Lobectomy versus stereotactic ablative radiotherapy for medically operable patients with stage IA non‐small cell lung cancer: A virtual randomized phase III trial stratified by age

Abstract

Background Although the choice between stereotactic ablative radiotherapy ( SABR) and lobectomy for early‐stage non‐small cell lung cancer (NSCLC) has been debated for years, the two procedures have not yet been directly compared in a randomized trial. We conducted a virtual randomized phase III trial stratified by age to compare the effectiveness of lobectomy and SABR for medically operable patients with stage IA (AJCC eighth) NSCLC using the Markov model analysis. Methods A Markov model was developed to simulate a cohort of patients aged 45–85 years with stage IA NSCLC who had undergone either lobectomy or SABR and were followed up for their remaining lifetime. Each virtual patient was randomly assigned to undergo lobectomy or SABR, and 10 000 patients were allocated to each group. All estimates of the variables were obtained by a systematic review of published articles. Results The lobectomy group showed a better life expectancy than the SABR group, in patients under 75 years of age. However, no statistically significant difference was seen in patients 75 years or older. The predicted life expectancy was 9.43 and 8.70 years in 75‐year‐old patients in the lobectomy and SABR groups, respectively. However, the 95%CI for the difference in life expectancy between the two groups was ‐ 0.06–1.50 years ( P = 0.0689). Conclusions The Markov model showed no statistically significant difference in the expected overall survival in stage IA NSCLC patients who were older than 75 years and had undergone SABR or lobectomy.

Robotic surgery can extend surgical indication in patients with lung cancer and impaired function

“…According to the findings of Kneuertz (17) and other previous works the minimally invasive approaches should be considered in comparative trials of surgery versus SBRT treatment as it is associated to reduced complications (30). Among them, RATS may represent the best minimally invasive surgical approach of the future in relation to the improved mediastinal and hilar lymph node dissection obtained (24,25), the indisputable technical advantages including better ergonomics and optimal 3D view and the possibility to easily perform complex interventions such as difficult anatomical segmentectomies using indocyanine green (31) for very early stages, thus sparing useful lung parenchima.…”

Bronchoscopic treatments for early‐stage peripheral lung cancer: Are we ready for prime time?

“…27,28 Markov modelling suggests survival outcomes may not differ in patients aged over 75 years. 29 This is important given the higher rates of perioperative mortality seen in octogenarian patients. 17,18 While SABR has revolutionized management of stage I NSCLC, particularly in high surgical risk, or medically inoperable patients, toxicities preclude its use in patients with underlying pulmonary disease (e.g.…”

A novel nomogram to predict lymph node metastasis in cT1 non-small-cell lung cancer based on PET/CT and peripheral blood cell parameters

“…Although lobectomy is still the gold standard for early-stage NSCLC patients, sub-lobar resection has been shown to achieve similar effects [ 3 , 4 ]. Besides, stereotactic ablative radiotherapy (SABR) can be an option for stage I patients especially in the elderly [ 5 , 6 ]. However, for stage N1 and N2 patients, lobectomy with systemic mediastinal lymph node dissection (SLD) is strongly recommended.…”