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Monday, April 21, 2014
My husband was diagnosed with lung cancer. He has a tumor the size of a golf ball, very well defined and not metastasized. Due to COPD he has only 25 - 35% lung capacity and the doctor thinks he wouldn`t survive surgery. He is 64 years old, lifelong smoker. What are the likely options? For instance is the Gamma Knife or the Thermal Ablation technology viable for lung cancer?
I am sorry to hear about the diagnosis. Surgical resection is the optimal treatment for lung cancer. While a few individuals with very poor lung function may not be ideal candidates for a traditional, open operation (lobectomy) there are a number of options.
First of all, you and your husband should meet with a general thoracic surgeon--a lung surgery specialist (not just a general surgeon or a heart surgeon or an internist or a pulmonologist or an oncologist or a radiation oncologist). General thoracic surgeons are experts in open, AND MINIMALLY INVASIVE, lung surgery.
Second, there are strategies to improve lung function prior to surgery--pulmonary rehabilitation.
Third, less invasive surgical approaches can be used--VATS (video-assisted throacoscopic surgery).
Fourth, sublobar resection (segmentectomy, wedge resection) is a good option.
If none of the aforementioned strategies is possible, based on the recommendation of a general thoracic surgeon, then non-operative approaches are an adequate backup plan. Two options are reasonably well-established: radiofrequency ablation (RFA) and stereotactic radiosurgery (sometimes other names are used, but the principle is that highly focused radiation is delivered in very few doses). These treatments are best performed by a general thoracic surgeon, radiation oncologist, or interventional radiologist who has particular expertise in lung cancer, and who has discussed the case beforehand in a multidisciplinary tumor board. This would typically be done in a cancer center with a high volume of lung cancer patients.
While this recommendation may seem stringent, that a general thoracic surgeon needs to see your husband. I am adamant that only an expert in thoracic surgical oncology can determine inoperability. This is especially critical since early stage lung cancer is curable by properly performed surgery.
Michael F Reed, MD
Assistant Professor of Surgery
College of Medicine
University of Cincinnati