A Propensity-Matched Comparison Between Minimally Invasive Surgery and Stereotactic Radiotherapy in the Treatment of Clinical Stage IA Non-Small-Cell Lung Cancer (NSCLC)

Eleni Josephides; Niccolò Daddi; Pietro Bertoglio; Marialuisa Lugaresi; Akshay Patel; Eleonora Farinelli; Giulia Fabbri; Sara Volpi; Giovanni Frezza; Tom Routledge; Shahreen Ahmad; Mieke Van Hemelrijck; Eleni Karapanagiotou; Daniel Smith; Solli Piergiorgio; Andrea Billè

doi:10.1016/j.cllc.2025.04.011

A Propensity-Matched Comparison Between Minimally Invasive Surgery and Stereotactic Radiotherapy in the Treatment of Clinical Stage IA Non-Small-Cell Lung Cancer (NSCLC)

Clin Lung Cancer. 2025 Apr 29:S1525-7304(25)00083-X. doi: 10.1016/j.cllc.2025.04.011. Online ahead of print.

Authors

Eleni Josephides¹, Niccolò Daddi², Pietro Bertoglio², Marialuisa Lugaresi², Akshay Patel¹, Eleonora Farinelli², Giulia Fabbri¹, Sara Volpi¹, Giovanni Frezza², Tom Routledge¹, Shahreen Ahmad¹, Mieke Van Hemelrijck³, Eleni Karapanagiotou¹, Daniel Smith¹, Solli Piergiorgio², Andrea Billè⁴

Affiliations

¹ Cancer Centre at Guy's, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, UK.
² Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
³ School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Campus, Great Maze Pond, London, UK.
⁴ Cancer Centre at Guy's, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, UK. Electronic address: andrea.bille@gstt.nhs.uk.

PMID: 40410021
DOI: 10.1016/j.cllc.2025.04.011

Abstract

Background: Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related death globally, with stage IA NSCLC presenting a unique opportunity for curative interventions. The efficacy of minimally invasive surgery (MIS) vs. stereotactic ablative radiotherapy (SABR) remains debated due to limited direct comparative data.

Methods: This multicenter observational study analyzed data from 1014 patients diagnosed with clinical stage IA NSCLC (2015-2021) and treated with MIS (including VATS and RATS) or SABR. After propensity score matching, 234 patients (117 per group) were included. Matching balanced age, ECOG performance status, Charlson Comorbidity Index, lung function, and histological subtype to compare overall survival (OS), freedom from recurrence (FFR), and recurrence rates.

Results: The mean follow-up was 35 months for MIS and 33 months for SABR. The matched cohort (n = 234) showed superior 5-year locoregional control (LRC) rates for MIS (93%) vs. SABR (88%). FFS at 2 and 5 years was higher for MIS (93.5% and 90.3%) than SABR (82.1% and 77.9%; P = .010). OS was significantly higher in MIS, with a hazard ratio of 1.60 (95% CI: 1.11-2.31). Early mortality rates were 2.6% for MIS at 30 and 90 days. SABR exhibited no 30-day mortality and a 90-day rate of 1.7%.

Conclusion: MIS is associated with higher OS, LRC and FFR, but higher treatment-related mortality compared to SABR for stage IA NSCLC. This study supports the preference for surgical interventions where feasible. While future randomized controlled trials may provide more insights, this observational study contributes valuable evidence to guide clinical decision-making.

Keywords: DFS; MIS; Minimally invasive surgery; Non–small-cell lung cancer; OS; Overall survival; Propensity score matching; RATS; REAL WORLD DATA; Real world evidence; Recurrence rates; Robotic-assisted thoracoscopic surgery; SABR; Stage I NSCLC; Stereotactic ablative radiotherapy; Thoracic surgery; VATS; Video-assisted thoracoscopic surgery.