Surgery or Radiotherapy for Early-Stage Lung Cancer?

Which early-stage lung cancer treatment best improves survival and outcomes has long been debated in oncology. An eagerly awaited study addressing this was published in January 2018 in the Journal of Clinical Oncology.

Early-stage non-small cell lung cancer is treated with surgery as standard. However, advances in radiotherapy and interventional radiology technologies have brought nonsurgical treatment options to the fore. One technological innovation in radiation treatment is stereotactic body radiotherapy (stereotactic body radiation therapy = SBRT) . The total calculated dose is delivered in one or a few sessions, with beams focused on the tumor from multiple points to destroy it completely.

• Small cell and non-small cell lung cancer – What are the differences?

The study assessed early-stage lung cancer patients in the United States National Cancer Database, numbering 84.839. They had no distant organ metastasis , non-small cell disease and tumors smaller than 4 cm. Of these, 76.623 underwent surgery and 8.216 SBRT.

According to the Study Results:

• The 30-day mortality rate was 2.4% after surgery versus 0.79% after SBRT, and
• 90-day mortality was 4.2% versus 2.8%, respectively; these differences were statistically significant.
• Early mortality after surgery (30 – 90 days) also increased with age and the amount of tissue removed.

Guidelines recommend surgery as the first choice for early-stage lung cancer. This study, however, found better early results with nonsurgical concentrated radiation targeting tumors.

• Innovations in lung cancer treatment – 2017 World Conference on Lung Cancer

Ongoing studies aim to assess long-term effects. Without results such as 3- or 5-year survival, radiotherapy cannot be declared the new standard for early-stage lung cancer. Despite higher short-term risks, surgery may remain more effective long-term. Nevertheless, lower mortality with radiotherapy in these data encourages its selection and further study.

• Is early lung cancer detection possible? Screening guidelines 2017