. To learn more about the
Stablemates trial, visit
Treatment Lags for Some Lung Cancer Patients Age 80 and Over