The standard treatment for early-stage non-small cell lung cancer is a lobectomy, where a surgeon eradicates cancerous tissue by removing a whole lung lobe.

Yet, latest research finds that select patients with early-stage disease who undergo a less invasive procedure have comparable outcomes, sparking hope for a less aggressive approach to lung cancer surgery.

The ten-year study, published within the Latest England Journal of Medicine and led by University of Chicago Medicine medical oncologist Everett Vokes, MD, adds evidence that supports a latest standard to preserve lung tissue in cancer patients every time possible.

It’s great to know that we will safely offer our patients a procedure that permits for the preservation of functional lung tissue so long as patients are properly staged and the surgical team has the mandatory experience.”

Everett Vokes, MD, University of Chicago Medicine medical oncologist

Lung cancer is some of the common types of cancer in the USA and causes essentially the most cancer deaths in each men and girls. While related to having a history of smoking, lung cancer is increasingly diagnosed in nonsmokers in addition to former smokers. An estimated 235,000 latest cases of lung cancer shall be diagnosed in 2023.

Most patients shall be diagnosed after the cancer has spread to other parts of their body. Fortunately, improved screening in smokers means doctors are detecting lung cancer at earlier stages.

On this study, 697 patients with peripheral stage 1 tumors lower than 2 centimeters in size were randomly assigned to undergo a lobectomy or a sublobar resection, where a part of the cancerous lobe is removed.

Within the case of the latter, patients received either a wedge resection, which involves removing a nonanatomic, wedge-shaped piece of tissue containing the tumor, or an anatomical segmentectomy wherein surgeons remove the anatomic lung segment with the tumor, together with the small airway, individual artery and vein that feed and drain the region.

After a median follow-up of seven years, the multicenter, phase 3 randomized trial found disease-free survival was similar between lobectomies and sublobar resections. Five-year disease-free survival and five-year overall survival were similar, supporting the less-invasive procedure as the popular option.

“That is an important study that may change how we treat patients with small early-stage lung cancers – especially as we move into the era of lung cancer screening, where we hope to seek out many more small nodules that could possibly be treated with this tailored surgical approach,” said UChicago Medicine thoracic surgeon Jessica Donington, MD, MSCR.

The research follows a study by Japanese researchers published last yr in The Lancet that compared lobectomy to segmentectomy (but not wedge resection). That study revealed patients who received segmentectomies fared higher when it comes to overall survival, but not for local reoccurrence. Saving lung tissue looked as if it would help with survival from other diseases and secondary cancers.

“Overall survival on this most up-to-date trial was around 80% in each arms,” said Donington, adding that more therapies are needed for lung cancer. “These are the earliest-stage patients and our smallest tumors. We have done all the currently beneficial therapy and yet overall survival remains to be only 80%, when it’s well above 90% for similar-stage breast cancer or prostate cancer.”

Generally, healthy nonsmokers with relatively good lung function can tolerate lobectomies without long-term unwanted side effects. Nevertheless, patients with reduced lung function, as a consequence of smoking or other comorbidities, could also be too sick to undergo the procedure.

“There are occasions when we will not do a lobectomy because there’s just not enough good lung for us to have the ability to remove a whole lobe,” said Donington. “This research is nice news for all patients.”

Each Donington and Vokes cautioned the importance of lung cancer patients finding a surgeon expert in performing sublobar resections, that are more technically difficult surgeries than a lobectomy.

The National Cancer Institute of the National Institutes of Health supported the study.

Source:

University of Chicago Medical Center

Journal reference:

Altorki, N., et al. (2023). Lobar or Sublobar Resection for Peripheral Stage IA Non–Small-Cell Lung Cancer. Latest England Journal of Medicine. doi.org/10.1056/nejmoa2212083.