Wedge Resection Versus Stereotactic Body Radiotherapy in Stage I Non-small Cell Lung Cancer

Non-small cell lung cancer continues to be a leading cause of cancer related mortality. Screening has increased cancers detected at an early stage. Based on a landmark trial from 1995, lobectomy has been the standard of care for early-stage lung cancer. Recent reports from the US and Japan have redefined the standard of care for early-stage lung cancer. Segmentectomy and non-anatomical wedge resection have shown similar outcomes to formal lobectomy for many patients with early-stage lung cancer. In patients who are unable to tolerate lobectomy, treatment has often been limited to radiotherapy. There has been an increasing trend to shift from conventional radiotherapy to stereotactic body radiotherapy (SBRT). This has shown comparable results with an improved side effect profile. The question then is whether patients with early-stage disease should undergo a sublobar resection or SBRT?