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Medically inoperable early-stage NSCLC — SCE Respiratory MCQ

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HardLung CancerMedically inoperable early-stage NSCLCSCE Respiratory

A 60-year-old woman has a 1.8 cm peripheral lung adenocarcinoma. PET-CT shows no nodal uptake. CT-guided biopsy confirms invasive adenocarcinoma. Pre-operative FEV1 is 38% predicted and TLCO is 36% predicted; CPET peak VO2 is very low. What is the most appropriate management?

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Correct answer: A — Stereotactic ablative radiotherapy after MDT discussion

For early-stage NSCLC in a patient with prohibitive surgical physiology, SABR is an appropriate radical treatment option after MDT assessment. Lobectomy would carry excessive risk given poor lung function and CPET. Palliative chemotherapy or no treatment would undertreat potentially curable localised disease.

Reference: NICE NG122 Lung cancer