Randomised controlled trials comparing surgery with non-surgical treatment for cancer have been notoriously difficult to complete, owing to challenges in both equipoise and preference in patients and providers alike.1 Debate on the relative merit of stereotactic ablative radiotherapy (SABR) versus surgery for early-stage non-small-cell lung cancer (NSCLC) is no exception. Prospective randomised controlled trials designed to identify a so-called winner between surgery and SABR have not been able to accrue, and the pooled analysis from the prematurely closed original STARS and ROSEL studies has been a lightning rod for discussion among thoracic oncologists.2 Even with other comparative effectiveness studies attempting to adjust for confounding, inherent limitations engender polarising opinions.3 In The Lancet Oncology, Joe Chang and colleagues present the results of the new revised STARS cohort of an additional 80 patients with medically operable early-stage NSCLC treated with SABR.4 The authors should be congratulated on the robust study conduct. Ultra-central tumours were not included; both lobectomy and SABR are challenging in this cohort and further comparative data are required.9 Furthermore, biomarker data were not available in STARS, and have implications for both prognostication and salvage therapies.10 Until randomised controlled trials are completed, for younger, fitter patients presenting with stage IA NSCLC, it seems that there are two outstanding treatment options available for long-term survival.