Surgical resection of non-small cell carcinoma after treatment for small cell carcinoma

Surgery for small cell lung cancer

Small-cell lung cancer (SCLC) comprises approximately 14% of all lung cancer cases. Most patients present with locally advanced or metastatic disease and are therefore treated nonoperatively with chemotherapy, radiotherapy, or both. A small subset of patients with SCLC present with early-stage disease and will benefit from surgical resection plus chemotherapy. The rationale for radiotherapy in these patients remains controversial.

Risk classification of cancer survival using ANN with gene expression data from multiple laboratories

Numerous cancer studies have combined gene expression experiments and clinical survival data to predict the prognosis of patients of specific gene types. However, most results of these studies were data dependent and were not suitable for other data sets. This study performed cross-laboratory validations for the cancer patient data from 4 hospitals. We investigated the feasibility of survival risk predictions using high-throughput gene expression data and clinical data. We analyzed multiple data sets for prognostic applications in lung cancer diagnosis. After building tens of thousands of various ANN architectures using the training data, five survival-time correlated genes were identified from 4 microarray gene expression data sets by examining the correlation between gene signatures and patient survival time. The experimental results showed that gene expression data can be used for valid predictions of cancer patient survival classification with an overall accuracy of 83.0% based on survival time trusted data. The results show the prediction model yielded excellent predictions given that patients in the high-risk group obtained a lower median overall survival compared with low-risk patients (log-rank test P-value<0.00001). This study provides a foundation for further clinical studies and research into other types of cancer. We hope these findings will improve the prognostic methods of cancer patients.

Small-cell lung cancer

The incidence and mortality of small-cell lung cancer worldwide make this disease a notable health-care issue. Diagnosis relies on histology, with the use of immunohistochemical studies to confirm difficult cases. Typical patients are men older than 70 years who are current or past heavy smokers and who have pulmonary and cardiovascular comorbidities. Patients often present with rapid-onset symptoms due to local intrathoracic tumour growth, extrapulmonary distant spread, paraneoplastic syndromes, or a combination of these features. Staging aims ultimately to define disease as metastatic or non-metastatic. Combination chemotherapy, generally platinum-based plus etoposide or irinotecan, is the mainstay first-line treatment for metastatic small-cell lung cancer. For non-metastatic disease, evidence supports early concurrent thoracic radiotherapy. Prophylactic cranial irradiation should be considered for patients with or without metastases whose disease does not progress after induction chemotherapy and radiotherapy. Despite high initial response rates, most patients eventually relapse. Except for topotecan, few treatment options then remain. Signalling pathways have been identified that might yield new drug targets.

Lobectomy of second primary cancer in survivor of small cell lung cancer with brain metastasis

Resection of a second primary nonsmall cell lung carcinoma in a long-term survivor of small cell lung carcinoma with brain metastasis is reported. The patient had squamous cell carcinoma as the second primary tumor and underwent lobectomy with node dissection. He was alive 79 months after the initial diagnosis of the small cell carcinoma, 64 months after the diagnosis of the brain metastasis, and 21 months after the curative pulmonary resection for his second primary carcinoma.

Follow-up and surveillance of the lung cancer patient following curative intent therapy: ACCP evidence-based clinical practice guideline (2nd edition)

BACKGROUND

To develop an evidence-based approach to follow-up of patients after curative intent therapy for lung cancer.

METHODS

Guidelines on lung cancer diagnosis and management published between 2002 and December 2005 were identified by a systematic review of the literature, and supplemental material appropriate to this topic was obtained by literature search of a computerized database (Medline) and review of the reference lists of relevant articles.

RESULTS

Adequate follow-up by the specialist responsible for the curative intent therapy should be ensured to manage complications related to the curative intent therapy and should last at least 3 to 6 months. In addition, a surveillance program should be considered to detect recurrences of the primary lung cancer and/or development of a new primary lung cancer early enough to allow potentially curative retreatment. A standard surveillance program for these patients, coordinated by a multidisciplinary tumor board and overseen by the physician who diagnosed and initiated therapy for the original lung cancer, is recommended based on periodic visits with chest imaging studies and counseling patients on symptom recognition. Smoking cessation and, if indicated, facilitation in participation in special programs is recommended for all patients following curative intent therapy for lung cancer.

CONCLUSIONS

The current evidence favors follow-up of complications related to curative intent therapy, and a surveillance program at regular intervals with imaging and review of symptoms. Smoking cessation after curative intent therapy to prevent recurrence of lung cancer is strongly supported by the available evidence.

Surgery for Small-Cell Lung Cancer

Treatment of small-cell lung cancer (SCLC) is typically chemotherapy with or without radiation, depending on the extent of disease. There are several situations where surgery may have a role to play. Patients with clinical stage T1-2 N0 SCLC may benefit from surgery for confirmation of diagnosis and improved local control when combined with chemotherapy. Surgery itself rarely contributes to prolonged survival for N2 SCLC. In this view, mediastinoscopy is recommended to exclude N2 disease before surgery is considered. Patients with a combined histology tumor (mixtures of SCLC with non-SCLC components) may be offered surgery since the non-SCLC component is less sensitive to chemotherapy and resection may contribute to cure. Salvage surgery should be considered for patients having relapse only in the primary site or a localized chemotherapy-resistant tumor, which can occur because of an unrecognized mixed tumor. Recent evidence has shown that platinum-based chemotherapy with concurrent hyperfractionated radiotherapy followed by surgery is feasible and a promising strategy for highly selected patients with SCLC. Among patients with nodal disease, only those with negative nodes following induction chemo/chemoradiotherapy should be candidates for surgery, which may offer improved local control. Further evidence for this strategy will be obtained from ongoing randomized clinical trials.

Follow-up and surveillance of the lung cancer patient following curative-intent therapy

The following two distinctly different issues should be taken into account when planning patient care following curative-intent therapy for lung cancer: adequate follow-up to manage complications related to the curative-intent therapy; and surveillance to detect recurrences of the primary lung cancer and/or development of a new primary lung cancer early enough to allow potentially curative retreatment. Follow-up for complications should be performed by the specialist responsible for the curative-intent therapy and should last 3 to 6 months. Recurrences of the original lung cancer will be more likely during the first 2 years after curative-intent therapy, but there will be an increased lifelong risk of approximately 1 to 2% per year of developing a metachronous, or new primary, lung cancer. A standard surveillance program for these patients is recommended based on periodic visits, with chest-imaging studies and counseling patients on symptom recognition. Whether subgroups of patients with a higher risk of developing a metachronous lung cancer (eg, those patients whose primary lung cancer was radiographically occult or central and those patients surviving for > 2 years after treatment for small cell lung cancer) should have a more intensive surveillance program is presently unclear. The surveillance program should be coordinated by a multidisciplinary tumor board and overseen by the physician who diagnosed and initiated therapy for the original lung cancer. Smoking cessation is recommended for all patients following curative-intent therapy for lung cancer.