Non-invasive radiation treatment as effective for lung cancer as surgery, study finds

For one Texas woman, a suspicious image during a routine mammogram led to a life-saving diagnosis of early-stage lung cancer and treatment with an innovative, non-invasive therapy. Three years later, she remains cancer free.

Judith Miller, 76, of Sour Lake, Tex., was referred to a breast cancer specialist after her primary care physician found suspect images on her X-rays during an annual mammogram. Miller underwent an MRI that revealed the suspicious signs were only scar tissue but that there was a tumor in her right lung.

“My specialist said, ‘Judith, God just saved your life. Because it was so small, it would never have been detected,” Miller told

Miller was referred to The University of Texas MD Anderson Cancer Center in Houston. Because her tumor was so small— slightly larger than a half-inch in diameter— Dr. Jack A. Roth, told her she would be a good candidate for the center’s phase III randomized clinical trial on stereotactic ablative radiotherapy (SABR).

Miller underwent three consecutive, daily SABR treatments in November at St. Luke's Health in Houston. She’s been healthy for nearly three years now.

For Miller, SABR was an easy choice because traditional treatment was always an option if SABR didn’t work, she said. After each treatment, she was warned she may experience some fatigue, but she was well enough to drive with her husband the 90 miles back home.

What is SABR?
SABR delivers a high dose of radiation from different angles, using image guidance to focus on a target and  treat operable stage I non-small cell lung cancer.
“Because of that, we are able to deliver such high doses that our local control is 98 percent— the highest local control in any lung cancer radiation therapy,” principal investigator Dr. Joe Y. Chang, a professor of radiation oncology at MD Anderson, told

In a study published on July 15 in The Lancet Oncology, MD Anderson researchers found that SABR had a better overall survival rate than traditional surgery. The three-year survival rates for study patients were 96 percent in the SABR group and 76 percent in the surgery group. Recurrence-free survival rates at three years were similar— 86 percent for SABR patients and 80 percent for surgery patients.

Only 10 percent of patients in their study had noticeable moderate or severe side effects, compared to 44 percent for invasive surgery. This lower rate of side effect may attribute to survival rates, because patients— who tend to be older adults with some degree of other disease— tolerate treatment better, researchers said.

Another potential benefit of SABR is a reduction in medical bills because the treatment has fewer complications and side effects, as well as no hospitalization time, Chang noted.

“As the patient population lives longer and we have more people older than 75 with lung cancer, those people will benefit even more with non-invasive SABR,” Chang said.

Lung cancer is the leading cancer killer in the United States. Typically, 75 percent of diagnoses are made in the advanced or metastatic stage. Only 25 percent of patients have early-stage lung cancer and, among them, only 10 percent have a stage 1 diagnosis, Chang said. With lung cancer screening, researchers believe more early-stage diagnoses can be made, likely increasing the population this coming year.

“It’s important to develop a non-invasive treatment as an option,” Chang said.

During treatment, patients remain awake and can see the SABR machine rotate around them and hear the machine click as it works. Treatment takes about 30 minutes, and patients can then go home. The number of sessions ranges from one to five, but three or four is common, Chang said.

“Most of my patients say, ‘I don’t feel anything. Are you sure the machine is on?’” Chang said.

SABR was initially used for patients with inoperable stage 1 lung cancer. Because of poor lung function, cardiovascular disease, or another significant medical problem, they are unable to tolerate surgery. Chang and his colleagues pursued their randomized study to see outcomes for medically operable patients using SABR and found that it achieved a better survival rate than surgery.

“It was a big surprise to all of us,” Chang said. “[We] definitely believe this data indicates that SABR should be considered as an option for operable stage 1 lung cancer.”

Because their study group was small— 58 patients— the next steps include a larger study in Department of Veterans Affairs (VA) hospitals nationwide and the United Kingdom to validate the findings. The VA study, which should begin this year, will have a total of 670 participants and span nine years.

“In the meantime … SABR should be mentioned to [an operable early-stage lung cancer] patient as an option or alternative to surgery,” Chang said. “It’s not the standard yet but should be considered an option to a patient who’s willing to consider it.”

Miller feels blessed that her lung cancer was found early.
“I feel really good. At my age, we all have maintenance to do, but I don’t worry about lung cancer returning,” she said. “I just picked up my life and continued as if it never happened.”