The Importance of Pulmonary Nodule Features in the Selection of Treatment for the High-risk Patient with Stage I Non-Small Cell Lung Cancer.

Objective: The American Association for Thoracic Surgery (AATS) Clinical Practice Standards Committee (CPSC) previously published important considerations in determining who is at high risk for complications or mortality after lobectomy. Sublobar resection, stereotactic ablative radiotherapy, or image-guided thermal ablation is typically considered when the risks associated with lobectomy are high. The current objective was to evaluate important lung-nodule-related factors to consider during treatment selection for high-risk patients with stage I non-small cell lung cancer (NSCLC).

Methods: The AATS CPSC assembled an expert panel. The expert panel generated an a priori list of lung-nodule-related factors to consider in treatment selection and graded the relative importance of each factor on a scale of 1-10 in an anonymous survey after systematic review of the literature.

Results: The expert panel survey identified several lung-nodule-related factors to consider in treatment selection. The panel ranked tumor location (peripheral vs central, mean score 8.4), tumor size (mean score 8.1), proximity to bronchovascular and critical structures (mean score 7.8), and the presence of interstitial lung disease/idiopathic pulmonary fibrosis (mean score 7.8) as the most important factors to consider.

Conclusions: This article summarizes the lung-nodule-related factors to consider when deciding between sublobar resection, stereotactic ablative radiotherapy, and image-guided thermal ablation during treatment selection for high-risk patients with stage I NSCLC. When possible, obtaining a biopsy is very important prior to non-surgical treatments. The choice of which modality is optimal in high-risk patients with stage I NSCLC is complex. A multi-disciplinary review of patient and tumor characteristics is essential for achieving an optimal decision.