Surgery versus SABR for early stage non-small cell lung cancer: the moving target of equipoise

The notion that lobectomy is the standard treatment approach for operable early stage non-small cell cancer (ES-NSCLC) was recently challenged by the results from a combined analysis of two prematurely closed randomized controlled trials (STARS and ROSEL trials; NCT00840749 and NCT00687986) (1). In this study, Chang et al. pooled data from 58 patients with operable T1–2a (<4 cm) N0M0 NSCLC treated with lobectomy versus stereotactic ablative radiotherapy (SABR) and reported a similar 3-year recurrence-free survival between the two modalities and a 3-year overall survival (OS) in favour of SABR. Despite the numerous limitations inherent to post-hoc analysis of studies with a small sample size, these results have cast doubt over the superiority of surgery and supported SABR as a valid alternate option in operable patients with ES-NSCLC.