Post-operative radiation therapy

Therapeutic bronchoscopy followed by sequential radiochemotherapy in the management of life-threatening tracheal adenoid cystic carcinoma: a case report

Background

Adenoid cystic carcinoma of the lung is a distinctive salivary-gland-type malignant epithelial neoplasm that rarely presents as a primary tumor of the respiratory tract. Complete surgical resection remains the treatment of choice for adenoid cystic carcinoma. We present a case of large ACC tumors that caused severe central airway obstruction and were effectively treated with therapeutic bronchoscopy followed by radiotherapy and chemotherapy.

Case presentation

A 31-year-old Malay Indonesian female patient who was a nonsmoker and had no family history of cancer was admitted to the emergency ward because of worsening breathlessness accompanied by stridor since 1 week prior. Chest computed tomography revealed segmental atelectasis of the left lung; a mass on the left main bronchus, with infiltrates in segments 1, 2, and 3 of the left lung; and consolidation in the left inferior lobe, with narrowing of the main left bronchus. Lobulated masses obstructing almost the entire distal trachea up to the carina and the entire left main bronchus were found on bronchoscopy. Owing to the large tumors causing severe central airway obstruction, the medical team decided to perform central airway mass removal through rigid bronchoscopy. A neodymium-doped yttrium-aluminum-garnet laser was used first to facilitate mass shrinkage. After the laser treatment, mechanical mass removal using a rigid scope was performed. The tracheal and carinal lumens were opened to > 50% of their diameter, with the left main bronchus lumen opened only slightly. After the treatment, the patient was stable, and no stridor was found. Adjuvant intensity-modulated radiotherapy and chemotherapy were performed after the therapeutic bronchoscopy. At the end of the entire treatment, reevaluation by thoracic computed tomography scan and bronchoscopy revealed no remaining mass.

Conclusions

In cases of nonresectable large adenoid cystic carcinoma tumors with life-threatening central airway obstruction, therapeutic bronchoscopy followed by sequential radiochemotherapy might achieve a complete response outcome.

Postoperative Radiotherapy for Patients With Resectable Stage III-N2 Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis

Purpose

For resectable cases of stage III-N2 non-small cell lung cancer (NSCLC), the best treatment after surgery is still uncertain. The effect of postoperative radiotherapy (PORT) is controversial. Thus, we performed this updated meta-analysis to reassess the data of PORT in stage III-N2 NSCLC patients, to figure out whether these patients can benefit from PORT.

Methods

We conducted searches of the published literature in EMBASE, PubMed, and the Cochrane Library for relevant randomized control trials (RCTs) comparing PORT group with the non-PORT group in NSCLC patients at stage III-N2. These studies allowed the prior chemotherapy in the treatment. We extracted the data from these articles and used the hazard ratios (HRs) and their 95% confidence intervals (CIs) as summary statistics for estimating the effect of PORT on overall survival (OS), disease-free survival (DFS), local-regional recurrence-free survival (LRFS).

Result

The analyses of seven randomized controlled trials (1,318 participants) show no benefit of PORT on survival (HR, 0.87; 95% CI, 0.71 to 1.07; p = 0.18) but a significantly different effect of PORT on DFS (HR, 0.83; 95% CI, 0.71 to 0.97; p = 0.02) and LRFS (HR, 0.64; 95% CI, 0.50 to 0.81; p = 0.0003). There is not enough evidence of a difference in the effect on survival by the utility of chemotherapy along with PORT though subgroup analysis of no chemotherapy group, concurrent chemoradiotherapy and sequential chemoradiotherapy group. Even in trials with 3D-CRT radiation technique, the pooled analysis shows no benefit of PORT on survival in patients with stage III-N2 NSCLC (data is not shown).

Conclusion

Our findings illustrate that in the postoperative treatment for patients with stage III-N2 NSCLC, PORT contributes to a significantly increased DFS and LR and may not associate with an improved OS, indicating a cautious selection.

[Prognostic Analysis of Lobectomy versus Sublobar Resection in Patients Aged ≥60 Years with Stage Ia Small Cell Lung Cancer]

背景与目的

目前，肺叶切除与亚肺叶切除治疗Ia期小细胞肺癌（small cell lung cancer, SCLC）的预后比较鲜有报道。本研究通过对年龄≥60岁的T1N0M0（≤3 cm）SCLC进行回顾性研究，旨在探索肺叶切除与亚肺叶切除治疗Ia期SCLC预后的对比分析。

方法

纳入“监测，流行病学和结果数据库”（Surveillance, Epidemiology and End Results database, SEER）在1992年-2010年间经病理诊断为Ia期SCLC患者共515例，数据使用Kaplan-Meier（Log-rank检验）和Cox模型进行比较统计分析。

结果

肺叶切除组（n=110）、亚肺叶切除组（n=57）、和非手术治疗组（n=348）的中位生存期分别为45个月、23个月和16个月；该三组相应的5年总生存期（OS）分别为44%、30%和14%（Lob vs Sub, χ²=4.851, P=0.028; Sub vs non-surgical, χ²=6.529, P=0.011）。SCLC有、无淋巴结采样/清扫患者的预后无显著差异（P=0.107）；肺叶切除+放化疗组（Lob+CR, n=59）的5年OS为50%。Cox分析证实，手术（肺叶与亚肺叶切除术）方式为独立预后预测因素之一。

结论

年龄≥60岁的Ia期SCLC患者，我们推荐解剖性肺叶切除联合辅助放化疗治疗。