Early lung cancer detection by low-dose CT screening: therapeutic implications.

INTRODUCTION: Lung cancer screening by low-dose chest computed tomography is currently implemented in the U.S. After implementation of screening, a stage shift may be observed from around 15% stage I non-small cell lung cancers (NSCLCs) in routine clinical practice to up to 70% in screening patients. This indicates a move in treatment options from advanced to early lung cancers, especially in those with small suspected intrapulmonary nodules. Areas covered: We have reviewed the current status of lung cancer screening from the different randomized controlled lung cancer screening studies and the clinical evidence so far for both surgical and non-surgical treatment options for (screen-detected) stage I NSCLC. Furthermore, we provide a step-wise approach for the treatment of stage I NSCLC. Expert Commentary: Recommended treatment for stage I NSCLC remains (VATS) lobectomy in case of a medically operable patient, VATS sublobar resection for subcentimeter nodules, and SBRT otherwise. Currently, there is too limited evidence for the value of ablative techniques in curative treatment of early stage NSCLC. Therefore, these therapies should only be used in expert centers for selected patients in clinical studies.