Surgical and nonsurgical approaches to small-size nonsmall cell lung cancer

Lobectomy and systematic nodal dissection are still the standard for small-size (<3 cm) nonsmall cell lung cancer. There is growing interest in more parenchyma-sparing surgery, so-called sublobar resections (wedge resection or segmentectomy). Indeed, nonrandomised trials suggest that a segmentectomy may result in local control rates that are similar to lobectomy. Nonsurgical approaches, such as stereotactic ablative radiotherapy, consistently result in local control rates of ∼90% and survival rates that are comparable to lobectomy. Therefore, we are moving towards an era in which several therapeutic possibilities are available, that are probably equivalent from an oncological point of view. Further trials are needed to define the optimal therapy for individual patients.