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

• DOI: 10.1097/jto.0b013e3181914d3a
• Publication Date: 2010-02-25T06:35:52Z
• Authors: Michael Hsie; Stefania Morbidin...; Leslie J. Kohman; Elisabeth Dexter; Ernest M. Scalzetti; Jeffrey A. Bogart
• Keywords: Pulmonary and Respiratory Medicine; Male; Lung Neoplasms; 03 medical and health sciences; 0302 clinical medicine; Non-small cell lung cancer; Risk Factors; Carcinoma, Non-Small-Cell Lung; Forced Expiratory Volume; Humans; Aged; Neoplasm Staging; Retrospective Studies; Aged, 80 and over; Radiotherapy; Radiotherapy Dosage; Middle Aged; Prognosis; Stage I; 3. Good health; Survival Rate; Treatment Outcome; Oncology; Medically inoperable; Female; Neoplasm Recurrence, Local

Lung cancer remains the leading cause of cancer death in both men and women. A substantial number of patients with early stage non-small cell lung cancer (NSCLC) are unfit for standard surgery due to cardiopulmonary dysfunction and/or other comorbidity. The appropriate management for this population has not been defined.Retrospective analysis of patients with clinical stage I NSCLC judged to be unsuitable for lobectomy between 1996 and 2005.Ninety-six patients, representing 23% of all patients treated for clinical stage I NSCLC were included in this analysis. The median age was 73 years and most patients were female. Patients underwent limited resection (LR, n = 45), primary radiotherapy (RT, n = 39) or radiofrequency ablation (n = 12). With median follow-up of 30 months, 61 patients remain alive. Actuarial 3-year survival is 65% following LR and 60% after primary RT. Local tumor relapse and distant metastases were observed with approximate equal probability following either LR or RT.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.