How do you approach the discussion and decision-making regarding surgery vs SBRT for stage I NSCLC in patients who are candidates for both?

I agree with Dr. @Dr. First Last that it requires a very nuanced and personalized discussion. Our Yale approach (led by Frank Detterbeck) has been detailed in a 4-paper series in the Journal of Thoracic Disease 2022 (overview and SBRT/ablation focus), with the general paradigm balancing short-term, ...

First, I would provide available randomized and non-randomized prospective clinical studies that indicated that both modalities have similar 5-Y OS. I would review the side effects of surgery vs SBRT (G3+ 50+% vs 1-3%). I would discuss the limitations of the studies and SBRT.

Finally, based on the p...

There are contemporary reviews that clarify the uncertainties of benefit with surgery or SBRT for stage I NSCLC whenever lung cancer-specific or overall survival is the driving concern. The 2022 reference posted by @Dr. First Last is one of the more thoughtful ones published on the topic (28p): Dett...

At our institution, if a patient is a surgical candidate, they have surgery as per the NCCN guidelines unless the patient declines surgery then we offer SBRT.