Advances and controversies in the management of early stage non-small cell lung cancer

Abstract

Complete resection continues to be the gold standard for the treatment of early-stage lung cancer. The landmark Lung Cancer Study Group trial in 1995 established lobectomy as the minimum intervention necessary for the management of early-stage non-small cell lung cancer, as it was associated with lower recurrence and metastasis rates than sublobar resection and lower postoperative morbidity and mortality than pneumonectomy. There is a growing tendency to perform sublobar resection in selected cases, as, depending on factors such as tumor size, histologic subtype, lymph node involvement, and resection margins, it can produce similar oncological results to lobectomy. Alternative treatments such as stereotactic body radiotherapy and radiofrequency ablation can also produce good outcomes in inoperable patients or patients who refuse surgery.

Clinical Outcomes Following Proton and Photon Stereotactic Body Radiation Therapy for Early-Stage Lung Cancer

“…Based on the global cancer statistics 2020, lung cancer is the most common cancer and the leading cause of cancer deaths in males, and the third most common cancer and second most common cause of cancer deaths in females, respectively [ 2 ]. The gold standard management of early-stage (cT1-2N0M0) non-small cell lung cancer (NSCLC) is complete surgical resection with lobectomy [ 3 ]. However, more than two-thirds of the patients are 65 years or older, usually having multiple comorbidities, which frequently makes these patients medically unfit for surgery [ 4 ].…”

Elevated BTG2 improves the radiosensitivity of non‐small cell lung cancer (NSCLC) through apoptosis

“…2 Surgical resection is currently considered the best treatment strategy for early-stage NSCLC. 3 For inoperable patients or patients who refuse surgery, radiation therapy is extensively applied. 3,4 However, radio-resistance to ionizing radiation (IR) is a major obstacle for the successful treatment of NSCLC as it can result in local recurrence and distant metastasis in the clinic, and greatly limits the application of radiation therapy.…”

“…3 For inoperable patients or patients who refuse surgery, radiation therapy is extensively applied. 3,4 However, radio-resistance to ionizing radiation (IR) is a major obstacle for the successful treatment of NSCLC as it can result in local recurrence and distant metastasis in the clinic, and greatly limits the application of radiation therapy. 5 Therefore, searching for the mechanisms underlying radio-resistance in NSCLC is a critical research focus.…”

“…Lung cancer is divided into two types, small cell lung cancer and non‐small cell lung cancer (NSCLC), and NSCLC constitutes approximately 85% of all lung cancer cases 2 . Surgical resection is currently considered the best treatment strategy for early‐stage NSCLC 3 . For inoperable patients or patients who refuse surgery, radiation therapy is extensively applied 3,4 .…”