New guidelines for treating stage 1 NSCLC patients

Experts have provided updated recommendations for treating stage 1 non-small cell lung cancer (NSCLC) patients who cannot undergo lobectomy due to health risks. Lobectomy is a common surgery, but it poses dangers for patients with severe health issues. In late 2024, the American Association for Thoracic Surgery (AATS) offered guidance specifically for these high-risk patients. Alternatives to lobectomy include sublobar resection, stereotactic ablative radiotherapy (SABR), and image-guided thermal ablation (IGTA). Dr. Sudish Murthy from Cleveland Clinic emphasized the need for quick treatment. Delays in care can lead to worse outcomes. The AATS's consensus statement aims to clear confusion among doctors about the best approaches for these patients. Sublobar resection is recommended when possible. It is essential to ensure that tumor margins are sufficient, as this leads to better survival rates. Doing a lymph node biopsy during surgery can also improve cancer staging and treatment decisions. If sublobar resection isn't an option, SABR is a viable non-surgical choice, but it requires careful planning, especially for patients with larger or central tumors. For those not suited for surgeries or radiation, IGTA is another option, particularly for smaller lung lesions. The recommendations also consider individual patient factors like age and health conditions. Studies indicate that outcomes after sublobar resection can be comparable to those after lobectomy, especially for older patients or those with smaller tumors. The AATS statement also highlights the importance of patient involvement in treatment decisions, acknowledging different patient priorities. Ultimately, treatment choices depend on both the tumor characteristics and the patient's specific needs.