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Two small trials that tried to ask whether precision radiotherapy could replace an operation for early lung cancer, closed early because almost nobody would agree to be randomised, and left the question open.
STARS and ROSEL both randomised patients with operable clinical stage I non-small-cell lung cancer to stereotactic ablative radiotherapy or lobectomy, and both closed early because patients and surgeons would not accept randomisation. Pooling them gave 58 patients, 31 assigned to radiotherapy and 27 to surgery.
At a median 40.2 months (radiotherapy) and 35.4 months (surgery), estimated three-year overall survival was 95 percent with radiotherapy against 79 percent with surgery (hazard ratio 0.14, 95 percent confidence interval 0.017 to 1.190, log-rank p=0.037), with six deaths in the surgical arm and one in the radiotherapy arm. Three-year recurrence-free survival was 86 against 80 percent (hazard ratio 0.69, p=0.54): the survival difference came from deaths not caused by the cancer. Grade 3 adverse events occurred in 3 of 31 radiotherapy patients and 12 of 27 surgical patients, with one surgical death.
The authors were explicit that 58 patients and three years cannot change practice, and the result is best read as a reason to run the larger trials (STABLE-MATES, VALOR and SABRTooth) rather than as evidence that radiotherapy is better. For patients who are medically inoperable, stereotactic radiotherapy is already the standard, which CHISEL established against conventional radiotherapy.
The full inclusion and exclusion criteria are on the registry record. Read 2026-10-07. Recruiting overall does not mean a particular site is open; ask the study team.
The full inclusion and exclusion criteria are on the registry record. Read 2026-10-07. Recruiting overall does not mean a particular site is open; ask the study team.
ClinicalTrials.gov data courtesy of the US National Library of Medicine.
Shares JCOG0802 / WJOG4607L, CALGB 140503 (Alliance), Resectable stage I to III non-small-cell lung cancer, Lung cancer (all types).
Shares JCOG0802 / WJOG4607L, CALGB 140503 (Alliance), Resectable stage I to III non-small-cell lung cancer, Lung cancer (all types).
Shares Curative intent vs palliative intent, Resectable stage I to III non-small-cell lung cancer, Lung cancer (all types).
Shares JCOG0802 / WJOG4607L, CALGB 140503 (Alliance), Resectable stage I to III non-small-cell lung cancer, SBRT / SABR (stereotactic radiotherapy).
Shares Resectable stage I to III non-small-cell lung cancer, SBRT / SABR (stereotactic radiotherapy).
Shares Resectable stage I to III non-small-cell lung cancer, SBRT / SABR (stereotactic radiotherapy).
Shares SBRT / SABR (stereotactic radiotherapy), Lung cancer (all types).
Shares Resectable stage I to III non-small-cell lung cancer, SBRT / SABR (stereotactic radiotherapy).
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