Surgery versus stereotactic body radiation therapy for stage I non–small cell lung cancer: A comprehensive review

Non–small cell lung cancer (NSCLC) is the leading cause of cancer‐related death in the United States. With the implementation of lung cancer screening, the number and proportion of patients diagnosed with early‐stage disease are anticipated to increase. Surgery is currently the standard of care for patients with operable stage I NSCLC. However, promising outcomes with stereotactic body radiation therapy (SBRT) in patients with inoperable disease has led to interest in directly comparing SBRT and surgery in operable patients. Unfortunately, early randomized trials comparing surgery and SBRT closed early because of poor accrual. In this article, the nuances of surgery and SBRT for early‐stage NSCLC are reviewed. Furthermore, retrospective and prospective analyses of SBRT in early‐stage NSCLC are discussed, and active randomized trials comparing these 2 approaches are described. Cancer 2018;124:667‐78. © 2017 American Cancer Society. Surgery is the standard treatment for stage I non–small cell lung cancer, but there is increasing interest in stereotactic body radiation therapy. Although stereotactic body radiation therapy is extremely well tolerated, is an outpatient procedure, and is associated with high rates of local tumor control, randomized trials will be necessary to confirm its efficacy in operable patients.