Stereotactic Body Radiation Therapy as an Alternative to Surgery in Early-Stage Non-Small-Cell Lung Cancer

Stereotactic body radiation therapy (SBRT) is a novel radiation technique that allows a high dose of radiation to be delivered to a tumor with relatively low dose to the surrounding normal tissue. SBRT has achieved extraordinary clinical success in patients with inoperable early-stage non-small-cell lung cancer (NSCLC). Local control of approximately 90% at 2 to 5 years has been demonstrated in multiple trials. In comparisons with surgical resection (in patients who are fit candidates for surgery), SBRT has provided similar local control, but was associated with worse survival, probably due to differences in the underlying patient populations. Three randomized trials of SBRT vs surgical resection closed due to poor accrual, but an analysis of patients treated in these trials suggested that SBRT might even be superior to surgery. New randomized trials are underway to further assess the question of whether SBRT can be the definitive treatment for early-stage NSCLC instead of surgery.