Verification of meta-analysis and propensity-matched analysis comparing stereotactic body radiation therapy versus surgery for early stage lung cancer

Stereotactic body radiation therapy (SBRT) has been recognized as a standard radical treatment for medically inoperable patients with stage I non-small cell lung cancers (NSCLCs). However, evaluation of SBRT in medically operable patients has shown widely varying results. Evidence-based guidelines published by the American Society for Radiation Oncology (ASTRO) in 2017 (1) prudently expressed that SBRT is not recommended as an alternative to surgery outside of a clinical trial setting. Contrastingly, the National Comprehensive Cancer Network (NCCN) guidelines published in 2018 (2) presented that SBRT is recommended for patients who are medically inoperable or who refused to undergo surgery after thoracic surgery evaluation. SBRT has been reported to achieve primary tumor control and overall survival (OS) rates that are comparable to those achieved with lobectomy by nonrandomized and population-based comparative studies involving older patients. SBRT is an appropriate option for patients with high surgical risk [those able to tolerate sublobar resection but not lobectomy (e.g., age ≥75 years, poor lung function)]. Additionally, a combined analysis of two randomized trials that compared SBRT with lobectomy in operable patients (3) was ignored in the ASTRO guidelines but was referred to in the NCCN guidelines. How are physicians and patients meant to interpret these guidelines