Are quality of life outcomes comparable following stereotactic radiotherapy and minimally invasive surgery for stage I lung cancer patients?

A best evidence topic in thoracic surgery was produced in accordance with published guidelines. The question addresses the effect of stereotactic ablative radiotherapy (SABR) and minimally-invasive anatomical lung resection on quality of life (QoL) in patients with stage I non-small-cell lung cancer. Altogether more than 428 papers were found using the reported search. Only one small RCT of 22 patients was identified that addressed the effect of SABR and surgery on QoL and found global health status to be statistically significantly worse for surgical patients when compared to SABR. Sixteen further studies provided some supporting evidence, but not directly compared QoL between the two treatment modalities. Consequently, there is no general consensus currently available from the literature. Among the nine SABR-only studies, only five specified the percentage of patients who were medically operable but refused surgery. None of the studies identified significant difference in most of the QoL domains 12 months after treatment. Within the surgical papers, patients recovered well after video-assisted thoracoscopic surgical (VATS) anatomical lung resection for stage-I NSCLC. Confirming previous evidence of open surgery, three studies demonstrated worsening of QoL domains from 8 weeks to 3 months and a return to baseline after 12 months. Emotional functioning (EF) showed an improvement across both treatments, often superseding baseline scores. Given the different population characteristics of all the available evidence, further appropriately powered and randomised studies are necessary to clarify this issue.