RESULTS OF A LIMITED RESECTION FOR COMPROMISED OR POOR-RISK PATIENTS WITH CLINICAL STAGE-I NONSMALL CELL-CARCINOMA OF THE LUNG

BACKGROUND: Patients with stage I non-small cell carcinoma of the lung may be unable to undergo a standard curative resection, such as lobec tomy, due to various medical reasons. Whether or not a limited resecti on is superior to radiotherapy in these patients, both in terms of lon g-term prognosis and treatment morbidity, is unknown. STUDY DESIGN: We retrospectively reviewed our results in treating compromised or poor- risk patients with clinical stage I non-small cell carcinoma of the lu ng who had received either a limited resection or radiotherapy. Sevent een patients underwent a limited resection (nine wedge resections and eight segmentectomies), while 18 patients received radiation therapy, RESULTS: The five-year survival rates for patients in the limited rese ction group and the radiation treatment group were 55.0 and 14.4 perce nt, respectively. A log-rank analysis showed a significant difference between the two groups (p=0.004). Furthermore, the survival rate of th e patients having a limited operation was significantly better than th at of patients achieving either complete response or partial response from radiotherapy (18.8 percent at five years, p=0.008). Recurrence at the surgical margin occurred in four patients in whom the tumor was g reater than 2 cm in longest diameter. The incidence of severe treatmen t-related complications was not different between the limited operatio n group and the radiotherapy group (11.8 compared to 11.1 percent). CO NCLUSIONS: The results indicate that a limited resection for patients with poor-risk clinical stage I carcinoma of the lung has an advantage over radiotherapy, especially for tumors longest diameter.