Comparing Surgical Treatment for Small NSCLC Tumors
Name of the Trial
Phase III Randomized Study of Lobectomy Versus Sublobar Resection in Patients With Small Peripheral Stage IA Non-Small Cell Lung Cancer (CALGB-140503). See the protocol summary.
Dr. Nasser Altorki, Cancer and Leukemia Group B; Dr. Harvey Pass, Radiation Therapy Oncology Group; Dr. Daniel Miller, American College of Surgeons Oncology Group; Dr. Kemp Kernstine, Southwest Oncology Group.
Why This Trial Is Important
Standard treatment for non-small cell lung cancer (NSCLC) detected at a very early stage is surgical removal of the lobe of the lung in which the tumor is found (lobectomy). Although lobectomy often results in long-term survival, patients may suffer from impaired lung function and may be less likely to be eligible for curative surgery if a second lung cancer develops.
Removing just a portion of the affected lung lobe (sublobar resection) has been shown in some nonrandomized studies to result in similar rates of survival as lobectomy for patients with small tumors (2 centimeters or smaller). However, these studies were not designed to prove definitively that sublobar resection is as good as lobectomy in patients with these small tumors.
In this randomized phase III trial, patients with stage 1A NSCLC measuring 2 centimeters or less and located in the outer third of the lung are randomly assigned to sublobar resection (either wedge resection or segmentectomy) or lobectomy. The researchers will follow the patients for 5 years to compare how long they live without their cancer recurring (disease-free survival). They will also compare how long the patients survive overall, their rates of lung cancer recurrence, and their lung function.
"Current practice is based on research conducted in the late 1980s," said Dr. Altorki. "We think that several developments have changed the way we should treat these small tumors. We now have much better staging and the ability to zero in on smaller tumors on the surface of lung segments.
"If the intervention is successful, this trial is likely to change the way lung cancer is managed surgically for years to come, and this will especially benefit patients who have comorbidities such as emphysema," Dr. Altorki added.
For More Information
See the list of eligibility criteria and contact information or call the NCI's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237). The call is toll free and confidential.