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J Thorac Cardiovasc Surg 2005;129:261-267
© 2005 The American Association for Thoracic Surgery

General Thoracic Surgery

Lobar and sublobar resection with and without brachytherapy for small stage IA non–small cell lung cancer

^a Division of Thoracic and Foregut Surgery
^b Department of Dental Public Health
^c University of Pittsburgh Medical Center, Pittsburgh, Pa, the Division of Thoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, Calif
^d Division of Thoracic Surgery, City of Hope Medical Center, Duarte, Calif
^e Division of Thoracic Surgery, Allegheny General Hospital, Pittsburgh, Pa

Read at the Eighty-fourth Annual Meeting of The American Association for Thoracic Surgery, Toronto, Ontario, Canada, April 25-28, 2004.

Received for publication April 22, 2004; revisions received August 26, 2004; accepted for publication September 3, 2004.

^* Address for reprints: Hiran C. Fernando, FRCS, Associate Professor, Department of Cardiothoracic Surgery, Boston Medical Center, 88 East Newton St, Robinson B402, Boston, MA 02118 (E-mail: hiran.fernando{at}bmc.org).

OBJECTIVE: Computed tomographic screening is detecting ever smaller peripheral non–small cell lung cancers. These smaller cancers are amenable to sublobar resection, but sublobar resection is not currently the treatment of choice. This study compared sublobar resection with lobar resection for stage IA non–small cell lung cancers to assess whether sublobar resection is appropriate treatment for certain lesions. The use of adjuvant brachytherapy was also evaluated.

METHODS: A retrospective multicenter study of 291 patients with T1 N0 disease was done. Outcomes after sublobar resection (n = 124) were compared with those after lobar resection (n = 167). Brachytherapy was used in conjunction with 60 (48%) sublobar resection operations. Analysis based on tumor diameter was performed.

RESULTS: There were 137 cancers smaller than 2 cm and 154 cancers ranging from 2 to 3 cm. Patients undergoing sublobar resection were older (68.4 vs 66.1 years, P = .018) with poorer pulmonary function (forced expiratory volume in 1 second of 53.1% vs 78.2%, P = .001). Mean follow-up was 34.5 months. Brachytherapy decreased local recurrence rate significantly among patients undergoing sublobar resection, from 11 (17.2%) to 2 (3.3%). For tumors smaller than 2 cm, there was no difference in survival between sublobar resection and lobar resection groups. For the larger tumors (2-3 cm), median survival was significantly better in the lobar resection group, at 70 versus 44.7 months (P = .003).

CONCLUSION: Intraoperative brachytherapy may reduce the local recurrence that is usually reported with sublobar resection. Our experience supports the further investigation of the use of sublobar resection with brachytherapy for peripheral stage IA non–small cell lung cancers smaller than 2 cm.

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