Comparing apples to oranges: short-term mortality after surgery versus stereotactic body radiotherapy for early-stage non-small cell lung cancer

Kathryn E. Engelhardt, David D. Odell, Malcolm M. DeCamp


Lung cancer is the leading cause of cancer-related death in the United States (US) with 224,390 new cases and 158,080 deaths estimated in 2016 (1). For patients with early stage (stage IA–IIA) non-small cell lung cancer (NSCLC), surgical resection provides the best chance for cure (2). In the past decade, stereotactic body radiotherapy (SBRT) has emerged as an alternate to surgical therapy for high medical risk patients with localized disease. Multiple analyses, including meta-analyses and Markov decision models, have suggested oncologic outcomes comparable to resection in medically inoperable patient populations with regard to locoregional control, disease-free survival, and overall survival (3-9). However, the data regarding short-term outcomes, including morbidity and mortality due to treatment, is limited.