A Retrospective Study on the Long-Term Outcomes of Stereotactic Ablative Radiotherapy Versus Sublobar Resection in Lung Cancer: Analysis From the Scottish Cancer Registry.

Introduction:  A comparison between sublobar resection and stereotactic ablative radiotherapy (SABR) in the treatment of lung cancer is a trending topic. However, there is still a lack of strong randomized controlled trials on this subject. We believe that the National Cancer Registry can provide good insight into decision-making when comparing these two modalities of treatment.

Methods:  The Scottish Cancer Network (SCAN) data were assessed retrospectively. These data included 2000 patients who had lung cancer between April 2013 and December 2022. We included 67 patients who had SABR (group 1) for early-stage lung cancer (T1-T2 N0) between January 2017 and December 2019 and 114 patients who had sublobar resection (group 2) for lung cancer (all comers) between April 2013 and December 2019.

Results:  The average age in the SABR group was 74 years vs. 69 years in the sublobar group (P = 0.002). The overall recurrence was similar in the SABR group (29 patients) and the sublobar resection group (19 patients) (28.3% vs. 25.4%, respectively, P = 0.667). The overall survival (primary endpoint) was significantly better with patients who were treated with surgery than SABR (85.15 vs. 60.14 months, P = 0.006). The sublobar resection group showed an upgrade in staging after surgery compared to the preoperative stage on PET scan in the T stage (31 patients, 27.2%) and in the N stage (five patients, 4.3%). Patients who had SABR needed more CT scans for follow-up compared to the sublobar resection group (seven vs. four scans, respectively).

Conclusion:  Sublobar lung resection should remain the preferable treatment for lung cancer in patients who are suitable for resection. Large randomized controlled trials are still needed to guide treatment in patients who are suitable for both options of treatment.