Is it time for SABR to overtake surgery as the treatment of choice for stage I non-small cell lung cancer?

The role of surgery as the standard of care for early stage non-small cell lung cancer (NSCLC) is being called into question. Lobectomy has traditionally been the accepted standard of care for early stage NSCLC; supported by a randomized trial that found that patients undergoing a sublobar resection in stage IA NSCLC had a local recurrence rate three times that of lobectomy (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).