SABR in early operable lung cancer: time for evidence – Part 2 of 9

This is an invited commentary on the article by Chang and colleagues (Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-cell lung cancer: a pooled analysis of two randomised trials). The authors congratulate Chang and colleagues for merging the data from the two trials in attempt to answer the controversial question of which therapy is most efficacious and agree that the results show that SABR is not inferior to surgery and that SABR may even be more effective than lobectomy. They point out that comparing SABR versus lobectomy may be complicated by the fact that a mediastinal lymph node dissection (MLND) is done at the time of lobectomy, thereby upstaging some of the surgical patients rendering a true comparison subject to bias. In addition, they point out that MLND is widely accepted without evidence of improvement in outcomes. They conclude by stating that clinicians have an obligation to seek evidence to support current practice and patients have a duty to participate in trials.