Editorial response: “Stereotactic Ablative Radiotherapy vs. Sublobar Resection for Non-Small Cell Lung Cancer: Choosing the Right Patients (an editorial)”
The authors do a commendable job of attempting to determine whether SABR and sublobar resection (SLR) are comparable in treatment for early-stage NSCLC disease (1). Using the primary endpoint of lung-cancer specific survival (LCSS), and thoroughly evaluating the Surveillance, Epidemiology and End Result (SEER) data using propensity matching, the authors show that, based on their primary analysis, SABR and SLR were equivalent in producing cancer-related survival. On secondary analysis, they suggest that patients with larger tumors (≤5 cm but >2 cm) may do better with SLR than SABR. Those conclusions are thought-provoking and provide rationale for future studies investigating these two techniques, which theoretically should have equivalent disease-related outcomes since neither address regional nodes and both have a highly comparable and focused local approach (2). Yet, as the authors note, even after their thorough evaluation, definitive conclusions cannot be drawn from the results, and more investigation is needed.