Dr Billè on the Use of Minimally Invasive Surgery vs Stereotactic Radiotherapy in NSCLC

Andrea Billè, MD, consultant thoracic surgeon, Guys’ and St Thomas’ NHS Foundation Trust, discusses findings from a propensity-matched comparison of minimally invasive surgery vs stereotactic ablative radiotherapy (SABR) in patients with clinical stage I non–small cell lung cancer (NSCLC), which he presented during the 2023 IASLC World Conference on Lung Cancer.

The standard of care (SOC) for patients with stage I NSCLC with small, peripheral tumors or medically high-risk disease is lobectomy or sub-lobar resection. Although SABR is the SOC for patients with inoperable disease, the role of SABR in operable disease is not well known.

This retrospective study included 1030 patients with stage I NSCLC from 2 institutional databases, 640 of whom had received surgery and 390 of whom had received SABR. Within the surgical cohort, the investigators compared the efficacy of video-assisted thoracoscopic surgery (VATS; n = 327) vs robotic surgery (n = 313), because thoracic robotic surgery has been increasingly offered to patients over the past several years.

The study results revealed that surgery generally led to better overall survival (OS) and disease-free survival (DFS) outcomes compared with SABR, Billè says. The 2-year OS rates were 98% and 93% in the surgery and SABR arms, respectively, and the 5-year OS rates were 92% and 84%, respectively. The 2-year DFS rates were 93% and 87% in the surgery and SBRT arms, respectively, and the 5-year DFS rates were 87% and 78%, respectively. Within the surgical group, robotic surgery generated slightly better 5-year OS and DFS rates compared with VATS, Billè explains.

The study also identified the number of lymph node stations that could be removed during surgery, Billè emphasizes. Surgeons were able to excise up to 7 lymph node stations per patient,resulting in a higher rate of upstaging at the time of surgery, according to Billè. Higher rates of upstaging allowed for more accurate staging of patients after undergoing surgery and increased their likelihood of receiving effective, targeted adjuvant treatments, Billè concludes.