Which is the Best in Early Lung Cancer; Surgery or Stereotactic Body Radiation Therapy?

Abstract

Despite all improvements in surgical treatment of lung cancer, 25% of early-stage lung cancer patients can either still not undergo safe resection due to medical comorbidities, or they reject surgical treatment. Even though sublober resections were approached with suspicion and even garnered strong reactions in the beginning, it was shown in many studies that results like lobectomy were obtained, and today it has now become a common and safe practice. Based upon the successful results achieved with stereotactic radiosurgery in primary and metastatic brain tumors, due to the technologic advancements, stereotactic body radiation therapy–stereotactic ablative body radiotherapy (SBRT-SABR) practices started to be used at the beginning of the 2000s, which are based on delivering a few fractions of an extremely high radiation dose to a single target. The aim of this study is to evaluate and to discuss the results of clinical interventions in literature about early lung cancer resections and SBRT. The medical literature in the thoracic and cardiovascular surgery and oncology network was reviewed, and studies, cases, and meta-analysis articles that provided early lung cancer treatment even surgical or SBRT outcomes were examined. A discussion was made by also analyzing the survival data in the light of the available guidelines. Surgery is the standard treatment for early-stage lung cancer. SABR is the suitable treatment option in patients that cannot or refuse to undergo surgery. There is no evidence that SABR can be an alternative to surgical treatment in early stage lung cancer cases with a medically fit condition that do not refuse surgery.