Stage I non-small cell lung cancer: Treatment modalities, Dutch daily practice and future perspectives. (2021)

• Record Type: Journal Article
• Authors: Hopstaken, Jana S.; de Ruiter, Julianne C.; Damhuis, Ronald A.M.; de Langen, Adrianus J.; van Diessen, Judi N.A.; Klomp, Houke M.; Klompenhouwer, Elisabeth G.; Hartemink, Koen J.
• Is Part Of: Cancer treatment and research communications. Number 28(2021)
• Publication Date: 2021
• Subjects: Non-small cell lung cancer -- Surgery -- Stereotactic body radiotherapy -- Systemic therapy -- Percutaneous ablation -- Multimodality treatment
• DOI: 10.1016/j.ctarc.2021.100404
• Languages: English
• ISSNs: 2468-2942

Abstract

Highlights: Anatomical resection with lymph node dissection is recommended for stage i NSCLC. Despite several trials, the role of SABR in operable patients is not clear yet. In the Netherlands, the proportion of patients treated with SABR has increased. Treatment variation suggests that several factors play a role in treatment decision-making. Studies investigating multimodality treatment for early-stage NSCLC are ongoing. Abstract: Objectives: Several treatment modalities are available for patients with stage I non-small cell lung cancer (NSCLC). Over the past decade, these treatment modalities have been further investigated and might have changed current treatment regimens. In this review we present an overview of the treatment options, developments and future perspectives for stage I NSCLC. Furthermore, we describe the current use of these treatment modalities in the Netherlands. Materials and Methods: A bibliographical search was performed in PubMed and the Cochrane Library for publications concerning treatment modalities for stage I NSCLC. In addition, evidence-based guidelines of the European Society for Medical Oncology (ESMO) and the National Comprehensive Cancer Network (NCCN) were studied. Results: The guideline-recommended treatment for operable stage I NSCLC patients is a lobectomy with systematic lymph node dissection. Inoperable patients or those refusing surgery are offered stereotactic ablative radiotherapy (SABR). Percutaneous ablation, such as radiofrequency ablation, is a non-surgical minimally invasive technique offered to those who are ineligible for surgery or SABR. The role of systemic therapy is currently limited. However, the efficacy of immunotherapy is being investigated in clinical trials. In the Netherlands, an increasing use of SABR and a relative decrease in resection rates have been observed. Conclusion: Surgery and SABR are currently the prevailing treatment modalities for stage I NSCLC patients. Despite optimization of treatment regimens, survival of patients with stage I NSCLC remains to be improved. Future studies are required to optimize treatment strategies, but also to investigate factors influencing treatment decision-making for patients with stage I NSCLC. Graphical abstract: NSCLC = non-small cell lung cancer, SABR = stereotactic ablative radiotherapy Image, graphical abstract