Following Jeff's question on therapy for lung Ca in octogenarian (see post below) I just saw a patient in a similar situation. This is an 85 y/o woman with a recent spiro revealing an FEV1 of 600 ml. She was just diagnosed with a 2-cm LUL adenoCa with no adenopathy and no other distant disease on PET. She is still fairly active but stated that even if her lung function improved, she would not want surgery.
With such a low FEV1 and with some risk of further loss of function with radiation, what would you suggest? And following on JJ's question, what are your alternatives for octogenarians (or anybody else) who can't or won't have surgery?
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Presuming that she would not consider a wedge resection, and there is fear that definitive radiation won't be tolerated, options are limited. For a 2cm lesion, if the location is amenable, radiofrequency ablation can be considered.
Stereotactic Body Radiation therapy has had excellent results in Japan and is being explored in the US for T1 or T2 tumors without nodal inovlvement. It delivers a high dose of external beam radiaiton with curative intent to the tumor. Local control is similar to historical controls for surgery and the therapy is well tolerated. There are articles by Timmerman about this approach.
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