CHEST Guidelines-Evaluation and Management for High-Risk Patients With Stage I Non-small Cell Lung Cancer

Evaluation and Management for High-Risk Patients With Stage I Non-small Cell Lung Cancer

Pdf Summary

The American College of Chest Physicians and the Society of Thoracic Surgeons have issued a consensus statement regarding the management of high-risk patients with Stage I Non-Small Cell Lung Cancer (NSCLC), who are not suitable candidates for the standard treatment of lobectomy due to severe medical comorbidities. About 25% of Stage I NSCLC patients fit this category, necessitating alternative treatments.<br /><br />The expert panel developed 13 suggestions for evaluating and treating such patients after a comprehensive literature review. Prefatory evaluation should prioritize cardiopulmonary physiology as respiratory failure post-surgery represents a significant risk. Alternative treatments include sublobar resection (with or without brachytherapy), stereotactic body radiation therapy (SBRT), and radiofrequency ablation (RFA). These options demonstrate reduced procedural morbidity and mortality compared to lobectomy but pose increased risks for recurrence within the involved lobe and regional sites.<br /><br />Current advancements in diagnostic imaging and surgeon-sparing techniques have shifted decisions toward less invasive treatments for high-risk patients. However, uniform reporting of patient outcomes across clinical trials remains insufficient, complicating unbiased assessment of treatment effectiveness.<br /><br />For medical assessments, the Forced Expiratory Volume (FEV1), Diffusing Capacity of the Lung for Carbon Monoxide (DLCO), and peak oxygen consumption during exercise are critical for forecasting postoperative risks. Additionally, patient outcomes should consider functional status, quality of life, and survival rates to appropriately assess treatment viability.<br /><br />Sublobar resection is a suggested alternative in high-risk patients, with anatomic segmentectomy preferred to wedge resection when feasible. SBRT is recommended over conventional fractionated radiation therapy for certain tumors due to superior localized control and survival rates. RFA is a viable option for small peripheral tumors but typically requires a combined approach with radiation for larger tumors due to limited control rates.<br /><br />Overall, while therapeutic options are evolving rapidly, there's a need for consistent reporting standards and continued interdisciplinary collaboration to optimize treatment paths for high-risk Stage I NSCLC patients.

Keywords

Stage I NSCLC

high-risk patients

sublobar resection

SBRT

radiofrequency ablation

cardiopulmonary evaluation

diagnostic imaging

treatment outcomes

FEV1 and DLCO

interdisciplinary collaboration