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Identifying patients with peripheral-type early non-small cell lung cancer (T1N0M0) for whom irradiation of the primary focus alone could lead to successful treatment

¹ Department of Radiation Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, ² Division of Drug Evaluation & Informatics, Graduate School of Pharmaceutical Sciences, University of Shizuoka, Departments of ³ Thoracic Surgery and ⁴ Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, ⁵ Department of Radiology, Southern Tohoku Research Institute for Neuroscience, ⁶ Department of Diagnostic Radiology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Japan 464-8681

Correspondence: Nobukazu Fuwa, 1-1 Kanokoden, Chikusaku, Nagoya, 464-0021, Japan. E-mail: nfuwa{at}aichi-cc.jp

We investigated the indication of radiotherapy in operable patients with peripheral-type early non-small cell lung cancer (T1N0M0 (TNM staging in 1997)). The subjects comprised 396 patients with non-small cell lung cancer in whom the clinical stage was evaluated as IA. We examined age, gender, Brinkmann's index, histopathological type, the grade of histopathological differentiation, tumour diameter and the level of carcinoembryonic antigen as factors involved in lymph node metastasis. Lymph node metastasis was detected in 79 patients (20%). Factors such as the grade of histopathological differentiation and tumour diameter were involved in lymph node metastasis. In well-differentiated lesions, the probability of metastasis was <10% even when the tumour diameter exceeded 2 cm. However, the probability rapidly increased with tumour size in moderately and poorly differentiated lesions. Among the patients with peripheral-type early non-small cell lung cancer (T1N0M0), the risk of lymph node metastasis was low in those with well-differentiated carcinoma and those with moderately differentiated lesions measuring 1.5 cm in diameter. The proportion of our patients fitting these criteria was approximately 30%. For these patients, stereotactic body radiotherapy and particle therapy may be indicated.