Updated February 2008

Guideline: Where the tumour is operable, surgical resection is the treatment of choice. Radical radiation treatment, however, may be considered when the patient refuses surgery in otherwise operable situations, or when the patient is medically unfit for thoracotomy.

Level of Evidence: III

Grade of Recommendation: B

The terms "unresectable" and "inoperable" are not synonymous. The former applies to the tumour; the latter applies to patient factors that preclude resection. Although surgery is standard treatment for potentially curable non-small cell lung cancer, radical radiotherapy may provide a reasonable alternative in the following circumstances:

1. High risk of general anaesthesia.
2. Inoperability because of limited pulmonary reserve.
3. Patient's refusal of surgery.

Patients may not tolerate radical radiotherapy due to poor pulmonary function, and possibly those with significant collagen vascular disease. Some of these patients may still benefit from palliative treatment (see sections below).

Key References:

1. Armstrong JG, Minsky BD. Radiation therapy for medically inoperable stage I and II non-small cell lung cancer. Cancer Treat Rev 1989;16:247. 

2. Coy P, Kennelly GM. The role of curative radiotherapy in the treatment of lung cancer. Cancer 1980;45:158. 

3. Graham P, Gebski V, Langlands A. radical radiotherapy for early Non small cell Lung Cancer. Int J Radiation Oncology, Biol, Phys 1995 Jan 15;31(2):261-6