[Limited resection or radiofrequency ablation for high risk patients]

The standard care for treatment of patients in good general conditions with stage 1 non-small cell lung cancer (NSCLC) is surgical resection by lobectomy and radical mediastinal lympadenectomy. Promising alternative treatments have been developed for high risk patients, who are (medically) inoperable due to bad general conditions. If lobe resection is not possible because of comorbidities or limited pulmonary function, we can offer less invasive surgical resection such as anatomic segmental resection or broad non-anatomic wedge resection. The results are similar to standard procedure, but the local recurrence rate is higher. Additional brachytherapy improves the outcome. Interventional radiological procedures are emerging as promising treatment options. First thermal methods such as radiofrequency ablation (RFA), microwave ablation (MWA) and kryoablation are available. In addition selective chemoembolisation by a vascular catheter-guided access allows local chemotherapy. The above-mentioned alternative treatments generate encouraging findings, but they should be applied only in clinical trials.