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Fatima M, Sehar A, Zaheer Z, Khan MH, Rehman OU, Abid SF, Ahmad U, Bajwa A, Cheema HA, Maqsood HA, Martins RS, Naqi SA. Oncological Outcomes of Sub-Lobar Resection Versus Lobectomy for Stage I Non-Small Cell Lung Cancer. J Surg Res 2024; 302:302-316. [PMID: 39121798 DOI: 10.1016/j.jss.2024.07.049] [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: 03/08/2024] [Revised: 06/20/2024] [Accepted: 07/06/2024] [Indexed: 08/12/2024]
Abstract
INTRODUCTION Although lobectomy has been the treatment of choice for early-stage non-small cell lung cancer (NSCLC), sub-lobar resection (i.e., segmentectomy or wedge resection) has emerged as an alternative over time due to its ability to preserve additional lung function. This meta-analysis explores the survival outcomes of sub-lobar resection versus lobectomy in patients with stage I NSCLC (tumor size: ≤2 cm). MATERIAL AND METHODS We conducted a systematic search of PubMed, EMBASE, and the Cochrane Library from inception up to July 28, 2023. The hazard ratios and odds ratios for overall survival (OS), disease-free survival (DFS), and mortality were calculated using the random effects model. RESULTS A total of 27 studies, comprising 10,449 patients, were included. Sub-lobar resection demonstrated comparable OS and DFS to that of lobectomy. Similarly, there was no significant risk of mortality associated with any of the groups. However, the subgroup analysis according to patient selection (intentional, compromised, not specified, and both [intentional and compromised]) showed that the patients in the compromised subgroup had a poor DFS with sub-lobar resection as compared to lobectomy (hazard ratio: 1.52, confidence interval: 1.14-2.02, P = 0.004). Additionally, there was no significant difference in OS, DFS, or overall mortality in the results stratified by surgical procedure or patient selection. CONCLUSIONS The patients with stage I NSCLC who underwent sub-lobar resection showed a significantly worse DFS and OS in the "compromised group." However, there was no overall significant difference in OS, DFS, or mortality in the sub-lobar resection group as compared to lobectomy.
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Affiliation(s)
- Maurish Fatima
- Department of Surgery, King Edward Medical University Lahore, Lahore, Pakistan.
| | - Ayesha Sehar
- Department of Surgery, King Edward Medical University Lahore, Lahore, Pakistan
| | - Zaofashan Zaheer
- Department of Surgery, King Edward Medical University Lahore, Lahore, Pakistan
| | | | - Obaid Ur Rehman
- Services Institute of Medical Sciences, Department of Medicine, Lahore, Pakistan
| | - Syeda Fatima Abid
- Department of Surgery, King Edward Medical University Lahore, Lahore, Pakistan
| | - Unaiza Ahmad
- Department of Medicine, Punjab Medical College, Faisalabad, Pakistan
| | - Ahmed Bajwa
- Department of Surgery, King Edward Medical University Lahore, Lahore, Pakistan
| | | | | | - Russell Seth Martins
- Department of Thoracic Surgery, Hackensack Meridian Health, Hackensack, New Jersey
| | - Syed Asghar Naqi
- Department of Surgery, King Edward Medical University Lahore, Lahore, Pakistan
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Folch E, Guo Y, Senitko M. Therapeutic Bronchoscopy for Lung Nodules: Where Are We Now? Semin Respir Crit Care Med 2022; 43:480-491. [PMID: 36104025 DOI: 10.1055/s-0042-1749368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Lobar resection has been the established standard of care for peripheral early-stage non-small cell lung cancer (NSCLC). Over the last few years, surgical lung sparing approach (sublobar resection [SLR]) has been compared with lobar resection in T1N0 NSCLC. Three nonsurgical options are available in those patients who have a prohibitive surgical risk, and those who refuse surgery: stereotactic body radiotherapy (SBRT), percutaneous ablation, and bronchoscopic ablation. Local ablation involves placement of a probe into a tumor, and subsequent application of either heat or cold energy, pulsing electrical fields, or placement of radioactive source under an image guidance to create a zone of cell death that encompasses the targeted lesion and an ablation margin. Despite being in their infancy, the bronchoscopic ablative techniques are undergoing rapid research, as they extrapolate a significant knowledge-base from the percutaneous techniques that have been in the radiologist's armamentarium since 2000. Here, we discuss selected endoscopic and percutaneous thermal and non-thermal therapies with the focus on their efficacy and safety.
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Affiliation(s)
- Erik Folch
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yanglin Guo
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Michal Senitko
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Mississippi Medical Center, Jackson, Mississippi.,Division of Cardiothoracic Surgery, University of Mississippi Medical Center, Jackson, Mississippi
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Wang P, Wang S, Liu Z, Sui X, Wang X, Li X, Qiu M, Yang F. Segmentectomy and Wedge Resection for Elderly Patients with Stage I Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11020294. [PMID: 35053989 PMCID: PMC8782039 DOI: 10.3390/jcm11020294] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/27/2021] [Accepted: 01/05/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Considerable controversies exist regarding the efficacies of segmentectomy and wedge resection for elderly patients with early-stage non-small cell lung cancer (NSCLC). This systematic review and meta-analysis aimed to solve these issues. Methods: We searched the online databases PubMed, Web of Science, EMBASE, and Cochrane Library to identify eligible studies. Elderly patients were defined as ≥65 years. Early-stage NSCLC was defined as stage I based on TNM systems. The primary endpoints were survival outcomes (overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS)) and recurrence patterns. The second endpoints were perioperative morbidities. The hazard rate (HR) and odds ratio (OR) were effect sizes. Results: Sixteen cohort studies (3140 participants) and four database studies were finally included. Segmentectomy and lobectomy showed no significant difference in OS (cohort studies HR 1.00, p = 0.98; database studies HR 1.07, p = 0.14), CSS (HR 0.91, p = 0.85), or DFS (HR 1.04, p = 0.78) in elderly patients with stage I NSCLC. In contrast, wedge resection showed inferior OS (HR 1.28, p < 0.001), CSS (HR 1.17, p = 0.001) and DFS (HR 1.44, p = 0.042) compared to lobectomy. Segmentectomy also showed comparable local recurrence risk with lobectomy (OR 0.98, p = 0.98), while wedge resection showed increased risk (OR 5.46, p < 0.001). Furthermore, sublobar resections showed a decreased risk of 30/90-day mortality, pneumonia, and leak complications compared to lobectomy. Conclusion: Segmentectomy is promising when applied to elderly patients with stage I NSCLC, while wedge resection should be limited. Randomized controlled trials are warranted to validate these findings.
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Affiliation(s)
| | | | | | | | | | | | | | - Fan Yang
- Correspondence: ; Tel.: +86-(10)-88326657
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Alzubaidi SJ, Liou H, Saini G, Segaran N, Scott Kriegshauser J, Naidu SG, Patel IJ, Oklu R. Percutaneous Image-Guided Ablation of Lung Tumors. J Clin Med 2021; 10:5783. [PMID: 34945082 PMCID: PMC8707332 DOI: 10.3390/jcm10245783] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/03/2021] [Accepted: 12/07/2021] [Indexed: 12/22/2022] Open
Abstract
Tumors of the lung, including primary cancer and metastases, are notoriously common and difficult to treat. Although surgical resection of lung lesions is often indicated, many conditions disqualify patients from being surgical candidates. Percutaneous image-guided lung ablation is a relatively new set of techniques that offers a promising treatment option for a variety of lung tumors. Although there have been no clinical trials to definitively compare its efficacy to those of traditional treatments, lung ablation is widely practiced and generally accepted to be safe and effective. Especially encouraging results have recently emerged for cryoablation, one of the newer ablative techniques. This article reviews the indications, techniques, contraindications, and complications of percutaneous image-guided ablation of lung tumors with special attention to cryoablation and its recent developments in protocol optimization.
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Affiliation(s)
- Sadeer J. Alzubaidi
- Department of Radiology, Mayo Clinic, Phoenix, AZ 85054, USA; (J.S.K.); (S.G.N.); (I.J.P.); (R.O.)
| | - Harris Liou
- Alix School of Medicine, Mayo Clinic, Scottsdale, AZ 85259, USA;
| | - Gia Saini
- Division of Vascular and Interventional Radiology, Laboratory for Patient Inspired Engineering, Mayo Clinic, Phoenix, AZ 85054, USA; (G.S.); (N.S.)
| | - Nicole Segaran
- Division of Vascular and Interventional Radiology, Laboratory for Patient Inspired Engineering, Mayo Clinic, Phoenix, AZ 85054, USA; (G.S.); (N.S.)
| | - J. Scott Kriegshauser
- Department of Radiology, Mayo Clinic, Phoenix, AZ 85054, USA; (J.S.K.); (S.G.N.); (I.J.P.); (R.O.)
| | - Sailendra G. Naidu
- Department of Radiology, Mayo Clinic, Phoenix, AZ 85054, USA; (J.S.K.); (S.G.N.); (I.J.P.); (R.O.)
| | - Indravadan J. Patel
- Department of Radiology, Mayo Clinic, Phoenix, AZ 85054, USA; (J.S.K.); (S.G.N.); (I.J.P.); (R.O.)
| | - Rahmi Oklu
- Department of Radiology, Mayo Clinic, Phoenix, AZ 85054, USA; (J.S.K.); (S.G.N.); (I.J.P.); (R.O.)
- Division of Vascular and Interventional Radiology, Laboratory for Patient Inspired Engineering, Mayo Clinic, Phoenix, AZ 85054, USA; (G.S.); (N.S.)
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Ijsseldijk MA, Shoni M, Siegert C, Wiering B, van Engelenburg AKC, Tsai TC, Ten Broek RPG, Lebenthal A. Oncologic Outcomes of Surgery Versus SBRT for Non-Small-Cell Lung Carcinoma: A Systematic Review and Meta-analysis. Clin Lung Cancer 2020; 22:e235-e292. [PMID: 32912754 DOI: 10.1016/j.cllc.2020.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/21/2020] [Accepted: 04/25/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The optimal treatment of stage I non-small-cell lung carcinoma is subject to debate. The aim of this study was to compare overall survival and oncologic outcomes of lobar resection (LR), sublobar resection (SR), and stereotactic body radiotherapy (SBRT). METHODS A systematic review and meta-analysis of oncologic outcomes of propensity matched comparative and noncomparative cohort studies was performed. Outcomes of interest were overall survival and disease-free survival. The inverse variance method and the random-effects method for meta-analysis were utilized to assess the pooled estimates. RESULTS A total of 100 studies with patients treated for clinical stage I non-small-cell lung carcinoma were included. Long-term overall and disease-free survival after LR was superior over SBRT in all comparisons, and for most comparisons, SR was superior to SBRT. Noncomparative studies showed superior long-term overall and disease-free survival for both LR and SR over SBRT. Although the papers were heterogeneous and of low quality, results remained essentially the same throughout a large number of stratifications and sensitivity analyses. CONCLUSION Results of this systematic review and meta-analysis showed that LR has superior outcomes compared to SBRT for cI non-small-cell lung carcinoma. New trials are underway evaluating long-term results of SBRT in potentially operable patients.
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Affiliation(s)
- Michiel A Ijsseldijk
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands; Division of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Melina Shoni
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Charles Siegert
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA; Division of Thoracic Surgery, West Roxbury Veterans Administration, West Roxbury, MA
| | - Bastiaan Wiering
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands
| | | | - Thomas C Tsai
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Richard P G Ten Broek
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands; Division of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Abraham Lebenthal
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA; Division of Thoracic Surgery, West Roxbury Veterans Administration, West Roxbury, MA; Harvard Medical School, Boston, MA
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Wang HH, Zhang CZ, Zhang BL, Chen J, Zeng XL, Deng L, Meng MB. Sublobar resection is associated with improved outcomes over radiotherapy in the management of high-risk elderly patients with Stage I non-small cell lung cancer: a systematic review and meta-analysis. Oncotarget 2018; 8:6033-6042. [PMID: 28002808 PMCID: PMC5351610 DOI: 10.18632/oncotarget.14010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 12/12/2016] [Indexed: 02/05/2023] Open
Abstract
Background and Aim A matched-pair comparison was performed to compare the efficacy and safety of sublobar resection versus radiotherapy for high-risk elderly patients with Stage I non-small cell lung cancer (NSCLC). Patients and Methods We searched the Cochrane Library, MEDLINE, CENTRAL, EMBASE and manual searches. The meta-analysis was performed to compare overall survival, pattern of failure, and toxicity among the homogeneous studies. Subdivided analyses were also performed. Results Sixteen studies containing 11540 patients were included in the meta-analysis. Among these studies, 9 were propensity-score matched (PSM) cohort studies, and 7 were cohort studies. Sublobar resection, compared with radiotherapy (either conventional fraction radiation therapy or stereotactic body radiation therapy), significantly improved the overall survival regardless in both PSM and non-PSM analyses (all p < 0.05). However, the difference in the pattern of failure and toxicity were not significant (all p > 0.05). Conclusions Sublobar resection was associated with improved outcomes in high-risk elderly patients with Stage I NSCLC, which supports the need to compare both treatments in large prospective, randomized, controlled clinical trials.
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Affiliation(s)
- Huan-Huan Wang
- Department of Radiation Oncology, Tianjin's Clinical Research Center for Cancer and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China
| | - Chun-Ze Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin 300121, China
| | - Bai-Lin Zhang
- Department of Radiation Oncology, Tianjin's Clinical Research Center for Cancer and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China
| | - Jie Chen
- Department of Radiation Oncology, Tianjin's Clinical Research Center for Cancer and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China
| | - Xian-Liang Zeng
- Department of Radiation Oncology, Tianjin's Clinical Research Center for Cancer and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China
| | - Lei Deng
- Department of Thoracic Cancer and Huaxi Student Society of Oncology Research, West China Hospital, West China School of Medicine, Sichuan University, Sichuan Province 610041, China
| | - Mao-Bin Meng
- Department of Radiation Oncology, Tianjin's Clinical Research Center for Cancer and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China
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Abstract
Lung cancer had an estimated incidence of 221,200 in 2015, making up 13% of all cancer diagnoses. Tumor ablation is an important treatment option for nonsurgical lung cancer and pulmonary metastatic patients. Radiofrequency ablation has been used for over a decade with newer modalities, microwave ablation, cryoablation, and irreversible electroporation presenting as additional and possibly improved treatment options for patients. This minimally invasive therapy is best for small primary lesions or favorably located metastatic tumors. These technologies can offer palliation and sometimes cure of thoracic malignancies. This article discusses the current available technologies and techniques available for tumor ablation.
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Zhang W, Liu Q, Dong X, Lei P. A meta-analysis comparing hyperfractionated vs. conventional fractionated radiotherapy in non-small cell lung cancer. J Thorac Dis 2015; 7:478-85. [PMID: 25922728 DOI: 10.3978/j.issn.2072-1439.2015.02.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 02/11/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Lung cancer is the leading cause of cancer-related mortality. Non-small cell lung cancer (NSCLC) accounts for most lung cancer and carries a 5-year survival rate of 15%. The squamous cell carcinoma, large cell carcinoma, and adenocarcinoma are the most common types of NSCLC. The data on long term use of hyperfractionated radiotherapy (HRT) in NSCLC treatment is lacking. We performed a meta-analysis, based on published randomized trials to compare HRT [continuous hyperfractionated accelerated radiotherapy (CHART)/continuous hyperfractionated accelerated radiotherapy weekend less (CHARTWEL)] vs. conventional fractionated (CF) radiotherapy in the treatment of NSCLC. METHODS A systematic search through the bibliographic databases, PubMed, Google Scholar and Cochrane Library was performed till December 2013. RESULTS Of 63 studies identified, 3 studies were analyzed. All were randomized studies and included 1,005 patients in total. The pooled results of the studies showed that HRT did not improve overall survival (OS) of patients suffering from NSCLC compared to CF after 2 years (OR, 1.29; 95% CI, 0.98-1.71; P=0.16) and 3 years (OR, 0.55; 95% CI, 0.34-0.87; P=0.22) which was statistically significant. HRT was no better than CF in controlling tumour (OR, 1.40; 95% CI, 1.03-1.91). No significant difference in metastasis free survival (OR, 1.08; 95% CI, 0.83-1.39) and late dysphagia (OR, 1.48; 95% CI, 0.75-2.92) were observed between the two groups. CONCLUSIONS The results of the present meta-analysis showed that HRT was not significantly better to conventional radiotherapy in NSCLC treatment.
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Affiliation(s)
- Weisan Zhang
- 1 Department of Geriatrics, 2 Tianjin Lung Cancer Institute, 3 Department of Hematology-Oncology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Qian Liu
- 1 Department of Geriatrics, 2 Tianjin Lung Cancer Institute, 3 Department of Hematology-Oncology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Xifeng Dong
- 1 Department of Geriatrics, 2 Tianjin Lung Cancer Institute, 3 Department of Hematology-Oncology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Ping Lei
- 1 Department of Geriatrics, 2 Tianjin Lung Cancer Institute, 3 Department of Hematology-Oncology, Tianjin Medical University General Hospital, Tianjin 300052, China
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Mokhles S, Verstegen N, Maat AP, Birim Ö, Bogers AJ, Mokhles MM, Lagerwaard FJ, Senan S, Takkenberg JJ. Comparison of clinical outcome of stage I non-small cell lung cancer treated surgically or with stereotactic radiotherapy: Results from propensity score analysis. Lung Cancer 2015; 87:283-9. [DOI: 10.1016/j.lungcan.2015.01.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 11/05/2014] [Accepted: 01/08/2015] [Indexed: 01/24/2023]
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Moore W, Talati R, Bhattacharji P, Bilfinger T. Five-Year Survival after Cryoablation of Stage I Non–Small Cell Lung Cancer in Medically Inoperable Patients. J Vasc Interv Radiol 2015; 26:312-9. [DOI: 10.1016/j.jvir.2014.12.006] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 12/03/2014] [Accepted: 12/03/2014] [Indexed: 11/26/2022] Open
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Mazzone PJ. Preoperative evaluation of the lung cancer resection candidate. Expert Rev Respir Med 2014; 4:97-113. [DOI: 10.1586/ers.09.68] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Outcome of the radical hypofractioned radiotherapy treatment in patients with stage I and II of non-small cell lung cancer. JOURNAL OF RADIOTHERAPY IN PRACTICE 2013. [DOI: 10.1017/s1460396912000052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractIntroduction: Surgery is the treatment of choice in stage I and II non-small-cell lung cancer (NSCLC). In the management of patients who are medically unfit to tolerate surgical intervention or who refuse surgery, radiotherapy is an acceptable alternative. We have performed a retrospective analysis of the effectiveness of radical radiotherapy in patients with early stage NSCLC treated over a period of 4 years.Methods: Thirty nine patients treated with radiotherapy of radical intent were identified. All patients received hypofractionated radiotherapy with a total dose of 55Gy in 20 fractions.Results: The median survival of all cases was 29 months. The one and two-year survival was respectively 61 % and 41%. The median survival of patients ≥75 years was 28 months, and age was the only prognostic factor identified in this analysis that affected survival.Conclusions: The presented survival results are consistent with those from other series published in the literature. At present, radical radiotherapy is often offered to patients with medically inoperable stage I and II NSCLC or those who decline surgery. But there is emerging evidence that some new techniques like stereotactic radiotherapy could be also used in the operable, early stage NSCLC.
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Usman M, Moore W, Talati R, Watkins K, Bilfinger TV. Irreversible electroporation of lung neoplasm: a case series. Med Sci Monit 2012; 18:CS43-7. [PMID: 22648257 PMCID: PMC3560719 DOI: 10.12659/msm.882888] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background Percutaneous irreversible electroporation (IRE) of lung tumors is a new minimally invasive technique which has recently been used in the treatment of soft tissue tumors. Case Reports The case histories are presented of two patients with unresectable malignancies in the lung, who underwent irreversible electroporation as a treatment attempt. The procedure was performed under CT guidance and was uneventful. Conclusions At follow up 6 months later, the tumors both appeared to have recurred. To our knowledge, no similar cases have previously been reported in the literature.
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Affiliation(s)
- Mumal Usman
- Department of Surgery, State University of New York at Stony Brook, University Hospital, Stony Brook, NY 11794, USA.
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Dahele M, Freeman M, Pearson S, Brade A, Cho B, Hope A, Franks K, Purdie T, Bissonnette J, Jaffray D, Bezjak A, Sun A. Early Metabolic Response Evaluation After Stereotactic Radiotherapy for Lung Cancer: Pilot Experience with 18F-fluorodeoxyglucose Positron Emission Tomography-Computed Tomography. Clin Oncol (R Coll Radiol) 2011; 23:359-63. [DOI: 10.1016/j.clon.2010.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Revised: 11/03/2010] [Accepted: 11/08/2010] [Indexed: 12/25/2022]
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Hatton M, Nankivell M, Lyn E, Falk S, Pugh C, Navani N, Stephens R, Parmar M. Induction chemotherapy and continuous hyperfractionated accelerated radiotherapy (chart) for patients with locally advanced inoperable non-small-cell lung cancer: the MRC INCH randomized trial. Int J Radiat Oncol Biol Phys 2010; 81:712-8. [PMID: 20932667 DOI: 10.1016/j.ijrobp.2010.06.053] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 06/14/2010] [Accepted: 06/18/2010] [Indexed: 12/13/2022]
Abstract
PURPOSE Recent clinical trials and meta-analyses have shown that both CHART (continuous hyperfractionated accelerated radiation therapy) and induction chemotherapy offer a survival advantage over conventional radical radiotherapy for patients with inoperable non-small cell-lung cancer (NSCLC). This multicenter randomized controlled trial (INCH) was set up to assess the value of giving induction chemotherapy before CHART. METHODS AND MATERIALS Patients with histologically confirmed, inoperable, Stage I-III NSCLC were randomized to induction chemotherapy (ICT) (three cycles of cisplatin-based chemotherapy followed by CHART) or CHART alone. RESULTS Forty-six patients were randomized (23 in each treatment arm) from 9 UK centers. As a result of poor accrual, the trial was closed in December 2007. Twenty-eight patients were male, 28 had squamous cell histology, 34 were Stage IIIA or IIIB, and all baseline characteristics were well balanced between the two treatment arms. Seventeen (74%) of the 23 ICT patients completed the three cycles of chemotherapy. All 42 (22 CHART + 20 ICT) patients who received CHART completed the prescribed treatment. Median survival was 17 months in the CHART arm and 25 months in the ICT arm (hazard ratio of 0.60 [95% CI 0.31-1.16], p = 0.127). Grade 3 or 4 adverse events (mainly fatigue, dysphagia, breathlessness, and anorexia) were reported for 13 (57%) CHART and 13 (65%) ICT patients. CONCLUSIONS This small randomized trial indicates that ICT followed by CHART is feasible and well tolerated. Despite closing early because of poor accrual, and so failing to show clear evidence of a survival benefit for the additional chemotherapy, the results suggest that CHART, and ICT before CHART, remain important options for the treatment of inoperable NSCLC and deserve further study.
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Zemlyak A, Moore WH, Bilfinger TV. Comparison of survival after sublobar resections and ablative therapies for stage I non-small cell lung cancer. J Am Coll Surg 2010; 211:68-72. [PMID: 20610251 DOI: 10.1016/j.jamcollsurg.2010.03.020] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Revised: 03/10/2010] [Accepted: 03/17/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lobectomy is the standard therapy for patients with stage I non-small cell lung cancer (NSCLC). Recently, sublobar resections (SLR), radiofrequency ablation (RFA), and percutaneous cryablation therapy (PCT) for high-risk patients unfit for standard resection have been reported. This study compares all 3 modalities in stage I NSCLC. STUDY DESIGN Patients with biopsied stage I NSCLC determined by PET/CT deemed medically unfit for standard resection were reviewed by a tumor board according to American College of Surgeons Oncology Group/NIH inoperability criteria before being offered SLR, RFA, or PCT under anesthesia. Patients were followed with CT scans alternating with PET scans. The primary end points were overall survival, cancer-specific survival, and cancer-free survival. Kaplan-Meier analysis and log-rank tests were used. RESULTS Sixty-four patients underwent SLR (n = 25; 11 men, 13 women; median age 66 years, range 49 to 85 years), RFA (n = 12; 8 men, 4 women; median age 74 years, range 62 to 83 years), and PCT (n = 27; 16 men, 11 women; median age 74 years; range 59 to 88 years). The probability of 3-year survival for the SLR, RFA, and PCT groups was 87.1%, 87.5%, and 77%, respectively (p > 0.05). The 3-year cancer-specific and cancer-free survival for SLR, RFA, and PCT groups was 90.6% and 60.8% versus 87.5% and 50% versus 90.2% and 45.6%, respectively. CONCLUSIONS This experience suggests comparable survival after sublobar resections and ablative therapies at 3 years. Ablative therapies appear to be a reasonable alternative in high-risk patients not fit for surgery. However, larger randomized studies with longer follow-up are needed to make recommendations for therapy.
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Affiliation(s)
- Alla Zemlyak
- Stony Brook University Medical Center, Stony Brook, NY 11790, USA
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Din OS, Lester J, Cameron A, Ironside J, Gee A, Falk S, Morgan SA, Worvill J, Hatton MQ. Routine Use of Continuous, Hyperfractionated, Accelerated Radiotherapy for Non–Small-Cell Lung Cancer: A Five-Center Experience. Int J Radiat Oncol Biol Phys 2008; 72:716-22. [DOI: 10.1016/j.ijrobp.2008.01.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Revised: 01/15/2008] [Accepted: 01/15/2008] [Indexed: 10/22/2022]
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Urbanic JJ, Turrisi AT, Sharma AK, Silvestri GA, Williams TE, Vanek KN, Sherman CA. Conformal High Dose External Radiation Therapy, 80.5 Gy, Alone for Medically Inoperable Non-small Cell Lung Cancer: A Retrospective Analysis. J Thorac Oncol 2006. [DOI: 10.1097/01243894-200602000-00003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Urbanic JJ, Turrisi AT, Sharma AK, Silvestri GA, Williams TE, Vanek KN, Sherman CA. Conformal High Dose External Radiation Therapy, 80.5 Gy, Alone for Medically Inoperable Non-small Cell Lung Cancer: A Retrospective Analysis. J Thorac Oncol 2006. [DOI: 10.1016/s1556-0864(15)31525-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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El-Sherif A, Luketich JD, Landreneau RJ, Fernando HC. New therapeutic approaches for early stage non-small cell lung cancer. Surg Oncol 2005; 14:27-32. [PMID: 15777887 DOI: 10.1016/j.suronc.2004.11.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Surgical resection remains the mainstay of therapy for early stage non-small cell lung cancer (NSCLC). Unfortunately, many patients present with advanced stage disease, and many with resectable early stage disease are unable to tolerate pulmonary resection because of compromised cardiopulmonary function. This article reviews the standard and some alternative therapies that are being introduced into clinical practice for early stage NSCLC. New therapies such as sublobar resection with brachytherapy, radiofrequency ablation and stereotactic radiosurgery offer some hope for those patients who are deemed poor candidates for curative resection.
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Affiliation(s)
- Amgad El-Sherif
- Division of Thoracic and Foregut Surgery, University of Pittsburgh Medical Center, Pittsburgh PA, USA
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