The following article features coverage from the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting. Click here to read more of Cancer Therapy Advisor‘s conference coverage.

Long-term results from the STARS trial indicate that stereotactic ablative radiotherapy (SABR) is not inferior to video-assisted thoracoscopic surgery (VATS) with mediastinal lymph node dissection (L-MLND) in patients with operable stage IA non-small cell lung cancer (NSCLC).

Joe Y. Chang, MD, PhD, of The University of Texas MD Anderson Cancer Center in Houston, presented these results at the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting.

The trial ( Identifier: NCT02357992) included 80 patients who received SABR. They received 54 Gy in 3 fractions to peripheral lesions and 50 Gy in 4 fractions to central lesions. 

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Patients underwent chest CT every 3 months for the first 2 years, every 6 months for another 3 years, and then annually. The study’s primary endpoint was overall survival (OS) at 3 years.

The median follow-up was 61 months. At 3 years, the OS rate was 91%, and the progression-free survival (PFS) rate was 80%. At 5 years, the OS rate was 87%, and the PFS rate was 77%.

Noninferiority was assessed by comparing the SABR data against historical data with VATS L-MLND. SABR would be deemed noninferior if the 3-year OS rate was not lower than the historical arm by more than 12%.

Noninferiority was met, as the 3-year OS rate was 91% with SABR and 85.5% with VATS L-MLND.

A propensity score-matched comparison of SABR to VATS L-MLND showed no significant differences in OS at 3 years (91% vs 91%), OS at 5 years (87% vs 84%), PFS at 3 years (80% vs 88%), and PFS at 5 years (77% vs 80%).

There were no significant differences between SABR and VATS L-MLND with regard to lung cancer-specific survival (P =.6875) or cumulative incidence rates of local (P =.103) or distant recurrence (P =.1938).

SABR was associated with a higher rate of regional recurrence compared with VATS L-MLND (12.5% vs 2.7%, P =.0167). However, during VATS, lymph nodes were upstaged in 10% of patients, and those patients received concurrent chemoradiotherapy. That may have contributed to a lower incidence of regional recurrence, Dr Chang said.

“SABR remains a promising approach for this population,” Dr Chang concluded. “Multidisciplinary management is strongly recommended.”

Disclosures: This research was supported by Varian Medical Systems. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Read more of Cancer Therapy Advisor’s coverage of the 2021 ASCO Annual Meeting by visiting the conference page.


Chang JY, Mehran RJ, Feng L, et al. Stereotactic ablative radiotherapy in operable stage I NSCLC patients: Long-term results of the expanded STARS clinical trial. J Clin Oncol. 2021;39:(suppl 15; abstr 8506). doi:10.1200/JCO.2021.39.15_suppl.8506