Video assisted thoracoscopic surgery and lobectomy, sublobar resection, radiofrequency ablation, and stereotactic radiosurgery: advances and controversies in the management of early stage non-small cell lung cancer.
OBJECTIVE
Lung cancer is the most common cause of cancer related mortality in the United States. The fastest growing segment of the population has been the elderly, who frequently have other significant co-morbidities. In the medically inoperable, high-risk patient, new treatment options including minimally invasive surgery, computed tomography-guided ablative therapy and sterotactic radiosurgery are encouraging. The purpose of this article is to review some of these advances and emerging technologies in the management of early stage lung cancer, particularly in the high-risk patient.


RESULTS
In this article, we review the results of video-assisted thoracoscopic lobectomy, controversies surrounding lobectomy versus sublobar resection, and results of brachytherapy mesh as an adjunct to sublobar resection. Finally, we will review emerging technologies such as radiofrequency ablation and stereotactic radiosurgery in the treatment of lung neoplasm.


CONCLUSIONS
Lobectomy remains the standard for early stage lung cancer. In compromised patients, minimally invasive surgical approaches via thoracoscopy allow sublobar resection (wedge resection or segmentectomy) with or without adjunct brachytherapy mesh to offer results that approach that of lobectomy in some cases. Radiofrequency ablation and stereotactic radiosurgery are emerging technologies for the treatment of lung neoplasm, which are particularly applicable in high-risk patients who are not fit for even minimally invasive surgery. Prospective studies are underway in our center and others to further define the role of these new technologies in the treatment of lung neoplasm.
Pennathur
Arjun
A
Heart, Lung, and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
Abbas
Ghulam
G
Christie
Neil
N
Landreneau
Rodney
R
Luketich
James D
JD
D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation; D003657:Decision Making; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods*; D016634:Radiosurgery; D020775:Thoracic Surgery, Video-Assisted; D016896:Treatment Outcome