Treatment selection for the high-risk patient with stage I non-small cell lung cancer: Sublobar resection, stereotactic ablative radiotherapy or image-guided thermal ablation? Editorial
| Authors: | Pennathur, A.; Lanuti, M.; Merritt, R. E.; Wolf, A.; Keshavarz, H.; Loo, B. W. Jr; Suh, R. D.; Mak, R. H.; Brunelli, A.; Criner, G. J.; Mazzone, P. J.; Walsh, G.; Liptay, M.; Wafford, Q. E.; Murthy, S.; Marshall, M. B.; Tong, B.; Pettiford, B.; Rocco, G.; Luketich, J.; Schuchert, M. J.; Varghese, T. K. Jr; D'Amico, T. A.; Swanson, S. J.; AATS Clinical Practice Standards Committee: Thoracic Surgery |
| Title: | Treatment selection for the high-risk patient with stage I non-small cell lung cancer: Sublobar resection, stereotactic ablative radiotherapy or image-guided thermal ablation? |
| Abstract: | A significant proportion of patients with stage I non–small cell lung cancer (NSCLC) are considered at high risk for complications or mortality after lobectomy. The American Association for Thoracic Surgery (AATS) previously published an expert consensus document detailing important considerations in determining who is at high risk. The current objective was to evaluate treatment options and important factors to consider during treatment selection for these high-risk patients. After systematic review of the literature, treatment options for high-risk patients with stage I NSCLC were reviewed by an AATS expert panel. Expert consensus statements and vignettes pertaining to treatment selection were then developed using discussion and a modified Delphi method. The expert panel identified sublobar resection, stereotactic ablative radiotherapy (SABR), and image-guided thermal ablation (IGTA) as modalities applicable in the treatment of high-risk patients with stage I NSCLC. The panel also identified lung-nodule-related factors that are important to consider in treatment selection. Using this information, the panel formulated 14 consensus statements and 5 vignettes illustrating clinical scenarios. This article summarizes important factors to consider in treatment selection using these modalities, which are applicable in high-risk patients with stage I NSCLC. The choice of which modality (sublobar resection, SABR, or IGTA) is optimal in high-risk patients with stage I NSCLC is complex, but a surgical approach is generally favored when deemed safe. SABR and IGTA are reasonable options in select patients. SABR is more commonly used than IGTA and is likely the next-best choice. A multi-disciplinary review of patient and tumor characteristics is essential for achieving an optimal decision. The clinical treatment decision should also take patient perspectives, preferences, and quality of life into consideration. © 2024 Elsevier Inc. |
| Keywords: | treatment outcome; surgical technique; overall survival; mortality; patient selection; adjuvant therapy; disease free survival; cancer staging; positron emission tomography; recurrence risk; neoplasm staging; consensus; computer assisted tomography; tumor volume; carcinoma, non-small-cell lung; lung neoplasms; pneumonectomy; risk factors; lung cancer; editorial; pathology; diagnostic imaging; risk factor; risk assessment; lung tumor; radiation oncology; systematic review; lymph node; radiosurgery; ablation techniques; surgery; bronchoscopy; clinical decision making; lung function; cryoablation; stereotactic body radiation therapy; thorax surgery; lobectomy; mediastinoscopy; therapy; ablation therapy; surgery, computer-assisted; recurrence free survival; non small cell lung cancer; high-risk; adverse event; thermal ablation; image guided radiotherapy; computer assisted surgery; procedures; sublobar resection; radiotherapy, image-guided; clinical decision-making; humans; human; image-guided ablation; segmentectomy; image guided thermal ablation; expert consensus; ultrasound guided fine needle aspiration; stage i non-small cell lung cancer; stereotactic body radiation treatment; contraindication; endobronchial ultrasound guided transbronchial needle aspiration |
| Journal Title: | Seminars in Thoracic and Cardiovascular Surgery |
| Volume: | 37 |
| Issue: | 1 |
| ISSN: | 1043-0679 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2025-03-01 |
| Start Page: | 114 |
| End Page: | 121 |
| Language: | English |
| DOI: | 10.1053/j.semtcvs.2024.10.004 |
| PUBMED: | 39662537 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Editorial -- Source: Scopus |
