Less May Be More When It Comes to Surgery for Early-Stage Lung Cancer
Some patients having surgery for early-stage lung cancer may no longer need to lose an entire lobe of their lung, new research shows.
The study results are from a phase 3 clinical trial sponsored by the Alliance for Clinical Trials in Oncology.
For the trial, nearly 700 patients with early-stage lung cancer were randomly chosen to receive either lobectomy surgery, which removes an entire lobe, or a sublobar resection, which removes only a portion of one of the five lobes. About half were in each group.
Participants were followed for a median of seven years after surgery, meaning half were followed longer, half for less time.
Those who lost only a portion of the lobe had somewhat better lung function, the trial showed. Survival rates were similar between the two groups.
Lobectomy, removing the entire lobe, has been the standard approach to early-stage lung cancer surgery for almost 30 years, the study authors noted.
“This is a practice-changing study,” said lead author Dr. Nasser Altorki, chief of thoracic surgery at Weill Cornell Medicine and NewYork-Presbyterian/Weill Cornell Medical Center in New York City.
Worldwide, more than 2 million people a year are diagnosed with lung cancer. Most have non-small cell lung cancer (NSCLC), which is often treated with surgery alone when the tumor is small and localized.
Lobectomy became the standard treatment after a 1995 clinical study found triple the rate of tumor recurrence and 50% higher deaths in the patients who had only a portion of lobe removed.
Improvements in imaging and determining cancer stage since then have led to increased detection of smaller, early-stage lung tumors. A Japanese trial published last year found that a sublobar technique called segmentectomy had comparable or modestly better outcomes to standard lobectomy.
The new trial took place from 2007 to 2017 in 83 clinical centers in the United States, Canada and Australia. Participants had NSCLC tumors no larger than 2 centimeters (about 3/4 inch) in size, and researchers confirmed their lymph nodes were not involved and their cancer hadn't spread. Tumors also had to be in the outer third of the lungs, where the risk of tumor spread is lower.
The two groups had similar rates of overall survival, disease-free survival and tumor recurrence.
Better lung function and the fact that removing less tissue may have other benefits should make sublobar resection the new standard for cancers of this type, the researchers concluded.
“We're pretty confident that these results are real, and they tell us that patients don't always have to have a full lobe of their lungs removed to cure their cancer,” Altorki said in a Weill Cornell news release.
Teams from Duke University in Durham, N.C., and 83 hospitals in the three countries also participated in the investigation.
The study findings were published Feb. 9 in the New England Journal of Medicine.
The American Cancer Society has more on lung cancer.
SOURCE: Weill Cornell Medicine, news release, Feb. 8, 2023