title: American College of Chest Physicians and Society of Thoracic Surgeons consensus statement for evaluation and management for high-risk patients with stage I non-small cell lung cancer.
abstract: BACKGROUND
  The standard treatment of stage I non-small cell lung cancer (NSCLC) is lobectomy with systematic mediastinal lymph node evaluation. Unfortunately, up to 25% of patients with stage I NSCLC are not candidates for lobectomy because of severe medical comorbidity.
  
  
  METHODS
  A panel of experts was convened through the Thoracic Oncology Network of the American College of Chest Physicians and the Workforce on Evidence-Based Surgery of the Society of Thoracic Surgeons. Following a literature review, the panel developed 13 suggestions for evaluation and treatment through iterative discussion and debate until unanimous agreement was achieved.
  
  
  RESULTS
  Pretreatment evaluation should focus primarily on measures of cardiopulmonary physiology, as respiratory failure represents the greatest interventional risk. Alternative treatment options to lobectomy for high-risk patients include sublobar resection with or without brachytherapy, stereotactic body radiation therapy, and radiofrequency ablation. Each is associated with decreased procedural morbidity and mortality but increased risk for involved lobe and regional recurrence compared with lobectomy, but direct comparisons between modalities are lacking.
  
  
  CONCLUSIONS
  Therapeutic options for the treatment of high-risk patients are evolving quickly. Improved radiographic staging and the diagnosis of smaller and more indolent tumors push the risk-benefit decision toward parenchymal-sparing or nonoperative therapies in high-risk patients. Unbiased assessment of treatment options requires uniform reporting of treatment populations and outcomes in clinical series, which has been lacking to date.
authors.affiliation: Department of Cardiothoracic Surgery, NYU School of Medicine, New York, NY. Electronic address: Jessica.donington@nyumc.org.
authors.forename: Jessica
authors.initials: J
authors.lastname: Donington
authors.affiliation: Department of Surgery, University of Chicago, Chicago, IL.
authors.forename: Mark
authors.initials: M
authors.lastname: Ferguson
authors.affiliation: Department of Pulmonary, Allergy, and Critical Care Medicine, Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: Peter
authors.initials: P
authors.lastname: Mazzone
authors.affiliation: Providence Cancer Center, Portland, OR.
authors.forename: John
authors.initials: J
authors.lastname: Handy
authors.affiliation: Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Schuchert
authors.affiliation: Department of Cardiothoracic Surgery, Boston Medical Center, Boston, MA.
authors.forename: Hiran
authors.initials: H
authors.lastname: Fernando
authors.affiliation: Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA.
authors.forename: Billy
authors.initials: B
authors.lastname: Loo
authors.affiliation: Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA.
authors.forename: Michael
authors.initials: M
authors.lastname: Lanuti
authors.affiliation: Department of Cardiothoracic Surgery, Northwestern Memorial Hospital, Chicago, IL.
authors.forename: Alberto
authors.initials: A
authors.lastname: de Hoyos
authors.affiliation: Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT.
authors.forename: Frank
authors.initials: F
authors.lastname: Detterbeck
authors.affiliation: Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Arjun
authors.initials: A
authors.lastname: Pennathur
authors.affiliation: Department of Surgery, Northshore University Health System, Evanston, IL.
authors.forename: John
authors.initials: J
authors.lastname: Howington
authors.affiliation: Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Rodney
authors.initials: R
authors.lastname: Landreneau
authors.affiliation: Division of Pulmonary Medicine and Critical Care, Medical University of South Carolina, Charleston, SC.
authors.forename: Gerard
authors.initials: G
authors.lastname: Silvestri
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology* / Q000628:therapy*; D017115:Catheter Ablation; D019468:Disease Management; D006801:Humans; D009367:Neoplasm Staging; D011013:Pneumonectomy; D016634:Radiosurgery; D018570:Risk Assessment; D012955:Societies, Medical; D014481:United States