Definitive Treatment of Poor-Risk Patients with Stage I Lung Cancer: A Single Institution Experience

Abstract

Medical inoperability does not necessarily correspond to poor survival in patients with early stage NSCLC. A nihilistic approach is not warranted towards this population, and prospective trials are needed to better define optimal treatment strategies.

British Thoracic Society guidelines for the investigation and management of pulmonary nodules: accredited by NICE

“…The majority of studies considered RFA (n=25 studies)266 – 290 and SABR (n=14)262 265 291–302. Other publications reported outcomes from conventional radiotherapy (n=3),281 297 303 percutaneous cryotherapy (n=1),276 microwave ablation (n=2)304 305 inhaled corticosteroids (n=2)306 307 and antibiotics (n=1) 308…”

“…Hsie et al 281 retrospectively compared outcomes in 96 patients with pathologically confirmed stage I NSCLC not suitable for standard surgical resection (lobectomy/pneumonectomy) and treated with either limited surgical resection, RFA or conventional radical radiotherapy. Patients were assigned to treatment groups by clinician preference and the cohorts were not well matched.…”

“…Propensity score matching was used to reduce bias by matching patients according to numerous baseline variables, and analysis was performed on an intention-to-treat basis of clinical diagnosis, irrespective of the final histological result. The four single-centre cohort studies281 294 297 303 have significant selection bias and major confounding factors, which preclude direct comparison between outcomes in the groups studied.…”

“…The frequency of complications in case series of patients treated with RFA266 267 271–273 275–278 280 281 283–287 289 290 304 305 was as follows: pneumothorax was the most commonly reported complication with rates varying from 9% to 54% in 19 case series. Other reported complications after RFA were bleeding (0.7–26%), pleural effusion (1.8–19%), pneumonia (1.8–12%), pleuritis (0.6–4.3%), lung abscess (0.3–3.1%), haemothorax (3.0%), severe pain (2%), bronchopleural fistula (1.5–1.8%), acute respiratory distress syndrome (1.5%) and pericardial tamponade (0.9%).…”

Outcome of Limited Resection for Lung Cancer

“…The rationale for conventional LR centers around improving early survival and quality of life, and preoperative risk analysis should be cautiously focused on precise assessment of risk-benefit relationship on an individual patient basis. Because patients with stage I NSCLC who are indicated for non-surgical treatment due to multiple risk factors are rare, there have been only a few reports on the long-term outcome of CRL in comparison to radiotherapy or chemotherapy [12,13] for this subset. In our study, the overall surgical outcome after CRL was less than optimal with high recurrence rate.…”