Alternatives to thoracic surgery in the early stages lung cancer?

Lobectomy with lymph node dissection is the standard of care for operable early stage non-small cell lung cancer (NSCLC). For patients not eligible for surgery, stereotactic body radiation therapy (SBRT) and image guided percutaneous ablation techniques such as radiofrequency ablation (RFA) are validated alternatives with very promising results for selected patients. SBRT has shown to be effective for patients non-amenable to surgery, with interesting 2-year local control rates of 84-98% and 3-year overall survival (OS) of 43-72%. Complications are rare and radiation pneumonitis is most frequent one. Studies comparing SBRT to surgery were closed because of slow accrual but preliminary results were favorable to radiotherapy. Percutaneous ablations are also a validated alternative for tumors <2-3 cm with local control rates >90% and overall survival similar to those obtained after surgical resection. The main complication is the possibility of a pneumothorax, which may require thoracic drainage. Outpatient treatment or short hospitalization, the possibility to obtain pathological confirmation during the same procedure, and the repeatability of the treatments are the major advantages of these techniques.