Chest
Evidence-Based MedicineAmerican College of Chest Physicians and Society of Thoracic Surgeons Consensus Statement for Evaluation and Management for High-Risk Patients With Stage I Non-small Cell Lung Cancer
Section snippets
Executive Summary
The standard treatment of stage I non-small cell lung cancer (NSCLC) is lobectomy with systematic mediastinal lymph node evaluation. Unfortunately, up to 25% of patients with stage I NSCLC are not lobectomy candidates because of severe medical comorbidity. Despite high competitive mortality from underlying lung disease, the mortality related to untreated NSCLC cannot be ignored except in patients who are severely debilitated by their comorbidity, with limited life expectancy. A
Materials and Methods
Task forces were independently assembled through the Workforce on Evidence-Based Surgery of the Society of Thoracic Surgeons (STS) and the Thoracic Oncology Network of the American College of Chest Physicians (ACCP) to address high-risk patients with stage I NSCLC, because of commonality of interest, efforts were combined and a multidisciplinary writing committee was assembled. Relevant population, intervention, comparison, and outcome (PICO) questions were formulated and provided to an
Medical Assessment
Morbidity following lobectomy via thoracotomy is not trivial, with a 30% to 40% incidence of postoperative complications and 1% to 5% operative mortality rate.1, 2, 3 Although morbidity is high, many complications do not contribute meaningfully to risk/benefit decisions, such as urinary tract infections, whereas others, including respiratory failure, can significantly impact survival and quality of life. Respiratory failure remains the leading cause of morbidity and mortality after lobectomy.
Discussion
The tendency for early metastasis from NSCLC makes treatment with localized therapies challenging. SBRT, RFA, and sublobar resection have been associated with increased risk for involved lobe and regional recurrence compared with lobectomy. Improvements in radiographic staging and detection of earlier and more indolent cancers tip the risk/benefit balance for high-risk stage I NSCLC toward less radical interventions. Evidence suggests that in well-staged and properly selected patients, sublobar
Summary
There are now several treatment options available for high-risk patients with stage I NSCLC. A multidisciplinary approach is essential for the management of individual high-risk patients with NSCLC, and a similar approach is required on an organizational level to further define the appropriate use of each modality.
Acknowledgments
Author contributions: Dr Donington takes responsibility for the integrity of the work.
Dr Donington: contributed to the conception and design of study, PICO question formation, review of records, analysis and interpretation of evidence, formation of suggestions, suggestions consensus, drafting of manuscript, manuscript editing, and approval of the published version.
Dr Ferguson: contributed to the design of study, review of records, analysis and interpretation of evidence, formation of
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