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The article discusses the suggestions for evaluation and treatment of patients at high risk for stage I non-small cell lung cancer (NSCLC) agreed upon by a consensus panel convened through the Thoracic Oncology Network of the American College of Chest Physicians and the Workforce on Evidence-Based Surgery of the Society of Thoracic Surgeons. The topics covered include cardiopulmonary physiology, lobectomy as treatment for NSCLC and alternative treatments such as radiofrequency ablation.

Esophagitis is a dose-limiting toxicity of combined chemoradiation therapy in patients with locally advanced lung cancer. Our study aimed at minimizing this complication by using glutamine in an attempt to escalate the dose of chemotherapy. This was a Phase I trial of escalating the dose of weekly paclitaxel and carboplatin with concurrent radiation therapy. Fifteen patients were enrolled, with median age 62 years (58-78), 13 males and 12 Caucasians. Due to multiple severe toxicities including hematological toxicities and esophagitis, the combination was deemed not feasible. In conclusion, the addition of glutamine does not prevent serious toxities of this concurrent chemoradiotherapy regimen. [ABSTRACT FROM AUTHOR]

Based on clinical assessment alone, patients with stage II non-small cell lung cancer (NSCLC) comprise only 5% of all patients with NSCLC. In addition, patients with stage II NSCLC represent a heterogeneous group, since stage II consists of patients with T1-2N1 or T3N0 tumors. By definition, patients with tumor invading the chest wall apex, mediastinum, diaphragm, or even the mainstem bronchus may all have T3 tumors. The extent of the data available regarding treatment of each of these different groups is therefore limited. The quality of the data is limited as well, because information often comes from small series of patients. Studies of adjuvant therapy after complete resection of stage II NSCLC are an important exception to this generalization, since data from large, randomized studies of adjuvant radiation therapy, chemotherapy, or a combination of the two are available for analysis. Superior sulcus tumors are discussed elsewhere in these guidelines. [ABSTRACT FROM AUTHOR]