Objective: Standard medical treatment for early non-small cell lung cancer (NSCLC) is surgery; however, stereotactic body radiotherapy (SBRT) can be a viable substitute for elderly patients who can no longer tolerate or refuse surgery. The unsurpassed care for elderly patients with early NSCLC remains inconclusive.We conducted a propensity-score matching analysis to compare the efficacy and sideeffects of SBRT and video-assisted thoracic surgery (VATS) in elderly patients with pathologically-proven early NSCLC. Methods: This single-institution retrospective study included 310 elderly patients who underwent VATS (n = 180) or SBRT (n = 130) from January 2011 to November 2018 at the Tianjin Medical University Cancer Institute and Hospital. Sex, performance status, pathology type, Charlson Comorbidity Index, and T-stage according to the eighth tumor node metastasis classification were considered when performing propensity-score matching.Results: After propensity-score matching, 71 patients were included in each group for analysis. A median follow-up period of 53.5 months was observed for all patients; 72 and 53 months for patients undergoing VATS and SBRT, respectively. Overall survival (p = 0.492), progression-free survival (p = 0.294), locoregional recurrence-free survival (p = 0.866), and distant metastasis-free survival (p = 0.452) did not differ significantly between the VATS and SBRT groups. Multivariate analysis showed a significantThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.