scholarly journals Sublobar resection for node-negative lung cancer 2–5 cm in size

2019 ◽  
Vol 56 (5) ◽  
pp. 858-866 ◽  
Author(s):  
Brendon M Stiles ◽  
Jialin Mao ◽  
Sebron Harrison ◽  
Benjamin Lee ◽  
Jeffrey L Port ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Treatment Options ◽  
Primary Lung Cancer ◽  
Patient Characteristics ◽  
Stage I ◽  
Sublobar Resection ◽  
Cancer Specific Survival ◽  
Extensive Lymphadenectomy ◽  
Risk Patients

Abstract OBJECTIVES Sublobar resection (SLR) is an alternative to lobectomy for non-small-cell lung cancer (NSCLC). Outcomes following SLR for tumours >2 cm are not well described. We sought to determine the utilization of SLR for stage I tumours >2–5 cm in size and to determine predictors of outcome. METHODS We utilized the Surveillance, Epidemiology and End Results Program (SEER)-Medicare database to identify NSCLC patients with primary lung cancer ≥66 years old with stage I cancers >2–5 cm in size. We evaluated overall survival and cancer-specific survival among cohorts undergoing lobectomy versus SLR. Propensity score matching was performed. We compared patient characteristics and survival between groups. RESULTS For the study time period (2007–2012), among patients with tumours >2 cm and ≤5 cm (n = 4582), 3890 lobectomies (85%) and 692 SLR (15%) were performed. Patients undergoing SLR were older, had smaller tumours and more comorbidities. Patients undergoing lobectomy were much more likely to have any lymph nodes removed (95.6% vs 65.6%, P < 0.001) and to have >10 nodes removed (29.6% vs 7.5%, P < 0.001). All-cause mortality [hazard ratio (HR) 1.65, confidence interval (CI) 1.48–1.85] and cancer-specific (HR 1.63, CI 1.29–2.06) mortality were higher following SLR. At 3 years, overall survival (60.9%, CI 57.0–64.6% vs 54.4%, CI 50.4–58.2%) and cancer-specific survival (87.3%, CI 83.5–90.3% vs 76.5%, CI 71.0–81.1%) favoured lobectomy over SLR. In propensity-matched groups, both all-cause (HR 1.27, CI 1.10–1.47) and cancer-specific (HR 1.54, CI 1.11–2.16) mortality rates were higher with SLR. CONCLUSIONS In pathologically staged patients, SLR appears inferior to lobectomy for stage I NSCLC 2–5 cm in size. SLR is associated with less extensive lymphadenectomy and with worse survival than lobectomy in this cohort of patients. However, the 76.5% 3-year cancer-specific survival in patients undergoing SLR may exceed that of other localized treatment options for NSCLC. As such, SLR may be an appropriate option for high-risk patients with carefully staged 2–5 cm N0 tumours.

Comparison between sublobar resection and 125Iodine brachytherapy after sublobar resection in high-risk patients with Stage I non–small-cell lung cancer

Surgery ◽  
2003 ◽  
Vol 134 (4) ◽  
pp. 691-697 ◽  
Author(s):  
Ricardo Santos ◽  
Athanasios Colonias ◽  
David Parda ◽  
Mark Trombetta ◽  
Richard H Maley ◽  
...  
Keyword(s):  
Lung Cancer ◽  
High Risk ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Small Cell ◽  
Stage I ◽  
Sublobar Resection ◽  
Small Cell Lung ◽  
High Risk Patients ◽  
Risk Patients

Management of Patients With Stage I Lung Cancer

2017 ◽  
Vol 13 (2) ◽  
pp. 69-76 ◽  
Author(s):  
Jeffrey A. Bogart ◽  
Jason Wallen
Keyword(s):  
Lung Cancer ◽  
Treatment Options ◽  
Stage I ◽  
Past Century ◽  
Sublobar Resection ◽  
Improved Outcomes ◽  
Stage I Lung Cancer ◽  
Prospective Trials ◽  
Potential Impact ◽  
Level 1

The treatment of stage I non–small-cell lung cancer has advanced markedly over the past century. The transition from therapeutic nihilism with ensured mortality to radical surgery with pneumonectomy to rational oncologic-based resection has resulted in dramatically improved outcomes and reduced morbidity. The superiority of anatomic resection with lobectomy over sublobar resection for fit patients with stage I disease, where more than one half of all patients should expect to be cured, is backed by level 1 evidence. Minimally invasive approaches have further decreased morbidity and mortality, and prospective trials continue to assess whether sublobar resection is appropriate in more select circumstances for tumors < 2 cm. Interest in studying the patient at high risk for complications after lobectomy has been spurred by recent advances in surgical, radiotherapy, and ablative treatment options. In particular, provocative results with stereotactic body radiotherapy have led to rapid adoption in clinical practice with a resultant decrease in the number of untreated patients. A comparison of outcomes across studies of competing modalities remains challenging given the potential impact of selection bias in single-arm trials, and attempts to conduct randomized studies have been largely unsuccessful. Given the uncertainty in defining optimal therapy, patients are best served by a multidisciplinary team of thoracic surgeons, radiation oncologists, pulmonologists, and chest and interventional radiologists to ensure that they receive the evaluation and treatment best suited not only to their tumor and medical challenges but also to their concerns, fears, and values.

scholarly journals Prognostic Factors Associated with Lung Cancer Survival: A Population-Based Study in Southern Spain

2019 ◽  
pp. 1-10
Author(s):  
Isabel Linares ◽  
José Expósito ◽  
Elena Molina-Portillo ◽  
Yoe-Ling Chang ◽  
Juan Pedro Arrebola ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Survival ◽  
Performance Status ◽  
Treatment Options ◽  
Survival Rates ◽  
Primary Lung Cancer ◽  
Stage Iv ◽  
Relative Survival ◽  
Population Based ◽  
Stage I

Purpose: Lung cancer is the leading cause of cancer death worldwide. The objective was to analyze survival for lung cancer in Granada, and to identify the factors influencing survival. Methods: Data were obtained from the population-based cancer registry in Granada (Spain). All cases of newly diagnosed primary lung cancer in 2011-2012 (n=685) were included. One and two-year relative survival was estimated. Results: Of our population, 65% of the patients were over 65 years of age, and 83% were men. 74% of patients had good performance status (PS); 81% of the tumors were microscopically verified; and 81% were non-small cell lung cancer. Overall, 16% were stage I-II, whereas 57% were stage IV. Radiotherapy was administered in 28% of cases, chemotherapy in 45%, whereas 23% of patients were operated. The two-year survival rate was 18% (67% and 5% for stage I and IV). Survival was higher among women (29%), <75 years of age (21.6%), and those with good PS (23%). Microscopic verification and surgery led to higher survival rates of 23.4% and 69%, respectively. Conclusions: Since the factors affecting survival were PS, stage, and surgery, efforts should target the early diagnosis of lung cancer since this would improve treatment options and outcomes.

scholarly journals Surgery or radiotherapy for stage I lung cancer? An intention-to-treat analysis

2019 ◽  
Vol 53 (6) ◽  
pp. 1801568 ◽  
Author(s):  
Katie L. Spencer ◽  
Martyn P.T. Kennedy ◽  
Katie L. Lummis ◽  
Deborah A.B. Ellames ◽  
Michael Snee ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Competing Risks ◽  
Stage I ◽  
Cancer Specific Survival ◽  
Subdistribution Hazard ◽  
Intention To Treat ◽  
Stage I Lung Cancer ◽  
Treat Analysis ◽  
Related Survival

IntroductionSurgery is the standard of care for early-stage lung cancer, with stereotactic ablative body radiotherapy (SABR) a lower morbidity alternative for patients with limited physiological reserve. Comparisons of outcomes between these treatment options are limited by competing comorbidities and differences in pre-treatment pathological information. This study aims to address these issues by assessing both overall and cancer-specific survival for presumed stage I lung cancer on an intention-to-treat basis.MethodsThis retrospective intention-to-treat analysis identified all patients treated for presumed stage I lung cancer within a single large UK centre. Overall survival, cancer-specific survival, and combined cancer and treatment-related survival were assessed with adjustment for confounding variables using Cox proportional hazards and Fine–Gray competing risks analyses.Results468 patients (including 316 surgery and 99 SABR) were included in the study population. Compared with surgery, SABR was associated with inferior overall survival on multivariable Cox modelling (SABR HR 1.84 (95% CI 1.32–2.57)), but there was no difference in cancer-specific survival (SABR HR 1.47 (95% CI 0.80–2.69)) or combined cancer and treatment-related survival (SABR HR 1.27 (95% CI 0.74–2.17)). Combined cancer and treatment-related death was no different between SABR and surgery on Fine–Gray competing risks multivariable modelling (subdistribution hazard 1.03 (95% CI 0.59–1.81)). Non-cancer-related death was significantly higher in SABR than surgery (subdistribution hazard 2.16 (95% CI 1.41–3.32)).ConclusionIn this analysis, no difference in cancer-specific survival was observed between SABR and surgery. Further work is needed to define predictors of outcome and help inform treatment decisions.

scholarly journals Utility of Geriatric Nutritional Risk Index in patients with lung cancer undergoing surgery

2020 ◽  
Vol 58 (4) ◽  
pp. 775-782 ◽  
Author(s):  
Haruaki Hino ◽  
Tomohito Saito ◽  
Hiroshi Matsui ◽  
Yohei Taniguchi ◽  
Tomohiro Murakawa
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Risk Index ◽  
Primary Lung Cancer ◽  
Lung Cancer Surgery ◽  
Nutritional Risk ◽  
Geriatric Nutritional Risk Index ◽  
Cancer Specific Survival ◽  
Nutritional Risk Index

Abstract OBJECTIVES The Geriatric Nutritional Risk Index (GNRI) based on serum albumin and body weight helps predict the risk of malnutrition and mortality in hospitalized elderly patients. However, its significance for patients with malignancy is unclear. We analysed the ability of GNRI to assess this risk in patients with lung cancer undergoing surgery. METHODS We retrospectively analysed the clinical characteristics and surgical outcomes of 739 patients with primary lung cancer who underwent surgery from 2006 to 2017 in a single institution. RESULTS GNRI values were ≤98 for 112 patients and &gt;98 for 627 patients; 532 patients had pathological stage I disease, 114 patients had stage II disease and 93 patients had stage III disease. Cox proportional hazards models revealed that age, GNRI value ≤98 and stages II and III diseases (all Ps &lt; 0.05) were significant negative prognostic factors for overall survival and that carcinoembryonic antigen level (P = 0.03), GNRI value ≤98 (P = 0.005) and stages II and III diseases (both Ps &lt; 0.001) were significant negative prognostic factors for cancer-specific survival. Rates of overall survival and cancer-specific survival stratified by lower and higher GNRI score were significantly different among patients aged 70 and older (P = 0.001 and P = 0.004, respectively) but not among patients aged 69 and younger (P = 0.09 and P = 0.12, respectively). CONCLUSIONS GNRI could help in predicting survival after lung cancer surgery, especially in older patients, and perioperative active nutritional support might improve the survival.

The effect of introducing pelvic lymphadenectomy on survival and recurrence rates in Danish endometrial cancer patients at high risk: a Danish Gynecological Cancer Group study

2019 ◽  
Vol 29 (1) ◽  
pp. 68-76 ◽  
Author(s):  
Gitte Ørtoft ◽  
Claus Høgdall ◽  
Caroline Juhl ◽  
Lone K Petersen ◽  
Estrid S Hansen ◽  
...  
Keyword(s):  
Overall Survival ◽  
Endometrial Cancer ◽  
Lymph Node ◽  
High Risk ◽  
Cancer Patients ◽  
Gynecological Cancer ◽  
Stage I ◽  
Cancer Specific Survival ◽  
High Risk Patients ◽  
Risk Patients

ObjectivesTo evaluate the rate of survival and recurrence related to the introduction of pelvic lymphadenectomy in Danish high-risk endometrial cancer patients.Study designData on 713 high-risk patients defined as grade 3 with >50% myometrial invasion or serous/clear/undifferentiated carcinomas stage I–IV endometrial cancer patients diagnosed from 2005 to 2012 were retrieved from the Danish Gynecological Cancer Database. Of these, 305 were high-risk stage I. Five year Kaplan-Meier survival estimates and actuarial recurrence rates were calculated, and adjusted Cox used for comparison. Findings were compared with earlier Danish results.ResultsLymphadenectomy in 390 radically operated high-risk patients resulted in upstaging of 31 patients from stage I to IIIC and 19 patients from stage II to IIIC corresponding to 12.8%. Upstaging from stage I to IIIC had a cancer-specific survival of 77%, almost comparable to lymph node-negative high-risk stage I patients (81%). Lymphadenectomy patients had a significant higher overall survival as compared with non-lymph node resected for all patients, but not for stage I patients. Lymphadenectomy, however, did not significantly affect cancer-specific survival, progression-free survival, recurrence rate or risk of local, distant, or lymph node recurrence. When the survival of high-risk stage I patients was compared with earlier Danish results, a small improvement in overall survival (7%) and cancer-specificsurvival (8%) was demonstrated.ConclusionOnly a small number of high-risk patients were upstaged from stage I to III due to lymphadenectomy. These patients showed a surprisingly good survival possibly due to correct stage identification and subsequent relevant adjuvant therapy. However, even though introduction of lymphadenectomy in the Danish high-risk population seems to increase overall survival, no significant change in cancer-specific survival, progression-free survival or recurrence patterns was demonstrated.

Impact of analgesia on cancer recurrence and mortality within 5 years after stage I non-small cell lung cancer resection

2021 ◽  
pp. 030089162110200
Author(s):  
Giulio Luca Rosboch ◽  
Edoardo Ceraolo ◽  
Ilaria De Domenici ◽  
Francesco Guerrera ◽  
Eleonora Balzani ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Propensity Score ◽  
Small Cell Lung Cancer ◽  
Cumulative Incidence ◽  
Cancer Recurrence ◽  
Small Cell ◽  
Stage I ◽  
Small Cell Lung ◽  
Perioperative Analgesia

Objective: The choice of analgesia after cancer surgery may play a role in the onset of cancer recurrence. Particularly opioids seem to promote cancer cell proliferation and migration. Based on this consideration, we assessed the impact of perioperative analgesia choice on cancer recurrence after curative surgery for stage I non-small cell lung cancer (NSCLC). Methods: We retrospectively reviewed the records of all patients undergoing lung resection for stage I NSCLC between January 2005 and December 2012. Patients received analgesia either by peridural (PERI group) or intravenous analgesia with opioids (EV group). Follow-up was concluded in August 2019. Five-year cumulative incidence of recurrence and overall survival were evaluated and adjusted using a propensity score matching method. Results: A total of 382 patients were evaluated, 312 belonging to the PERI group (81.7%) and 70 to the EV group (18.3%). There was no statistically significant difference between the two groups in 5-year cumulative incidence of recurrence ( p = 0.679) or overall survival rates ( p = 0.767). These results were confirmed after adjustment for propensity score matching for cumulative incidence of recurrence ( p = 0.925) or overall survival ( p = 0.663). Conclusions: We found no evidence suggesting an association between perioperative analgesia choice and recurrence-free survival or overall survival in patients undergoing surgical resection of stage I NSCLC.

Excessive Toxicity When Treating Central Tumors in a Phase II Study of Stereotactic Body Radiation Therapy for Medically Inoperable Early-Stage Lung Cancer

2006 ◽  
Vol 24 (30) ◽  
pp. 4833-4839 ◽  
Author(s):  
Robert Timmerman ◽  
Ronald McGarry ◽  
Constantin Yiannoutsos ◽  
Lech Papiez ◽  
Kathy Tudor ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Radiation Therapy ◽  
Phase Ii ◽  
Local Control ◽  
Stereotactic Body Radiation Therapy ◽  
Early Stage ◽  
Stage I ◽  
Severe Toxicity ◽  
Stereotactic Body Radiation

PurposeSurgical resection is standard therapy in stage I non–small-cell lung cancer (NSCLC); however, many patients are inoperable due to comorbid diseases. Building on a previously reported phase I trial, we carried out a prospective phase II trial using stereotactic body radiation therapy (SBRT) in this population.Patients and MethodsEligible patients included clinically staged T1 or T2 (≤ 7 cm), N0, M0, biopsy-confirmed NSCLC. All patients had comorbid medical problems that precluded lobectomy. SBRT treatment dose was 60 to 66 Gy total in three fractions during 1 to 2 weeks.ResultsAll 70 patients enrolled completed therapy as planned and median follow-up was 17.5 months. The 3-month major response rate was 60%. Kaplan-Meier local control at 2 years was 95%. Altogether, 28 patients have died as a result of cancer (n = 5), treatment (n = 6), or comorbid illnesses (n = 17). Median overall survival was 32.6 months and 2-year overall survival was 54.7%. Grade 3 to 5 toxicity occurred in a total of 14 patients. Among patients experiencing toxicity, the median time to observation was 10.5 months. Patients treated for tumors in the peripheral lung had 2-year freedom from severe toxicity of 83% compared with only 54% for patients with central tumors.ConclusionHigh rates of local control are achieved with this SBRT regimen in medically inoperable patients with stage I NSCLC. Both local recurrence and toxicity occur late after this treatment. This regimen should not be used for patients with tumors near the central airways due to excessive toxicity.

Patterns of lung cancer in people living with human immunodeficiency virus (HIV): A retrospective, single-center study in Washington, D.C.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e21154-e21154
Author(s):  
Margaret Pruitt ◽  
Rajesh Naidu Janapala ◽  
Faysal Haroun
Keyword(s):  
Lung Cancer ◽  
Late Stage ◽  
Early Stage ◽  
Primary Lung Cancer ◽  
Large Cell ◽  
Molecular Data ◽  
Stage I ◽  
Stage Iii ◽  
Small Cell Lung ◽  
Neuroendocrine Cancer

e21154 Background: Lung cancer is the leading cause of cancer death and the most common non-acquired immune deficiency syndrome defining malignancy in people living with HIV (PLWH). Disparities in outcomes have been observed despite lung cancer mortality reportedly decreasing in the general population over the last decade due to lower rates of smoking and the advent of novel therapies. To better understand the current trend in lung cancer in PLWH, we explored demographic characteristics, comorbidities, and lung cancer pathology and molecular data in this population. Methods: A retrospective search of patient charts was conducted from 2004 to January 2021 using billing codes for HIV and primary lung cancer. Patients who had incorrect HIV or primary lung cancer diagnoses were excluded. Results: The search yielded 45 patients, of which 11 were excluded as described above: 66% were males, 82% African American, and 18% Caucasian. About two-thirds of patients were living in zip codes with predominantly low to medium household incomes. The median pack years of patients diagnosed with Stage I or II non-small cell lung cancer (NSCLC) was 40, Stage III or IV NSCLC was 20, early stage small cell lung cancer (SCLC) was 30, and late stage SCLC was 60. The median time between HIV and lung cancer diagnoses was 21.7 years for Stage I or II NSCLC, 17.1 years for Stage III or IV NSCLC, 15.2 for early stage SCLC, and 13.3 for late stage SCLC. Of 26 patients with viral load (VL) data, 21 (80.7%) had VL less than 500 when lung cancer was diagnosed. Of the 33 charts with available pathology data, there were 16 adenocarcinomas, 6 squamous carcinomas, 3 adenosquamous carcinomas, 1 large cell neuroendocrine cancer, 4 SCLCs, 1 mesothelioma, and 2 unspecified NSCLCs. Of 19 patients with a histologic grade, 11 had a high-grade tumor (57.9%). For the NSCLCs, 8 were Stage I (28.5%), 2 Stage II (7.1%), 8 Stage III (28.5%), 9 Stage IV (32.1%), and 1 with an unspecified stage. One SCLC was early stage and the remaining 3 were late stage. Five patients had brain metastasis. Molecular data or PDL-1 expression was available for 10 adenocarcinomas (62.5%), 1 adenosquamous (33%), 3 squamous carcinomas (50%), and the large cell neuroendocrine cancer. An EGFR mutation was detected in 2 cancers. ALK rearrangement was found in 1. Other mutations were detected. Two cancers were in each PDL1 expression category: < 1%, 1-50%, and > 50%. Conclusions: Our study suggests that PLWH with lung cancer continue to have high rates of smoking. Viral load was well controlled. A range in stages of lung cancer was observed including earlier stages. Although molecular data was limited, available EGFR and ALK gene alterations, and PD-L1 expression prevalence were on par with that of the general population. With advancements in lung cancer treatment, additional research is needed in the PLWH population to better understand and mitigate disparities.

scholarly journals Non-Smoking-Associated Lung Cancer: A distinct Entity in Terms of Tumor Biology, Patient Characteristics and Impact of Hereditary Cancer Predisposition

Cancers ◽  
2019 ◽  
Vol 11 (2) ◽  
pp. 204 ◽  
Author(s):  
Elisabeth Smolle ◽  
Martin Pichler
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Tobacco Smoke ◽  
Treatment Options ◽  
Tumor Biology ◽  
Patient Characteristics ◽  
Driver Genes ◽  
Unique Type ◽  
Personalized Cancer Therapy ◽  
Personalized Cancer

Non-small cell lung cancer (NSCLC) in non-, and especially in never-smoking patients is considered a biologically unique type of lung cancer, since risk factors and tumorigenic conditions, other than tobacco smoke, come into play. In this review article, we comprehensively searched and summarized the current literature with the aim to outline what exactly triggers lung cancer in non-smokers. Changes in the tumor microenvironment, distinct driver genes and genetic pathway alterations that are specific for non-smoking patients, as well as lifestyle-related risk factors apart from tobacco smoke are critically discussed. The data we have reviewed highlights once again the importance of personalized cancer therapy, i.e., careful molecular and genetic assessment of the tumor to provide tailored treatment options with optimum chances of good response—especially for the subgroups of never-smokers.

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