Definitive treatment of poor-risk patients with stage I lung cancer: a single institution experience.
OBJECTIVE
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.


METHODS
Retrospective analysis of patients with clinical stage I NSCLC judged to be unsuitable for lobectomy between 1996 and 2005.


RESULTS
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.


CONCLUSIONS
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.
Hsie
Michael
M
SUNY Upstate Medical University, Department of Radiation Oncology, Syracuse, New York, USA. hsiem@upstate.edu
Morbidini-Gaffney
Stefania
S
Kohman
Leslie J
LJ
Dexter
Elisabeth
E
Scalzetti
Ernest M
EM
Bogart
Jeffrey A
JA
D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D009367:Neoplasm Staging; D011379:Prognosis; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome