S805
Clinical - Lung
ESTRO 2026
adjustment with the instrumental variable analysis, all- cause mortality at three years was 30.3 (95% CI 24.0;36.7) following SABR, and 21.6% (95% CI 20.1;23.0) after surgery, with an adjusted mean absolute risk difference of 8.8% (95% CI 1.4;16.2) (Table 1). The corresponding mean absolute risk difference in lung-cancer-specific mortality was 6.1% (95% CI -0.6;12.9). The mean absolute risk differences in three-year all-cause mortality were smaller and not statistically-significant for those diagnosed in 2020 versus 2015 and for older patients (aged 80 and above) (Figure 1). Table 1. Predicted probabilities and mean absolute risk difference in all-cause, lung- cancer-associated mortality, and recurrence following SABR versus surgery for early-stage NSCLC.
Kontopantelis, T van Staa, S Devaney, S Holm, G Price, C Faivre-Finn (2025). Developing a prospective rapid- learning methodology to evaluate the survival impact of changing radiotherapy practice to include a new heart dose limit for patients with lung cancer in a UK specialist cancer centre (RAPID-RT): a protocol. BMJ Open, 15(8), e105519. https://doi.org/10.1136/bmjopen-2025-105519 Keywords: Voxel-based analysis, heart dose Stereotactic ablative radiotherapy (SABR) versus surgical resection for early-stage non-small lung cancer (NSCLC): The SORT study Eva Kagenaar 1 , David G Lugo-Palacios 1 , Andrew Hutchings 1 , Ajay Aggarwal 1,2 , Stephen O'Neill 3 , Bernard Rachet 1 , John Edwards 1 , Corinne Faivre-Finn 1 , Richard Grieve 1 1 Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom. 2 Guy's & St Thomas' NHS Trust, Guy's & St Thomas' NHS Trust, London, United Kingdom. 3 Stephen.ONeill@lshtm.ac.uk, London School of Hygiene & Tropical Medicine, London, United Kingdom Digital Poster Highlight 2955
Figure 1. Mean absolute risk difference in 3-year all- cause mortality for SABR vs surgery across subgroups and time periods.
Purpose/Objective: This study aimed to assess the comparative
effectiveness of SABR versus surgical resection for early-stage NSCLC, using an innovative “target trial” design applied to national datasets. It is the first emulated trial in this setting to evaluate comparative effectiveness. while minimising baseline prognostic between groups. Material/Methods: The study used English NHS National Cancer Registry data to identify individuals aged 18–79 years with a recorded performance status of 0–2 and those aged 80+ years with a performance status of 0–1. Patients were diagnosed with T1-2N0M0 NSCLC during 2015– 2020 and underwent SABR or surgical resection within 6 months of diagnosis. Data were linked to Hospital Episode Statistics and National Radiotherapy Dataset to define treatment receipt. All-cause mortality at three years was the primary outcome. Secondary outcomes included all-cause and lung cancer-specific mortality, overall recurrence and 90-day readmissions. We conducted an instrumental variable analysis to compare outcomes following SABR versus surgery while minimising confounding (Kagenaar et al., 2025). Results: A total of 12,546 met the eligibility criteria, of whom 2,299 had SABR and 10,247 surgery. The unadjusted 3- year all-cause mortality was 39.4% after SABR and 19.8% after surgical resection. After confounder
Conclusion: This first target trial emulation of its kind found that, for NSCLC patients eligible for either modality, three- year all-cause mortality was higher following SABR versus surgical resection. However, this difference decreased over time and was not statistically significant for those diagnosed in 2020, providing supporting evidence for a radiotherapy learning curve and improved selection. The results confirm the role
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