American Board of Internal Medicine (ABIM) Certification Practice Exam

If surgery is not possible for patients with localized NSCLC, what is the recommended alternative?

1. Observation

2. Radiation therapy

3. Chemotherapy

4. Immunotherapy

The correct answer is: Radiation therapy

When surgery is not a viable option for patients with localized non-small cell lung cancer (NSCLC), radiation therapy is often recommended as a primary treatment modality. Radiation therapy can effectively target and destroy cancer cells in the affected area, which is particularly important for local control of the disease. In patients with localized NSCLC who cannot undergo surgery due to factors such as poor pulmonary function, significant comorbidities, or the location of the tumor, radiation is a critical intervention. It can be administered as definitive treatment with curative intent or palliatively to relieve symptoms. Additionally, in some cases, radiation may be combined with chemotherapy in a concurrent approach to enhance treatment efficacy, although this combination is more common when there is no contraindication for surgery. While observation may be suitable in certain limited scenarios, such as for very early-stage disease in patients with significant risk factors for surgery, it does not provide a treatment effect. Chemotherapy and immunotherapy are typically considered when there is advanced disease or as adjuvant treatment following surgery but are not the first-line alternatives when surgery is contraindicated in localized disease. Therefore, radiation therapy stands out as the most appropriate alternative for local disease management in these patients.