Stage I NSCLC: SABR tops standard RT in phase 3 CHISEL trial

  • Ball D & al.
  • Lancet Oncol
  • 12 Feb 2019

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • Stereotactic ablative body radiotherapy (SABR) offered better outcomes for inoperable, peripherally located, stage I NSCLC compared with standard radiotherapy (RT) and with lower radiation doses.

Why this matters

  • Single-group studies have shown high local control with SABR, but studies investigating the technique’s effect on OS have produced conflicting results.

Study design

  • Multicenter, randomized, controlled, phase 3 clinical CHISEL trial.
  • 101 patients with stage 1 NSCLC with noncentral tumors confirmed by whole-body 18F-fluorodeoxyglucose (FDG)-PET scanning received SABR at 54 or 48 Gy (n=66) or standard radiotherapy at 66 or 50 Gy (n=35).
  • Funding: Australian Government Department of Health and others.

Key results

  • Prior history of cancer in 43% of the SABR group and 34% of the standard radiotherapy group.
  • Mortality and local disease progression were lower with SABR vs standard radiotherapy (39% vs 62% and 14% vs 31%, respectively).
  • Freedom from local treatment failure (HR, 0.32; P=.008), median 5-year OS (HR, 0.53; P=.027), and lung cancer-specific survival (HR, 0.49; P=.092) were better with SABR.
  • Adverse events were similar between SABR and standard radiotherapy groups.

Limitations

  • Large number of patients had a history of cancer.
  • Use of time to local treatment failure as primary endpoint instead of RECIST criteria.

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