While the majority of patients with stage I non-small cell lung cancer (NSCLC) are treated surgically, approximately 30% are not considered candidates for lobectomy owing to pulmonary dysfunction and/or other co-morbidities. Under these circumstances, a nihilistic approach was commonly adopted in the past; however, the majority of untreated patients died not from their co-morbid disease but from their lung cancer, despite its early stage at diagnosis. Recent advances, including image-guided stereotactic radiotherapy, minimally invasive sublobar resection, and radiofrequency ablation, have altered the situation. A number of prospective studies have yielded promising results, and it is now widely recognized that definitive treatment should be considered in this population.
This book is a detailed guide to the evaluation and management of high-risk patients with early stage NSCLC. It first addresses issues such as pathologic considerations, assessment of co-morbidity, and the imaging and staging of NSCLC. Surgical and radiotherapy treatment options, including sublobar resection, minimally invasive surgery, brachytherapy, stereotactic body radiotherapy, and proton and charged particle therapy, are then discussed in detail. The role of radiofrequency ablation, salvage local therapy, and systemic chemotherapy is also considered. Treatment of High-Risk Early Stage Lung Cancer will be of great interest to radiation and medical oncologists, thoracic surgeons, interventional radiologists, and pulmonologists.