Alternatives to Surgical Resection for Non–Small Cell Lung Cancer
Pp. 412-436 (25)
Akın Eraslan Balcı
Surgical resection for lung cancer remains the mainstay of therapy for earlystage
non–small cell lung cancer (NSCLC) and provides the best opportunity for cure.
Every patient with locoregional NSCLC should be approached as a potential candidate
for resection. For stage 1A, 1B, 2A and 2B NSCLC, an operation is the treatment of
Patients with clinical stage I non-small cell lung cancer (NSCLC) can be considered
falling into three treatment groups: (1) good-risk patients, who are usually treated with
lobectomy; (2) high-risk patients, who are usually treated with sublobar (segmental or
wedge) resection; and (3) medically inoperable patients, who traditionally have been
treated with external beam radiation therapy . Stereotactic body radiation therapy
(SBRT) and radiofrequency ablation (RFA) are two nonoperative approaches that are
gaining increasing popularity for the treatment of NSCLC. Radiofrequency ablation
(RFA) therapy is a minimally invasive technique that can be used in the management of
inoperable non-small-cell lung cancer and for palliation in selected patients with
pulmonary metastases. Surgical resection remains the gold standard of treatment;
however, many patients are ineligible due to comorbidities or poor cardiopulmonary
reserve. Some have claimed that SBRT is superior to sublobar resection and may even
be equivalent to lobectomy. This assumption is incorrect. At best, stereotactic body
radiation therapy and radiofrequency ablation can only approximate a wedge resection
if it is assumed that 100% tumour destruction has occurred. Lymph node dissection and
sampling can also be undertaken at the time of sublobar resection, potentially improving
outcomes and allowing identification of unsuspected nodal disease. Despite this,
stereotactic body radiation therapy and radiofrequency ablation may be clinically
equivalent to sublobar resection for the high-risk patient because of lower procedural
morbidity and more rapid return to normal function [6, 7].
Radiofrequency, radiosurgery, stereotactic, microwave, ablation,
cyberknife, lung cancer.
Euphrates University School of Medicine, Department of Thoracic Surgery, Elazig, Turkey.