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

Purpose: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.Conclusion: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.