目前比较立体定向消融放疗（stereotactic ablative radiotherapy, SABR）与手术治疗早期非小细胞肺癌（non-small cell lung cancer, NSCLC）的随机研究证据尚不多，高水平的循证医学证据更是缺乏。尽管STARS和ROSEL两项随机研究结果荟萃分析显示SABR较手术耐受性更好，生存不劣于手术，但是目前仍仅推荐拒绝手术或不可手术的早期NSCLC首选SABR，期待着正在进行的随机研究VALOR（Veterans Affairs Lung Cancer Surgery or Stereotactic Ra-diotherapy in the US）和SABRTooth（SABRTooth study in the United Kingdom）的结果。许多回顾性的研究和病例对照研究显示了SABR治疗的安全性和有效性（局部控制率达90%以上，5年生存率达70%），但是由于肿瘤分期定义、如何决定可否手术及手术患者采用手术方式（开胸或胸腔镜辅助）等不同，很难比较SABR和手术的优劣，尽管大部分结论是两种方法疗效相似，但难以成为循证医学证据，因此争论热点是哪一种方法更安全、创伤更小。本文将就以上争论热点进行述评。%High level evidence from randomized studies comparing stereotactic ablative radiotherapy (SABR) to surgery is lacking. Although the results of pooled analysis of two randomized trials for STARS and ROSEL showed that SABR is better tolerated and might lead to better overall survival than surgery for operable clinical stage I non-small cell lung cancer (NSCLC), SABR, however, is only recommended as a preferred treatment option for early stage NSCLC patients who cannot or will not undergo surgery. We, therefore, are waiting for the results of the ongoing randomized studies [Veterans af-fairs lung cancer surgery or stereotactic radiotherapy in the US (VALOR) and the SABRTooth study in the United Kingdom (SABRTooths)]. Many retrospective and case control studies showed that SABR is safe and effective (local control rate higher than 90%, 5 years survival rate reached 70%), but there are considerable variations in the deifnitions and staging of lung cancer, operability determination, and surgical approaches to operable lung cancer (open vs video-assisted). hTerefore, it is diffcult to compare the superiority of radiotherapy and surgery in the treatment of early staged lung cancer. Most studies demonstrated that the effcacy of the two modalities for early staged lung cancer is equivalent;however, due to the limited data, the conclu-sions from those studies are diffcult to be evidence based. hTerefore, the controversies will be focusing on the safety and inva-siveness of the two treatment modalities. hTis article will review the ongoing debate in light of these goals.
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