Non-small cell lung cancer (NSCLC) remains the leading cause of cancer death worldwide. Approximately 15 to 20% of NSCLC patients present with early or localised disease; this figure is expected to grow with the increased use of low-dose computed tomography (CT) scans for screening (1). The standard treatment for operable stage I NSCLC is lobectomy or pneumonectomy with mediastinal lymphadenectomy. Five-year survival rates of early stage NSCLC patients range between 60 and 80% after surgical resection (2). Despite major developments in minimally-invasive surgical procedures, a substantial proportion of patients are not suitable for surgery due to their comorbidities. Stereotactic body radiation therapy (SBRT) or stereotactic ablative radiotherapy (SABR) has recently emerged as a benchmark of care for medically inoperable patients. SABR is a more concise and well-planned treatment procedure with enhanced local control and survival while minimising treatment cost against conventional radiotherapy.Cancer-specific outcomes of patients in SABR series are generally comparable to surgical series; however, overall survival results are usually reported to be superior in the surgical cohorts because of major differences in the two groups.Approximately one in every three patient dies as a result of comorbidity-related complications instead of cancer in SBRT series. As a result, in patients with operable stage I NSCLC, surgical operation continues to be the benchmark of care. In this review, we plan to summarise the published evidence for the treatment of early stage NSCLC with surgery and SABR.
THE SURGICAL MANAGEMENT OF EARLY STAGE NSCLCSurgical resection remains the treatment of choice for patients with stage I or II NSCLC, since it provides the optimal likelihood of cure and long-term survival. Such an operation includes both complete anatomical resection of the tumour and mediastinal lymph node evaluation (3).
PREOPERATIVE EVALUATIONPatients with NSCLC who are surgical candidates are often cigarette smokers, which makes them vulnerable to atheroThe management of early-stage Non-small Cell Lung Cancer (NSCLC) has improved recently due to advances in surgical and radiation modalities. Minimallyinvasive procedures like Video-assisted thoracoscopic surgery (VATS) lobectomy decreases the morbidity of surgery, while the numerous methods of staging the mediastinum such as endobronchial and endoscopic ultrasound-guided biopsies are helping to achieve the objectives much more effectively. Stereotactic Ablative Radiotherapy (SABR) has become the frontrunner as the standard of care in medically inoperable early stage NSCLC patients, and has also been branded as tolerable and highly effective. Ongoing researches using SABR are continuously validating the optimal dosing and fractionation schemes, while at the same time instituting its role for both inoperable and operable patients.