10-Year Study Finds Radiation Matches Surgery for Early Lung Cancer

Results from a landmark clinical trial shows that stereotactic radiation therapy offers long-term survival outcomes comparable to surgery for patients with small, early-stage non-small cell lung cancer (NSCLC), were announced at the American Society for Radiation Oncology (ASTRO) 2025 Annual Meeting.

The STARS trial (NCT02357992) is the first to report 10-year outcomes from a head-to-head comparison of radiation and surgery in operable NSCLC.

“Our study confirms, based on a decade of data, that stereotactic radiotherapy is a strong alternative to surgery for most patients with operable stage I NSCLC,” said Joe Y. Chang, MD, PhD, FASTRO, senior author and professor of thoracic radiation oncology at the University of Texas MD Anderson Cancer Center. “This highly targeted, non-invasive treatment achieved the same long-term overall survival as lobectomy, while offering many patients an easier recovery and potentially better quality of life.”

Key Results

Researchers enrolled 80 patients with small tumors (≤3 cm, no lymph node involvement) who received stereotactic ablative radiotherapy (SABR). They were matched with 80 patients who underwent minimally invasive lobectomy with lymph node removal. All were treated at MD Anderson between 2015 and 2017 and followed up for 10 years.

At a median 8.3-year follow-up, overall survival was nearly identical: 69% for SABR versus 66% for surgery. Lung cancer–specific survival (92% vs. 89%) and recurrence-free survival (57% vs. 65%) were also similar. SABR patients reported minimal side effects, with no treatment-related hospitalizations or deaths, compared with higher rates of post-surgical complications.

“Surgery historically was the only standard option for early-stage NSCLC, but upwards of 50% of patients experience moderate or severe side effects afterward,” Dr. Chang said. “As patients age, many cannot tolerate surgery, so there’s a growing demand for non-invasive options that provide durable local control.”

While results support SABR as a safe alternative for many patients, Dr. Chang noted that surgery remains appropriate for larger or more complex tumors. Researchers are now studying whether combining SABR with immunotherapy or using artificial intelligence to detect hidden lymph node involvement could further improve outcomes.

“While SABR has delivered excellent long-term results, up to a third of patients treated with local therapies still developed recurrences,” Dr. Chang said. “Our goal is to find new ways to push survival even higher.”