Radiation monotherapy is a reasonable option for treatment in patients with NSCLC who are not candidates for surgery due to comorbidities or other reasons. In non-surgical candidates or those refusing surgery presenting with a peripherally located stage I NSCLC, radiotherapy is the preferred treatment, with local control rates of approximately 90% at 5 years.
As a general rule of thumb, patients with a FEV1 of > 2.5 L are able to tolerate pneumonectomy, whereas a lobectomy is possible for patients with an FEV1 of 1.1-2.4 L. Patients with an FEV1 of < 1 L are not considered candidates for surgery. The presence of cardiac disease or other comorbid conditions should also be considered in the preoperative evaluation.
Recurrence rates and 5-year and long-term overall survival appear similar in patients receiving VATS and those receiving traditional open thoracotomies. Older patients tend to tolerate VATS better as well, and patients treated with VATS appear to have fewer delays and dose reductions in adjuvant chemotherapy. Practice guidelines suggest that VATS is a feasible approach in patients where adequate resection is possible.
At present, the standard of care for patients with locally advanced unresectable NSCLC (stage IIIA) and good risk (ie, Karnofsky performance status score of 70-100, minimal weight loss) is combined-modality therapy consisting of platinum-based chemotherapy in conjunction with radiation therapy. This combination has been associated with a statistically significant improvement in both disease-free and overall survival rates compared with either modality used alone.
For additional information, refer to the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Non–Small Cell Lung Cancer and the European Society for Medical Oncology (ESMO) Clinical Practice Guidelines: Lung and Chest Tumours.
Learn more about the treatment and management of NSCLC.
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Cite this: Daniel S. Schwartz. Fast Five Quiz: Non–Small Cell Lung Cancer - Medscape - Feb 03, 2021.