***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The authors evaluated the efficacy , patterns of failure , and toxicity of stereotactic ablative radiotherapy ( SABR ) for patients with medically inoperable , clinical stage I non – small cell lung cancer ( NSCLC ) in a prospect i ve clinical trial with 7 years of follow‐up . Clinical staging was performed according to the seventh edition of the American Joint Committee on Cancer TNM staging system BACKGROUND This prospect i ve study was undertaken to establish a novel management algorithm using new indicators to decide the type of lung resection for small peripheral lung lesions . METHODS Inclusion criteria were : ( 1 ) < or=20 mm peripheral lung lesion(s ) and ( 2 ) absence of significant lymph node swelling on preoperative CT . Along with the conventional criteria , the percentage of ground-glass opacity ( GGO ) ( > or=50 % as GGO type and < 50 % as solid type ) on high-resolution CT scan was employed . In accordance with such indicators , a wide wedge resection ( WWR ) , segmentectomy or lobectomy was planned for individual patients . The primary endpoint was to estimate the effectiveness of limited resection in  patients with lung cancer by analyzing their locally disease-free survival rates at 5 and 10 years . RESULTS Of 179 patients enrolled between 1997 and 2002 , 90 were male and 89 female . They were divided into 77 GGO types and 102 solid types . During surgery , conversions from limited resections to st and ard operations were performed on six patients to avoid the risk of local-regional recurrence . Finally , WWR was performed on 73 patients , segmentectomy on 26 and lobectomy on 80 , respectively . There were 138 lung cancers and 41 non-cancers . Of 138 cancer patients , 114 patients are alive and 24 died . There were no local-regional recurrences among the 58 cancer patients who underwent limited resection . CONCLUSIONS This intermediate-term outcome suggests that the selection of the type for lung resection using this management algorithm for small peripheral lung lesions was effective for preventing both local-regional recurrences and the excessive resection of normal lung tissue PURPOSE Image-guided biopsy occasionally fails to diagnose small lung lesions , which are highly suggestive of primary lung cancer . The aim of the present study was to evaluate the outcome of stereotactic body radiotherapy ( SBRT ) for small lung lesions that were clinical ly diagnosed as primary lung cancer without pathologic confirmation . METHODS AND MATERIAL S A total of 115 patients were treated with SBRT in 12 institutions . Tumor size ranged from 5 to 45 mm in diameter , with a median of 20 mm . RESULTS The 3-year and 5-year overall survival rates for patients with a tumor size < or = 20 mm in diameter ( n = 58 ) were both 89.8 % , compared with 60.7 % and 53.1 % for patients with tumors > 20 mm ( n = 57 ) ( p < 0.0005 ) , respectively . Local progression occurred in 2 patients ( 3.4 % ) with a tumor size < or = 20 mm and in 3 patients ( 5.3 % ) with tumors > 20 mm . Among the patients with a tumor size < or = 20 mm , Grade 2 pulmonary complications were observed in 2 ( 3.4 % ) , but no Grade 3 to 5 toxicity was observed . In patients with a tumor size > 20 mm , Grade s 2 , 3 , and 5 toxicity were observed in 5 patients ( 8.8 % ) , 3 patients ( 5.3 % ) , and 1 patient ( 1.8 % ) , respectively . CONCLUSION In patients with a tumor < or = 20 mm in diameter , SBRT was reasonably safe in this retrospective study . The clinical implication s of the high local control rate depend on the accuracy of clinical /radiologic diagnosis for small lung lesions and are to be carefully evaluated in a prospect i ve study BACKGROUND Stereotactic body radiation therapy ( SBRT ) has been proposed as a potential alternative to surgery for early lung cancer , although we lack well-powered prospect i ve r and omized data comparing these treatments , and existing studies suffer from incomplete information on confounders that can bias results . Here , we evaluated the comparative effectiveness of surgery  and  SBRT  in lung cancer treatment using a large extensively detailed data base from the Veteran 's Affairs system . METHODS We identified veterans with biopsy-proven clinical stage I non-small cell lung cancer diagnosed between 2006 and 2015 from within the Veteran 's Affairs Informatics and Computing Infrastructure . We compared cancer-specific survival among patients receiving lobectomy , sublobar resection , or SBRT  using univariable and multivariable competing risk analyses . Multivariable analyses adjusted for confounders including preoperative pulmonary function , smoking status , comorbidity , and staging workup procedures . RESULTS In all , 4,069 patients were included ( 449 SBRT , 2,986 lobectomy , 634 sublobar resection ) . Unadjusted analysis found higher immediate postprocedural mortality in the surgery groups compared with the SBRT group . The multivariable analysis considering long-term survival found higher cancer-specific mortality for SBRT compared with lobectomy ( subdistribution hazard ratio 1.45 , 95 % confidence interval : 1.09 to 1.94 , p = 0.01 ) , although no survival difference between SBRT and sublobar resection ( subdistribution hazard ratio 1.25 , 95 % confidence interval : 0.93 to 1.68 , p = 0.15 ) . CONCLUSIONS Among a large cohort of early stage lung cancer patients , we found that lobectomy had improved survival compared with SBRT , although we found no survival difference between sublobar resection and SBRT . Despite these findings , the potential for unmeasured confounding remains and prospect i ve r and omized trials are needed to better compare these treatment modalities PURPOSE The impact of stereotactic body radiotherapy ( SBRT ) on 3-year progression-free survival of medically inoperable patients with stage I non-small-cell lung cancer ( NSCLC ) was analyzed in a prospect i ve phase II study . PATIENTS AND METHODS Fifty-seven patients with T1NOMO ( 70 % ) and T2N0M0 ( 30 % ) were included between August 2003 and September 2005 at seven different centers in Sweden , Norway , and Denmark and observed up to 36 months . SBRT was delivered with 15 Gy times three at the 67 % isodose of the planning target volume . RESULTS Progression-free survival at 3 years was 52 % . Overall- and cancer-specific survival at 1 , 2 , and 3 years was 86 % , 65 % , 60 % , and 93 % , 88 % , 88 % , respectively . There was no statistically significant difference in survival between patients with T1 or T2 tumors . At a median follow-up of 35 months ( range , 4 to 47 months ) , 27 patients ( 47 % ) were deceased , seven as a result of lung cancer and 20 as a result of concurrent disease . Kaplan-Meier estimated local control at 3 years was 92 % . Local relapse was observed in four patients ( 7 % ) . Regional relapse was observed in three patients ( 5 % ) . Nine patients ( 16 % ) developed distant metastases . The estimated risk of all failure ( local , regional , or distant metastases ) was increased in patients with T2 ( 41 % ) compared with those with T1 ( 18 % ) tumors ( P = .027 ) . CONCLUSION With a 3-year local tumor control rate higher than 90 % with limited toxicity , SBRT emerges as state-of-the-art treatment for medically inoperable stage I NSCLC and may even challenge surgery in operable instances BACKGROUND The optimal surgical technique for lobectomy in lung cancer is not well defined . Proponents of video-assisted thoracic surgery ( VATS ) hypothesize that less trauma leads to quicker recovery , whereas those who advocate thoracotomy cl aim it as an oncologically superior procedure . However , a well-balanced comparison of the two procedures is lacking in the literature . METHODS All patients who underwent lobectomy for clinical stage 1A lung cancer by computed tomographic and positron emission tomographic scan were identified from a prospect i ve data base . Patient characteristics were compared by the Student t test , Pearson chi(2 ) , and Fisher exact test . A propensity score-matched analysis was performed . Survival was assessed by Kaplan-Meier and Cox proportional hazards analysis . Complications were assessed by a multivariate logistic regression model evaluating age , sex , comorbidities , pulmonary function , tumor size , nodal status , surgeon , and histologic characteristics . RESULTS From May 2002 to August 2007 , 398 patients underwent an attempt at VATS lobectomy and 343 underwent thoracotomy .  An " intent-to-treat " analysis was performed . There was 1 postoperative death in each group . Survival by Cox model was no different for VATS versus thoracotomy ( hazard ratio 0.72 ; P = .12 ) , whereas age ( hazard ratio 1.03 ; P < .001 ) , larger tumor size ( hazard ratio 1.34 ; P < .001 ) , and higher nodal stage ( hazard ratio 1.92 ; P < .001 ) were associated with worse survival . Logistic regression demonstrated fewer complications for VATS lobectomy ( odds ratio 0.73 ; P = .06 ) , whereas age ( odds ratio 1.04 ; P < .001 ) and tumor size ( odds ratio 1.2 ; P < .020 ) correlated with a greater number of complications . Patients undergoing VATS lobectomy demonstrated a 2-day shorter length of stay than patients undergoing thoracotomy ( P < .001 ) . Propensity score-matched analysis supported these findings . CONCLUSIONS VATS lobectomy and thoracotomy demonstrated similar 5-year survivals . However , VATS lobectomy was associated with fewer complications and shorter length of hospital stay BACKGROUND The st and ard of care for operable , stage I , non-small-cell lung cancer ( NSCLC ) is lobectomy with mediastinal lymph node dissection or sampling . Stereotactic ablative radiotherapy ( SABR ) for inoperable stage I NSCLC has shown promising results , but two independent , r and omised , phase 3 trials of SABR in patients with operable stage I NSCLC ( STARS and ROSEL ) closed early due to slow accrual . We aim ed to assess overall survival for SABR versus surgery by pooling data from these trials . METHODS Eligible patients in the STARS and ROSEL studies were those with clinical T1 - 2a ( < 4 cm ) , N0M0 , operable NSCLC . Patients were r and omly assigned in a 1:1 ratio to SABR or lobectomy with mediastinal lymph node dissection or sampling . We did a pooled analysis in the intention-to-treat population using overall survival as the primary endpoint . Both trials are registered with Clinical Trials.gov ( STARS : NCT00840749 ; ROSEL : NCT00687986 ) . FINDINGS 58 patients were enrolled and r and omly assigned ( 31 to SABR and 27 to surgery ) . Median follow-up was 40·2 months ( IQR 23·0 - 47·3 ) for the SABR group and 35·4 months ( 18·9 - 40·7 ) for the surgery group . Six patients in the surgery group died compared with one patient in the SABR group . Estimated overall survival at 3 years was 95 % ( 95 % CI 85 - 100 ) in the SABR group compared with 79 % ( 64 - 97 ) in the surgery group ( hazard ratio [ HR ] 0·14 [ 95 % CI 0·017 - 1·190 ] , log-rank p=0·037 ) . Recurrence-free survival at 3 years was 86 % ( 95 % CI 74 - 100 ) in the SABR group and 80 % ( 65 - 97 ) in the surgery group ( HR 0·69 [ 95 % CI 0·21 - 2·29 ] , log-rank p=0·54 ) . In the surgery group , one patient had regional nodal recurrence and two had distant metastases ; in the SABR group , one patient had local recurrence , four had regional nodal recurrence , and one had distant metastases . Three ( 10 % ) patients in the SABR  group had grade 3 treatment-related adverse events ( three [ 10 % ] chest wall pain , two [ 6 % ] dyspnoea or cough , and one [ 3 % ] fatigue and rib fracture ) . No patients given SABR  had grade 4 events or treatment-related death . In the surgery group , one ( 4 % ) patient died of surgical complications and 12 ( 44 % ) patients had grade 3 - 4 treatment-related adverse events . Grade 3 events occurring in more than one patient in the surgery group were dyspnoea ( four [ 15 % ] patients ) , chest pain ( four [ 15 % ] patients ) , and lung infections ( 
    Output:
    
RESULTS The lobectomy group showed a better life expectancy than the SABR group , in patients under 75 years of age .
The Markov model showed no statistically significant difference in the expected overall survival in stage IA NSCLC patients who were older than 75 years and had undergone SABR or lobectomy