Stereotactic body radiotherapy is not replacing surgery in the treatment of early stage lung cancer yet

Recently, an article entitled “Video-assisted thoracoscopic lobectomy versus stereotactic radiotherapy for stage I lung cancer” was published on the Annals of Thoracic Surgery. This is a retrospective comparison of video-assisted thoracoscopic surgery (VATS) lobectomy vs. stereotactic body radiotherapy (SBRT) in biopsy-proven clinical stage I non-small cell lung cancer (NSCLC) (1). The authors’ study showed that surgery was superior to SBRT in various aspects including overall survival (OS), cause-specific survival (CSS), recurrence-free survival (RFS), local control and distant control. SBRT as a treatment for early stage lung cancer has been a hot topic recently. Prior to this article, there had been several published studies claiming that SBRT was not inferior to or even better than surgery. The contention thus ensued between thoracic surgeons and radiation therapists could not be easily settled.