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Stage 1 NSCLC Benefits from Early Aggressive Treatment

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NEW YORK JUL 19, 2007 (Reuters Health) - Given that long-term survival of untreated stage 1 non-small cell lung cancer (NSCLC) is virtually nil, and that five-year survival of surgically resected stage I NSCLC is as high as 80%, early surgical resection and ablative therapy is indicated, according to investigators at the University of California at San Francisco.

To determine the survival rates of untreated NSCLC, Dr. Dan J. Raz and colleagues analyzed the California Cancer Center registry between 1999 and 2003, which included 101,844 incident cases of NSCLC. Of these, 19,702 were stage 1 disease and 1,432 cases had no treatment.

Of the 1,432 patients who were not treated at diagnosis, only 42 patients were alive five years later. Five-year overall survival was 6%. For T1 tumors, specifically, it was 9%. And five-year overall survival was 11% for patients who did not undergo surgical resection.

Untreated patients had a median survival of 9 months overall, 13 months for patients with T1 disease, and 14 months for patients who refused surgical resection.

Five-year lung cancer-specific survival rates were 16% overall, 23% for T1 cancer and 22% for patients who declined treatment.

"In contrast, the 5-year survival for patients with surgically resected stage I NSCLC is 60% to 80% in clinical studies," the authors write in the July issue of Chest.

"Our results underscore the therapeutic benefit of surgical resection for early stage lung cancer," they note. "Despite ongoing controversy regarding overdetection of clinically insignificant lung cancers with screening, untreated lung cancer is a fatal disease in the great majority of patients with stage I disease."

"Right now it is impossible to tell what the natural history is of a particular lung cancer, however there is a lot of exciting research going on about genomic prediction of outcome," Dr. Raz told Reuters Health. "In the not-so-distant future, clinicians are going to be treating lung cancer by first analyzing genomic markers and using that information to direct treatment-- which could one day include no treatment for indolent tumors."

In their paper, the investigators noted that "While our study is observational, a randomized study of treatment of stage I NSCLC would be unethical to perform. Results from ongoing clinical trials of CT screening will provide important information on the benefit of treatment of screen detected cancers relative to the harm caused by treating clinically indolent cancers."

"Our findings should not change the decision to screen patients for lung cancer," he emphasized. "Our findings do suggest that treatment of stage I lung cancers should not be delayed. Moreover, clinicians should consider therapies such as radiation or radiofrequency ablation to patients who are not surgical candidates."

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