Researchers of the phase 2 revised STARS trial reported 10-year results showing stereotactic ablative radiotherapy (SABR) was noninferior to video-assisted thoracoscopic lobectomy with mediastinal lymph node dissection (VATS L-MLND) for operable stage I non-small cell lung cancer. Using propensity-matched cohorts (SABR n=80; surgery n=80) with tumors ≤3 cm and no nodal/metastatic disease, the study prespecified a noninferiority margin of 1.965 for overall survival. After a median 8.3-year follow-up, median overall survival (OS) was 11.4 years for surgery and not reached for SABR. OS did not differ significantly (HR 0.77; 95% CI 0.42–1.44; P=.417). Seven-year OS was 81% with SABR vs 69% with surgery, and 10-year OS was 69% vs 66%, respectively.
Lung cancer–specific survival (92% vs 89%; HR 0.95; P=.928) and 10-year recurrence-free survival (57% vs 65%; HR 1.17; P=.586) were also similar between arms. Short-term moderate/severe complications were higher after surgery, while limited long-term survey data (28% response) suggested comparable physical and mental quality-of-life measures, with over half of respondents reporting no financial burden from radiation. Investigators conclude SABR represents a strong noninvasive alternative for many operable patients, though up to one-third still recur, underscoring the need for strategies to further improve durable control.
Reference: The ASCO Post Staff. SABR May Be Comparable to Surgery for Early-Stage NSCLC. The ASCO Post. Published October 1, 2025. Accessed October 16, 2025. https://ascopost.com/news/october-2025/sabr-may-be-comparable-to-surgery-for-early-stage-nsclc/
Link: https://ascopost.com/news/october-2025/sabr-may-be-comparable-to-surgery-for-early-stage-nsclc/
