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Page 10 of 12 Galvez et al. Mini-invasive Surg 2020;4:86 I http://dx.doi.org/10.20517/2574-1225.2020.86

safety profile, although the evidence is limited by the absence of randomized trials in this specific subset
of patients. A multidisciplinary assessment in a tumor board with different professionals should guide the
individual decision-making process.

QUESTIONS THAT REMAIN UNANSWERED
Some important topics should be investigated with emphasis to achieve quality levels of evidence in order
to set the role of SLR and SABR in NSCLC treatment algorithms:

 Is SLR really an alternative to lobectomy in early stage NSCLC, and if so, which is its exact indications
(e.g. tumor size, margin to tumor ratio, histological types and subtypes, radiological pattern, nodal
assessment)?
 What is the role of wedge resection in stage I NSCLC and which patients benefit?
 Is SABR a real alternative to limited resection in patients with stage I NSCLC at high-risk for surgery?
 Should SABR be offered in operable stage I NSCLC now that minimally-invasive surgery and SLR are
available?
 Regarding the limitations of SABR in nodal staging and the difficulties in surveillance of post-radiation
lung scars, does patient age play a role in offering SABR during the decision-making process?

CONCLUSION
High-quality multicenter and randomized studies comparing SLR with SABR in NSCLC treatment
are missing. Retrospective and prospective comparative studies and series, and some meta-analysis or
propensity score matching studies show that SABR is a potential alternative treatment for in stage I NSCLC
patients. A trend towards better survival and local control has been found with SLR, but lower adverse
effects profile makes SABR an attractive alternative, especially when dealing with patients at high-risk or
inoperable stage I NSCLC, so it should be included in the decision-making process.

DECLARATIONS
Authors’ contributions
Review and writing: Galvez C
Conception and design of the study: Galvez C, Bolufer S, Corcoles JM, Lirio F, Sesma J, Mafe JJ, Cerezal J

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2020.