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Prof David Ball
Stereotactic ablative radiotherapy (SABR) should be the treatment of choice for patients with inoperable peripherally located stage 1 non-small cell lung cancer (NSCLC), say the Australian authors of a phase 3 trial published in Lancet Oncology.
The randomised CHISEL trial conducted across 14 hospitals in Australia and New Zealand randomly assigned 101 patients with peripherally located stage 1 NSCLC who were either unfit for surgery or refused surgery to either conventional radiotherapy (n=35; 66 Gy in 33 fractions of 2 Gy or 50 Gy in 20 fractions of 2·5 Gy) or SABR (n=66; 54 Gy in three 18 Gy fractions or 48 Gy in four 12 Gy fractions).
SABR achieved improvements in freedom from local failure, the primary endpoint (hazard ratio for SABR vs standard radiotherapy 0·32 [95% CI 0·13–0·77], p=0·008).
The secondary endpoint of 2-year overall survival was achieved by 77% (95% CI 67–88) of the SABR group compared to 59% of the standard radiotherapy group.
Treatment was generally well tolerated in both treatment groups.
According to the study authors led by Professor David Ball from the Peter MacCallum Cancer Centre in Melbourne, the study is the first randomised trial to compare SABR with standard radiotherapy in patients who had pathologically proven non-small cell lung cancer at stage T1–T2aN0M0, determined by FDG-PET scanning.