Surgery for all patients with T1N0 non-small cell lung cancer?

T1N0 non-small cell lung cancers account for about 20 % of all lung cancer cases and are defined as tumours up to 3cm without nodal or distant metastasis. The incidence of early-stage diagnoses is increasing, largely driven by the implementation of low dose computed tomography screening programs. Surgery has long been considered the standard of care for these tumours, offering excellent oncologic outcomes and allowing essential pathological staging. However, surgery may be indicated or poorly tolerated in certain populations, particularly elderly or medically inoperable patients. Stereotactic body radiotherapy has emerged as a non-invasive alternative with high local control rates and reduced early morbidity. This raises a critical question: should all patients with early-stage non-small cell lung cancer be managed surgically, or is there a role for treatment individualization? Current evidence highlights the need of balancing curative intent with treatment-related risks. Several clinical trials are currently evaluating stereotactic body radiotherapy in operable patients, aiming to identify subsets that may derive benefit from a non-surgical approach. This review advocates for a personalized, patient-centred treatment strategy, integrating tumour characteristics, operability, comorbidities, and patient preference.