Stereotactic Body Radiation Therapy Equally Effective as Surgery in Stage I NSCLC

A new study1 found that the use of stereotactic body radiation therapy (SBRT) produced similar overall survival in patients with stage I non–small cell lung cancer (NSCLC) when compared with the use of surgery, making it a potential alternative in patients who are at risk should they have surgery.

NSCLC is often treated through the use of lobectomy and mediastinal lymph node dissection when it is in early stages.2 However, some patients cannot undertake surgery due to their overall health, which could make them susceptible to complications from surgery. SBRT is a means of providing treatment for these patients that has the potential for similar outcomes when compared with lobectomy. The current study compared SBRT and lobectomy with mediastinal lymph node dissection to assess the differences in treatment outcomes.

Stereotactic body radiation therapy had comparable overall survival to lobectomy in patients with stage I NSCLC | Image credit: Rasi - stock.adobe.com

All patients in the study were diagnosed with stage I NSCLC between 2016 and 2021 at Ajou University Hospital. Patients were excluded if they had double primary lung cancers or had a history of other malignancies within the previous 5 years. The surgery group consisted of patients who had a lobectomy as their initial treatment. Thoracotomy or video-assisted thoracoscopic surgery was used to perform the surgery.

There were 214 patients included in the study, of which 93 had a lobectomy and 31 patients received SBRT. The mean (SD) age was significantly different between SBRT and lobectomy groups before propensity score matching (PSM) (79.6 [5.1] vs 65.2 [10.2] years, respectively). This difference remained significant after PSM (79.6 [5.1] vs 72.7 [4.9] years).

Pathologically positive lymph nodes were found in 15 patients in the surgery group, and 17 patients in the surgery group received adjuvant chemotherapy. Before matching, the difference in overall survival (OS) was not significant (3-year OS, 90.0% vs 93.0%). The surgery group had better disease-free survival (before PSM: 54.5% vs 78.1%; after PSM: 54.4% vs 68.2%). Recurrence-free survival was higher in the surgery group as well, but distant recurrence-free survival had no significant difference between the 2 groups.

A total of 19.4% of the patients who had SBRT experienced local recurrence compared with 0% of the surgery group. However, regional and distant recurrence did not differ significantly.

There were some limitations to this study. Generalizability may be limited due to the retrospective design, with all participants coming from a single center. There was a short follow-up period, which limits the assessment of long-term outcomes. There was a small number of participants in the study. There was a significant difference in age between the 2 groups. Poorer covariate balance may have occurred with the use of PSM.

The researchers concluded that OS and distant recurrence outcomes were similar between SBRT and lobectomy despite a higher rate of local recurrence when SBRT is used in patients with stage I NSCLC.

“Given its non-invasive nature, SBRT may be a reasonable alternative for elderly patients or those at high surgical risk,” the authors wrote. “…Further research with larger cohorts and longer follow-up is warranted to validate these findings and explore the role of adjuvant therapies.”

References

1. Lee S, Noh OK. Comparison of surgery and stereotactic body radiation therapy for clinical stage I NSCLC: a propensity score-matched analysis from a single institution. J Thorac Dis. 2025;17(9):6884-6892. doi:10.21037/jtd-2025-925

2. Treatment choices for non–small cell lung cancer, by stage. American Cancer Society. Updated June 23, 2025. Accessed October 29, 2025. https://www.cancer.org/cancer/types/lung-cancer/treating-non-small-cell/by-stage.html