A new emulated target trial in the Journal of Clinical Oncology compares stereotactic ablative radiotherapy (SABR) with surgical resection for early-stage non-small cell lung cancer. The study has prompted discussion among oncology specialists on X about how to interpret its results and the methods behind it.
C. Jillian Tsai, Lead of Palliative Radiotherapy and Oligometastases Program (PROP) at Princess Margaret Cancer Centre, shared on X:
“JCO emulated trial, SABR vs surgery
Surgery’s benefit was significant for all-cause mortality only; not lung cancer-specific mortality. That signals clinical imbalance, not inferior SABR:
- ECOG2 26% vs 7%,
- COPD 46% vs 26%.
Salvage and nuanced treatment decision not in registry.”
See the table from the study, with Dr. Tsai’s highlights, in the gallery
Evan Thomas, Executive Chair and Founder at Renaissance Institute of Precision Oncology and Radiosurgery, responded:
“The volume of methodologically fragile emulated trials emerging from the surgical literature feels less like organic scientific inquiry and more like preemptive positioning ahead of the actual randomized trial results.”
Brendon Stiles, Professor and Chief of Thoracic Surgery and Surgical Oncology at Montefiore Health System, then replied:
“Questioning methodology is fair. Questioning investigators’ motives is another matter. Particularly when your own practice website promotes multiple treatments without definitive RCTs.
Shouldn’t we apply consistent scientific standards?”
Title: Stereotactic Ablative Radiotherapy Versus Surgical Resection for Early-Stage Non–Small Cell Lung Cancer: An Emulated Target Trial
Authors: Eva Kagenaar, David G Lugo-Palacios, Ajay Aggarwal, Andrew Hutchings, Stephen O’Neill, Bernard Rachet, John Edwards, Corinne Faivre-Finn, Richard Grieve.
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