Radiotherapy issues in non-small cell lung cancer: radiotherapy versus surgery in the treatment of early stage

We discussed in this article about the role of surgery, in a broad sense, and radiotherapy for the treatment of early stage of non-small cell lung cancer (NSCLC), and we also examined if patients' outcomes after radiation therapy are comparable to the ones after surgery. Radiotherapy is at present a less attractive alternative to surgery in operable patients with early stage of NSCLC. Indeed, radiotherapy is frequently reserved for patients who are deemed unfit for surgery due to poor pulmonary function or other comorbidities. This introduces a large patient selection bias compared to surgery, rendering overall survival less suitable for comparison. When we compare patients who are deemed operable but refuse surgery, the 5-year overall survival rate observed, after a high effective dose, is equivalent to the outcome after surgery. On the other hand, it is difficult to enrol patients in randomized clinical trials for this purpose, propensity matched analysis allows to compares the effectiveness of radiotherapy and surgery using comparable series of patients, using this methodology two studies obtained similar results. This data support the need of continuous investigation for non-surgical alternatives in this disease, radiotherapy can be a good option. Until then, surgery remains the treatment of choice for early stage of NSCLC.