手术是对可手术的I期非小细胞肺癌（NSCLC）（T1-T2aN0M0）患者的标准治疗。立体定向体放射治疗（SBRT）是不可手术患者的选择治疗方法，并且对于可手术患者的位置仍需明确。治疗I期NSCLC后的复发模式主要由远处复发的风险所主导，这为联合系统治疗，特别是检查点抑制剂（CPI）与手术或SBRT的患者进行了理性依据。尽管术后CPI对微转移疾病的益处可以在两种治疗方式的简单叠加效应范围内进行合理考虑，但同时考虑CPI和SBRT的协同作用也是合理的。在肿瘤引流淋巴结在抗肿瘤免疫反应中的作用下，由SBRT实现的“保护肿瘤引流淋巴结”策略可能对联合CPI具有重要意义。在确认CPI与RTS联合治疗I期NSCLC的作用之前，我们在本综述中讨论了这种治疗策略与手术策略相比可能具有的理论优势。版权所有 © 2023 Société française de radiothérapie oncologique (SFRO)，由 Elsevier Masson SAS 出版。保留所有权利。

Surgery is the standard treatment for operable patients with stage I non-small cell lung cancer (NSCLC) (T1-T2aN0M0). Stereotactic body radiotherapy (SBRT) is the treatment of choice for non-operable patients, and its positioning for operable patients remains to be clarified. The pattern of recurrence after management of stage I NSCLC is dominated by the risk of distant recurrence, this constituting the rationale for the adjunction of systemic treatment, and especially check point inhibitor (CPI), in combination with surgery or SBRT for patients with high risk features. While the benefit of postoperative CPI on the micro-metastatic disease is logically considered within the framework of a simply additive effect of both therapeutic modalities, it is reasonable to consider a synergistic effect of both CPI and SBRT. Given the role of tumor draining nodes in the development of an anti-tumor immune response, a "tumor-draining node sparing" strategy enabled by SBRT could therefore be of major interest in combination with CPI. Pending confirmation of the role of CPI in combination with RTS for the management of stage I NSCLC, we thus discuss in this review the theoretical advantages that this therapeutic strategy could have compared to a surgical strategy.Copyright © 2023 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.