Opinion Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Dec 24, 2021; 12(12): 1089-1100
Published online Dec 24, 2021. doi: 10.5306/wjco.v12.i12.1089
Advances and controversies in the management of early stage non-small cell lung cancer
Angel Cilleruelo-Ramos, Esther Cladellas-Gutiérrez, Carolina de la Pinta, Laura Quintana-Cortés, Paloma Sosa-Fajardo, Felipe Couñago, Xabier Mielgo-Rubio, Juan Carlos Trujillo-Reyes
Angel Cilleruelo-Ramos, Department of Thoracic Surgery, Clinic Universitary Hospital, Valladolid 47005, Spain
Angel Cilleruelo-Ramos, Department of Surgery, Universidad de Valladolid, Valladolid 47001, Spain
Esther Cladellas-Gutiérrez, Juan Carlos Trujillo-Reyes, Department of Thoracic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona 08029, Spain
Carolina de la Pinta, Department of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
Laura Quintana-Cortés, Department of Medical Oncology, Hospital Don Benito-Villanueva, Badajoz 06400, Spain
Paloma Sosa-Fajardo, Department of Radiation Therapy, Complejo Hospitalario Universitario, Santiago de Compostela, La Coruña 15706, Spain
Felipe Couñago, Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Madrid 28223, Spain
Felipe Couñago, Department of Radiation Oncology, Hospital La Luz, Madrid 28223, Spain
Felipe Couñago, Department of Medicine, School of Biomedical Sciences, Universidad Europea, Madrid 28223, Spain
Xabier Mielgo-Rubio, Department of Medical Oncology Unit, Hospital Universitario Fundación Alcorcón, Madrid 28922, Spain
Juan Carlos Trujillo-Reyes, Department of Surgery, Universitat Autónoma, Barcelona 08029, Spain
Author contributions: All authors wrote the paper.
Conflict-of-interest statement: No conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Angel Cilleruelo-Ramos, MD, PhD, Surgeon, Department of Thoracic Surgery, Clinic Universitary Hospital, Ramón y Cajal 3, Valladolid 47005, Spain. ancillera@hotmail.com
Received: April 15, 2021
Peer-review started: April 15, 2021
First decision: July 16, 2021
Revised: July 20, 2021
Accepted: December 10, 2021
Article in press: December 10, 2021
Published online: December 24, 2021
Abstract

Complete resection continues to be the gold standard for the treatment of early-stage lung cancer. The landmark Lung Cancer Study Group trial in 1995 established lobectomy as the minimum intervention necessary for the management of early-stage non-small cell lung cancer, as it was associated with lower recurrence and metastasis rates than sublobar resection and lower postoperative morbidity and mortality than pneumonectomy. There is a growing tendency to perform sublobar resection in selected cases, as, depending on factors such as tumor size, histologic subtype, lymph node involvement, and resection margins, it can produce similar oncological results to lobectomy. Alternative treatments such as stereotactic body radiotherapy and radiofrequency ablation can also produce good outcomes in inoperable patients or patients who refuse surgery.

Keywords: Video-assisted thoracoscopic surgery, Sublobar resection, Radiofrequency ablation, Stereotactic radiosurgery, Early stage, Lung cancer

Core Tip: Complete resection continues to be the gold standard for the treatment of early-stage lung cancer. Lobectomy remains the gold standard for the treatment of early-stage non-small cell lung cancer, but there is a growing tendency to perform sublobar resection in selected cases. Alternative treatments such as stereotactic body radiotherapy and radiofrequency ablation can also produce good outcomes in inoperable patients or patients who refuse surgery.