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Surgery should remain the primary treatment for people with early-stage non-small cell lung cancer (NSCLC) who are suitable for either surgery or a highly targeted form of radiotherapy, a new study from the London School of Hygiene & Tropical Medicine (LSHTM) suggests.

Published in the Journal of Clinical Oncology, the study compared surgery with stereotactic ablative radiotherapy (SABR), a highly targeted treatment that delivers high doses of radiation directly to a tumor, in NSCLC patients eligible for either treatment. Using national cancer data from 12,546 people diagnosed with early-stage NSCLC in England between 2015 and 2020, in a world first, researchers compared surgery and SABR using an emulated target trial, which applies the principles of a randomized controlled trial to real-world data.

Among the study participants, 10,247 underwent surgery and 2,299 received SABR. After adjusting for differences between the groups, researchers estimated that 21.6% of people who underwent surgery died of any cause within three years, compared with 30.3% of those who had SABR, an average difference of 8.8 percentage points.

However, among people aged 80 and older, the research found no evidence of a clinically meaningful difference in three-year all-cause mortality between the two interventions. The findings suggest SABR could offer an alternative treatment with curative intent for selected older patients.

Eva Kagenaar, a research fellow at LSHTM and co-author of the study, said, "Using data from England's Cancer Registry, we found that surgery resulted in better survival than SABR for people with early-stage lung cancer.

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