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

Background/Aim: 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.

Patients and Methods: 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.

Results: 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.

Conclusion: 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.