1
|
Zhang W, Zhang Y, Ouyang WW, Fa Su S, Ma Z, Li QS, Gang Yang W, Xia Chen X, Liu J, Lu B. Quality control of postoperative radiotherapy for non-small cell lung cancer: A study of mediastinal shift. Cancer Radiother 2024; 28:152-158. [PMID: 38320903 DOI: 10.1016/j.canrad.2023.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 02/08/2024]
Abstract
PURPOSE This study aimed to assess the shifting patterns of the mediastinum, including the target volume and the isocenter point during the postoperative radiotherapy (PORT) process of non-small cell lung cancer (NSCLC), and to observe the occurrence of radiation injury. Additionally, we investigated the significance of mid-term assessment during the implementation of the PORT process. MATERIAL AND METHODS We established coordinate axes based on bone anatomy and measured the mediastinum's three-dimensional direction and the shift of the isocenter point's shift in the PORT process. Statistical analysis was performed using Wilcoxon, Kruskal-Wallis, and the Chi-square test. P<0.05 was considered statistically significant. RESULTS In this study, the analysis of patients revealed that the shift of anterior and posterior mediastinum (X), left and right mediastinum (Y), upper and lower mediastinum (Z), anterior and posterior isocenter point (Xi), and the left and right isocenter points (Yi) in the PORT process were 0.04-0.53, 0.00-0.84, 0.00-1.27, 0.01-0.86, and 0.00-0.66cm, respectively. The shift distance of the mediastinum was Z>Y>X, and the shift distance of the isocenter point was Xi>Yi. According to the ROC curve, the cut-off values were 0.263, 0.352, 0.405, 0.238, and 0.258, respectively, which were more significant than the cut-off values in 25 cases (25%), 30 cases (30%), 30 cases (30%), 17 cases (17%), and 15 cases (15%). In addition, there was a significant difference in the shift of the mediastinum and the isocenter point (all P=0.00). Kruskal-Wallis test showed no statistically significant difference between mediastinal shift and resection site in X, Y, and Z directions (P=0.355, P=0.239, P=0.256), surgical method (P=0.241, P=0.110, P=0.064). There was no significant difference in the incidence of RE and RP in PORT patients (P>0.05). No III-IV RP occurred. However, the incidence of ≥ grade III RE in the modified plan cases after M-S was significantly lower than in the original PORT patients, 0% and 7%, respectively (P=0.000). CONCLUSION In conclusion, this study provides evidence that mediastinal shift is a potential complication during the PORT process for patients with N2 stage or R1-2 resection following radical resection of NSCLC. This shift affects about 20-30% of patients, manifesting as actual radiation damage to normal tissue and reducing the local control rate. Therefore, mid-term repositioning of the PORT and revision of the target volume and radiation therapy plan can aid in maintaining QA and QC during the treatment of NSCLC patients and may result in improved patient outcomes.
Collapse
Affiliation(s)
- W Zhang
- Department of Oncology, Affiliated Hospital of Guizhou Medical University/Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China; Department of Oncology, Guizhou Medical University, Guiyang, China
| | - Y Zhang
- Department of Oncology, Affiliated Hospital of Guizhou Medical University/Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China; Department of Oncology, Guizhou Medical University, Guiyang, China
| | - W-W Ouyang
- Department of Oncology, Affiliated Hospital of Guizhou Medical University/Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China; Department of Oncology, Guizhou Medical University, Guiyang, China
| | - S Fa Su
- Department of Oncology, Affiliated Hospital of Guizhou Medical University/Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China; Department of Oncology, Guizhou Medical University, Guiyang, China
| | - Z Ma
- Department of Oncology, Affiliated Hospital of Guizhou Medical University/Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China
| | - Q-S Li
- Department of Oncology, Affiliated Hospital of Guizhou Medical University/Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China; Department of Oncology, Guizhou Medical University, Guiyang, China
| | - W Gang Yang
- Department of Oncology, Affiliated Hospital of Guizhou Medical University/Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China; Department of Oncology, Guizhou Medical University, Guiyang, China
| | - X Xia Chen
- Department of Oncology, Affiliated Hospital of Guizhou Medical University/Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China; Department of Oncology, Guizhou Medical University, Guiyang, China
| | - J Liu
- Department of Oncology, Affiliated Hospital of Guizhou Medical University/Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China; Department of Oncology, Guizhou Medical University, Guiyang, China
| | - B Lu
- Department of Oncology, Affiliated Hospital of Guizhou Medical University/Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China; Department of Oncology, Guizhou Medical University, Guiyang, China.
| |
Collapse
|
2
|
Inci I. Extended Pulmonary Resection for T4 Non-Small Cell Lung Cancer. Praxis (Bern 1994) 2023; 112:103-110. [PMID: 36722106 DOI: 10.1024/1661-8157/a003991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
T4 non-small cell lung cancer is a locally advanced disease with poor prognosis. The operation can be challenging even for an experienced surgeon. N2 disease has been shown repeatedly as a risk factor for poor outcome, and these patients should not be candidates for surgical treatment. Surgery for locally advanced T4 tumors without mediastinal lymph node involvement (T4N0 and T4N1) has been demonstrated to result in good outcomes in carefully selected patients. Patients with T4N0-1M0 should be rejected for surgery only after consulting an expert surgical center. As with other stages, the decision for resectability and surgery should be made by a multidisciplinary team.
Collapse
Affiliation(s)
- Ilhan Inci
- Klinik Hirslanden, Chirurgisches Zentrum Zürich, Thoracic Surgery, Zurich, Switzerland
- School of Medicine, University of Zurich, Zurich, Switzerland
| |
Collapse
|
3
|
Harigai A, Saito AI, Inoue T, Suzuki M, Namba Y, Suzuki Y, Makino F, Nagashima O, Sasaki S, Sasai K. The prognostic value of 18F-FDG PET/CT taken immediately after completion of radiotherapy for lung cancer treated with concurrent chemoradiotherapy: A pilot study. Cancer Radiother 2022; 26:711-716. [PMID: 35715357 DOI: 10.1016/j.canrad.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 12/10/2021] [Accepted: 01/13/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE The prognostic value of F-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) taken immediately after completion of radiotherapy in lung cancer patients is not well known. The purpose of this study is to assess the prognostic value of PET/CT taken immediately after completion of radiotherapy in lung cancer patients. MATERIALS AND METHODS Patients with primary lung cancer planned to undergo concurrent chemoradiotherapy were enrolled. Patients underwent PET/CT scans at 3 time points: before radiotherapy, within 24hours of completing radiotherapy (im-PET/CT), and 2-9 months after radiotherapy (post-PET/CT). Maximum standardized uptake value (SUVmax) was obtained. A post-PET/CT-SUVmax cut-off of 2.5 was determined as radiotherapy success. RESULTS Nineteen patients were enrolled. im-PET/CT-SUVmax for patients in the high post-PET/CT-SUVmax group was significantly higher than that of the low group (P=0.004). Receiver operator curve analysis indicated that im-PET/CT-SUVmax of 4.35 was an optimal cut-off value to discriminate between the two groups. Multivariable analysis showed that a high im-PET/CT-SUVmax was significantly associated with a high post-PET/CT-SUVmax (P=0.003). CONCLUSION PET/CT-SUVmax taken immediately following radiotherapy was associated with that evaluated 2-9 months after radiotherapy.
Collapse
Affiliation(s)
- A Harigai
- Clinical training center, Juntendo university, Urayasu hospital, 2-1-1 Tomioka Urayasushi, Chiba, Japan
| | - A I Saito
- Department of radiation oncology, Juntendo university, faculty of medicine, Tokyo, Japan.
| | - T Inoue
- Department of radiation oncology, Juntendo university, faculty of medicine, Tokyo, Japan
| | - M Suzuki
- Department of radiology, Juntendo Tokyo Koto geriatric medical center, Tokyo, Japan
| | - Y Namba
- Department of respiratory medicine, Juntendo university, Urayasu hospital, Chiba, Japan
| | - Y Suzuki
- Department of respiratory medicine, Juntendo university, Urayasu hospital, Chiba, Japan
| | - F Makino
- Department of respiratory medicine, Juntendo university, Urayasu hospital, Chiba, Japan
| | - O Nagashima
- Department of respiratory medicine, Juntendo university, Urayasu hospital, Chiba, Japan
| | - S Sasaki
- Department of respiratory medicine, Juntendo university, Urayasu hospital, Chiba, Japan
| | - K Sasai
- Department of radiation oncology, Juntendo university, faculty of medicine, Tokyo, Japan
| |
Collapse
|
4
|
Yu JH, Wang CL, Liu Y, Wang JM, Lv CX, Liu J, Zhang Q, Fu XL, Cai XW. Study of the predictors for radiation pneumonitis in patient with non-small cell lung cancer received radiotherapy after pneumonectomy. Cancer Radiother 2021; 25:323-329. [PMID: 33446419 DOI: 10.1016/j.canrad.2020.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/10/2020] [Accepted: 11/16/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE To identify the valuable predictors of grade≥2 radiation pneumonitis (RP) in patient treated with radiotherapy after pneumonectomy for non-small cell lung cancer (NSCLC); and to construct a nomogram predicting the incidence of grade≥2 RP in such patients. PATIENTS AND METHODS We reviewed 82 patients with NSCLC received radiotherapy after pneumonectomy from 2008 to 2018. The endpoint was grade≥2 RP. Univariate and multivariate regression analysis were conducted to evaluate significant factors of grade≥2 RP. Receiver operating characteristic (ROC) curve was used to establish optimal cutoff values and the nomogram was built to make the predictive model visualized. Descriptive analysis was performed on 5 patients with grade 3 RP. RESULTS A total of 22(26.8%) patients developed grade 2 RP and 5(6.1%) patients were grade 3 RP. V5, V10, V20, V30, MLD, PTV, and PTV/TLV were associated with the occurrence of grade≥2 RP in univariate analysis, while none of the clinical factors was significant; V5(OR,1.213;95%CI,1.099-1.339; P<0.001) and V20(OR,1.435;95%CI,1.166-1.765; P=0.001) were the independent significant predictors by multivariate analysis and were included in the nomogram. The ROC analysis for the cutoff values for predicting grade≥2 RP were V5>23% (AUC=0.819, sensitivity:0.701, specificity:0.832) and V20>8% (AUC=0.812, sensitivity:0.683, specificity:0.811). Additionally, grade≥3 RP did not occur when V5<30%, V20<13% and MLD<751.2cGy, respectively. CONCLUSIONS Our study showed that V5 and V20 were independent predictors for grade≥2 RP in NSCLC patients receiving radiotherapy after pneumonectomy. Grade 3 RP did not occur whenV5<30%, V20<13% and MLD<751.2cGy, respectively. In addition, patient underwent right pneumonectomy may have a lower tolerance to radiation compared to left pneumonectomy.
Collapse
Affiliation(s)
- J-H Yu
- Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030 China
| | - C-L Wang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030 China
| | - Y Liu
- Department of Statistics, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - J-M Wang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030 China
| | - C X Lv
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030 China
| | - J Liu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030 China
| | - Q Zhang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030 China
| | - X-L Fu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030 China
| | - X-W Cai
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030 China.
| |
Collapse
|
5
|
Sert F, Cosgun G, Yalman D, Ozkok S. Can we define any marker associated with brain failure in patients with locally advanced non-small cell lung cancer? Cancer Radiother 2021; 25:316-322. [PMID: 33422415 DOI: 10.1016/j.canrad.2020.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/12/2020] [Accepted: 11/14/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To define the factors which may be related to brain metastasis (BM) in patients with locally advanced non-small cell lung cancer (LA-NSCLC) who developed brain metastases after definitive treatment. PATIENTS AND METHODS A total of 208 patients with LA-NSCLC, without BM who received definitive radiotherapy (RT) or RT+chemotherapy (CT) between January 2005 and January 2016 were evaluated retrospectively. Platelet, neutrophil, lymphocyte counts, LDH, CRP, Hb levels, neutrophil-to-lymphocyte radio (NLR), platelet-to-lymphocyte radio (PLR), advanced lung cancer inflammation index (ALI) and FDG-PET/CT parameters (SUVmax of the primary tumor and mediastinal lymph nodes), and patient characteristics were evaluated for brain metastasis free survival (BMFS). RESULTS Median follow-up duration was 25 months (range: 3-130months). Cut-off values for platelet, NLR, PLR, LDH, CRP, and Hb were 290×103/μL, 2.6, 198, 468 IU/L, 2.5mg/dL, and 11.5g/dl. We defined each parameter as low or high according to the cut-off values. 56 patients (26.9%) developed brain metastases during follow-up. In univariate analysis, high NLR (P=0.001), PLR (P=0.037), LDH (P=0.028), CRP (P=0.002) values, value ≥7.5 for lymph nodes (P=0.005) and low ALI value (P=0.002) were poor prognostic factors for BMFS. In multivariate analysis, high NLR (P=0.022), PLR (P=0.017), CRP (P=0.006), stage ≥IIIB disease (P<0.001), multi-stational N2 disease (P=0.036), adenocarcinoma histology (P<0.001) and SUVmax value ≥7.5 (P=0.035) were poor prognostic factors for BMFS. CONCLUSIONS High NLR, PLR, LDH, CRP values, SUVmax values for lymph nodes, and low ALI which indicates high tumor burden were additional prognostic factors besides stage, histology, and lymph node status.
Collapse
Affiliation(s)
- F Sert
- Ege University Faculty of Medicine, Department of Radiation Oncology, Izmir, Turkey.
| | - G Cosgun
- Ege University Faculty of Medicine, Department of Radiation Oncology, Izmir, Turkey
| | - D Yalman
- Ege University Faculty of Medicine, Department of Radiation Oncology, Izmir, Turkey
| | - S Ozkok
- Ege University Faculty of Medicine, Department of Radiation Oncology, Izmir, Turkey
| |
Collapse
|
6
|
Prieto M, Bobbio A, Fournel L, Icard P, Canny EH, Mansuet Lupo A, Leroy K, Wislez M, Damotte D, Alifano M. [Surgical management of resectable non-small cell lung cancer: Towards new paradigms]. Bull Cancer 2020; 107:904-911. [PMID: 32674934 DOI: 10.1016/j.bulcan.2020.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/21/2020] [Accepted: 05/11/2020] [Indexed: 10/23/2022]
Abstract
Adapting therapies and providing personalized care for patients with resectable non-small cell lung cancer represent major challenges. This involves integrating several parameters into the patient's management, not only crude pathologic results, but also a better understanding of the mechanisms involved in tumor progression. Many studies have looked at the impact of host and tumor characteristics and their interactions through inflammatory processes or tumor immune environment. Beyond tumor stage, poor nutrition, sarcopenia and inflammatory state have been identified as independent factors that can directly impact postoperative outcome. The development of Enhanced Recovery After Surgery (ERAS), in which patient becomes the main player in their own management, seems to be an interesting answer since it seems to allow a reduction in postoperative complications, length of stay and indirectly reduction in costs. A broader and more complete vision including morphometric evaluation of the patient, physical performances, inflammatory state and nutritional state would provide additional discriminating information which can predict postoperative outcome and help in adapting therapies in a personalized way.
Collapse
Affiliation(s)
- Mathilde Prieto
- AP-HP Centre, UNIVERSITE de Paris, hôpital Cochin, service de chirurgie thoracique, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Antonio Bobbio
- AP-HP Centre, UNIVERSITE de Paris, hôpital Cochin, service de chirurgie thoracique, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Ludovic Fournel
- AP-HP Centre, UNIVERSITE de Paris, hôpital Cochin, service de chirurgie thoracique, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Philippe Icard
- AP-HP Centre, UNIVERSITE de Paris, hôpital Cochin, service de chirurgie thoracique, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Emelyne Hamelin Canny
- AP-HP Centre, UNIVERSITE de Paris, hôpital Cochin, service de chirurgie thoracique, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Audrey Mansuet Lupo
- AP-HP Centre, université de Paris, hôpital Cochin, service de pathologie, Paris, France
| | - Karen Leroy
- AP-HP Centre, université de Paris, hôpital Cochin, service de génétique et biologie moléculaire, Paris, France
| | - Marie Wislez
- AP-HP Centre, université de Paris, hôpital Cochin, service de pneumologie, Paris, France
| | - Diane Damotte
- AP-HP Centre, université de Paris, hôpital Cochin, service de pathologie, Paris, France
| | - Marco Alifano
- AP-HP Centre, UNIVERSITE de Paris, hôpital Cochin, service de chirurgie thoracique, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France.
| |
Collapse
|
7
|
Eberst G, Lakhzoum W, Tomasini P, Andreotti N, Abcaya J, Mascaux C, Barlesi F. [Autoimmune-related bleeding occurring during combined immunotherapy for lung cancer - Case report]. Rev Mal Respir 2018; 35:974-977. [PMID: 30318433 DOI: 10.1016/j.rmr.2018.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 04/25/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Specific immune-related adverse events in lung cancer treatment are rare and it is important that they are identified as they may have important adverse consequences. We report such a case here. CASE REPORT A Caucasian female diagnosed with KRAS mutant advanced adenocarcinoma of the lung was enrolled in a phase Ib trial assessing the combination of an anti cytotoxic T-lymphocyte- associated protein 4 antibody and a programmed death-Ligand 1 inhibitor. For several years, she had also been taking warfarin for recurrent pulmonary embolism. At day 15 of treatment, she presented with grade 1 haematomas and signs of grade 2 hyperthyroidism. Blood tests revealed a normal number of platelets but an INR increased to 6.5. Thyroid function tests and auto antibodies confirmed the presence of an autoimmune thyroitidis. The study treatment was then stopped and the patient received 1mg/kg of prednisone and 40mg of propranolol. At day 28, the thyroid function and symptoms were normalized. No direct interactions exist between immunotherapy and vitamin K antagonists (VKA) but hyperthyroidism, through pharmacokinetic and metabolic mechanisms, can boost VKA plasma levels and increase INR, leading to hemorrhagic complications. CONCLUSIONS This case emphasizes that special consideration should be given to patients with VKA treatment planned to receive immunotherapy.
Collapse
Affiliation(s)
- G Eberst
- Université d'Aix-Marseille, Assistance publique Hôpitaux de Marseille, centre essais précoces en cancérologie de Marseille CLIP2, hôpital La Timone, boulevard Saint-Pierre, 13005 Marseille, France
| | - W Lakhzoum
- Université d'Aix-Marseille, Assistance publique Hôpitaux de Marseille, centre essais précoces en cancérologie de Marseille CLIP2, hôpital La Timone, boulevard Saint-Pierre, 13005 Marseille, France
| | - P Tomasini
- Université d'Aix-Marseille, Assistance publique Hôpitaux de Marseille, centre essais précoces en cancérologie de Marseille CLIP2, hôpital La Timone, boulevard Saint-Pierre, 13005 Marseille, France; Inserm UMR1068, CNRS UMR7258, UM105, université d'Aix-Marseille, predictive oncology laboratory, centre de recherche en cancérologie de Marseille, 13009 Marseille, France
| | - N Andreotti
- Université d'Aix-Marseille, Assistance publique Hôpitaux de Marseille, centre essais précoces en cancérologie de Marseille CLIP2, hôpital La Timone, boulevard Saint-Pierre, 13005 Marseille, France
| | - J Abcaya
- Université d'Aix-Marseille, Assistance publique Hôpitaux de Marseille, centre essais précoces en cancérologie de Marseille CLIP2, hôpital La Timone, boulevard Saint-Pierre, 13005 Marseille, France
| | - C Mascaux
- Université d'Aix-Marseille, Assistance publique Hôpitaux de Marseille, centre essais précoces en cancérologie de Marseille CLIP2, hôpital La Timone, boulevard Saint-Pierre, 13005 Marseille, France; Inserm UMR1068, CNRS UMR7258, UM105, université d'Aix-Marseille, predictive oncology laboratory, centre de recherche en cancérologie de Marseille, 13009 Marseille, France
| | - F Barlesi
- Université d'Aix-Marseille, Assistance publique Hôpitaux de Marseille, centre essais précoces en cancérologie de Marseille CLIP2, hôpital La Timone, boulevard Saint-Pierre, 13005 Marseille, France; Inserm UMR1068, CNRS UMR7258, UM105, université d'Aix-Marseille, predictive oncology laboratory, centre de recherche en cancérologie de Marseille, 13009 Marseille, France.
| |
Collapse
|
8
|
Abstract
Initial staging is a key part of the initial evaluation of non-small cell lung cancer. It relies on the 7th edition of the TNM classification. Proposals have been recently developed for the 8th edition of the classification, which is due to be enacted in early 2017. Among these proposals, the weight of tumor size has been increased and new N descriptors have been introduced to further describe N category depending on the number station involved. Regarding M descriptors, oligometastatic disease is distinguished from multiple distant extrathoracic metastases.
Collapse
Affiliation(s)
- G Chassagnon
- Radiologie A, groupe hospitalier Cochin-Hôtel Dieu, université Paris Descartes, 75014 Paris, France.
| | - S Bennani
- Radiologie A, groupe hospitalier Cochin-Hôtel Dieu, université Paris Descartes, 75014 Paris, France
| | - M-P Revel
- Radiologie A, groupe hospitalier Cochin-Hôtel Dieu, université Paris Descartes, 75014 Paris, France
| |
Collapse
|
9
|
Riquet M, Legras A, Pricopi C, Badia A, Arame A, Dujon A, Foucault C, Le Pimpec Barthes F, Fabre E. [Evolution of species: Lung cancer evolution over one third of a century]. Rev Pneumol Clin 2016; 72:234-242. [PMID: 27421142 DOI: 10.1016/j.pneumo.2016.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 03/14/2016] [Accepted: 03/16/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Management of non-small cell lung cancer (NSCLC) is getting better and results on long-term survival have improved. We reviewed the modifications observed in surgery over a 32-year time period. PATIENTS AND METHOD Data of 6105 patients who underwent surgery from 1979 to 2010 were analyzed over three equal time-periods: gender, age, type of surgery, histology, pTNM, tobacco addiction, comorbidity and time periods. RESULTS Age, number of females and high-risk patients with comorbidity (including the history of a previous cancer) increased with time periods. Number of exploratory thoracotomy (7.7 % to 1.6 %) and pneumonectomy (48 % to 18 %) decreased. Number of wedge resection (0.5 % to 6 %) and lobectomy (42 % to 64 %) increased. Rates of the other types of resection were unchanged. Neoadjuvant treatments accounted for more than 20 % of patients in the last time period. Postoperative mortality (4 %) did not vary but non-lethal complication rates increased (16.9 % to 27.7 %). Global 5-year survival rates dramatically increased with time going from 37.4 % to 49.8 % (P<10(-6)). Survival improvement was observed in the different components of the pTNM and whatever the type of treatment. However, survival was affected by increasing age and multiplication of comorbidities but without impairing the general better outcome trend. CONCLUSION NSCLC itself, its diagnostic and therapeutic management, and patient's characteristics evolved with time. Survival improved in most studied prognosis factors. Time period factor was of paramount importance and might be included in research dealing with NSCLC.
Collapse
Affiliation(s)
- M Riquet
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 20, rue Leblanc, 75015 Paris, France.
| | - A Legras
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 20, rue Leblanc, 75015 Paris, France
| | - C Pricopi
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 20, rue Leblanc, 75015 Paris, France
| | - A Badia
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 20, rue Leblanc, 75015 Paris, France
| | - A Arame
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 20, rue Leblanc, 75015 Paris, France
| | - A Dujon
- Service de chirurgie thoracique, centre médico-chirurgical du Cèdre, 76230 Bois-Guillaume, France
| | - C Foucault
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 20, rue Leblanc, 75015 Paris, France
| | - F Le Pimpec Barthes
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 20, rue Leblanc, 75015 Paris, France
| | - E Fabre
- Service d'oncologie médicale, hôpital européen Georges-Pompidou, université Paris-Descartes, 20, rue Leblanc, 75015 Paris, France
| |
Collapse
|
10
|
Zeng YC, Wu R, Xing R, Chi F, Wang SL, Chen XD, Xuan Y, Wu LN, Duan QY, Tang MY, Niu N, Sun YN, Fan GL, Wang HM. Radiation-enhancing effect of sodium glycididazole in patients suffering from non-small cell lung cancer with multiple brain metastases: A randomized, placebo-controlled study. Cancer Radiother 2016; 20:187-92. [PMID: 27052296 DOI: 10.1016/j.canrad.2016.02.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 02/05/2016] [Accepted: 02/14/2016] [Indexed: 01/06/2023]
Abstract
PURPOSE Median survival of patients with brain metastases from non-small cell lung cancer is poor. This study was to investigate the radiation-enhancing effect of sodium glycididazole combined with whole-brain radiotherapy of multiple brain metastases from non-small cell lung cancer. PATIENTS AND METHODS Sixty-four patients with multiple brain metastases from non-small cell lung cancer were included: the study group (n=32) received whole-brain radiotherapy combined with sodium glycididazole at a dose of 700mg/m(2) intravenous infusion 30minutes before radiotherapy, three times a week; the control group (n=32) only received whole-brain radiotherapy. The primary end point was central nervous system (CNS) progression-free survival and overall survival. The treatment-related toxicity was also recorded. RESULTS The CNS disease control rate was better (90.6% vs 65.6%, P=0.016) in the study group than in the control group at 3 month of follow-up. The median CNS progression-free survival time was longer in the study group than in the control group (7.0 months vs 4.0 months, P=0.038). There was no significant difference of the median overall survival time between the study group and the control group (11.0 months vs 9.0 months, P=0.418). On the other hand, the treatment-related toxicity showed no statistically significant difference between these two groups (P>0.05). CONCLUSIONS The study indicated that sodium glycididazole was an effective, promising radiation-enhancing agent that improved CNS disease control rate, extended the median CNS progression-free survival time and was well tolerated in patients suffering from non-small cell lung cancer with multiple brain metastases.
Collapse
Affiliation(s)
- Y C Zeng
- Department of Medical Oncology, Cancer Center, Shengjing Hospital of China Medical University, 39, Huaxiang Road, Shenyang 110022, China
| | - R Wu
- Department of Medical Oncology, Cancer Center, Shengjing Hospital of China Medical University, 39, Huaxiang Road, Shenyang 110022, China.
| | - R Xing
- Department of Medical Oncology, Cancer Center, Shengjing Hospital of China Medical University, 39, Huaxiang Road, Shenyang 110022, China
| | - F Chi
- Department of Medical Oncology, Cancer Center, Shengjing Hospital of China Medical University, 39, Huaxiang Road, Shenyang 110022, China
| | - S L Wang
- Department of Medical Oncology, Cancer Center, Shengjing Hospital of China Medical University, 39, Huaxiang Road, Shenyang 110022, China
| | - X D Chen
- Department of Medical Oncology, Cancer Center, Shengjing Hospital of China Medical University, 39, Huaxiang Road, Shenyang 110022, China
| | - Y Xuan
- Department of Medical Oncology, Cancer Center, Shengjing Hospital of China Medical University, 39, Huaxiang Road, Shenyang 110022, China
| | - L N Wu
- Department of Medical Oncology, Cancer Center, Shengjing Hospital of China Medical University, 39, Huaxiang Road, Shenyang 110022, China
| | - Q Y Duan
- Department of Medical Oncology, Cancer Center, Shengjing Hospital of China Medical University, 39, Huaxiang Road, Shenyang 110022, China
| | - M Y Tang
- Department of Medical Oncology, Cancer Center, Shengjing Hospital of China Medical University, 39, Huaxiang Road, Shenyang 110022, China
| | - N Niu
- Department of Medical Oncology, Cancer Center, Shengjing Hospital of China Medical University, 39, Huaxiang Road, Shenyang 110022, China
| | - Y N Sun
- Department of Medical Oncology, Cancer Center, Shengjing Hospital of China Medical University, 39, Huaxiang Road, Shenyang 110022, China
| | - G L Fan
- Department of Otorhinolaryngology, Harbin First Hospital, 151, Diduan Street, Harbin 150010, China
| | - H M Wang
- Department of Radiation Oncology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China
| |
Collapse
|
11
|
Riquet M, Rivera C, Pricopi C, Badia A, Arame A, Dujon A, Foucault C, Le Pimpec-Barthes F, Fabre E. [Clinical and paraclinical prognostic factors in non-small cell lung cancer surgery]. Rev Pneumol Clin 2015; 71:264-274. [PMID: 26315208 DOI: 10.1016/j.pneumo.2015.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 04/10/2015] [Accepted: 06/02/2015] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Lung cancer prognosis is mainly based on the TNM, histology and molecular biology. Our aim was to analyze the prognostic value of certain clinical and paraclinical variables. PATIENTS AND METHODS We studied among 6105 patients operated on, divided during 3 time-periods (1979 to 2010), the following prognostic factors: type of surgery, pTNM, histology, age, sex, smoking history, clinical presentation, and paraclinical variables. RESULTS Postoperative mortality was 4% (243/6105), rate of complications was 23.3% (1424/6105). The 5-year overall survival was 43.2% and 10-year was 27%. Best survival was observed after complete resection (R0) (P<10(-6)), lobectomy (P<10(-6)), lymph node dissection (P=0.0006), early pTNM stages (P<10(-6)), absence of a solid component in adenocarcinoma. Other pejorative factors were: male gender (P=10(-5)), age (P=0.0000002), comorbidity (P=0.016), history of cancer (P<10(-5)), postoperative complications (P=0.0018), FEV lower than 80% (P=0.0000025), time-periods (P<10(-6)). All these factors were confirmed by multivariate analysis, except gender. Smoking was not poor prognostic factor in univariate analysis (P=0.09) but became significant in the multivariate one (P=0.013). CONCLUSION Medical and human factors, and the general physiological state, play an important role in prognosis after surgery. We do not know their exact meaning and, like studies on chemotherapy, they justify special research.
Collapse
Affiliation(s)
- M Riquet
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20, rue Leblanc, 75015 Paris, France.
| | - C Rivera
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20, rue Leblanc, 75015 Paris, France
| | - C Pricopi
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20, rue Leblanc, 75015 Paris, France
| | - A Badia
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20, rue Leblanc, 75015 Paris, France
| | - A Arame
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20, rue Leblanc, 75015 Paris, France
| | - A Dujon
- Service de chirurgie thoracique, centre médico-chirurgical du Cèdre, 76230 Bois-Guillaume, France
| | - C Foucault
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20, rue Leblanc, 75015 Paris, France
| | - F Le Pimpec-Barthes
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20, rue Leblanc, 75015 Paris, France
| | - E Fabre
- Service d'oncologie médicale, hôpital européen Georges-Pompidou, université Paris Descartes, 75015 Paris, France
| |
Collapse
|
12
|
Rivera C, Pricopi C, Borik W, Foucault C, Dujon A, Le Pimpec Barthes F, Riquet M. [pT4 non-small cell lung cancer: Surgical characteristics in present practice]. Rev Pneumol Clin 2014; 70:214-222. [PMID: 24874406 DOI: 10.1016/j.pneumo.2014.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/10/2014] [Accepted: 02/13/2014] [Indexed: 06/03/2023]
Abstract
INTRODUCTION pT4 is a group of miscellaneous tumors: our goal was to revisit their surgical reality. METHODS The different characteristics and prognostic factors of lung pT4 (n=403) were analysed according to three subgroups: G1 - by direct extension; G2 - by nodule in other ipsilateral lobe; G3 - because of both. RESULTS There were 332 males and 71 females mean aged 61.5 years. Surgery [exploratory: 89 (22.1 %), lobectomy: 149 (37 %), pneumonectomy: 169 (41.9 %)] was followed by 26 postoperative deaths (6.5 %), 82 complications (20.3 %) and concerned few pN0 (47.6 %). G1 (n=196) and G3 (n=53) were not different. By comparison with them, G2 (n=53) were mainly females (24\13 %), with less explorative thoracotomy (2.6\34 %), more complete R0 resections (77\29 %), less pneumonectomy (31\47 %), more small sized tumors (mean: 37\57 mm), more adenocarcinoma (67\32 %), more N0 tumors (48\31.7 %) and stages IIIA disease (46.7\56 %). G2 5-year survival rates were higher (G2: 22 %; G1: 13 %; G3: 15 %); G1 rates depended of the invaded structure (20.9 % for the vertebra down to 0 % for the esophagus and carina). pN2 rates were not very high but not different between groups (G1: 13.6 %; G2: 15.6 %; G3: 14.3 %; P=0.52). Multivariate analysis demonstrated completeness and type of resection, stage and age as independent factors of prognosis. CONCLUSION Surgery for pT4 is justified provided rigorous selection of extension forms. However, assimilating extension and ipsilateral lobe nodule in a same group does not obey to surgical reality.
Collapse
Affiliation(s)
- C Rivera
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, Paris Descartes université, 75015 Paris, France
| | - C Pricopi
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, Paris Descartes université, 75015 Paris, France
| | - W Borik
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, Paris Descartes université, 75015 Paris, France
| | - C Foucault
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, Paris Descartes université, 75015 Paris, France
| | - A Dujon
- Centre médico-chirurgical du Cèdre, 76230 Bois-Guillaume, France
| | - F Le Pimpec Barthes
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, Paris Descartes université, 75015 Paris, France
| | - M Riquet
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, Paris Descartes université, 75015 Paris, France.
| |
Collapse
|