Should stereotactic ablative radiotherapy be considered as an equal to surgical resection in the management of operable stage I lung cancer?

Lobectomy is the accepted standard of care for early stage non-small cell lung cancer (NSCLC); supported by a randomized trial which reported a local recurrence rate three times that of lobectomy in patients undergoing sublobar resection for stage IA NSCLC (1). However, not all patients have the performance status to tolerate a lobectomy; they are technically resectable but not physically operable candidates. The American College of Chest Physicians guidelines recommend that such patients should be offered, based on decreasing levels of performance status, segmentectomy, wedge resection and stereotactic ablative radiotherapy (SABR) (2).