Does Aggressive Versus Less Aggressive Non-operative Treatment of Large and Very Large (≥7 cm) Lung Cancers Matter?

The alternative non-surgical treatment approach for large and very large lung cancers (LVL-LC) has rarely been investigated. We describe the outcomes of patients whose LVL-LCs were managed non-operatively with clear intents.

The effects of definitive (concurrent chemoradiotherapy, 23 patients) or palliative (short course of radiotherapy with chemotherapy, chemotherapy, or radiotherapy alone, 16 patients) treatment for LVL-LC during a 10-year period (2012-2022) were reviewed.

The overall rate of (a) tumor regression, (b) disease progression, and (c) median survival were 82% (32/39), 67% (26/39), and 13 months, respectively. These endpoints in patients with large and very large cancers were (a) 82% (22/27) and 83% (10/12), respectively, p=0.90; (b) 74% (20/27) and 50% (6/12), respectively, p>0.40, and (c) 13.5 months and six months, respectively, p>0.70. In definitively and palliatively treated patients, the outcomes were: (a) 87% (20/23) and 75% (12/16), respectively, p>0.30; (b) 65% (15/23) and 69% (11/16), respectively, p>0.80, and (c) 14 months and 5.5 months, respectively, p>0.70. Low-grade, transient side-effects and imaging-shown lung fibrosis occurred in 65% (15/23) and 26% (10/39) of cases, respectively. On univariate analysis, the prospect of longer survival was suggested for older patients when the upper lobe cancers were not very large and when definitive treatment was administered.

An aggressive management approach seems to be a reasonable treatment strategy for promoting tumor resolution and progression-free survival with acceptable toxicity in LVL-LC.