Stereotactic Radiation Therapy (SBRT) is an emerging radiotherapy modality that uses complex imaging techniques with multiple fields to allow multiple fields to intersect and converge at the tumor site to create a higher dose of radiation locally to the tumor. It has been shown to improve local control rates and overall survival in patients with early inoperable lung cancer. For resectable early-stage lung cancer, the “battle” between surgical treatment and SBRT is a difficult one. While previous retrospective studies have generally concluded that the former has higher overall survival, results from a randomized clinical trial published in The Lancet Oncology in May this year showed that the latter resulted in higher 3-year overall survival and recurrence-free survival rates. Given the limited number of cases included in previous studies, Dr. Puri, from the University of Washington, used the National Cancer Database (NCDB) to review data on surgical treatment versus SBRT in patients with stage I lung cancer. The findings were recently published in the Journal of Thoracic Oncology. The study collected data on 111,731 patients treated with surgery and 5,887 patients with stage I lung cancer treated with SBRT from the NCDB database between 1998 and 2010, and compared age, gender, tumor size, clinical T-stage and overall median survival between the two groups. The results showed that patients treated with surgery were younger (70.1 years : 74.7 years), had a higher incidence of cardiopulmonary concomitant disease, and had a mortality rate of 2.4% within 30 days after surgery. Patients who underwent SBRT were more likely to be in T1 stage (76.0% : 71.8%) than those who underwent surgery. Data from the matched analysis showed that patients treated surgically had a higher median survival (62.3 months: 33.1 months). This study suggests that men with stage I lung cancer who have few preoperative comorbidities and are in good health are more likely to choose surgical treatment and have better overall survival. However, this study did not include data on local and distant tumor recurrence after surgery in the NCBD database and may have overlooked important covariates affecting survival, so prospective randomized controlled clinical trials with large sample sizes are needed to further evaluate the short- and long-term outcomes of both in early-stage lung cancer.