Limited field irradiation for medically inoperable patients with peripheral stage I non-small cell lung cancer

Questions with inconclusive answers

“…It was with interest that we read the recent article by EGERMANN et al [1] on the outcome of regular followup in patients with nonsmall-cell lung cancer (NSCLC) treated with curative resection, including cost-effectiveness analysis. We wholeheartedly agree with the conclusions of the study, but would like to extend this observation to another subset of patients, namely those with technically operable, but medically inoperable early stage NSCLC, usually treated with radiation therapy (RT) alone [2][3][4][5]. There are a number of similarities and differences between these two patient groups.…”

“…The challenge of reducing overall resistance rates by reducing antimicrobial selection pressure cannot be resolved by withholding antimicrobial treatment and implementing invasive diagnostic measures in order to establish the presence of VAP. It should be remembered that antimicrobial pretreatment is not the only confounder when applying diagnostic techniques based on quantitative cultures [5,6]. Instead, the preferred strategy when facing this challenge is the definition and implementation of: 1) an appropriate policy of empiric initial antimicrobial treatment; 2) an infection control programme, including strict measures in hospital environments with excess resistance rates; and 3) a critical judgment, including clinical and microbiological data, when estimating the probability of pneumonia in individual patients.…”

Regular follow­up for patients irradiated for early stage nonsmall­cell lung cancer too!

“…We wholeheartedly agree with the conclusions of the study, but would like to extend this observation to another subset of patients, namely those with technically operable, but medically inoperable early stage NSCLC, usually treated with radiation therapy (RT) alone [2][3][4][5]. There are a number of similarities and differences between these two patient groups.…”

“…Thirdly, while we agree with EGERMANN et al [1] that the outcome of their patient population may have been burdened by advanced age and pre-existing comorbidities, this was even more the case for the RT-treated patients who were not surgical candidates, with the exception of a few patients who refused surgery for their initial early NSCLC [2][3][4][5]. We have used a very similar follow-up approach to that of EGERMANN et al [1] in our patient population, and, although we did not perform cost-effectiveness analysis, we are almost certain that the same would have happened with RT.…”

Effectiveness of Radiation Therapy for Elderly Patients with Unresected Stage I and II Non–Small Cell Lung Cancer

“…Several retrospective analyses have reported the outcomes of patients treated with RT alone but did not include a control group (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). These studies showed that the prognosis of these patients is poor, with a 20% (range 13-39%) 5-year lung cancer-specific survival rate.…”