1051
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Abstract
PURPOSE OF REVIEW Significant advances have been made in the field of stereotactic ablative radiotherapy (SABR) for the treatment of pulmonary neoplasms in recent years. This review aims to summarize recent salient evidence on SABR for early-stage nonsmall cell lung cancer (ES-NSCLC). RECENT FINDINGS In medically inoperable patients, SABR remains the standard of care. The optimal SABR dosing regimen is being studied. Comparisons with non-SABR radiotherapy regimens with lower doses per fraction revealed benefit of SABR. In operable patients, no prospective clinical trial comparing SABR and surgery has been completed, although multiple trials are currently underway to address this question. SABR is generally cost-effective and safe in most patients, with preserved patient-reported quality of life. However, increased toxicity with SABR is noted in patients with disease close to, or invading the proximal tracheobronchial tree. Significant SABR-related toxicity and mortality is also reported in patients with coexisting interstitial lung disease. Considerations on pathologic confirmation, surveillance and multiple primaries are also addressed. SUMMARY SABR is an effective and safe treatment for inoperable ES-NSCLC. Ongoing trials and comparative effectiveness research will help to clarify SABR's role in various lung cancer indications going forward.
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1052
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Long term efficacy and toxicity after stereotactic ablative reirradiation in locally relapsed stage III non-small cell lung cancer. BMC Cancer 2019; 19:305. [PMID: 30943943 PMCID: PMC6448259 DOI: 10.1186/s12885-019-5542-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 03/28/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND In stage III non-small cell lung cancer (NSCLC) treated with concomitant chemoradiotherapy, there is a high rate of relapse. Some of these relapses are only local and can be treated by stereotactic ablative radiation therapy (SABR). Previous studies reporting outcome after SABR reirradiation of the thorax consisted of a heterogeneous population of various lung cancer stages or even different types of cancer. The purpose of study is to evaluate toxicity and outcome of this strategy in locally relapsed stage III NSCLC only. METHODS From February 2007 to November 2015, 46 Stage III NSCLC patients treated with SABR, for lung recurrence following conventionally fractionated radiation therapy (CFRT), were retrospectively analyzed. RESULTS Median follow-up was 47.3 months (1-76.9). The 2 and 4-year progression-free survival (PFS), and overall survival (OS) were of 25.5%/8.6 and 48.9%/30.8%, respectively. Highest presenting toxicity in patients (grade 1 through 5) was: 13 (28.3%), 7 (15.2%), 1 (2.2%), 0 and 2 (4.4%), with deaths due to hemoptysis (n = 1) and alveolitis (n = 1). Although the Biological Effective Dose (at Planning Tumor Volume isocenter) was lower for central tumors treated for an in-field relapse (n = 21, 116 Gy versus 168 Gy, p = 0.005), they had no significant difference in OS than the remaining cohort, but with a higher rate of grade 2-5 toxicities (OR = 0.22, [0.06-0.8], p = 0.02). CONCLUSION Reirradiation with SABR for local relapse in patients previously treated for stage III NSCLC, is feasible and associated with good outcome. This is also true for central tumors treated for an in-field relapse, but should be radiated with caution to mitigate toxicity.
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1053
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Mediastinoscopy for Staging of Non-Small Cell Lung Cancer: Surgical Performance in The Netherlands. Ann Thorac Surg 2019; 107:1024-1031. [DOI: 10.1016/j.athoracsur.2018.11.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 09/14/2018] [Accepted: 11/15/2018] [Indexed: 12/25/2022]
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1054
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Song Z, Du J, Zhou L, Sun B. lncRNA AWPPH promotes proliferation and inhibits apoptosis of non‑small cell lung cancer cells by activating the Wnt/β‑catenin signaling pathway. Mol Med Rep 2019; 19:4425-4432. [PMID: 30942396 DOI: 10.3892/mmr.2019.10089] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 11/21/2018] [Indexed: 11/06/2022] Open
Abstract
AWPPH is a newly discovered long non‑coding (lnc)RNA that serves an oncogenic role in the development of several types of cancer; however, its involvement in non‑small cell lung cancer (NSCLC) is unknown. Therefore, the aim of the present study was to investigate the function of AWPPH in NSCLC. The results demonstrated that AWPPH expression levels were significantly upregulated in the lung tissues and serum samples of patients with NSCLC compared with in healthy controls. High expression levels of AWPPH effectively distinguished NSCLC patients from healthy controls. In addition, patients with high expression levels of AWPPH had significantly shorter survival time. AWPPH overexpression in NSCLC cells promoted proliferation and inhibited apoptosis, and activated the Wnt/β‑catenin signaling pathway, which is a classic signaling pathway involved in the development and progression of different types of cancers. Treatment with a Wnt/β‑catenin signaling pathway activator produced no significant effect on AWPPH expression. Therefore, it was concluded that lcRNA AWPPH could promote the growth of NSCLCs by activating the Wnt/β‑catenin signaling pathway.
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Affiliation(s)
- Zhan Song
- Department of Respiratory Medicine, Cangzhou Central Hospital, Cangzhou, Hebei 061001, P.R. China
| | - Junfeng Du
- Department of Respiratory Medicine, Cangzhou Central Hospital, Cangzhou, Hebei 061001, P.R. China
| | - Lirong Zhou
- Department of Respiratory Medicine, Cangzhou Central Hospital, Cangzhou, Hebei 061001, P.R. China
| | - Baohua Sun
- Department of Respiratory Medicine, Cangzhou Central Hospital, Cangzhou, Hebei 061001, P.R. China
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1055
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De Ruysscher D, van Baardwijk A, Wanders R, Hendriks LE, Reymen B, van Empt W, Öllers MC, Bootsma G, Pitz C, van Eijsden L, Dingemans AMC. Individualized accelerated isotoxic concurrent chemo-radiotherapy for stage III non-small cell lung cancer: 5-Year results of a prospective study. Radiother Oncol 2019; 135:141-146. [PMID: 31015160 DOI: 10.1016/j.radonc.2019.03.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 03/08/2019] [Accepted: 03/11/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Stage III non-small cell lung cancer (NSCLC) still has a poor prognosis. Prior studies with individualized, accelerated, isotoxic dose escalation (INDAR) with 3D-CRT showed promising results, especially in patients not treated with concurrent chemo-radiotherapy. We investigated if INDAR delivered with IMRT would improve the overall survival (OS) of stage III NSCLC patients treated with concurrent chemotherapy and radiotherapy. PATIENTS AND METHODS Patients eligible for concurrent chemo-radiotherapy were entered in this prospective study. Radiotherapy was given to a dose of 45 Gy/30 fractions BID (1.5 Gy/fraction), followed by QD fractions of 2 Gy until a total dose determined by the normal tissue constraints. The primary endpoint was OS, secondary endpoints were loco-regional relapses and toxicity. RESULTS From May 4, 2009 until April 26, 2012, 185 patients were included. The mean tumor dose was 66.0 ± 12.8 Gy (36-73 Gy), delivered in a mean of 39.7 fractions in an overall treatment time of 38.2 days. The mean lung dose (MLD) was 17.3 Gy. The median OS was 19.8 months (95% CI 17.3-22.3) with a 5-year OS of 24.3%. Loco-regional failures as first site of recurrence occurred in 59/185 patients (31.8%). Isolated nodal failures (INF) were observed in 3/185 patients (1.6%). Dyspnea grade 3 was seen in 3.2% of patients and transient dysphagia grade 3 in 22%. CONCLUSIONS INDAR with IMRT concurrently with chemotherapy did not lead to a sign of an improved OS in unselected stage III NSCLC patients.
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Affiliation(s)
- Dirk De Ruysscher
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands.
| | - Angela van Baardwijk
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Rinus Wanders
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Lizza E Hendriks
- Maastricht University Medical Center, Department of Pulmonology, GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Bart Reymen
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Wouter van Empt
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Michel C Öllers
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Gerben Bootsma
- Zuyderland Hospital, Department of Pulmonology, Geleen, The Netherlands
| | - Cordula Pitz
- Laurentius Hospital, Department of Pulmonology, Roermond, The Netherlands
| | - Linda van Eijsden
- Sint Jans Gasthuis, Department of Pulmonology, Weert, The Netherlands
| | - Anne-Marie C Dingemans
- Maastricht University Medical Center, Department of Pulmonology, GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
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1056
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Spectral CT and its specific values in the staging of patients with non-small cell lung cancer: technical possibilities and clinical impact. Clin Radiol 2019; 74:456-466. [PMID: 30905380 DOI: 10.1016/j.crad.2019.02.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 02/12/2019] [Indexed: 12/25/2022]
Abstract
AIM To investigate how spectral computed tomography (SCT) values impact the staging of non-small cell lung cancer (NSCLC) patients. MATERIALS AND METHODS One hundred and thirteen patients with confirmed NSCLC were included in a prospective cohort study. All patients underwent single-phase contrast-enhanced SCT (using the fast tube voltage switching technique, 80-140 kV). SCT values (iodine content [IC], spectral slope pitch, and radiodensity increase) of malignant tissue (primary and metastases) and lymph nodes (LNs) were measured. Adrenal masses were evaluated in a virtual non-contrast series (VNS). If pulmonary embolism was present, pulmonary perfusion was analysed as an additional finding. RESULTS Fifty-two untreated primary NSCLC lesions were evaluable. Lung adenocarcinoma had significantly higher normalised IC (NIC: 19.37) than squamous cell carcinoma (NIC: 12.03; p=0.035). Pulmonary metastases were not significantly different from benign lung nodules. A total of 126 LNs were analysed and histologically proven metastatic LNs (2.08 mg/ml) had significantly lower IC than benign LNs (2.58 mg/ml; p=0.023). Among 34 adrenal masses, VNS identified adenomas with high sensitivity (91%) and specificity (100%). In two patients, a perfusion defect due to pulmonary embolism was detected in the iodine images. CONCLUSION SCT may contribute to the differentiation of histological NSCLC subtypes and improve the identification of LN metastases. VNS differentiates adrenal adenoma from metastasis. In case of pulmonary embolism, iodine imaging can visualise associated pulmonary perfusion defects.
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1057
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Friedlaender A, Banna G, Malapelle U, Pisapia P, Addeo A. Next Generation Sequencing and Genetic Alterations in Squamous Cell Lung Carcinoma: Where Are We Today? Front Oncol 2019; 9:166. [PMID: 30941314 PMCID: PMC6433884 DOI: 10.3389/fonc.2019.00166] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 02/25/2019] [Indexed: 12/26/2022] Open
Abstract
Lung cancer is the leading cause of cancer-related mortality and will affect ~6% of the population. It is divided into two broad categories, small cell lung cancer and non-small cell lung cancer (NSCLC), the latter representing 85% of all lung cancers. It mainly comprises adenocarcinoma (65%) and squamous cell carcinoma (30%) histologies. In recent years, there have been two major therapeutic advances in NSCLC. The first, immunotherapy, has greatly improved the prognosis of adenocarcinomas and squamous cell carcinomas. The second, the treatment of targetable driver mutations, has so far only benefited adenocarcinomas. Squamous cell carcinoma carries a high rate of mutations and is found mostly among smokers. This raises two important problems: identifying driver mutations and finding those of clinical relevance. Large-scale genomic analyses such as The Cancer Genome Atlas have allowed for the identification of frequent gene alterations, although their role and potential for targeted therapy remain unknown. The emergence of next generation sequencing has changed the landscape of precision medicine, in particular in lung cancer. In this review, we discuss the landscape of genetic alterations found in squamous cell lung cancer, the results of current targeted therapy trials, the difficulties in identifying and treating these alterations and how to integrate modern tools in clinical practice.
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Affiliation(s)
- Alex Friedlaender
- Oncology Department, Geneva University Hospital, Geneva, Switzerland
| | - Giuseppe Banna
- Oncology Department, Ospedale Cannizzaro, Catania, Italy
| | - Umberto Malapelle
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Pasquale Pisapia
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Alfredo Addeo
- Oncology Department, Geneva University Hospital, Geneva, Switzerland
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1058
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Creemers IHP, Kusters JMAM, van Kollenburg PGM, Bouwmans LCW, Schinagl DAX, Bussink J. Comparison of dose metrics between automated and manual radiotherapy planning for advanced stage non-small cell lung cancer with volumetric modulated arc therapy. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2019; 9:92-96. [PMID: 33458432 PMCID: PMC7807870 DOI: 10.1016/j.phro.2019.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 03/04/2019] [Accepted: 03/06/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Iris H P Creemers
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Johannes M A M Kusters
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Liza C W Bouwmans
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Dominic A X Schinagl
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Johan Bussink
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
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1059
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Fang L, Wang L, Wang Y, Wu Y, Ye P, Lv W, Hu J. Predictors and survival impact of station 4L metastasis in left non-small cell lung cancer. J Cancer Res Clin Oncol 2019; 145:1313-1319. [PMID: 30877377 DOI: 10.1007/s00432-019-02880-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 02/25/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND It remains unclear about the predictors and survival impact of station 4L metastasis in left-sided non-small cell lung cancer (NSCLC). This study aims to investigate these issues to explore the significance of station 4L lymph-node dissection (LND). METHODS We retrospectively enrolled 405 patients with station 4L LND, and divided them into the positive station 4L metastasis group and the negative station 4L metastasis group. The logistic regression was performed to identify the predictors of station 4L metastasis. The survival outcomes including disease-free survival (DFS) and overall survival (OS) were analyzed in pN2 patients to explore the prognostic effect of station 4L metastasis. RESULTS There were 48 (11.9%) patients in the positive station 4L metastasis group and 357 (88.1%) patients in the negative station 4L metastasis group. Station 5 metastasis (P = 0.008, OR 7.578, 95% CI 1.710-33.589), station 10 metastasis (P = 0.004, OR 7.133, 95% CI 1.904-26.717), and cN2 (P = 0.010, OR 5.062, 95% CI 1.473-17.392) were independent risk factors of station 4L metastasis. In pN2 patients, the positive station 4L metastasis group had inferior DFS (P = 0.019) and OS (P = 0.006) compared with the negative station 4L metastasis group, and station 4L metastasis was the independent risk factor for poor prognosis. CONCLUSION It is of great necessity to perform station 4L LND in left NSCLC, because station 4L metastasis is not rare and has an unfavorable prognosis.
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Affiliation(s)
- Likui Fang
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Luming Wang
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Yiqing Wang
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Yihe Wu
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Peng Ye
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Wang Lv
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Jian Hu
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
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1060
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Bousabarah K, Temming S, Hoevels M, Borggrefe J, Baus WW, Ruess D, Visser-Vandewalle V, Ruge M, Kocher M, Treuer H. Radiomic analysis of planning computed tomograms for predicting radiation-induced lung injury and outcome in lung cancer patients treated with robotic stereotactic body radiation therapy. Strahlenther Onkol 2019; 195:830-842. [PMID: 30874846 DOI: 10.1007/s00066-019-01452-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 03/02/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To predict radiation-induced lung injury and outcome in non-small cell lung cancer (NSCLC) patients treated with robotic stereotactic body radiation therapy (SBRT) from radiomic features of the primary tumor. METHODS In all, 110 patients with primary stage I/IIa NSCLC were analyzed for local control (LC), disease-free survival (DFS), overall survival (OS) and development of local lung injury up to fibrosis (LF). First-order (histogram), second-order (GLCM, Gray Level Co-occurrence Matrix) and shape-related radiomic features were determined from the unprocessed or filtered planning CT images of the gross tumor volume (GTV), subjected to LASSO (Least Absolute Shrinkage and Selection Operator) regularization and used to construct continuous and dichotomous risk scores for each endpoint. RESULTS Continuous scores comprising 1-5 histogram or GLCM features had a significant (p = 0.0001-0.032) impact on all endpoints that was preserved in a multifactorial Cox regression analysis comprising additional clinical and dosimetric factors. At 36 months, LC did not differ between the dichotomous risk groups (93% vs. 85%, HR 0.892, 95%CI 0.222-3.590), while DFS (45% vs. 17%, p < 0.05, HR 0.457, 95%CI 0.240-0.868) and OS (80% vs. 37%, p < 0.001, HR 0.190, 95%CI 0.065-0.556) were significantly lower in the high-risk groups. Also, the frequency of LF differed significantly between the two risk groups (63% vs. 20% at 24 months, p < 0.001, HR 0.158, 95%CI 0.054-0.458). CONCLUSION Radiomic analysis of the gross tumor volume may help to predict DFS and OS and the development of local lung fibrosis in early stage NSCLC patients treated with stereotactic radiotherapy.
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Affiliation(s)
- Khaled Bousabarah
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Susanne Temming
- Department of Radiation Oncology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Mauritius Hoevels
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Jan Borggrefe
- Institute of Diagnostic and Interventional Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Wolfgang W Baus
- Department of Radiation Oncology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Daniel Ruess
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Maximilian Ruge
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Martin Kocher
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
- Department of Radiation Oncology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Harald Treuer
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
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1061
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Parente P, Chan BA, Hughes BGM, Jasas K, Joshi R, Kao S, Hegi-Johnson F, Hui R, McLaughlin-Barrett S, Nordman I, Stone E. Patterns of care for stage III non-small cell lung cancer in Australia. Asia Pac J Clin Oncol 2019; 15:93-100. [PMID: 30868747 DOI: 10.1111/ajco.13140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 01/28/2019] [Indexed: 12/25/2022]
Abstract
Stage III non-small cell lung cancer (NSCLC) makes up a third of all NSCLC cases and is potentially curable. Despite this 5-year survival rates remain between 15% and 20% with chemoradiation treatment alone given with curative intent. With the recent exciting breakthroughs in immunotherapy use (durvalumab) for stage III NSCLC, further improvements in patient survival can be expected. Most patients with stage III NSCLC present initially to their general practitioner (GP). The recommended time from GP referral to first specialist appointment is less than 14 days with treatment initiated within 42 days. Our review found that there is a shortfall in meeting these recommendations, however a number of initiatives have been established in Australia to improve timely and accurate diagnosis and treatment patterns. The lung cancer multidisciplinary team (MDT) is critical to consistency of evidence-based diagnosis and treatment and can improve patient survival. We aimed to review current patterns of care and clinical practice recommendations for stage III NSCLC across Australia and identify opportunities to improve practice in referral, diagnosis and treatment pathways.
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Affiliation(s)
- Phillip Parente
- Eastern Health Monash University, Box Hill, Victoria, Australia
| | - Bryan A Chan
- The Adem Crosby Cancer Centre, Sunshine Coast University Hospital, Birtinya, Queensland, Australia.,University of Queensland, St Lucia, Queensland, Australia
| | - Brett G M Hughes
- University of Queensland, St Lucia, Queensland, Australia.,The Royal Brisbane and Women's Hospital, Herston, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Kevin Jasas
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Rohit Joshi
- Calvary Central Districts Hospital, Elizabeth Vale, South Australia, Australia
| | - Steven Kao
- Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | | | - Rina Hui
- Westmead Hospital, Westmead, NSW, Australia.,University of Sydney, Sydney, NSW, Australia
| | | | - Ina Nordman
- Calvary Mater Newcastle, Waratah, NSW, Australia
| | - Emily Stone
- St Vincent's Hospital and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia
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1062
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Vera P, Mihailescu SD, Lequesne J, Modzelewski R, Bohn P, Hapdey S, Pépin LF, Dubray B, Chaumet-Riffaud P, Decazes P, Thureau S. Radiotherapy boost in patients with hypoxic lesions identified by 18F-FMISO PET/CT in non-small-cell lung carcinoma: can we expect a better survival outcome without toxicity? [RTEP5 long-term follow-up]. Eur J Nucl Med Mol Imaging 2019; 46:1448-1456. [PMID: 30868230 DOI: 10.1007/s00259-019-04285-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 02/06/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE Chemoradiotherapy is the reference curative-intent treatment for nonresectable locally advanced non-small-cell lung carcinoma (NSCLC), with unsatisfactory survival, partially due to radiation resistance in hypoxic tissues. The objective was to update survival and toxicity at 3 years following radiotherapy boost to hypoxic tumours in NSCLC patients treated with curative-intent chemoradiotherapy. METHODS This was an open-label, nonrandomized, multicentre, phase II clinical trial. 18F-Fluoromisonidazole (18F-FMISO) PET/CT was used to determine the hypoxic profile of the patients. 18F-FMISO-positive patients and those without organ-at-risk constraints received a radiotherapy boost (70-84 Gy); the others received standard radiotherapy (66 Gy). Overall survival (OS), progression-free survival (PFS) and safety were assessed. RESULTS A total of 54 patients were evaluated. OS and PFS rates at 3 years were 48.5% and 28.8%, respectively. The median OS in the 18F-FMISO-positive patients was 25.8 months and was not reached in the 18F-FMISO-negative patients (p = 0.01). A difference between the groups was also observed for PFS (12 months vs. 26.2 months, p = 0.048). In 18F-FMISO-positive patients, no difference was observed in OS in relation to dose, probably because of the small sample size (p = 0.30). However, the median OS seemed to be in favour of patients who received the radiotherapy boost (26.5 vs. 15.3 months, p = 0.71). In patients who received the radiotherapy boost, no significant late toxicities were observed. CONCLUSION 18F-FMISO uptake in NSCLC patients is strongly associated with features indicating a poor prognosis. In 18F-FMISO-positive patients, the radiotherapy boost seemed to improve the OS by 11.2 months. A further clinical trial is needed to investigate the efficacy of a radiotherapy boost in patients with hypoxic tumours.
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Affiliation(s)
- Pierre Vera
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108 - FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France.
| | - Sorina-Dana Mihailescu
- Department of Statistics and Clinical Research Unit, Henri Becquerel Cancer Center, Rouen, France
| | - Justine Lequesne
- Department of Statistics and Clinical Research Unit, Henri Becquerel Cancer Center, Rouen, France
| | - Romain Modzelewski
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108 - FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France
| | - Pierre Bohn
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108 - FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France
| | - Sébastien Hapdey
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108 - FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France
| | - Louis-Ferdinand Pépin
- Department of Statistics and Clinical Research Unit, Henri Becquerel Cancer Center, Rouen, France
| | - Bernard Dubray
- Department of Radiation Oncology, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108], Rouen, France
| | | | - Pierre Decazes
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108 - FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France
| | - Sébastien Thureau
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108 - FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France
- Department of Radiation Oncology, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108], Rouen, France
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1063
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Driessen E, Detillon D, Bootsma G, De Ruysscher D, Veen E, Aarts M, Janssen-Heijnen M. Population-based patterns of treatment and survival for patients with stage I and II non-small cell lung cancer aged 65-74 years and 75 years or older. J Geriatr Oncol 2019; 10:547-554. [PMID: 30876833 DOI: 10.1016/j.jgo.2019.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/24/2019] [Accepted: 03/01/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Insights regarding utilization and survival of surgery and radiotherapy (stereotactic body radiotherapy (SBRT) or conventional radiotherapy (RT)) are lacking for older patients with stage I and II non-small cell lung cancer (NSCLC) in clinical practice. METHODS Data from the Netherlands Cancer Registry were retrieved for patients ≥65 years with clinical stage I-II NSCLC in 2010-2015. Descriptive analyses, overall survival (OS), and cox regression were stratified for stage I (n = 8742) and II (n = 3439) and compared age groups (65-74 years vs ≥75 years). RESULTS Patients aged 65-74 underwent surgery significantly more often compared to those aged ≥75 (stage I 55% vs 27%; stage II: 65% vs 35%), and received SBRT less often (I: 29% vs 42%; II: 5% vs 11%), conventional RT less often (I: 6% vs 11%; II 10% vs 24%) and best supportive care alone less often (BSC, I: 8% vs 19%; II: 9% vs 25%). One-year OS was significantly higher in patients aged 65-74 compared to those aged ≥75 (I: 87% vs 78%; II: 74% vs 60%); as was five-year OS (I: 49% vs 31%; II: 36% vs 18%). After adjustment for gender, histology, stage, treatment, and comorbidity, hazard ratio (HR) of death was higher for patients aged ≥75 compared to those aged 65-74 (I: HR 1.3, 95% confidence interval (CI) 1.1-1.5; II: HR 1.3 95%CI 1.1-1.7). CONCLUSION Patients aged ≥75 with stage I-II NSCLC had poorer OS, underwent surgery less often, and received SBRT, conventional RT, and BSC more often than patients aged 65-74. In both stages, one-year OS within age groups was similar for surgery and SBRT. However, long-term OS adjusted for prognostic factors was superior for surgery compared to SBRT and remained poorer for those aged ≥75. Prospective research should focus on predictive characteristics for treatment selection and patient-centered outcomes.
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Affiliation(s)
- Elisabeth Driessen
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, the Netherlands; Department of Epidemiology, Maastricht University Medical Centre+, GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands.
| | | | - Gerbern Bootsma
- Department of Pulmonology, Zuyderland Medical Centre, Heerlen, the Netherlands.
| | - Dirk De Ruysscher
- Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands.
| | - Eelco Veen
- Department of Surgery, Amphia Hospital, Breda, the Netherlands.
| | - Mieke Aarts
- Netherlands Cancer Registry, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands.
| | - Maryska Janssen-Heijnen
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, the Netherlands; Department of Epidemiology, Maastricht University Medical Centre+, GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands.
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1064
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Xu J, Liu P, Da J, Hao J, Peng W, Sun G. Prognostic value of Ki-67 in stage I non-small-cell lung cancer: A meta-analysis involving 1931 patients. Pathol Res Pract 2019; 215:855-860. [PMID: 30871912 DOI: 10.1016/j.prp.2019.02.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/05/2019] [Accepted: 02/26/2019] [Indexed: 12/25/2022]
Abstract
There is growing interest in exploring the prognostic value of Ki-67 in non-small-cell lung cancer (NSCLC). However, whether Ki-67 can be regarded as a routine biomarker in clinical practice is still under debate. The present meta-analysis investigated the relationship between Ki-67 and the overall survival (OS) or disease-free survival (DFS) of patients suffering from stage I NSCLC. We searched the Web of Science, Cochrane, and PubMed databases to extract eligible articles. In total, 15 studies involving 1931 patients were included. Pooled hazard ratio (HR) analysis revealed that patients with high Ki-67 labeling index (LI) had poorer OS (HR = 1.95, 95% confidence interval (CI) = 1.43-2.66, P < 0.0001) and DFS (HR = 3.12, 95% CI = 2.17-4.48, P < 0.00001) than those with low Ki-67 LI. In subgroup analysis, high Ki-67 LI was significantly associated with poor prognoses in stage I adenocarcinoma. In future studies, a consensus for the optimal cutoff value for high Ki-67 LI needs to be explored and demonstrated in stage I NSCLC patients.
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Affiliation(s)
- Jing Xu
- Department of Oncology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Pingping Liu
- Department of Oncology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jie Da
- Department of Oncology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jiqing Hao
- Department of Oncology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wanren Peng
- Department of Oncology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Guoping Sun
- Department of Oncology, First Affiliated Hospital of Anhui Medical University, Hefei, China.
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1065
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Mohindra P, Sawant A, Griffin RJ, Lamichhane N, Vlashi E, Xu‐Welliver M, Dominello M, Joiner MC, Burmeister J. Three discipline collaborative radiation therapy (3DCRT) special debate: I would treat all early-stage NSCLC patients with SBRT. J Appl Clin Med Phys 2019; 20:7-13. [PMID: 30793828 PMCID: PMC6414141 DOI: 10.1002/acm2.12545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 01/24/2019] [Accepted: 01/24/2019] [Indexed: 11/27/2022] Open
Affiliation(s)
- Pranshu Mohindra
- Department of Radiation OncologyUniversity of Maryland School of MedicineBaltimoreMDUSA
| | - Amit Sawant
- Department of Radiation OncologyUniversity of Maryland School of MedicineBaltimoreMDUSA
| | - Robert J. Griffin
- Department of Radiation OncologyUniversity of Arkansas for Medical SciencesLittle RockARUSA
| | - Narottam Lamichhane
- Department of Radiation OncologyUniversity of Maryland School of MedicineBaltimoreMDUSA
| | - Erina Vlashi
- Department of Radiation OncologyUniversity of California‐Los AngelesLos AngelesCAUSA
| | - Meng Xu‐Welliver
- Department of Radiation OncologyThe James Cancer CenterOhio State UniversityColumbusOHUSA
| | - Michael Dominello
- Department of OncologyWayne State University School of MedicineDetroitMIUSA
| | - Michael C. Joiner
- Department of OncologyWayne State University School of MedicineDetroitMIUSA
| | - Jay Burmeister
- Department of OncologyWayne State University School of MedicineDetroitMIUSA
- Gershenson Radiation Oncology CenterBarbara Ann Karmanos Cancer InstituteDetroitMIUSA
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1066
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Blaauwgeers H, Damhuis R, Lissenberg-Witte BI, de Langen AJ, Senan S, Thunnissen E. A Population-Based Study of Outcomes in Surgically Resected T3N0 Non–Small Cell Lung Cancer in The Netherlands, Defined Using TNM-7 and TNM-8; Justification of Changes and an Argument to Incorporate Histology in the Staging Algorithm. J Thorac Oncol 2019; 14:459-467. [DOI: 10.1016/j.jtho.2018.10.164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 10/15/2018] [Accepted: 10/31/2018] [Indexed: 12/25/2022]
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1067
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Kim ES, Roy UB, Ersek JL, King J, Smith RA, Martin N, Martins R, Moore A, Silvestri GA, Jett J. Updates Regarding Biomarker Testing for Non–Small Cell Lung Cancer: Considerations from the National Lung Cancer Roundtable. J Thorac Oncol 2019; 14:338-342. [DOI: 10.1016/j.jtho.2019.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 12/29/2018] [Accepted: 01/01/2019] [Indexed: 12/25/2022]
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1068
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Navani N, Fisher DJ, Tierney JF, Stephens RJ, Burdett S. The Accuracy of Clinical Staging of Stage I-IIIa Non-Small Cell Lung Cancer: An Analysis Based on Individual Participant Data. Chest 2019; 155:502-509. [PMID: 30391190 PMCID: PMC6435782 DOI: 10.1016/j.chest.2018.10.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/17/2018] [Accepted: 10/02/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Clinical staging of non-small cell lung cancer (NSCLC) helps determine the prognosis and treatment of patients; few data exist on the accuracy of clinical staging and the impact on treatment and survival of patients. We assessed whether participant or trial characteristics were associated with clinical staging accuracy as well as impact on survival. METHODS We used individual participant data from randomized controlled trials (RCTs), supplied for a meta-analysis of preoperative chemotherapy (± radiotherapy) vs surgery alone (± radiotherapy) in NSCLC. We assessed agreement between clinical TNM (cTNM) stage at randomization and pathologic TNM (pTNM) stage, for participants in the control group. RESULTS Results are based on 698 patients who received surgery alone (± radiotherapy) with data for cTNM and pTNM stage. Forty-six percent of cases were cTNM stage I, 23% were cTNM stage II, and 31% were cTNM stage IIIa. cTNM stage disagreed with pTNM stage in 48% of cases, with 34% clinically understaged and 14% clinically overstaged. Agreement was not associated with age (P = .12), sex (P = .62), histology (P = .82), staging method (P = .32), or year of randomization (P = .98). Poorer survival in understaged patients was explained by the underlying pTNM stage. Clinical staging failed to detect T4 disease in 10% of cases and misclassified nodal disease in 38%. CONCLUSIONS This study demonstrates suboptimal agreement between clinical and pathologic staging. Discrepancies between clinical and pathologic T and N staging could have led to different treatment decisions in 10% and 38% of cases, respectively. There is therefore a need for further research into improving staging accuracy for patients with stage I-IIIa NSCLC.
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Affiliation(s)
- Neal Navani
- Lungs for Living Research Centre, UCL Respiratory and Department of Thoracic Medicine, University College London Hospital, London, England.
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1069
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Can Inflammatory and Nutritional Serum Markers Predict Chemotherapy Outcomes and Survival in Advanced Stage Nonsmall Cell Lung Cancer Patients? BIOMED RESEARCH INTERNATIONAL 2019; 2019:1648072. [PMID: 30941358 PMCID: PMC6421052 DOI: 10.1155/2019/1648072] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/27/2019] [Accepted: 02/13/2019] [Indexed: 12/11/2022]
Abstract
Purpose. To determine the values of prognostic nutritional and inflammatory markers in chemotherapy outcomes and survival in the patients with advanced nonsmall cell lung cancer (NSCLC) and also in the secondary malnutrition and cachexia. Methods. Twenty-five patients with diagnosis of aNSCLC were registered for the prospective study. Malnutrition was determined by the Subjective Global Assessment (SGA) and performance status by criteria of the Eastern Cooperative Oncology Group (ECOG). Before treatment, serum levels of albumin, prealbumin, vitamin D, zinc (Zn), C-reactive protein (CRP), IL-6, IL-1 β, TNF-α, lipoprotein lipase (LPL), and the Glasgow Prognostic Score (GPS) were recorded. Patients were followed prospectively for treatment outcomes and survival. Results. Due to the deaths of 18 patients during the 4-month follow-up period, no adequate measurements of inflammatory and nutritional markers could be performed. However, seven patients completed the treatment period and evaluations of these markers could be performed during the three periods. Eighty-four percent of patients were male with a mean age of 63.3 ± 8.7 years. Evaluation of the malnutrition by SGA showed that 5 (20%) patients were well nourished (A), 12(48%) were moderately malnourished (B), and 8(32%) were severely malnourished (C). Low levels of serum albumin (<3.5g/dl), prealbumin (<20 mg/ml), 25-hydroxycholecalciferol (<30 ng/ml), and Zn (<70mg/ml) were detected in 15(60%), 17(68%), 24 (96%), and 22 (88%) patients, respectively. Elevated levels of CRP (≥10 mg/L), IL6 (≥18pg/ml), TNF-α (≥24pg/ml), IL-1β (≥10pg/ml), and LPL (<12pg/ml) were found in 24 (96%), 11(44%), 9(36), 13(52%), and 11(44%) patients, respectively. Moderate and severe malnutrition, acute phase response, and reduced survival were determined in patients with NCSLC. In 7 patients that completed the treatment period, there was an association between elevated serum levels of IL-6, IL-1β, TNF-α, CRP, and LPL and also the reduced serum levels of albumin, prealbumin, Zn, vitamin D, and GPS, respectively. Similarly, Friedman analysis indicated that prealbumin significantly increased (p=0.007) in the follow-up period. But the serum levels of CRP (mean 37.3±22.3; Wilcoxon test P=0.368) in the seven patients were lower than those of the 18 patients that expired (mean 75.82±56.2). Conclusion. Malnutrition and cachexia negatively influence oncological outcomes in patients with NSCLC. These nutritional/inflammatory markers may be useful for selection of high risk and reduced survival in patients with aNSCLC undergoing adjuvant chemotherapy.
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1070
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Ramaekers B, De Ruysscher D. Quality of Life After Stereotactic Radiotherapy for Early-Stage Lung Cancer: Mission Accomplished? J Thorac Oncol 2019; 14:326-327. [PMID: 30782377 DOI: 10.1016/j.jtho.2018.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 12/25/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Bram Ramaekers
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Dirk De Ruysscher
- Department of Radiation Oncology (Maastro Clinic), Maastricht University Medical Centre, GROW School of Oncology and Developmental Biology, Maastricht, Netherlands.
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1071
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Miyahara N, Nii K, Benazzo A, Hoda MA, Iwasaki A, Klepetko W, Klikovits T, Hoetzenecker K. Solid predominant subtype in lung adenocarcinoma is related to poor prognosis after surgical resection: A systematic review and meta-analysis. Eur J Surg Oncol 2019; 45:1156-1162. [PMID: 30772108 DOI: 10.1016/j.ejso.2019.01.220] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/02/2019] [Accepted: 01/29/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Recent studies have indicated that solid predominant (SP) subtype of lung adenocarcinoma (LADC) may be associated with early recurrence and worse prognosis. Hence, a systematic review and meta-analysis were performed to evaluate the association between LADC subtype and survival. METHODS The MEDLINE, SCOPUS, Web of Science and Cochrane Libraries were reviewed for eligible studies in December 2017. Studies were included if they compared outcomes of patients with and without SP subtype in resection specimens of LADC patients after surgical treatment by using multivariate Cox regression analysis. A meta-analysis for overall survival (OS) and disease-free survival (DFS) was performed. The hazard ratios (HR) or odds ratios with 95% confidence intervals (CIs) from each study were used to calculate pooled HRs. Statistical analyses were performed using Review Manager 5.3. RESULTS In total, 14 eligible studies including 12,137 LADC patients were identified, which assessed the impact of SP subtype on OS and DFS in patients treated with pulmonary resection. SP subtype was reported in 1246 (10.2%) patients and was associated with significantly worse OS (pooled HR, 1.51; 1.29-1.75) and DFS (pooled HR, 1.26; 1.14-1.40). CONCLUSIONS SP subtype is associated with significantly worse OS and DFS in patients with LADC after pulmonary resection. These data provide evidence for the integration of the distinct histological LADC subtyping into prognostic tools and guidelines for adjuvant treatment after complete surgical resection.
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Affiliation(s)
- Naofumi Miyahara
- Division of Thoracic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria; Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka City, Fukuoka, 814-0180, Japan
| | - Kazuhito Nii
- Division of Thoracic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Alberto Benazzo
- Division of Thoracic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Mir Alireza Hoda
- Division of Thoracic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Akinori Iwasaki
- Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka City, Fukuoka, 814-0180, Japan
| | - Walter Klepetko
- Division of Thoracic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Thomas Klikovits
- Division of Thoracic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Konrad Hoetzenecker
- Division of Thoracic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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1072
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Chen S, Huang S, Yu S, Han Z, Gao L, Shen Z, Kang M. The clinical value of a new method of functional lymph node dissection in video-assisted thoracic surgery right non-small cell lung cancer radical resection. J Thorac Dis 2019; 11:477-487. [PMID: 30962991 DOI: 10.21037/jtd.2019.01.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background To evaluate the safety, thoroughness and feasibility of "tunnel-type en bloc mediastinal lymph node dissection" in video-assisted thoracic surgery (VATS) for right non-small cell lung cancer (NSCLC) radical resection, which functionally dissected the lymph nodes of station 2R/4R/7. Methods A retrospective study was performed in the clinical data of 196 patients with VATS right NSCLC radical resection. According to the different methods of lymph node dissection of station 2R, 4R and 7, they were divided into the tunnel-type group (n=102) and the routine group (n=94). The clinical data of two group were compared. Results The analyses of the baselines of the two groups are comparable. For lymph nodes dissection of station 2R/4R/7, operation time, the total number, positive number and metastasis incidence shown no significant difference between two groups (P>0.05). However, the amount of bleeding, postoperative thoracic drainage volume, extubation time, hospitalization days, the incidence of postoperative pulmonary infection and chronic cough were significantly lower in the tunnel-type group (P<0.05). There was no significant difference in 3-year recurrence and metastasis and in 3-year survival between tunnel-type group and routine group. Conclusions The tunnel-type group has more advantages, such as less surgical trauma, shorter hospitalization time, faster postoperative rehabilitation, even less postoperative chronic cough compared with the routine group. Therefore, we believe that the tunnel-type en bloc mediastinal lymph node dissection is a safe, thorough and feasible surgical method, which is worthy of being popularized and applied in the VATS right NSCLC radical resection.
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Affiliation(s)
- Sui Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Shijie Huang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Shaobin Yu
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Ziyang Han
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Lei Gao
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Zhimin Shen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Mingqiang Kang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China.,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou 350122, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou 350122, China
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1073
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Addition of chemotherapy improves overall survival in patients with T2N0M0 non-small cell lung cancer undergoing definitive radiation therapy: An analysis of the SEER database. Radiother Oncol 2019; 131:75-80. [DOI: 10.1016/j.radonc.2018.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/27/2018] [Accepted: 12/02/2018] [Indexed: 12/25/2022]
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1074
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Rotolo N, Cattoni M, D'Andria M, Cavanna L, Patrizio G, Imperatori A, Nicolini A. Comparison of an expiratory flow accelerator device versus positive expiratory pressure for tracheobronchial airway clearance after lung cancer lobectomy: a preliminary study. Physiotherapy 2019; 110:34-41. [PMID: 33563372 DOI: 10.1016/j.physio.2019.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 01/06/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE A new type of device has recently been introduced in chest physiotherapy as an aid to tracheo-bronchial airway clearance: expiratory flow accelerator (EFA). It promotes mucus clearance without generating any pressure gradient, allowing patients to breathe at tidal volume against no resistance. DESIGN Pilot randomized controlled study. SETTING Tertiary hospital. PARTICIPANTS Fifty adult patients who underwent lung cancer lobectomy were randomized to undergo chest physiotherapy with EFA (n=26) or PEP (n=24). INTERVENTIONS EFA; PEP bottle. MAIN OUTCOMES Incidence of postoperative pulmonary complications (PPC) and length of stay. SECONDARY OUTCOMES trends in inspiratory capacity, respiratory rate, oxygen saturation, and dyspnoea. Patients rated user-friendliness of the two devices on a 5-point Likert scale. RESULTS A slightly different incidence of PPCs was observed between the EFA and PEP group. Nevertheless, the length of stay was similar in the two groups. No substantial differences were seen in trends of inspiratory capacity, respiratory rate, oxygen saturation, dyspnoea between the two groups. Patient-reported user-friendliness of the two devices did not differ significantly, although the use of the EFA device appeared less strenuous. CONCLUSIONS Results of this pilot study point to the use of EFA as an alternative treatment option rather than as a replacement for the PEP bottle in chest physiotherapy following lung cancer lobectomy. EFA may be preferable for weaker patients and/or with airway leakages in whom PEP has limited indications. Further investigation in a larger sample is required to statistically confirm the findings. Clinical Trial Registration Number ChiCTR-ONC-17013255.
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Affiliation(s)
- Nicola Rotolo
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Maria Cattoni
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Michele D'Andria
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Laura Cavanna
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Giorgia Patrizio
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Andrea Imperatori
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
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1075
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Cao P, Liu B, Du F, Li D, Wang Y, Yan X, Li X, Li Y. Scutellarin suppresses proliferation and promotes apoptosis in A549 lung adenocarcinoma cells via AKT/mTOR/4EBP1 and STAT3 pathways. Thorac Cancer 2019; 10:492-500. [PMID: 30666790 PMCID: PMC6397905 DOI: 10.1111/1759-7714.12962] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/08/2018] [Accepted: 12/10/2018] [Indexed: 12/25/2022] Open
Abstract
Background Scutellarin (SCU), a flavonoid isolated from Erigeron breviscapus (Vant.) Hand.‐Mazz., increases autophagy and apoptosis in the adenocarcinoma A549 cell line, which is resistant to cisplatin. However, whether SCU alone has antitumor activity against non‐small cell lung cancer (NSCLC) is unknown. Methods Cell Counting Kit‐8, flow cytometry, colony formation, Hoechst 33258 staining, and Western blot analyses were used to examine the proliferation and apoptosis of A549 cells treated with SCU and the possible molecular mechanisms. Results The cell viability assay indicated that SCU markedly suppressed the proliferation of A549 cells in concentration and time‐dependent manners. SCU caused significant G0/G1 phase arrest and apoptosis, as evidenced by flow cytometric analyses, Hoechst 33258 staining, and Western blot analyses of cyclin D1, cyclin E, BCL‐2, cleaved‐caspase‐3, and BAX. Furthermore, SCU treatment reduced the level of pan‐AKT, phosphorylated (p)‐mTOR, mTOR, BCL‐XL, STAT3, and p‐STAT3, and increased the level of 4EBP1. Conclusions SCU can suppress proliferation and promote apoptosis in A549 cells through AKT/mTOR/4EBP1 and STAT3 pathways. This suggests that SCU may be developed into a promising antitumor agent for treating NSCLC.
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Affiliation(s)
- Pikun Cao
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Bin Liu
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan, China.,Interventional Oncology Institute of Shandong University, Jinan, China
| | - Feng Du
- Department of Radiology, Pingyin County Hospital of Traditional Chinese Medicine, Jinan, China
| | - Dong Li
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan, China.,Interventional Oncology Institute of Shandong University, Jinan, China
| | - Yongzheng Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan, China.,Interventional Oncology Institute of Shandong University, Jinan, China
| | - Xiaoyan Yan
- Department of Radiology, Pingyin County Hospital of Traditional Chinese Medicine, Jinan, China
| | - Xiao Li
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yuliang Li
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan, China.,Interventional Oncology Institute of Shandong University, Jinan, China
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1076
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Matsuo Y. A Systematic Literature Review on Salvage Radiotherapy for Local or Regional Recurrence After Previous Stereotactic Body Radiotherapy for Lung Cancer. Technol Cancer Res Treat 2019; 17:1533033818798633. [PMID: 30198413 PMCID: PMC6131295 DOI: 10.1177/1533033818798633] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose: The purpose of this review article was to summarize available data on the efficacy and safety of salvage radiotherapy for isolated local or regional recurrence after prior stereotactic body radiotherapy for lung cancer. Methods: Studies were systematically searched on PubMed, following which suitable papers were selected. Reported outcomes and toxicities were qualitatively reviewed. Results: Nineteen papers, which were retrospective studies based on single institution experiences, were selected. Sixteen papers were on salvage radiotherapy for local tumor recurrence, and the remaining 3 papers evaluated radiotherapy for regional failures after stereotactic body radiotherapy for lung cancer. Patient cohorts in the selected papers seemed very frail with 2-year survival of 30% to 40% after the salvage. Local control was reported to be approximately 60% to 70%, which is worse than that after primary stereotactic body radiotherapy. Reported rates of toxicity grade 3 or worse were considered acceptable. Larger target volume and central tumor localization were suggested as risk factors for severe toxicities. Dosimetric data on patients having toxicities were found to help with considering dose constraints for organs at risk. Conclusion: Based on data from a limited number of articles, salvage radiotherapy is a reasonable treatment option for select patients with local or regional tumor recurrence after prior stereotactic body radiotherapy for lung cancer. Optimal patient selection and dose prescription can be clarified with a larger study that include more data on experiences with salvage radiotherapy.
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Affiliation(s)
- Yukinori Matsuo
- 1 Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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1077
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Costa GJ, Ferreira CG, Thuler LCS. Concurrent chemoradiotherapy for stage III non-small cell lung cancer: correct clinical management as the basis to move beyond. ANNALS OF TRANSLATIONAL MEDICINE 2019; 6:S65. [PMID: 30613640 DOI: 10.21037/atm.2018.10.38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Guilherme Jorge Costa
- Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) and Hospital de Câncer de Pernambuco, Recife, Pernambuco, Brazil
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1078
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Predicting tumor responses and patient survival in chemoradiotherapy-treated patients with non-small-cell lung cancer using dynamic contrast-enhanced integrated magnetic resonance-positron-emission tomography. Strahlenther Onkol 2019; 195:707-718. [PMID: 30610356 DOI: 10.1007/s00066-018-1418-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 12/14/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE We investigated whether radiologic parameters by dynamic contrast-enhanced (DCE) integrated magnetic resonance-positron-emission tomography (MR-PET) predicts tumor response to treatment and survival in non-metastatic non-small-cell lung cancer (NSCLC) patients receiving chemoradiotherapy (CRT). METHODS Patients underwent DCE integrated MR-PET imaging 1 week before CRT. The following parameters were analyzed: primary tumor size, gross tumor volume, maximal standardized uptake value (SUVmax), total lesion glycolysis (TLG), apparent diffusion coefficient (ADC), volume transfer constant (Ktrans), reverse reflux rate constant (kep), extracellular extravascular volume fraction (ve), blood plasma volume fraction (vp), and initial area under the time-concentration curve defined over the first 60 s post-enhancement (iAUC60). CRT responses were defined using the revised Response Evaluation Criteria in Solid Tumors (RECIST) guideline (version 1.1). RESULTS Thirty patients were included. Non-responders demonstrated higher baseline TLG (p = 0.012), and lower baseline Ktrans (p = 0.020) and iAUC60 (p = 0.016) compared to responders, indicating the usefulness of DCE integrated MR-PET to predict treatment responses. Receiver operating characteristic curve indicated that TLG has the best differentiation capability to predict responders. By setting the threshold of TLG to 277, the sensitivity, specificity, and accuracy were 66.7%, 83.3%, and 75.0%, respectively, with an area under the curve of 0.776. The median follow-up time was 19.6 (range 7.8-32.0) months. In univariate analyses, baseline TLG >277 (p = 0.005) and baseline Ktrans <254 (10-3 min-1; p = 0.015) correlated with poor survival after CRT. In multivariate analysis, baseline TLG >277 remained the significant factor in predicting progression (p = 0.012) and death (p = 0.031). CONCLUSIONS The radiologic parameters derived from DCE integrated MR-PET scans are useful for predicting treatment response in NSCLC patients treated with CRT; furthermore, these parameters are correlated with clinical and survival outcomes including tumor progression and death.
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1079
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Radiation Therapy in Non-small-Cell Lung Cancer. Radiat Oncol 2019. [DOI: 10.1007/978-3-319-52619-5_34-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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1080
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Früh M, Betticher DC, Stupp R, Xyrafas A, Peters S, Ris HB, Mirimanoff RO, Ochsenbein AF, Schmid R, Matzinger O, Stahel RA, Weder W, Guckenberger M, Rothschild SI, Lardinois D, Mach N, Mark M, Gautschi O, Thierstein S, Biaggi Rudolf C, Pless M. Multimodal Treatment in Operable Stage III NSCLC: A Pooled Analysis on Long-Term Results of Three SAKK trials (SAKK 16/96, 16/00, and 16/01). J Thorac Oncol 2019; 14:115-123. [DOI: 10.1016/j.jtho.2018.09.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/05/2018] [Accepted: 09/08/2018] [Indexed: 12/25/2022]
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1081
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Sun H, Wang H, Xu N, Li J, Shi J, Zhou N, Ni M, Hu X, Chen Y. Patient Preferences For Chemotherapy In The Treatment Of Non-Small Cell Lung Cancer: A Multicenter Discrete Choice Experiment (DCE) Study In China. Patient Prefer Adherence 2019; 13:1701-1709. [PMID: 31631985 PMCID: PMC6790116 DOI: 10.2147/ppa.s224529] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/20/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The study aims to quantify patients' risk-benefit preferences for chemotherapy in the treatment of non-small cell lung cancer (NSCLC), and to elicit their willingness to pay (WTP) for treatment outcomes. METHODS A face-to-face discrete choice experiment (DCE) was conducted on NSCLC patients in four tertiary hospitals each from Beijing, Shanghai, Guangzhou and Chengdu in China. Patients were invited to complete choice questions that constructed by seven attributes: progression-free survival (PFS), disease control rate (DCR), rash, nausea and vomiting, tiredness, mode of administration and out-of-pocket costs. A mixed logit model was used to evaluate the choice model. Estimates of relative preferences and marginal willingness to pay for each attribute were then explored. RESULTS A total of 361 patients completed the survey. Improvements in PFS (10, 95% CI: 8.4-11.6) were the most important attribute for patients, followed by increase in DCR (4.6, 95% CI: 3.4-5.8). Tiredness (3.9, 95% CI: 2.9-5.1) was judged to be the most important risk. While remaining attributes were ranked in decreasing order of importance: nausea and vomiting (1.9, 95% CI: 0.9-3.0), mode of administration (0.8, 95% CI: 0.2-1.4) and rash (0.5, 95% CI: -0.6-1.5). There was little variation in preferences among patients with different sociodemographic characteristics. Patients were monthly willing to pay $2304 (95% CI, $1916-$2754) that guaranteed 11 months of PFS, followed by $1465 (95% CI, $1163-$1767) per month to improve their disease control rate by 90%. CONCLUSION The results suggested that efficacy was the most important attribute for patients. Side effects, mode of administration and treatment cost significantly influenced patient preferences. Patient engagement in prioritizing their treatment preferences should be emphasized during the clinical decision-making process and regimen implementation.
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Affiliation(s)
- Hui Sun
- Key Lab of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai, People’s Republic of China
- Department of Health Technology Assessment Research, Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, People’s Republic of China
| | - Huishan Wang
- The Second Clinical Medical School of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Ningze Xu
- Key Lab of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai, People’s Republic of China
| | - Junling Li
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Jufang Shi
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Naitong Zhou
- West China School of Pharmacy, Sichuan University, Chengdu, People’s Republic of China
| | - Ming Ni
- Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China
| | - Xianzhi Hu
- Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China
| | - Yingyao Chen
- Key Lab of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai, People’s Republic of China
- Correspondence: Yingyao Chen School of Public Health, Fudan University, Shanghai200032, People’s Republic of ChinaTel +86-21-33565183Fax +86-21-64169552 Email
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1082
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Preliminary Study of the Effect of Stereotactic Body Radiotherapy (SBRT) on the Immune System in Lung Cancer Patients Unfit for Surgery: Immunophenotyping Analysis. Int J Mol Sci 2018; 19:ijms19123963. [PMID: 30544863 PMCID: PMC6320787 DOI: 10.3390/ijms19123963] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 12/05/2018] [Accepted: 12/06/2018] [Indexed: 12/25/2022] Open
Abstract
An immunophenotyping analysis was performed in peripheral blood samples from seven patients with lung cancer unfit for surgery treated with stereotactic body radiotherapy (SBRT). The objective was to characterize the effect of SBRT on the host immune system. Four patients received 60 Gy (7.5 Gy × 8) and three 50 Gy (12.5 Gy × 4). Analyses were performed before SBRT, 72 h after SBRT, and at one, three, and six months after the end of SBRT. Of note, there was a specific increase of the immunoactive component of the immune system, with elevation of CD56+highCD16+ natural killer (NK) cells (0.95% at baseline to 1.38% at six months), and a decrease of the immunosuppressive component of the immune system, with decreases of CD4+CD25+Foxp3+CDA5RA- regulatory T cells (4.97% at baseline to 4.46% at six months), granulocytic myeloid-derived suppressor cells (G-MDSCs) (from 66.1% at baseline to 62.6% at six months) and monocytic (Mo-MDSCs) (8.2% at baseline to 6.2% at six months). These changes were already apparent at 72 h and persisted over six months. SBRT showed an effect on systemic immune cell populations, which is a relevant finding for supporting future combinations of SBRT with immunotherapy for treating lung cancer patients.
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1083
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Current Status and Future Perspectives on Neoadjuvant Therapy in Lung Cancer. J Thorac Oncol 2018; 13:1818-1831. [DOI: 10.1016/j.jtho.2018.09.017] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/17/2018] [Accepted: 09/17/2018] [Indexed: 12/25/2022]
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1084
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Penault-Llorca F, Radosevic-Robin N. Tumor mutational burden in non-small cell lung cancer-the pathologist's point of view. Transl Lung Cancer Res 2018; 7:716-721. [PMID: 30505716 PMCID: PMC6249617 DOI: 10.21037/tlcr.2018.09.26] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 09/26/2018] [Indexed: 12/17/2022]
Abstract
In non-small cell lung cancer (NSCLC), the pathologist has contributed to the development of personalized medicine from the determination of the right histological type to EGFR and ALK/ROS1 molecular screening for targeted therapies. With the development of immunotherapies, pathologists intervene forefront with programmed death-ligand 1 (PD-L1) immunohistochemical testing, companion test for pembrolizumab monotherapy, first line and complementary test to the other programmed cell death-1 (PD-1) PD-L1 inhibitors. Recently, tumor mutational burden has emerged as a promising tool to evaluate sensitivity to immunotherapy (IO). The pathologist has a crucial role in the setting of tumor mutational burden (TMB) testing for the selection and the preparation of the sample for high throughput molecular analysis, and in the first steps of the next-generation sequencing (NGS) workflow.
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1085
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Brun C, Gay P, Cottier M, Karpathiou G, Patoir A, Tiffet O, Barral FG, Vergnon JM, Froudarakis ME. Comparison of cytology, chest computed and positron emission tomography findings in malignant pleural effusion from lung cancer. J Thorac Dis 2018; 10:6903-6911. [PMID: 30746236 DOI: 10.21037/jtd.2018.11.127] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Malignant pleural effusion (MPE) is a common medical problem in lung cancer (LC). Pleural fluid cytology (PFC), chest computed tomography (CCT) and positron emission tomography (PET) findings are helpful as first line approach. The objectives of this study were to evaluate whether there is a correlation between PFC, CCT and PET in patients with MPE due to LC. Methods We selected patients from our electronic files. Data of PFC, pleural biopsy (PB), CCT and PET have been recorded and analyzed. Results A total of 101 consecutive patients (66 males, 65.3%) with a mean age of 66.2±31 years were selected. Types of LC were adenocarcinoma in 71 patients (70.2%), squamous in 13 (12.8%), small-cell in 12 (11.8%) and large cell in 5 (4.9%). CCT showed nodules in 6 (5.9%), pleural thickening in 8 (7.9%) and both in 17 (16.8%) patients. PFC was positive in 55/91 thoracentesis (60.4%) and 32/52 thoracoscopy (61.5%), while PB in 38/40 performed (95%). PET fixation was found in 32/47 (68%) patients who had MPE at diagnosis. When we associate PFC to CCT and PET findings, the yield in our study becomes 90%. No correlation was observed between CCT findings and PFC (P=0.62) between PFC and PET fixation (P=0.63) or between CCT and PET (P=0.06). Conclusions In our cohort of LC patients with MPE, we observed a high sensitivity for PFC, while in most of the cases no findings were observed in CCT. PET had a relative low sensitivity. However, when all 3 methods were combined the yield was 90%.
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Affiliation(s)
- Clement Brun
- Departments of Pneumonology and Thoracic Oncology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Pierre Gay
- Departments of Pneumonology and Thoracic Oncology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Michele Cottier
- Departments of Cytology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Georgia Karpathiou
- Departments of Pathology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Arnaud Patoir
- Departments of Thoracic Surgery, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Oliviet Tiffet
- Departments of Thoracic Surgery, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Fabrice-Guy Barral
- Departments of Radiology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Jean-Michel Vergnon
- Departments of Pneumonology and Thoracic Oncology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Marios E Froudarakis
- Departments of Pneumonology and Thoracic Oncology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
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1086
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Campbell D, O'Day K, Hertel N, Penrod JR, Manley Daumont M, Lees M. The present and future burden of previously treated advanced non-small cell lung cancer (NSCLC) by histology and line of therapy in France, Germany, Italy, and Spain: model-based predictions. Popul Health Metr 2018; 16:17. [PMID: 30477516 PMCID: PMC6257974 DOI: 10.1186/s12963-018-0174-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 11/07/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The burden of advanced non-small cell lung cancer (NSCLC) is not well understood, and the number of patients likely to receive treatment in Europe has not been quantified. The aim of this study was to forecast the annual number of patients with squamous and non-squamous advanced NSCLC likely to receive second and third lines of therapy (LOT) from 2016 to 2020 in France, Germany, Italy, and Spain. METHODS A patient count model (PCM) was developed in Microsoft Excel to estimate the number of patients with refractory advanced NSCLC eligible to receive systemic treatment. Using historical population-based cancer registry data, segmented linear regression ("Joinpoint") was used to forecast age- and sex-stratified lung cancer incidence rates in each country through 2020. Yearly incident case count totals by country were apportioned according to NSCLC histology and stage at diagnosis. Country-specific treatment rates came from a recent medical chart review study, and early- to advanced-stage disease progression rates were estimated over a 10-year interval. A probabilistic sensitivity analysis (PSA) was performed to estimate variability in the patient counts. RESULTS The combined number of squamous and non-squamous advanced NSCLC patients estimated to receive second and third LOT, respectively, in 2016 were France = 11,600 and 3500; Germany = 15,100 and 4900; Italy = 13,500 and 2500; Spain = 9400 and 2100. The forecasted numbers of patients receiving second and third LOT, respectively, in 2020 were France = 13,900 and 4200; Germany = 16,200 and 5200; Italy = 15,100 and 2600; Spain = 11,000 and 2500. CONCLUSIONS Driven by growth in the incidence of NSCLC among women, the model forecasts an overall increase in the number of patients with advanced-stage squamous and non-squamous NSCLC likely to receive systemic treatment in the year 2020. The results highlight the significant burden of refractory advanced NSCLC and the need for more robust surveillance data to accurately quantify the burden of disease.
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Affiliation(s)
| | - Ken O'Day
- Xcenda LLC, Palm Harbor, Florida, USA
| | - Nadine Hertel
- Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb Pharmaceuticals Ltd, Uxbridge, UK
| | - John R Penrod
- Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb Pharmaceuticals Ltd, Princeton, NJ, USA
| | - Melinda Manley Daumont
- Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb Pharmaceuticals Ltd, Rueil-Malmaison, France
| | - Michael Lees
- Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb Pharmaceuticals Ltd, Rueil-Malmaison, France
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1087
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Cavic M, Spasic J, Krivokuca A, Boljevic I, Kuburovic M, Radosavljevic D, Jankovic R. TP53 and DNA-repair gene polymorphisms genotyping as a low-cost lung adenocarcinoma screening tool. J Clin Pathol 2018; 72:75-80. [PMID: 30467244 DOI: 10.1136/jclinpath-2018-205553] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 11/01/2018] [Accepted: 11/02/2018] [Indexed: 12/16/2022]
Abstract
AIM TP53 and DNA repair polymorphisms have been proposed as cancer risk factors. This study evaluated the usability of TP53 Arg72Pro single-nucleotide polymorphism, X RCC1 Arg399Gln and RAD51 G135C as a low-cost lung adenocarcinoma screening tool. PATIENTS AND METHODS This case-control study included 78 atients with lung adenocarcinoma and 79 healthy matched controls. TP53, XRCC1 and RAD51 genotyping was done by PCR followed by restriction length polymorphism. Descriptive analyses included genotype and allelic frequencies and deviations of the frequencies from those expected under Hardy-Weinberg equilibrium were assessed using the χ2 test. The OR and 95% CIs were calculated as an estimate of relative risk, with significance set at p value <0.05. RESULTS The TP53 codon 72 Pro allele and the XRCC1 codon 399 Arg allele in a homozygous state were associated with lung adenocarcinoma (p=0.037; OR (95% CI) 2.42 (1.10 to 5.31)), that is, p=0.037; OR (95% CI) 2.16 (1.08 to 4.33), respectively. Also, carriers of the TP53 codon 72 Pro allele and the XRCC1 codon 399 ArgArg genotype older than 50 showed an even higher risk of developing lung adenocarcinoma (p=0.03 in both cases). CONCLUSIONS The TP53 codon 72 Arg allele and XRCC1 codon 399 Gln allele are likely to have a protective effect against lung adenocarcinoma, especially in individuals older than 50 years of age. XRCC1 and TP53 genotyping might be a useful low-cost tool for evaluating individual lung cancer risk, leading to earlier detection and management of this disease.
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Affiliation(s)
- Milena Cavic
- Department of Experimental Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Jelena Spasic
- Clinic for Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Ana Krivokuca
- Department of Experimental Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Ivana Boljevic
- Department of Experimental Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Mira Kuburovic
- Department of Experimental Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Davorin Radosavljevic
- Clinic for Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Radmila Jankovic
- Department of Experimental Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
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1088
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Christensen NL, Dalton SO, Mellemgaard A, Christensen J, Kejs AMT, Rasmussen TR. Assessing the pattern of recurrence in Danish stage I lung cancer patients in relation to the follow-up program: are we failing to identify patients with cerebral recurrence? Acta Oncol 2018; 57:1556-1560. [PMID: 30010453 DOI: 10.1080/0284186x.2018.1490028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND There is paucity of evidence regarding the optimal follow-up (FU) regimen for lung cancer. Consequently, FU is organized differently across countries. The Danish FU regimen has short FU intervals with a computed tomography (CT) scan of the chest and upper abdomen every three months in the early phase (first 2 years), then every six months in the late phase of FU (3rd, 5th year). Characterizing recurrences missed by the FU program in terms of site, tumor histology, department, and phase of FU, could improve the FU program. MATERIAL AND METHOD A case-control study of curatively treated stage I lung cancer patients who attended the Danish FU-program and had recurrence identified through the follow-up program (controls, FU group) or outside FU program (cases, symptomatic group). RESULTS Of 233 included patients with recurrence, the FU group constituted 85% (n = 197). Among the 15% (n = 36) in the symptomatic group, 53% had involvement of the central nervous system compared with 3% in the FU group. The unadjusted odds ratio (OR) for having an isolated brain recurrence (IBR) in the symptomatic group was 52.3 (95%CI: 15.1-181.4) as compared with the FU group. The OR for having a symptomatic recurrence in the early phase of FU was 2.5 (95%CI: 0.7-8.7) compared with the late phase. CONCLUSIONS The FU program did not identify the majority of patients with IBR. Including cerebral imaging in the FU program may result in an earlier detection of brain metastases. These matters should be studied in a prospective setting.
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Affiliation(s)
- Niels Lyhne Christensen
- Department of Documentation and Quality, Danish Cancer Society, Copenhagen Ø, Denmark
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Jane Christensen
- Department of Documentation and Quality, Danish Cancer Society, Copenhagen Ø, Denmark
| | | | - Torben Riis Rasmussen
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
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1089
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Xi JJ, Yin JC, Wang L, Lu CL, Wang Q, Jiang W. A surveillance method-oriented detection of post-operative spatial-temporal recurrence for non-small cell lung cancer. J Thorac Dis 2018; 10:6107-6117. [PMID: 30622782 DOI: 10.21037/jtd.2018.10.32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background This study evaluated spatial-temporal recurrence patterns after curative resection for non-small cell lung cancer (NSCLC) to clarify and recommend appropriate post-operative surveillance. Methods A total of 2,486 consecutive patients between January 2005 and December 2012 with NSCLC (stage I-IIIA) who underwent definitive surgical resection were retrospectively analyzed. We used a hazard rate curve to evaluate event dynamics. Disease-free survival (DFS) was evaluated by the Kaplan-Meier method. Univariate and multivariate analyses with Cox proportional hazards regression identified risk factors that predicted DFS. Results The median follow-up was 50.1 months. Recurrences were diagnosed in 852 (34.3%) patients. Four hundred eighty-nine events first occurred in the chest, 177 in the brain, 117 in the bone, and 71 in the abdomen. Of all recurrences, 78.5% occurred in the first 3 years. Univariate and multivariate analyses identified the age at diagnosis (P<0.001), histology (P=0.023), tumor size (P<0.001), pathologic N stage (P<0.001), and grade (P=0.043) as independent risk factors for intra-thoracic recurrences. Histology (P<0.001), tumor size (P<0.001), surgical method (P=0.021), pathologic N stage (P<0.001), and grade (P=0.005) were independent to predict extra-thoracic recurrences. The hazard rate curve displayed an initial surge of time to any treatment failure during 12 months after surgery. Based on sub-group analysis, both intra- and extra-recurrences increased with stage and brain recurrences in stage IIIA occurred earlier than stage II. Hazard rate curve of brain recurrences in squamous cell carcinoma showed a moderate peak during 9-15 months. Hazard rate curves of brain and bone recurrences in adenocarcinoma displayed clear peaks at 9-27 and 15-30 months, respectively. Conclusions Intra- and extra-thoracic recurrences correlate with different clinicopathological factors. Brain MRI and bone ECT were recommended for selected patients in particular time to early detect extra-thoracic recurrences.
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Affiliation(s)
- Jun-Jie Xi
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Jia-Cheng Yin
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Lin Wang
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Chun-Lai Lu
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Wei Jiang
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China
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1090
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Tone M, Awano N, Inomata M, Kuse N, Jo T, Yoshimura H, Furuhata Y, Takemura T, Kumasaka T, Izumo T. The combination of EBUS-TBNA and the PAB antibody led to a successful treatment for lung cancer in a patient with asymptomatic sarcoidosis mimicking nodal metastasis. Respir Med Case Rep 2018; 25:296-299. [PMID: 30364678 PMCID: PMC6198119 DOI: 10.1016/j.rmcr.2018.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/16/2018] [Indexed: 11/21/2022] Open
Abstract
Correct staging of lung cancer is important for the selection of the best therapy, but discriminating between lymphadenopathy from lung cancer and from sarcoidosis by imaging examinations is difficult. Additionally, distinguishing lymphadenopathy of sarcoidosis from sarcoid reactions which are sometimes caused by lung cancer is difficult on imaging and pathological findings. A 73-year-old woman was diagnosed as lung cancer clinical T1bN3M0 stage ШB based on false-positive 18F-fluoro-2-deoxyglucose positron emission tomography uptake. Because the effects of chemotherapy were different between the lymphadenopathy and the primary lesion, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was performed and revealed sarcoidosis as the cause of the lymphadenopathy with using a specific monoclonal antibody against Propionibacterium acnes (PAB antibody). Accordingly, the stage was changed to clinical T1bN0M0 stage ІA, for which radical operation was performed. EBUS-TBNA should be performed aggressively when the effect of chemotherapy is different between lymphadenopathies and other lesions, and the PAB antibody can help to discriminate between sarcoidosis and sarcoid reactions caused by lung cancer. The combination of EBUS-TBNA and the PAB antibody is expected to be valuable in the definitive diagnosis of a lymphadenopathy for the staging of lung cancer.
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Affiliation(s)
- Mari Tone
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan
| | - Nobuyasu Awano
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan
| | - Minoru Inomata
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan
| | - Naoyuki Kuse
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan
| | - Tatsunori Jo
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan
| | - Hanako Yoshimura
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan
| | - Yoshiaki Furuhata
- Department of Thoracic Surgery, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan
| | - Tamiko Takemura
- Department of Pathology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan
| | - Toshio Kumasaka
- Department of Pathology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan
| | - Takehiro Izumo
- Department of Pathology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan
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1091
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Evison M, McDonald F, Batchelor T. What is the role of surgery in potentially resectable N2 non-small cell lung cancer? Thorax 2018. [DOI: 10.1136/thoraxjnl-2018-212287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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1092
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Dickhoff C, Otten RHJ, Heymans MW, Dahele M. Salvage surgery for recurrent or persistent tumour after radical (chemo)radiotherapy for locally advanced non-small cell lung cancer: a systematic review. Ther Adv Med Oncol 2018; 10:1758835918804150. [PMID: 30305851 PMCID: PMC6174644 DOI: 10.1177/1758835918804150] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 09/03/2018] [Indexed: 12/25/2022] Open
Abstract
Background: Once recurrent or persistent locoregional tumour after radical chemoradiotherapy (CRT) for non-small cell lung cancer (NSCLC) is identified, few curative-intent treatment options are available. Selected patients might benefit from surgical salvage. We performed a systematic review of the available literature for this emerging treatment option. Methods: A systematic literature search was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Publications about persistent or (locoregional) recurrent disease after radical/definitive CRT for locally advanced non-small cell lung cancer were identified. Results: Eight full papers were found, representing 158 patients. All were retrospective series and data were heterogeneous: definition and indication for salvage surgery varied and the median time from radiotherapy to surgery was 4.1–33 months. Complete resection (R0) was achieved in 85–100%, with vital tumour in 61–100%. A large number of pneumonectomies were performed, and additional structures were often resected. Where reported, 90-day mortality was 0–11.4%. Reported survival metrics varied but included median overall survival 9–46 months and 5-year survival 20–75%. Conclusion: There are limited, low-level, heterogeneous data in support of salvage surgery after radical CRT. Based on this, perioperative mortality appears acceptable and long-term survival is possible in (highly) selected patients. In suitable patients (fit, no distant metastases, tumour appears completely resectable and preferably with confirmed viable tumour), this treatment option should be discussed in an experienced multidisciplinary lung cancer team.
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Affiliation(s)
- Chris Dickhoff
- Department of Surgery and Cardiothoracic Surgery, Amsterdam UMC, Cancer Centre Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Rene H J Otten
- Medical Library, Vrije Universiteit, Amsterdam, The Netherlands
| | - Martijn W Heymans
- Department of Biostatistics and Epidemiology, Cancer Centre Amsterdam, Amsterdam, The Netherlands
| | - Max Dahele
- Department of Radiation Oncology, Amsterdam UMC, Cancer Centre Amsterdam, Amsterdam, The Netherlands
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1093
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Minute ventilation-to-carbon dioxide slope is associated with postoperative survival after anatomical lung resection. Lung Cancer 2018; 125:218-222. [PMID: 30429023 DOI: 10.1016/j.lungcan.2018.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/30/2018] [Accepted: 10/01/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The aim of the study was to identify whether ventilation-to-carbon dioxide output (VE/V CO2) slope obtained from cardiopulmonary exercise test (CPET) as part of the preoperative functional workup was an independent prognostic factor for short and long-term survival after major lung resection. PATIENTS AND METHODS 974 consecutive patients undergoing lobectomy (n = 887) or segmentectomy (n = 87) between April 2014 to March 2018 were included. 209 (22%) underwent CPET, and pulmonary function tests and several clinical factors including age, sex, performance status and comorbidities were retrospectively investigated to identify the prognostic factors with a multivariable Cox regression analysis. RESULTS Among the patients with measured VE/V CO2, the incidence of cardiopulmonary complications in patients with high VE/V CO2 slope (>40) was 37% (19 of 51) vs. 27% (33 of 121) in those with lower slope values (p = 0.19). The 90-day mortality in patients with high VE/V CO2 slope (n = 8) was 16% vs. 5% (n = 6) in those with lower slope values (p = 0.03). No overall difference in 2-year mortality was identified between the two groups (VE/VCO2 > 40: 70% (54-80) vs. VE/VCO2 ≤ 40: 72% (63-80), log-rank test, p = 0.39). In a Cox regression analysis VE/VCO2 values were associated with poorer 2-year survival (HR 1.05, 95% CI 1.01-1.10, p = 0.030). CONCLUSIONS We found that VE/V CO2 slope was an independent prognostic factor for the 90-day mortality and 2-year survival after anatomic pulmonary resection. This finding may assist during the multidisciplinary treatment decision-making process in high-risk patients with lung cancer.
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1094
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Bennett L, Howell M, Memon D, Smowton C, Zhou C, Miller CJ. Mutation pattern analysis reveals polygenic mini-drivers associated with relapse after surgery in lung adenocarcinoma. Sci Rep 2018; 8:14830. [PMID: 30287876 PMCID: PMC6172282 DOI: 10.1038/s41598-018-33276-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 09/26/2018] [Indexed: 12/12/2022] Open
Abstract
The genomic lesions found in malignant tumours exhibit a striking degree of heterogeneity. Many tumours lack a known driver mutation, and their genetic basis is unclear. By mapping the somatic mutations identified in primary lung adenocarcinomas onto an independent coexpression network derived from normal tissue, we identify a critical gene network enriched for metastasis-associated genes. While individual genes within this module were rarely mutated, a significant accumulation of mutations within this geneset was predictive of relapse in lung cancer patients that have undergone surgery. Since it is the density of mutations within this module that is informative, rather than the status of any individual gene, these data are in keeping with a 'mini-driver' model of tumorigenesis in which multiple mutations, each with a weak effect, combine to form a polygenic driver with sufficient power to significantly alter cell behaviour and ultimately patient outcome. These polygenic mini-drivers therefore provide a means by which heterogeneous mutation patterns can generate the consistent hallmark changes in phenotype observed across tumours.
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Affiliation(s)
- Laura Bennett
- RNA Biology Group, CRUK Manchester Institute, The University of Manchester, Alderley Park, Manchester, SK10 4TG, UK
| | - Matthew Howell
- RNA Biology Group, CRUK Manchester Institute, The University of Manchester, Alderley Park, Manchester, SK10 4TG, UK
- Cancer Research UK Lung Cancer Centre of Excellence, The University of Manchester, Alderley Park, Manchester, SK10 4TG, UK
| | - Danish Memon
- RNA Biology Group, CRUK Manchester Institute, The University of Manchester, Alderley Park, Manchester, SK10 4TG, UK
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, UK
| | - Chris Smowton
- Scientific Computing Team, CRUK Manchester Institute, The University of Manchester, Alderley Park, Manchester, SK10 4TG, UK
| | - Cong Zhou
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, Manchester Cancer Research Centre, University of Manchester, Wilmslow Road, Manchester, M20 4GJ, UK
| | - Crispin J Miller
- RNA Biology Group, CRUK Manchester Institute, The University of Manchester, Alderley Park, Manchester, SK10 4TG, UK.
- Cancer Research UK Lung Cancer Centre of Excellence, The University of Manchester, Alderley Park, Manchester, SK10 4TG, UK.
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1095
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Uhlig J, Ludwig JM, Goldberg SB, Chiang A, Blasberg JD, Kim HS. Survival Rates after Thermal Ablation versus Stereotactic Radiation Therapy for Stage 1 Non-Small Cell Lung Cancer: A National Cancer Database Study. Radiology 2018; 289:862-870. [PMID: 30226453 DOI: 10.1148/radiol.2018180979] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose To compare survival rates of thermal ablation and stereotactic radiation therapy (SRT) for stage 1 non-small cell lung cancer (NSCLC). Materials and Methods In this retrospective study, patients with stage 1 NSCLC treated by thermal ablation (TA) or SRT were identified in the 2004-2013 National Cancer Database. Patients who underwent TA and SRT were one-to-one propensity matched to undergo thermal ablation. Outcomes were overall survival and unplanned hospital readmission within 30 days after treatment. Results This study included 28 834 patients (TA, 1102 patients; SRT, 27 732 patients). Patients treated with TA had more comorbidities (Charlson comorbidity index of 1 vs ≥2, 32.8% [362 of 1102] vs 19.7% [217 of 1102], respectively) compared with SRT (Charlson comorbidity index of 1 vs ≥2, 26.9% [7448 of 27 732] vs 15.3% [4251 of 27 732], respectively; P , .001) and smaller tumor size (mean tumor size, TA vs SRT: 19 mm vs 22 mm, respectively; P , .001). In the propensity score-matched cohort with balanced distribution of potential confounders, there was no significant difference in overall survival between TA and SRT at a mean follow-up of 52.4 months (survival difference, P = .69). Overall survival rates were comparable between TA and SRT (1 year, 85.4% vs 86.3%, respectively, P = .76; 2 years, 65.2% vs 64.5%, respectively, P = .43; 3 years, 47.8% vs 45.9%, respectively, P = .32; 5 years, 24.6% vs 26.1%, respectively, P = .81). Unplanned hospital readmission rates were higher for patients who underwent TA versus those who underwent SRT (3.7% [40 of 1070] vs 0.2% [two of 1070], respectively; P , .001). Conclusion Regarding overall survival, thermal ablation was noninferior to stereotactic radiation therapy for primary treatment of stage 1 non-small cell lung cancer. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Shyn in this issue.
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Affiliation(s)
- Johannes Uhlig
- From the Division of Interventional Radiology, Department of Radiology and Biomedical Imaging (J.U., J.M.L., H.S.K.), Division of Medical Oncology, Department of Medicine (S.B.G., A.C., H.S.K.), Division of Thoracic Surgery, Department of Surgery (J.D.B.), and Yale Cancer Center (H.S.K., S.B.G., A.C., J.D.B.), Yale School of Medicine, 330 Cedar St, New Haven, CT 06510; Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Germany (J.U.); Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (J.M.L.)
| | - Johannes M Ludwig
- From the Division of Interventional Radiology, Department of Radiology and Biomedical Imaging (J.U., J.M.L., H.S.K.), Division of Medical Oncology, Department of Medicine (S.B.G., A.C., H.S.K.), Division of Thoracic Surgery, Department of Surgery (J.D.B.), and Yale Cancer Center (H.S.K., S.B.G., A.C., J.D.B.), Yale School of Medicine, 330 Cedar St, New Haven, CT 06510; Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Germany (J.U.); Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (J.M.L.)
| | - Sarah B Goldberg
- From the Division of Interventional Radiology, Department of Radiology and Biomedical Imaging (J.U., J.M.L., H.S.K.), Division of Medical Oncology, Department of Medicine (S.B.G., A.C., H.S.K.), Division of Thoracic Surgery, Department of Surgery (J.D.B.), and Yale Cancer Center (H.S.K., S.B.G., A.C., J.D.B.), Yale School of Medicine, 330 Cedar St, New Haven, CT 06510; Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Germany (J.U.); Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (J.M.L.)
| | - Anne Chiang
- From the Division of Interventional Radiology, Department of Radiology and Biomedical Imaging (J.U., J.M.L., H.S.K.), Division of Medical Oncology, Department of Medicine (S.B.G., A.C., H.S.K.), Division of Thoracic Surgery, Department of Surgery (J.D.B.), and Yale Cancer Center (H.S.K., S.B.G., A.C., J.D.B.), Yale School of Medicine, 330 Cedar St, New Haven, CT 06510; Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Germany (J.U.); Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (J.M.L.)
| | - Justin D Blasberg
- From the Division of Interventional Radiology, Department of Radiology and Biomedical Imaging (J.U., J.M.L., H.S.K.), Division of Medical Oncology, Department of Medicine (S.B.G., A.C., H.S.K.), Division of Thoracic Surgery, Department of Surgery (J.D.B.), and Yale Cancer Center (H.S.K., S.B.G., A.C., J.D.B.), Yale School of Medicine, 330 Cedar St, New Haven, CT 06510; Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Germany (J.U.); Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (J.M.L.)
| | - Hyun S Kim
- From the Division of Interventional Radiology, Department of Radiology and Biomedical Imaging (J.U., J.M.L., H.S.K.), Division of Medical Oncology, Department of Medicine (S.B.G., A.C., H.S.K.), Division of Thoracic Surgery, Department of Surgery (J.D.B.), and Yale Cancer Center (H.S.K., S.B.G., A.C., J.D.B.), Yale School of Medicine, 330 Cedar St, New Haven, CT 06510; Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Germany (J.U.); Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (J.M.L.)
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1096
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Abstract
Lung cancer diagnosis and ancillary testing are increasingly relying on cytology and small biopsy specimens obtained via minimally invasive means. Paired with traditional immunohistochemical characterization of tumors, biomarker testing and comprehensive genomic profiling are becoming essential steps in the workup of lung cancer to identify targetable alterations and guide optimal therapy selection. Recent advances in immune checkpoint inhibitor therapy have led to an increasingly complex and unresolved landscape for tumor PD-L1 testing. The prevalence and importance of lung cancer cytology specimens are growing, with more required by the cytopathologist in directing the care of patients with lung cancer.
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Affiliation(s)
- Paul A VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.
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1097
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Pass HI. PACIFIC: Time for a surgical IIIA uprising. J Thorac Cardiovasc Surg 2018; 156:1249-1254. [DOI: 10.1016/j.jtcvs.2018.05.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 04/07/2018] [Accepted: 05/14/2018] [Indexed: 12/25/2022]
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1098
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Zhang Y, Ni J, Wei K, Tian J, Sun S. CT, MRI, and F-18 FDG PET for the detection of non-small-cell lung cancer (NSCLC): A protocol for a network meta-analysis of diagnostic test accuracy. Medicine (Baltimore) 2018; 97:e12387. [PMID: 30235705 PMCID: PMC6160194 DOI: 10.1097/md.0000000000012387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Non-small-cell lung cancer (NSCLC) is a rare cancer in lung carcinomas and has been widely known as a difficult curable disease among all the tumors. However, early detection of malignant potential in patients with NSCLC has still been a huge challenge all around the world. CT, MRI, and F-18 FDG PET are all considered as good tests for diagnosing malignant NSCLC efficiently, but no recommended suggestion presents that which test among the 3 is the prior one in diagnose. We perform this study through network meta-analysis method, and to rank these tests using a superiority index. METHODS AND ANALYSIS PubMed, Embase.com, and the Cochrane Central Register of Controlled Trials (CENTRAL) will be searched from their inception to March 2018. We will include diagnostic tests which assessed the accuracy of CT, MRI, and F-18 FDG PET for diagnosing NSCLC. The risk of bias for each study will be independently assessed as low, moderate, or high using criteria adapted from Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). Network meta-analysis will be performed using STATA 12.0 and R 3.4.1 software. The competing diagnostic tests will be ranked by a superiority index. RESULTS This study is ongoing, and will be submitted to a peer-reviewed journal for publication. CONCLUSION This study will provide systematically suggestions to select different diagnostic measures for detecting the early NSCLC. ETHICS AND DISSEMINATION Ethical approval and patient consent are not required since this study is a network meta-analysis based on published studies. The results of this network meta-analysis will be submitted to a peer-reviewed journal for publication. PROSPERO REGISTRATION NUMBER PROSPEROCRD42018094542.
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Affiliation(s)
- Yi Zhang
- School of Basic Medical Sciences, Lanzhou University
| | - Jinman Ni
- School of Basic Medical Sciences, Lanzhou University
| | - Kongyuan Wei
- Department of General Surgery, First Affiliated Hospital of Lanzhou University
| | - Jinhui Tian
- Evidence-based Medicine Center, School of Basic Medical Sciences
| | - Shaobo Sun
- Gansu university of Chinese Medicine, Lanzhou University, Lanzhou, China
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1099
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Grass GD, Naghavi AO, Abuodeh YA, Perez BA, Dilling TJ. Analysis of Relapse Events After Definitive Chemoradiotherapy in Locally Advanced Non-Small-Cell Lung Cancer Patients. Clin Lung Cancer 2018; 20:e1-e7. [PMID: 30268836 DOI: 10.1016/j.cllc.2018.08.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 07/24/2018] [Accepted: 08/11/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND The appropriate follow-up frequency after definitive chemoradiotherapy (CRT) for locally advanced non-small-cell lung cancer patients is unknown. Although surveillance guidelines have been proposed, very few data support current recommendations. Here we analyze relapse events after CRT and investigate whether symptomatic relapses versus those detected by surveillance imaging influences outcomes. PATIENTS AND METHODS Stage III non-small-cell lung cancer patients treated with CRT at our institution between 2005 and 2014 were retrospectively analyzed. Relapse events were grouped into posttreatment intervals and analyzed with cumulative tables. Time to relapse and overall survival (OS) were compared between patients with relapse detection via symptomatic presentation versus surveillance imaging. RESULTS A total of 211 patients were identified for analysis. The median follow-up was 43 months for patients alive at the time of analysis. The median age was 63 years, and equal proportions had IIIA or IIIB disease. A total of 135 patients (64%) experienced disease relapse, and of these, 74% did so within 12 months. In those who did not experience relapse at ≤ 12 months, 16%, 6%, and < 5% experienced relapse during 12 to 24, 24 to 36, and > 36 months of follow-up, respectively. In patients with relapse, 56% presented symptomatically, which led to inferior median OS compared to those identified by surveillance imaging (23 vs. 36 months; P = .013). CONCLUSION This study identified that most relapses occur within 1 year of completing CRT, and approximately half of these occur within 6 months. A symptomatic relapse led to inferior OS. More aggressive surveillance imaging may therefore identify asymptomatic relapses that are amenable to earlier salvage therapy.
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Affiliation(s)
- G Daniel Grass
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Arash O Naghavi
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Yazan A Abuodeh
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Bradford A Perez
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Thomas J Dilling
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
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1100
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Jiang G, Chen C, Zhu Y, Xie D, Dai J, Jin K, Shen Y, Wang H, Li H, Zhang L, Gao S, Chen K, Zhang L, Zhou X, Shi J, Wang H, Xie B, Jiang L, Fan J, Zhao D, Chen Q, Duan L, He W, Zhou Y, Liu H, Zhao X, Zhang P, Qin X. [Shanghai Pulmonary Hospital Experts Consensus on the Management of Ground-Glass Nodules Suspected as Lung Adenocarcinoma (Version 1)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:147-159. [PMID: 29587930 PMCID: PMC5973030 DOI: 10.3779/j.issn.1009-3419.2018.03.05] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
随着胸部计算机断层扫描(computed tomography, CT)检查,尤其是低剂量薄层CT筛查项目在中国的广泛开展,越来越多的无症状肺部磨玻璃结节(ground-glass nodules, GGNs)被发现。虽然国内及国际上已发布了一系列针对肺部GGNs的指南,但是这些指南的撰写者多来自呼吸、肿瘤及影像专业,可能缺乏对现代微创胸外科的充分认识,造成外科手术在肺部GGNs诊治中的作用不明确,甚至被低估;而且,肺部肿瘤相关的各学科对于早期肺癌,尤其是浸润前病变的处理也缺乏统一规范。因此,基于国内外现有文献及上海市肺科医院多年积累的经验,上海市肺科医院撰写了此诊疗共识。本共识推荐对于疑似肺腺癌的GGNs进行多学科评估,依据诊断,选择合理的处置方式。对于疑似原位腺癌,推荐进行胸部薄层CT随访,或在特定情况下进行不超过肺段切除的限制性肺切除;对于疑似微浸润腺癌,推荐进行限制性肺切除或肺叶切除;对于疑似浸润性腺癌,建议依据病灶是否含有磨玻璃成分、位置、大小、个数及患者躯体情况选择合理的手术方式;而肺多发结节的处理原则推荐为主病灶优先,兼顾次要病灶,综合选择治疗方案。
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Affiliation(s)
- Gening Jiang
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Chang Chen
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Yuming Zhu
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Dong Xie
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Jie Dai
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Kaiqi Jin
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Yingran Shen
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Haifeng Wang
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Hui Li
- Capital Medical University Affiliated Beijing Chao-Yang Hospital, Beijing 100020 , China
| | - Lanjun Zhang
- Sun Yat-sen University Cancer Center, Guangzhou 510060 , China
| | - Shugeng Gao
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China
| | - Keneng Chen
- Peking University Cancer Hospital and Institute, Beijing 100142 , China
| | - Lei Zhang
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Xiao Zhou
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Jingyun Shi
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Hao Wang
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Boxiong Xie
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Lei Jiang
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Jiang Fan
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Deping Zhao
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Qiankun Chen
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Liang Duan
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Wenxin He
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Yiming Zhou
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Hongcheng Liu
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Xiaogang Zhao
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Peng Zhang
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Xiong Qin
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
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