Weighing the relative importance of short-term versus long-term outcomes when comparing surgery versus stereotactic body radiation therapy (SBRT) for early-stage non-small cell lung cancer

Lung cancer continues to be the leading cause of cancer death in the United States, with an estimated 234,030 new cases and 154,050 deaths expected in 2018 alone (1). Approximately one-sixth of new cases are early-stage (T1-2N0) non-small cell lung cancer (NSCLC), a proportion which is anticipated to grow with increased use of low-dose CT lung cancer screening programs (2). While lobectomy has traditionally been considered the standard of care for definitive management of early stage NSCLC, alternative treatment strategies have increased in popularity. Of these, the primary non-surgical modality has been stereotactic body radiation therapy (SBRT), which has seen an exponential increase in popularity over the past decade. By some estimates, SBRT is currently the primary treatment modality for nearly 10% of early-stage NSCLC (3)