Non-surgical management of early-stage lung cancer

2017 ◽  
Author(s):  
Jim Brown ◽  
Neal Navani
Keyword(s):  
Lung Cancer ◽  
Early Stage ◽  
Pulmonary Nodules ◽  
The Elderly ◽  
Multidisciplinary Teams ◽  
Solitary Pulmonary Nodules ◽  
Early Stage Lung Cancer ◽  
Mortality And Morbidity ◽  
Inoperable Patient ◽  
Ablative Techniques

As low-dose computed tomography screening of ‘high-risk’ smokers is occurring with increasing frequency, the incidental discovery of solitary pulmonary nodules is becoming more frequent, and lung cancer multidisciplinary teams are now often faced with balancing risk and benefit when making decisions regarding the radical treatment of patients with a clinical diagnosis of early lung cancer but borderline fitness. Surgery offers the best prospect of cure but is associated with significant mortality and morbidity; the elderly and frail experience more toxicity and a greater impact on the quality of life. This chapter reviews the criteria for assessing surgical fitness and examines the evidence for minimally invasive and ablative techniques for the treatment of early peripheral lung cancer in the medically inoperable patient.

scholarly journals Does aggressive management of solitary pulmonary nodules pay off?

Breathe ◽  
2019 ◽  
Vol 15 (1) ◽  
pp. 15-23 ◽  
Author(s):  
Stefano Elia ◽  
Serafina Loprete ◽  
Alessandro De Stefano ◽  
Georgia Hardavella
Keyword(s):  
Lung Cancer ◽  
Minimally Invasive ◽  
Early Stage ◽  
Large Diameter ◽  
False Negative ◽  
Pulmonary Nodules ◽  
Solitary Pulmonary Nodules ◽  
Early Stage Lung Cancer ◽  
Fdg Uptake ◽  
Negative Results

Indeterminate solitary pulmonary nodules (SPNs), measuring up to 3 cm in diameter, are incidental radiological findings. The ever-growing use of modern imaging has increased their detection. The majority of those nodules are benign; however, the possibility of diagnosing early-stage lung cancer still stands. Guidelines for the management of SPNs have never been validated in prospective comparative studies.Positron emission tomography (PET) is a useful tool to provide functional information on SPNs. However, overall sensitivity and specificity of PET in detecting malignant SPNs of at least 10 mm in diameter are about 90% and false-negative results are reported.The development of video-assisted thoracic surgery has provided minimally invasive diagnosis and treatment of SPNs. In our series, 105 patients underwent surgery based on combined increased18F-labelled 2-fluoro-2-deoxy-d-glucose (FDG) uptake on PET computed tomography and radiological features (morphology and density) without prior histological confirmation. We detected 26 false negatives (24.8%) and only nine false positives (8.57%). Therefore, our minimally invasive surgical approach prevented 25% of patients with lung cancer from a delayed treatmentversusonly 9% undergoing “overtreatment”.In our monocentric cohort, patients with SPNs with large diameter, irregular outline, no calcifications, central location, increased FDG uptake and/or subsolid aspect benefited from a primary surgical resection.

scholarly journals Diagnosis and outcome of resected solitary pulmonary nodules after liver transplantation

2019 ◽  
Author(s):  
Mari Tone ◽  
Nobuyasu Awano ◽  
Takehiro Izumo ◽  
Hanako Yoshimura ◽  
Tatsunori Jo ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Liver Transplantation ◽  
Early Stage ◽  
Lung Resection ◽  
Invasive Pulmonary Aspergillosis ◽  
Primary Lung Cancer ◽  
Pulmonary Nodules ◽  
Solitary Pulmonary Nodules ◽  
Computed Tomography Scans

Abstract Objective Solitary pulmonary nodules after liver transplantation are challenging clinical problems. Herein, we report the causes and clinical courses of resected solitary pulmonary nodules in patients who underwent liver transplantation. Methods We retrospectively obtained medical records of 68 patients who underwent liver transplantation between March 2009 and June 2016. This study mainly focused on patients with solitary pulmonary nodules observed on computed tomography scans during follow-ups that were conducted until their deaths or February 2019. Results Computed tomography scans revealed solitary pulmonary nodules in 7 of the 68 patients. Definitive diagnoses were obtained using video-assisted lung resection in all seven patients. None experienced major postoperative complications. The final pathologic diagnoses were primary lung cancer in three patients, pulmonary metastases from hepatocellular carcinoma in one patient, invasive pulmonary aspergillosis in one patient, post-transplant lymphoproliferative disorder in one patient, and hemorrhagic infarction in one patient. The three patients with lung cancer were subsequently treated with standard curative resection. Conclusions Solitary pulmonary nodules present in several serious but potentially curable diseases, such as early-stage lung cancer. Patients who present with solitary pulmonary nodules after liver transplantation should be evaluated by standard diagnostic procedures, including surgical biopsy if necessary.

scholarly journals The Role of IGF-Pathway Biomarkers in Determining Risks, Screening, and Prognosis in Lung Cancer: A Systematic Review.

2021 ◽  
Author(s):  
Alexander W. Pohlman ◽  
Hita Moudgalya ◽  
Lia Jordano ◽  
Gabriela C. Lobato ◽  
David Gerard ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Early Stage ◽  
Pulmonary Nodules ◽  
Lung Cancer Screening ◽  
Smoking History ◽  
Early Stage Lung Cancer ◽  
Detection Rates ◽  
Variable Expression ◽  
Igf I ◽  
Igfbp 3

Abstract Background: Detection rates of early-stage lung cancer are traditionally low, which contributes to inconsistent treatment responses and the highest rates of annual cancer deaths in the U.S. Currently, age and smoking history are the primary factors that qualify patients for low-dose computed tomography (LDCT) screening, which contributes heavily to a high false discovery rate. This limitation to the current screening paradigm has prompted research to identify biomarkers that will help more clearly define eligible patients for LDCT screening, differentiate indeterminate pulmonary nodules, and select individualized cancer therapy. Biomarkers within the Insulin-like Growth Factor (IGF) family have come to the forefront of this research. Methods: Literature available through PubMed and Google Scholar sources was cataloged using keywords: {Lung Cancer} AND {IGF} AND {Risk OR Diagnosis OR Prognosis OR Prognostication OR Treatment}. The results were summarized and provided herein.Results: Multiple biomarkers within the IGF family (or axis) have been investigated, most notably IGF-I and IGF binding protein 3 (IGFBP-3). However, newer studies seek to expand this search to other molecules within the IGF axis. Results have differed, however, due to features such as the pre-disease variable expression of IGF-I and IGFBP-3, likely promoted by factors such as obesity and smoking history. Certain studies have demonstrated these biomarkers are useful as a companion test alongside lung cancer screening, but other findings were not as conclusive, possibly owing to measurement bias from pre-analytical variables and non-standardized assay techniques. Research also has suggested IGF biomarkers may be beneficial in the prognostication and subsequent application of treatment via systemic therapy. Despite these advances, however, additional knowledge as to the intricacies of regulatory mechanisms inherent to this system are necessary to more fully harness the potential clinical utility for diagnostic tests and to identify novel targets for therapeutic intervention. Conclusions: The IGF system likely plays a role in multiple phases of lung cancer; however, there is a surplus of conflicting data, especially prior to development of the disease and during early stages of detection. IGF biomarkers may be valuable in the screening, prognosis, and treatment of lung cancer, though their exact application requires further study.

Management of lung cancer in elderly population: A mono-centric retrospective study at University Hospital of Caen, Normandy, France.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e21573-e21573
Author(s):  
Youssef Oulkhouir ◽  
Emmanuel Bergot ◽  
Jeannick Madelaine ◽  
Boris Stchepinsky
Keyword(s):  
Lung Cancer ◽  
Survival Data ◽  
Poor Prognosis ◽  
Elderly Population ◽  
Early Stage ◽  
Lung Cancer Surgery ◽  
The Elderly ◽  
University Hospital ◽  
Care Group ◽  
Early Stage Lung Cancer

e21573 Background: Lung cancer is one of the leading causes of death worldwide and its incidence is increasing in the elderly patient population. Management of these population is not as well codified as that of younger patients due to their under-representation in clinical trials. The objective of this study is to assess the clinical characteristics, diagnostics and treatments in our population at the University Hospital of Caen (CHU). Methods: It was a retrospective monocentric study including all patients over 75 years old who were diagnosed with a lung cancer between January 1, 2014 and December 31, 2017 in our center of Caen. We analyzed epidemiological, clinical and therapeutic criteria. We evaluated the overall survival and according to the type of treatment used, the identification of factors of poor prognosis. Adverse events in that specific population of patients were analyzed. We also looked at the correlation between length of hospitalization and survival data. Results: 132 patients aged 75 to 95 years were included, with a large predominance of men. Almost 90% of our patients had comorbidities. The median survival of the entire population was 7 months. Factors identified as significantly influencing survival are the initiation of a specific cancer treatment, performans status, undernutrition, presence of comorbidities, age, stage of disease, and hospitalization at diagnosis. 58.9% of our patients received treatment including 60% chemotherapy and 17.7% surgery. 52% of patients treated with chemotherapy had Grade 3-4 toxicities. None of the patients treated with targeted therapy had any major side effects. 67.4% of our patients were hospitalized for diagnosis. The percentage of survival time spent in hospital is also significantly higher in the best supportive care group with a rate of 69% versus 25%. 14 patients had a diagnosis of early stage lung cancer. Surgery and radiotherapy were performed and were well tolerated. Conclusions: The elderly population with lung cancer managed in our center is highly diagnosed at an advanced stage and has many associated comorbidities affecting survival. Performans status, nutritional condition and inaugural hospitalization are factors of poor prognosis leading to exclusive palliative care. However, in early stages disease radical treatment good be performed and be well tolerated.

Secondary Analysis of the NLST data with simpler comparative methods between CXR and LDCT

2019 ◽  
Author(s):  
Wissam Al-Janabi
Keyword(s):  
Lung Cancer ◽  
Death Rate ◽  
Screening Tool ◽  
Early Stage ◽  
Secondary Analysis ◽  
High Sensitivity ◽  
Lung Cancer Mortality ◽  
Early Stage Lung Cancer ◽  
Mortality And Morbidity ◽  
The Usa

Abstract: The death rate from lung cancer is highest amongst all cancers; it comprises approximately 20% of all cancer death. After decades of striving to find a screening tool similar to Chest x-ray (CXR) and blood biomarkers for the deadliest cancer in the world, three decades ago, the screening with Low Dose Computed Tomography (LDCT) began. Unless the patient becomes symptomatic with a cough, hemoptysis, weight loss, this cancer was hard to detect. Even though smoking cessation is the best way to reduce mortality and morbidity from lung cancer, LDCT showed its ability to identify lung cancer earlier and thus decrease the death rate from lung cancer in countries that can afford to use this tool. LDCT can decrease all-cause mortality by approximately 7% and lower lung cancer mortality by about 20%. LDCT has high sensitivity when compared to the CXR. In addition to detecting late-stage cancer, LDCT can also detect early-stage lung cancer (stage I), which can decrease mortality as well as morbidity. When first introduced as a screening tool for lung cancer, clinicians and scientists raised concerns about radiation exposure, cost, psychological effects, and high false positive rates. Due to these concerns, countries like the USA and some European countries were hesitant to approve LDCT as a screening tool for two decades. Notwithstanding, in 2013, the United State Preventive Services Task Forces (USPSTF) gave the LDCT a B recommendation as a screening tool for lung cancer.

scholarly journals The Value of a Seven-Autoantibody Panel Combined with the Mayo Model in the Differential Diagnosis of Pulmonary Nodules

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Zhougui Ling ◽  
Jifei Chen ◽  
Zhongwei Wen ◽  
Xiaomou Wei ◽  
Rui Su ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Early Detection ◽  
Sensitivity And Specificity ◽  
Detection Rate ◽  
Early Stage ◽  
Pulmonary Nodules ◽  
Enzyme Linked Immunosorbent Assay ◽  
Clinical Value ◽  
Chi Square ◽  
Early Stage Lung Cancer

Background. Identifying malignant pulmonary nodules and detecting early-stage lung cancer (LC) could reduce mortality. This study investigated the clinical value of a seven-autoantibody (7-AAB) panel in combination with the Mayo model for the early detection of LC and distinguishing benign from malignant pulmonary nodules (MPNs). Methods. The concentrations of the elements of a 7-AAB panel were quantitated by enzyme-linked immunosorbent assay (ELISA) in 806 participants. The probability of MPNs was calculated using the Mayo predictive model. The performances of the 7-AAB panel and the Mayo model were analyzed by receiver operating characteristic (ROC) analyses, and the difference between groups was evaluated by chi-square tests ( χ 2 ). Results. The combined area under the ROC curve (AUC) for all 7 AABs was higher than that of a single one. The sensitivities of the 7-AAB panel were 67.5% in the stage I-II LC patients and 60.3% in the stage III-IV patients, with a specificity of 89.6% for the healthy controls and 83.1% for benign lung disease patients. The detection rate of the 7-AAB panel in the early-stage LC patients was higher than that of traditional tumor markers. The AUC of the 7-AAB panel in combination with the Mayo model was higher than that of the 7-AAB panel alone or the Mayo model alone in distinguishing MPN from benign nodules. For early-stage MPN, the sensitivity and specificity of the combination were 93.5% and 58.0%, respectively. For advanced-stage MPN, the sensitivity and specificity of the combination were 91.4% and 72.8%, respectively. The combination of the 7-AAB panel with the Mayo model significantly improved the detection rate of MPN, but the positive predictive value (PPV) and the specificity were not improved when compared with either the 7-AAB panel alone or the Mayo model alone. Conclusion. Our study confirmed the clinical value of the 7-AAB panel for the early detection of lung cancer and in combination with the Mayo model could be used to distinguish benign from malignant pulmonary nodules.

Stereotactic body radiation therapy (SBRT) for early-stage lung cancer in the elderly

2018 ◽  
Vol 45 (4) ◽  
pp. 210-219 ◽  
Author(s):  
Ashwin Shinde ◽  
Richard Li ◽  
Jae Kim ◽  
Ravi Salgia ◽  
Arti Hurria ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Radiation Therapy ◽  
Stereotactic Body Radiation Therapy ◽  
Early Stage ◽  
The Elderly ◽  
Early Stage Lung Cancer ◽  
Stereotactic Body Radiation ◽  
Stage Lung Cancer

scholarly journals The Value of A Seven-Autoantibody Panel Combined With The Mayo Model In The Differential Diagnosis of Pulmonary Nodules 

2020 ◽  
Author(s):  
Zhougui Ling ◽  
Jifei Chen ◽  
Zhongwei Wen ◽  
Xiaomou Wei ◽  
Rui Su ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Early Detection ◽  
Sensitivity And Specificity ◽  
Detection Rate ◽  
Early Stage ◽  
Pulmonary Nodules ◽  
Enzyme Linked Immunosorbent Assay ◽  
Clinical Value ◽  
Chi Square ◽  
Early Stage Lung Cancer

Abstract BACKGROUND: Identifying malignant pulmonary nodules and detecting early-stage lung cancer (LC) could reduce mortality. This study investigated the clinical value of a seven-autoantibody (7-AAB) panel in combination with the Mayo model for the early detection of LC and distinguishing benign from malignant pulmonary nodules (MPNs).METHODS: The concentrations of the elements of a 7-AAB panel were quantitated by enzyme-linked immunosorbent assay (ELISA) in 806 participants. The probability of MPNs was calculated using the Mayo predictive model. The 7-AAB panel and the Mayo model performances were analyzed by receiver operating characteristic (ROC) analyses, and the difference between groups was evaluated by Chi-square tests (χ2).RESULTS: The combined area under the ROC curve (AUC) for all 7 AABs was higher than that of a single one. The 7-AAB panel sensitivities were 67.5% in the stage I-II LC patients and 60.3% in stage III-IV patients, with a specificity of 89.6% for the healthy controls and 83.1% for benign lung disease patients. The detection rate of the 7-AAB panel in the early-stage LC patients was higher than that of traditional tumor markers. The AUC of the 7-AAB panel combined with the Mayo model was higher than that of the 7-AAB panel alone or the Mayo model alone in distinguishing MPN from benign nodules. For early-stage MPN, the sensitivity and specificity of the combination were 93.5% and 58.0%, respectively. For advanced-stage MPN, the sensitivity and specificity of the combination were 91.4% and 72.8%, respectively. The combination of the 7-AAB panel with the Mayo model significantly improved the detection rate of MPN, but the positive predictive value (PPV) and the specificity were not improved when compared with either the 7-AAB panel alone or the Mayo model alone.CONCLUSION: Our study confirmed the clinical value of the 7-AAB panel for the early detection of lung cancer, and in combination with the Mayo model, could be used to distinguish benign from malignant pulmonary nodules.

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