Is SBRT the optimal first-line treatment for operable early-stage NSCLC in elderly patients?

The introduction of screening programs and the increase in life expectancy in developed countries have significantly raised the incidence of early-stage non-small cell lung cancer (ES-NSCLC). Surgery remains the standard of care for ES-NSCLC; however, stereotactic body radiotherapy (SBRT) has become the treatment of choice for patients with inoperable ES-NSCLC. Despite its growing use, there is a lack of robust data from randomized phase III trials comparing SBRT to surgery, mostly due to challenges in recruitment. This gap is particularly pronounced in the elderly, who are often excluded from clinical studies. With the rising incidence of ES-NSCLC and an aging population, non-invasive therapies like SBRT may offer significant advantages by minimizing treatment-related morbidity while effectively controlling the disease. This review critically evaluates the current literature on managing ES-NSCLC in elderly patients and assesses the potential benefits and limitations of SBRT as a standard of care in this complex population.