American 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

Jessica Donington, Mark Ferguson, Peter Mazzone, John Handy, Matthew Schuchert, Hiran Fernando, Billy Loo, Michael Lanuti, Alberto De Hoyos, Frank Detterbeck, Arjun Pennathur, John Howington, Rodney Landreneau, Gerard Silvestri

Research output: Contribution to journalArticle

114 Scopus citations

Abstract

Background: 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 candidates for lobectomy because of severe medical comorbidity. Methods: A panel of experts was convened through the Thoracic Oncology Network of the American College of Chest Physicians and the Workforce on Evidence-Based Surgery of the Society of Thoracic Surgeons. Following a literature review, the panel developed 13 suggestions for evaluation and treatment through iterative discussion and debate until unanimous agreement was achieved. Results: Pretreatment evaluation should focus primarily on measures of cardiopulmonary physiology, as respiratory failure represents the greatest interventional risk. Alternative treatment options to lobectomy for high-risk patients include sublobar resection with or without brachytherapy, stereotactic body radiation therapy, and radiofrequency ablation. Each is associated with decreased procedural morbidity and mortality but increased risk for involved lobe and regional recurrence compared with lobectomy, but direct comparisons between modalities are lacking. Conclusions: Therapeutic options for the treatment of high-risk patients are evolving quickly. Improved radiographic staging and the diagnosis of smaller and more indolent tumors push the risk-benefit decision toward parenchymal-sparing or nonoperative therapies in high-risk patients. Unbiased assessment of treatment options requires uniform reporting of treatment populations and outcomes in clinical series, which has been lacking to date.

Original languageEnglish (US)
Pages (from-to)1620-1635
Number of pages16
JournalChest
Volume142
Issue number6
DOIs
StatePublished - Jan 1 2012

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ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Donington, J., Ferguson, M., Mazzone, P., Handy, J., Schuchert, M., Fernando, H., Loo, B., Lanuti, M., De Hoyos, A., Detterbeck, F., Pennathur, A., Howington, J., Landreneau, R., & Silvestri, G. (2012). American 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. Chest, 142(6), 1620-1635. https://doi.org/10.1378/chest.12-0790