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Lin WC, Chen WM, Shia BC, Wu SY. Prognostic factors for survival in unresectable stage III EGFR mutation-positive lung adenocarcinoma: impact of pre-CCRT PET-CT. Thorax 2024:thorax-2023-220702. [PMID: 38331580 DOI: 10.1136/thorax-2023-220702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/16/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To assess the survival impact of pre-concurrent chemoradiotherapy (CCRT) staging with positron emission tomography-CT (PET-CT) in patients with unresectable epidermal growth factor receptor (EGFR) mutation-positive adenocarcinoma. METHODS Patients with unresectable stage IIIA-IIIC EGFR mutation-positive adenocarcinoma undergoing definitive CCRT were divided into two groups: those who received PET-CT staging prior to CCRT and those with other staging methods. Survival outcomes were compared after propensity score matching. RESULTS Analysis of 11 856 patients (5928 in each group) showed that PET-CT staging was associated with improved survival (adjusted HR of all-cause mortality: 0.74, 95% CI 0.71 to 0.79). Other prognostic factors included male sex, age group, clinical stage, adjuvant treatment, smoking status, Charlson Comorbidity Index score and treatment setting. CONCLUSION Pre-CCRT staging with PET-CT in patients with unresectable EGFR mutation-positive adenocarcinoma of clinical stage IIIA-IIIC was associated with enhanced survival. Independent prognostic factors were also identified.
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Affiliation(s)
- Wei-Chun Lin
- Division of Chest Medicine, Department of Internal Medicine, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Wan-Ming Chen
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Ben-Chang Shia
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan
| | - Szu-Yuan Wu
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Management, College of Management, Fo Guang University, Yilan, Taiwan
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Qie P, Xun X, Nie X, Yin Q, Cui H, Liu L, Wang H. Efficacy and safety of radiofrequency ablation in the treatment of inoperable patients with pulmonary malignant nodules. ANZ J Surg 2023; 93:2969-2973. [PMID: 37915293 DOI: 10.1111/ans.18734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 08/08/2023] [Accepted: 09/28/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Radiofrequency ablation (RFA) has been recently applied as an alternative treatment in the patients with pulmonary malignancies. The aim of our study was to assess the incidence of complications and survival rate of RFA for malignant lung nodules, and evaluate the efficacy and safety of RFA in the treatment of inoperable patients with pulmonary malignant nodules. METHODS The clinical data of 50 patients with primary and metastatic lung malignant nodules treated with RFA from June 2015 and July 2017 in Hebei General Hospital were considered, and the characteristics and clinical data of these patients were analysed. Complications, progression-free survival and overall survival at 1, 2 and 5 years of these patients were evaluated. RESULTS Following the procedure. There were no major complications and deaths during the operation. 26 (52%) patients presented mild-to-moderate chest pain that was easily controlled by analgesic drugs. 8 (16%) patients with pneumothorax, 4 (8%) haemoptysis, 6 (12%) pneumonia, 7 (14%) pleural effusion and 1 (2%) postoperative bronchopleural fistula. Needle-track implantation was observed in 2 (4%) patients. Median progression-free survival (PFS) was 24.6 months. The PFS at 1, 2, 5 years was 76%, 52% and 20%, respectively. Median overall survival (OS) was 35.5 months. The OS at 1, 2 and 5 years was 80%, 58% and 32%, respectively. CONCLUSION RFA is a safe and effective alternative treatment for the inoperable patients with primary or metastatic pulmonary malignant nodules. The clinical impact and long-term results of RFA need to be further confirmed in a larger series of patients, and RFA should ideally be compared with surgery.
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Affiliation(s)
- Peng Qie
- Department of Thoracic Surgery, Hebei General Hospital, Shijiahuang, Hebei Province, People's Republic of China
| | - Xuejiao Xun
- Department of Pharmacy, Hebei General Hospital, Shijiahuang, Hebei Province, People's Republic of China
| | - Xiaodong Nie
- Nutritional Department, Hebei General Hospital, Shijiahuang, Hebei Province, People's Republic of China
| | - Qifan Yin
- Department of Thoracic Surgery, Hebei General Hospital, Shijiahuang, Hebei Province, People's Republic of China
| | - Hongshang Cui
- Department of Thoracic Surgery, Hebei General Hospital, Shijiahuang, Hebei Province, People's Republic of China
| | - Lijun Liu
- Department of Thoracic Surgery, Hebei General Hospital, Shijiahuang, Hebei Province, People's Republic of China
| | - Huien Wang
- Department of Thoracic Surgery, Hebei General Hospital, Shijiahuang, Hebei Province, People's Republic of China
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Beers CA, Pond GR, Wright JR, Tsakiridis T, Okawara GS, Swaminath A. The impact of staging FDG-PET/CT on treatment for stage III NSCLC - an analysis of population-based data from Ontario, Canada. Front Oncol 2023; 13:1210945. [PMID: 37681028 PMCID: PMC10482027 DOI: 10.3389/fonc.2023.1210945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 07/24/2023] [Indexed: 09/09/2023] Open
Abstract
Purpose Fluoro-2-deoxyglucose positron-emission tomography (FDG-PET/CT) is now considered a standard investigation for the staging of new cases of stage III NSCLC. However, there is not published level 3 evidence demonstrating the impact of FDG-PET/CT on appropriate therapy in this setting. Using retrospective population-based data, we sought to examine the role and timing that FDG-PET/CT scans play in influencing treatment choice, as well as survival in patients diagnosed with stage III NSCLC. Materials and methods A retrospective cohort of patients diagnosed with stage III NSCLC from 2009-2017 in Ontario were identified from the IC/ES (formerly Institute of Clinical Evaluative Sciences) database. FDG-PET/CT utilization over time, trends in mediastinal biopsy technique and usage, the impact of FDG-PET/CT on overall survival (OS), and its influence on use of concurrent chemoradiotherapy (CRT) were explored. The impact of timing of pre-treatment FDG-PET/CT on OS was also analyzed (≤28 days prior to treatment, 29-56 days prior, and >56 days prior). Results Between 2007 and 2017, a total of 13 796 people were diagnosed with stage III NSCLC in Ontario. FDG-PET/CT utilization increased over time with 0% of cases in 2007 and 74% in 2017 with pre-treatment FDG-PET/CT scans. The number of patients who received a mediastinal biopsy similarly increased in this timeframe increasing from 41% to 53%. More patients with pre-treatment FDG-PET/CT scans received curative-intent therapy than those who did not: 23% vs 13% for CRT (p<0.001), and 23% vs 10% for surgery (p<0.001). Median OS was longer in those with FDG-PET/CT scans prior to treatment (17 vs 11 months), as was 5-year survival (22% vs 14%, p<0.001), and this held true on both univariate and multivariate analyses. Timing of FDG-PET/CT scan relative to treatment was not associated with differences in OS. Conclusion Improvements in OS were seen in this cohort of stage III NSCLC patients who underwent a pre-treatment FDG-PET/CT scan. This can likely be attributed to stage-appropriate therapy due to more complete staging using FDG-PET/CT. This study stresses the importance of complete staging for suspected stage III NSCLC using FDG-PET/CT, and a need for continued advocacy for increased access to FDG-PET/CT scans.
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Affiliation(s)
- Craig A. Beers
- Division of Radiation Oncology, Juravinski Cancer Centre, Hamilton, ON, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Gregory R. Pond
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - James R. Wright
- Division of Radiation Oncology, Juravinski Cancer Centre, Hamilton, ON, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Theodoros Tsakiridis
- Division of Radiation Oncology, Juravinski Cancer Centre, Hamilton, ON, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Gordon S. Okawara
- Division of Radiation Oncology, Juravinski Cancer Centre, Hamilton, ON, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Anand Swaminath
- Division of Radiation Oncology, Juravinski Cancer Centre, Hamilton, ON, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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Guo X, Li Y, Yang C, Hu Y, Zhou Y, Wang Z, Zhang L, Hu H, Wu Y. Deep Learning-Based Computed Tomography Imaging to Diagnose the Lung Nodule and Treatment Effect of Radiofrequency Ablation. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:6556266. [PMID: 34721825 PMCID: PMC8550842 DOI: 10.1155/2021/6556266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 10/01/2021] [Indexed: 11/18/2022]
Abstract
This study aimed to detect and diagnose the lung nodules as early as possible to effectively treat them, thereby reducing the burden on the medical system and patients. A lung computed tomography (CT) image segmentation algorithm was constructed based on the deep learning convolutional neural network (CNN). The clinical data of 69 patients with lung nodules diagnosed by needle biopsy and pathological comprehensive diagnosis at hospital were collected for specific analysis. The CT image segmentation algorithm was used to distinguish the nature and volume of lung nodules and compared with other computer aided design (CAD) software (Philips ISP). 69 patients with lung nodules were treated by radiofrequency ablation (RFA). The results showed that the diagnostic sensitivity of the CT image segmentation algorithm based on the CNN was obviously higher than that of the Philips ISP for solid nodules <5 mm (63 cases vs. 33 cases) (P < 0.05); it was the same result for the subsolid nodule <5 mm (33 case vs. 5 cases) (P < 0.05) that was slightly higher for solid and subsolid nodules with a diameter of 5-10 mm (37 cases vs. 28 cases) (P < 0.05). In addition, the CNN algorithm can reach all detection for calcified nodules and pleural nodules (7 cases; 5 cases), and the diagnostic sensitivities were much better than those of Philips ISP (2 cases; 3 cases) (P < 0.05). Patients with pulmonary nodules treated by RFA were in good postoperative condition, with a half-year survival rate of 100% and a one-year survival rate of 72.4%. Therefore, it could be concluded that the CT image segmentation algorithm based on the CNN could effectively detect and diagnose the lung nodules early, and the RFA could effectively treat the lung nodules.
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Affiliation(s)
- Xixi Guo
- Department 2 of Thoracic Oncology, Xinxiang Central Hospital, Xinxiang 453000, Henan, China
| | - Yuze Li
- Disinfection and Supply Center, Liyang People's Hospital, Liyang 213300, Jiangsu, China
| | - Chunjie Yang
- Department of Thoracic Surgery, Liyang People's Hospital, Liyang 213300, Jiangsu, China
| | - Yanjiang Hu
- Department of Thoracic Surgery, Liyang People's Hospital, Liyang 213300, Jiangsu, China
| | - Yun Zhou
- Department of Thoracic Surgery, Liyang People's Hospital, Liyang 213300, Jiangsu, China
| | - Zhenhua Wang
- Department 2 of Thoracic Oncology, Xinxiang Central Hospital, Xinxiang 453000, Henan, China
| | - Liguo Zhang
- Department 2 of Thoracic Oncology, Xinxiang Central Hospital, Xinxiang 453000, Henan, China
| | - Hongjun Hu
- Department 2 of Thoracic Oncology, Xinxiang Central Hospital, Xinxiang 453000, Henan, China
| | - Yuemin Wu
- Department of Thoracic Surgery, Liyang People's Hospital, Liyang 213300, Jiangsu, China
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Kasymjanova G, Anwar A, Cohen V, Sultanem K, Pepe C, Sakr L, Friedmann J, Agulnik JS. The Impact of COVID-19 on the Diagnosis and Treatment of Lung Cancer at a Canadian Academic Center: A Retrospective Chart Review. Curr Oncol 2021; 28:4247-4255. [PMID: 34898542 PMCID: PMC8544580 DOI: 10.3390/curroncol28060360] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/05/2021] [Accepted: 10/18/2021] [Indexed: 02/07/2023] Open
Abstract
The large burden of COVID-19 on health care systems worldwide has raised concerns among medical oncologists about the impact of COVID-19 on the diagnosis and treatment of lung cancer patients. In this retrospective cohort study, we investigated the impact of COVID-19 on lung cancer diagnosis and treatment before and during the COVID-19 era. New lung cancer diagnoses decreased by 34.7% during the pandemic with slightly more advanced stages of disease, there was a significant increase in the utilization of radiosurgery as the first definitive treatment, and a decrease in both systemic treatment as well as surgery compared to the pre-COVID-19 era. There was no significant delay in starting chemotherapy and radiation treatment during the pandemic compared to pre-COVID-19 time. However, we observed a delay to lung cancer surgery during the pandemic time. COVID-19 seems to have had a major impact at our lung cancer center on the diagnoses and treatment patterns of lung cancer patients. Many oncologists fear that they will see an increase in newly diagnosed lung cancer patients in the coming year. This study is still ongoing and further data will be collected and analyzed to better understand the total impact of the COVID-19 pandemic on our lung cancer patient population.
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Affiliation(s)
- Goulnar Kasymjanova
- Peter Brojde Lung Cancer Center, Jewish General Hospital, McGill University, Montreal, QC H3T1E2, Canada; (C.P.); (L.S.); (J.S.A.)
- Correspondence:
| | - Aksa Anwar
- Department of Oncology, McGill University, Montreal, QC H3T1E2, Canada;
| | - Victor Cohen
- Segal Cancer Centre, Medical Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T1E2, Canada; (V.C.); (J.F.)
| | - Khalil Sultanem
- Segal Cancer Centre, Radiation Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T1E2, Canada;
| | - Carmela Pepe
- Peter Brojde Lung Cancer Center, Jewish General Hospital, McGill University, Montreal, QC H3T1E2, Canada; (C.P.); (L.S.); (J.S.A.)
| | - Lama Sakr
- Peter Brojde Lung Cancer Center, Jewish General Hospital, McGill University, Montreal, QC H3T1E2, Canada; (C.P.); (L.S.); (J.S.A.)
| | - Jennifer Friedmann
- Segal Cancer Centre, Medical Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T1E2, Canada; (V.C.); (J.F.)
| | - Jason S. Agulnik
- Peter Brojde Lung Cancer Center, Jewish General Hospital, McGill University, Montreal, QC H3T1E2, Canada; (C.P.); (L.S.); (J.S.A.)
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