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Alternatives to Surgery for Early Stage Non-Small Cell Lung Cancer-Ready for Prime Time?

  • Lung Cancer
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Surgery is the standard of care for early stage non-small cell lung cancer (NSCLC), with lobectomy being the most oncologically sound resection. Medically inoperable patients and high-risk surgical candidates require effective alternatives to surgery; even operable patients may opt for less invasive options if they are proven to achieve similar outcomes to surgery. Minimally invasive local treatment modalities including dose-intensified conformal radiation therapy, most notably stereotactic ablative radiotherapy (SABR; also known as stereotactic body radiation therapy), and thermal ablation methods such as radiofrequency ablation (RFA) and microwave ablation (MWA) are emerging as promising treatment options whose roles in the treatment of early stage lung cancer are being defined. Early clinical experience and a rapidly growing body of prospective clinical trials, primarily in medically inoperable patients, are demonstrating encouraging effectiveness and safety outcomes in some cases approaching historical results with surgery. Given the very poor prognosis of the medically inoperable patient population, these alternatives to surgery, particularly SABR, are starting to be considered appropriate first-line therapy in properly selected patients, and prospective cooperative group trials to evaluate and optimize RFA and SABR in specific patient subsets are being conducted. For operable patients, prospective multi-center and cooperative groups trials of SABR are ongoing or completed, and international randomized trials of SABR vs. surgery have been initiated. Thus, promising alternatives to surgery for early stage NSCLC are ready for prime time evaluation in the setting of clinical trials, and participation in ongoing trials for both operable and medically inoperable patients is strongly encouraged.

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Authors and Affiliations

  1. Department of Medicine, Division of Medical Oncology, Stanford Cancer Center, 875 Blake Wilbur Drive, Stanford, CA, 94305, USA

    Millie Das MD

  2. Department of Radiology, Division of Interventional Radiology, Stanford University, 300 Pasteur Drive, H3652, Stanford, CA, 94305-5642, USA

    Mohamed H. K. Abdelmaksoud MD, MS & Nishita Kothary MD

  3. Department of Radiation Oncology, Stanford University and Cancer Center, 875 Blake Wilbur Drive, Stanford, CA, 94305-5847, USA

    Billy W. Loo Jr. MD, PhD

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  1. Millie Das MD
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  2. Mohamed H. K. Abdelmaksoud MD, MS
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  3. Billy W. Loo Jr. MD, PhD
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  4. Nishita Kothary MD
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Correspondence to Billy W. Loo Jr. MD, PhD or Nishita Kothary MD.

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Das, M., Abdelmaksoud, M.H.K., Loo, B.W. et al. Alternatives to Surgery for Early Stage Non-Small Cell Lung Cancer-Ready for Prime Time?. Curr. Treat. Options in Oncol. 11, 24–35 (2010). https://doi.org/10.1007/s11864-010-0119-z

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