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Physiologic Evaluation of the Patient With Lung Cancer Being Considered for Resectional Surgery: Risk of Suboptimal Treatment of Lung Cancer

Physiologic Evaluation of the Patient With Lung Cancer Being Considered for Resectional Surgery: Risk of Suboptimal Treatment of Lung Cancer

conventional radiation therapyLittle information is available on the long-term survival of patients who were deemed to be inoperable because of physiologic limitations, especially when compared to a group of patients with similar physiologic limitations who underwent surgical resection. In a study reporting on outcomes for a group of 66 high-risk lung cancer patients, 5 patients who were at very high risk for poor outcome underwent curative-intent surgical resection. One patient died in the perioperative period, but the long-term survival curve for the whole group of 5 high-risk patients undergoing surgery, including surgical death, was no different than that for 39 similar patients who were deemed to be inoperable.

Recent studies from Japan and the United States have provided information on prognosis for patients with early-stage lung cancer who did not undergo curative-intent surgery. From 1982 to 1991, 4,947 patients with clinical stage I lung cancer were identified in the National Chest Hospital Study Group for Lung Cancer in Japan. Of these 4,947 patients, 4,127 (83%) were treated surgically. The 799 patients (16%) who were treated nonoperatively had a 5-year survival rate of 16.6%. Many of these patients were treated with some combination of radiation therapy, chemotherapy, and immunotherapy, but no significant effect of these treatment modalities on survival was seen. Interestingly, 49 of the patients (6%) treated nonoperatively survived for > 5 years. The reasons why surgery was not performed were not provided but probably were related to comorbid disease and patient refusal. Patients may make orders of My Canadian Pharmacy’s preparations to treat various diseases.

Between 1994 and 1999, stage I or IIa lung cancer was diagnosed in 128 patients at a single US hospital. Of these 128 patients, 49 (38%) did not receive any treatment, and their median (± SD) survival time was 14.2 ± 2.4 months. This was significantly worse than the median survival time of 46.2 ± 3.2 months for the 43 patients (34%) who underwent lobectomy. Another 36 patients (28%) underwent radiation therapy, and their median survival time was 19.9 ± 5.6 months. This survival time was significantly greater than that for the no-treatment group, but the radiation therapy was often for palliative purposes, not curative purposes. The survival results for this single-center study are similar to the data collected on outcomes of patients with stage I lung cancer from 1988 to 2001 that was reported in the Surveillance, Epidemiology, and End Results regis-try. The median survival time for untreated patients was 14 months; it was 21 months for patients treated with radiation therapy.

The survival benefits of conventional radiation therapy for early-stage NSCLC are small, and a cure should not be expected. Qiao and colleagues evaluated the results of radiation therapy, usually provided to medically inoperable patients, in the treatment of stage I NSCLC from 18 studies. They found that the median survival time from these studies ranged from 18 to 33 months, and that the mean 5-year survival rate was 21 ± 8%. Local control of the cancer and survival seemed to be higher in patients receiving > 60 to 65 Gy of radiation. Newer techniques for administering radiation therapy may improve overall survival with a reduced risk for lung toxicity. Three-dimensional conformal radiotherapy may allow the tolerable administration of up to 84 Gy of radiation with potentially improved survival.

<p “=””>These data provide useful background information on the prognosis for patients with stage I and II lung cancer who do not undergo curative-intent surgical resection. Overall survival is poor with no therapy; radiation therapy provides a survival benefit compared to no therapy, but a suboptimal outcome compared to surgery (see “Lung Cancer” chapter). Guidelines for the management of NSCLC strongly advise the use of radiation therapy with or without chemotherapy in patients who choose to not undergo operative resection. However, it should be recognized that the risks of reduced long-term survival due to suboptimal (nonoperative) treatment of early-stage lung cancer are substantial.