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Trial compares radiation to surgery for early-stage lung cancer

A new trial is examining the effectiveness of surgery compared to a specialized type of radiation in patients with non-small cell lung cancer

April 9, 2012

A phase III clinical trial at the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine is designed to determine the best treatment for patients with the most common type of lung cancer, non-small cell lung cancer (NSCLC).

For decades, the standard treatment for early-stage non-small cell lung cancer has been surgery, but the procedure can be difficult for patients with poor lung function, such as those with emphysema and pulmonary hypertension.

The randomized trial compares a type of radiation therapy, called stereotactic body radiation therapy (SBRT), to a more limited surgical procedure. Rather than remove the entire section of the lung, surgeons remove only a small portion, which may reduce complications after surgery.

SBRT pinpoints high doses of radiation directly to the tumor, while reducing damage to surrounding tissues. It can also be delivered in just several treatments over seven to 10 days, compared to conventional radiation, where treatment is given over six to eight weeks.

The trial includes 420 patients and is sponsored by the National Cancer Institute and coordinated through the American College of Surgeons Oncology Group (ACOSOG) and the Radiation Therapy Oncology Group (RTOG).

Too frail for surgery

Bryan Meyers, MD is chief of the Section of Thoracic Surgery and co-investigator on a study comparing surgery with radiation therapy in lung cancer patients.
Bryan Meyers, MD, is chief of the Section of Thoracic Surgery and co-investigator on a study comparing surgery with radiation therapy in lung cancer patients.

“Our hope is that doctors and patients will embrace this cutting-edge trial so we can clarify the optimal treatment for this group of higher-risk patients,” says study co-investigator Bryan Meyers, MD, chief of the Section of Thoracic Surgery and chair of the ACOSOG Thoracic Disease Site Committee. “For very frail patients, we have SBRT. For fit patients, surgery still dominates. This trial looks at people on the cusp for whom we don’t have certainty.”

“We have been evaluating SBRT for lung cancer since 2004 and have one of the largest US experiences,” says study co-investigator Jeffrey Bradley, MD, professor of radiation oncology and chair of RTOG’s lung cancer committee. “In an earlier trial of technology in very frail NSCLC patients who were not eligible for surgery, we and others showed that more than half of patients who received stereotactic body radiation therapy survived for three years after their diagnosis.”

For this study, researchers compared overall survival and disease-free survival in the two treatment arms. They also evaluated patients’ quality of life.

Read more about SBRT versus surgery for lung cancer in Outlook magazine.