scholarly journals Cryoablation of Early-Stage Primary Lung Cancer

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Masanori Inoue ◽  
Seishi Nakatsuka ◽  
Masahiro Jinzaki
Keyword(s):  
Lung Cancer ◽  
Gold Standard ◽  
Standard Treatment ◽  
Early Stage ◽  
Primary Lung Cancer ◽  
Lung Tumors ◽  
Current Status ◽  
Early Stage Nsclc ◽  
Primary Lung Tumors ◽  
Initial Results

Worldwide, lung cancer is the most commonly diagnosed cancer, and lobectomy is the gold-standard treatment for early-stage non-small cell lung cancer (NSCLC). However, many patients are poor surgical candidates for various reasons. Recently, image-guided ablation is being used for lung tumors. Cryoablation has been applied for the treatment of cancer in various nonaerated organs; recently it has been adapted to the treatment of lung tumors. Since an ice ball can be detected by computed tomography (CT), cryoablation of lung tumors is performed under CT guidance. Its first clinical application was reported in 2005, and it has been reported to be feasible in a few studies. Minor complications occurred at a high frequency (up to 70.5%), but major complications were rare (up to 1%). The most common complication is pneumothorax, and most cases need no further intervention. Local efficacy depends on tumor size and presence of a thick vessel close to the tumor. Midterm survival after cryoablation is 77%–88% at 3 years in patients with early-stage NSCLC. Although surgery is the gold-standard treatment for such patients, the initial results of cryoablation are promising. In this paper, the current status of cryoablation for primary lung tumors is reviewed.

scholarly journals Radiologically Occult Lung Cancer Curatively Treated with High-Dose Rate Endobronchial Brachytherapy

2021 ◽  
Vol 11 ◽  
pp. 45
Author(s):  
Deepinder Pal Singh ◽  
Khush Aujla ◽  
Michael Nead ◽  
Kevin Bylund
Keyword(s):  
Lung Cancer ◽  
Dose Rate ◽  
Early Stage ◽  
Primary Lung Cancer ◽  
Lower Lobe ◽  
High Dose Rate ◽  
High Dose ◽  
Curative Intent ◽  
Long Term Outcome ◽  
Early Stage Nsclc

Most patients diagnosed with early-stage non-small cell lung cancer (NSCLC) can be easily cured with surgery or stereotactic body radiotherapy (SBRT). Modalities such as photodynamic therapy, cryotherapy, or laser therapy only offer temporary palliation. A 79-year-old gentleman with early-stage NSCLC who underwent a left lower lobe lobectomy in 2009 presented to us again in 2010 with hemoptysis. A friable ~5 cm tumor along the bifurcation of anterior and the posterior segment of the right upper lobe was noted on bronchoscopic examination, and biopsy confirmed this to be squamous cell carcinoma. Because of his previous surgery, the patient was not a candidate for another surgery. SBRT was not possible as the lesion could not be seen on radiologic imaging. The patient was, therefore, treated with curative intent high-dose rate endobronchial brachytherapy (HDR-EBBT) in 4 weekly sessions of 7 Gy per fraction delivered at a depth of 8 mm, covering ~5 cm tumor plus 1 cm margin proximally and distally. He tolerated the treatment well without any acute or late side effects and was followed every 3 months thereafter with bronchoscopy examinations for 6 months and subsequently with computerized tomography (CT) imaging. In July 2018, the patient started having episodes of hemoptysis and evaluation leads to diagnosis of a third primary lung cancer, which was successfully treated with SBRT with image-guided radiotherapy using a five-fraction regimen. The patient’s most recent CT from July 2019 showed no evidence of disease. We conclude that in patients with early-stage NSCLC, when surgery or SBRT is not feasible due to radiologic occult nature, HDR-EBBT can yield excellent long-term outcome.

scholarly journals Comparison of Oncologic Outcomes between Carbon Ion Radiotherapy and Stereotactic Body Radiotherapy for Early-Stage Non-Small Cell Lung Cancer

Cancers ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 176
Author(s):  
Yuhei Miyasaka ◽  
Shuichiro Komatsu ◽  
Takanori Abe ◽  
Nobuteru Kubo ◽  
Naoko Okano ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Propensity Score ◽  
Small Cell Lung Cancer ◽  
Stereotactic Body Radiotherapy ◽  
Early Stage ◽  
Small Cell ◽  
Oncologic Outcomes ◽  
Comparison Study ◽  
Small Cell Lung ◽  
Early Stage Nsclc

Lung cancer is a leading cause of cancer-related deaths worldwide. Radiotherapy is an essential treatment modality for inoperable non-small cell lung cancer (NSCLC). Stereotactic body radiotherapy (SBRT) is the standard treatment for early-stage NSCLC because of its favorable local control (LC) compared to conventional radiotherapy. Carbon ion radiotherapy (CIRT) is a kind of external beam radiotherapy characterized by a steeper dose distribution and higher biological effectiveness. Several prospective studies have shown favorable outcomes. However, there is no direct comparison study between CIRT and SBRT to determine their benefits in the management of early-stage NSCLC. Thus, we conducted a retrospective, single-institutional, and contemporaneous comparison study, including propensity score-adjusted analyses, to clarify the differences in oncologic outcomes. The 3-year overall survival (OS) was 80.1% in CIRT and 71.6% in SBRT (p = 0.0077). The 3-year LC was 87.7% in the CIRT group and 79.1% in the SBRT group (p = 0.037). Multivariable analyses showed favorable OS and LC in the CIRT group (hazard risk [HR] = 0.41, p = 0.047; HR = 0.30, p = 0.040, respectively). Log-rank tests after propensity score matching and Cox regression analyses using propensity score confirmed these results. These data provided a positive efficacy profile of CIRT for early-stage NSCLC.

scholarly journals Circulating serum exosomal miR-20b-5p and miR-3187-5p as efficient diagnostic biomarkers for early-stage non-small cell lung cancer

2020 ◽  
Vol 245 (16) ◽  
pp. 1428-1436
Author(s):  
Zhi-Jun Zhang ◽  
Xing-Guo Song ◽  
Li Xie ◽  
Kang-Yu Wang ◽  
You-Yong Tang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Early Stage ◽  
Small Cell ◽  
Small Cell Lung ◽  
Diagnostic Biomarkers ◽  
Non Invasive ◽  
Early Stage Nsclc ◽  
Nsclc Patients

Circulating exosomal microRNAs (ExmiRNAs) provide an ideal non-invasive method for cancer diagnosis. In this study, we evaluated two circulating ExmiRNAs in NSCLC patients as a diagnostic tool for early-stage non-small lung cancer (NSCLC). The exosomes were characterized by qNano, transmission electron microscopy, and Western blot, and the ExmiRNA expression was measured by microarrays. The differentially expressed miRNAs were verified by RT-qPCR using peripheral blood specimens from NSCLC patients ( n = 276, 0 and I stage: n = 104) and healthy donors ( n = 282). The diagnostic values were measured by receiver operating characteristic (ROC) analysis. The results show that the expression of both ExmiR-20b-5p and ExmiR-3187-5p was drastically reduced in NSCLC patients. The area under the ROC curve (AUC) was determined to be 0.818 and 0.690 for ExmiR-20b-5p and ExmiR-3187-5p, respectively. When these two ExmiRNAs were combined, the AUC increased to 0.848. When the ExmiRNAs were administered with either carcinoembryonic antigen (CEA) or cytokeratin-19-fragment (CYFRA21-1), the AUC was further improved to 0.905 and 0.894, respectively. Additionally, both ExmiR-20b-5p and ExmiR-3187-5p could be used to distinguish early stages NSCLC (0 and I stage) from the healthy controls. The ROC curves showed that the AUCs were 0.810 and 0.673, respectively. Combination of ExmiR-20b-5p and ExmiR-3187-5p enhanced the AUC to 0.838. When CEA and CYFRA21-1 were administered with the ExmiRNAs, the AUCs were improved to 0.930 and 0.928, respectively. In summary, circulating serum exosomal miR-20b-5p and miR-3187-5p could be used as effective, non-invasive biomarkers for the diagnosis of early-stage NSCLC, and the effects were further improved when the ExmiRNAs were combined. Impact statement The high mortality of non-small cell lung cancer (NSCLC) is mainly because the cancer has progressed to a more advanced stage before diagnosis. If NSCLC can be diagnosed at early stages, especially stage 0 or I, the overall survival rate will be largely improved by definitive treatment such as lobectomy. We herein validated two novel circulating serum ExmiRs as diagnostic biomarkers for early-stage NSCLC to fulfill the unmet medical need. Considering the number of specimens in this study, circulating serum exosomal miR-20b-5p and miR-3187-5p are putative NSCLC biomarkers, which need to be further investigated in a larger randomized controlled clinical trial.

scholarly journals Genome-Wide Analysis of Survival in Early-Stage Non–Small-Cell Lung Cancer

2009 ◽  
Vol 27 (16) ◽  
pp. 2660-2667 ◽  
Author(s):  
Yen-Tsung Huang ◽  
Rebecca S. Heist ◽  
Lucian R. Chirieac ◽  
Xihong Lin ◽  
Vidar Skaug ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Massachusetts General Hospital ◽  
Early Stage ◽  
The United States ◽  
Small Cell ◽  
Genome Wide Analysis ◽  
Early Stage Nsclc ◽  
Genome Wide ◽  
Nsclc Patients

Purpose Lung cancer, of which 85% is non–small-cell (NSCLC), is the leading cause of cancer-related death in the United States. We used genome-wide analysis of tumor tissue to investigate whether single nucleotide polymorphisms (SNPs) in tumors are prognostic factors in early-stage NSCLC. Patients and Methods One hundred early-stage NSCLC patients from Massachusetts General Hospital (MGH) were used as a discovery set and 89 NSCLC patients collected by the National Institute of Occupational Health, Norway, were used as a validation set. DNA was extracted from flash-frozen lung tissue with at least 70% tumor cellularity. Genome-wide genotyping was done using the high-density SNP chip. Copy numbers were inferred using median smoothing after intensity normalization. Cox models were used to screen and validate significant SNPs associated with the overall survival. Results Copy number gains in chromosomes 3q, 5p, and 8q were observed in both MGH and Norwegian cohorts. The top 50 SNPs associated with overall survival in the MGH cohort (P ≤ 2.5 × 10−4) were selected and examined using the Norwegian cohort. Five of the top 50 SNPs were validated in the Norwegian cohort with false discovery rate lower than 0.05 (P < .016) and all five were located in known genes: STK39, PCDH7, A2BP1, and EYA2. The numbers of risk alleles of the five SNPs showed a cumulative effect on overall survival (Ptrend = 3.80 × 10−12 and 2.48 × 10−7 for MGH and Norwegian cohorts, respectively). Conclusion Five SNPs were identified that may be prognostic of overall survival in early-stage NSCLC.

scholarly journals Stereotactic body radiation therapy versus surgery for patients with early-stage non–small cell lung cancer( ≤ 5cm): A systematic review and meta-analysis

2021 ◽  
Author(s):  
Yueling Zhou ◽  
Ping Wen ◽  
Yue Yu ◽  
Zhenyi Yang ◽  
Yixuan Luo ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Systematic Review ◽  
Radiation Therapy ◽  
Stereotactic Body Radiation Therapy ◽  
Early Stage ◽  
Meta Analysis ◽  
Small Cell ◽  
Survival Outcomes ◽  
Small Cell Lung ◽  
Early Stage Nsclc

Abstract Background: Stereotactic body radiation therapy (SBRT) is considered as the preferred treatment method for inoperable early-stage non-small cell lung cancer (NSCLC). However, there is still a debate on the efficacy of SBRT and surgery. This meta-analysis aimed to compare survival outcomes of SBRT and surgery for early-stage NSCLC (≤5cm).Methods: A systematic review and meta-analysis were performed to compare survival outcomes of surgery and SBRT. And the pooled analysis was conducted with STATA 14.0 software. Results: Thirty-nine comparative studies were included for systematic review and twenty-eight of which for quantitative analysis. Compared with SBRT, overall survival (OS) was superior after surgical resection, included lobectomy, sublobar resection, video-assisted thoracoscopic surgery, and thoracotomy, for patients with early-stage NSCLC (≤5cm). And the results of subgroup analysis remained the support of surgery except for the OS of operable matched cohorts and the one matched cohort of age ≥75. However, the HR of OS showed a reduction from patients with unspecific age, ≥65 to ≥75 years old and histopathologically confirmed NSCLC to clinical NSCLC. Although cancer-specific survival and local control was superior after surgery, the recurrence rate of tumors, locoregional control, distant control, and regional control of matched patients demonstrated no significantly different outcomes between SBRT and surgery for early-stage NSCLC.Conclusions: Results show that surgery has superior OS, CSS and local control compared to SBRT for early-stage NSCLC. There is still necessary to explore the survival difference between SBRT and surgery for patients with different characteristics by large-sample, long-term follow-up randomized clinical studies.

scholarly journals Molecular Identification and Genetic Characterization of Early-Stage Multiple Primary Lung Cancer by Large-Panel Next-Generation Sequencing Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Guotian Pei ◽  
Mingwei Li ◽  
Xianjun Min ◽  
Qiang Liu ◽  
Dasheng Li ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Next Generation Sequencing ◽  
Early Stage ◽  
Primary Lung Cancer ◽  
Advanced Stage ◽  
Next Generation ◽  
Molecular Method ◽  
Multiple Primary ◽  
Large Panel ◽  
Generation Sequencing

ObjectiveThe incidence of early stage multiple primary lung cancer (MPLC) has been increasing in recent years, while the ideal strategy for its diagnosis and treatment remains controversial. The present study conducted genomic analysis to identify a new molecular classification method for accurately predicting the diagnosis and therapy for patients with early stage MPLC.MethodsA total of 240 tissue samples from 203 patients with multiple-non-small-cell lung cancers (NSCLCs) (n = 30), early stage single-NSCLC (Group A, n = 94), and advanced-stage NSCLC (Group B, n = 79) were subjected to targeted multigene panel sequencing.ResultsThirty patients for whom next-generation sequencing was performed on &gt;1 tumor were identified, yielding 45 tumor pairs. The frequencies of EGFR, TP53, RBM10, ERBB2, and CDKN2A mutations exhibited significant differences between early and advanced-stage NSCLCs. The prevalence of the EGFR L858R mutation in early stage NSCLC was remarkably higher than that in advanced-stage NSCLC (P = 0.047). The molecular method classified tumor pairs into 26 definite MPLC tumors and four intrapulmonary metastasis (IM) tumors. A high rate of discordance in driver genetic alterations was found in the different tumor lesions of MPLC patients. The prospective Martini histologic prediction of MPLC was discordant with the molecular method for three patients (16.7%), particularly in the prediction of IM (91.7% discordant).ConclusionsComprehensive molecular evaluation allows the unambiguous delineation of clonal relationships among tumors. In comparison, the Martini and Melamed criteria have notable limitations in the recognition of IM. Our results support the adoption of a large panel to supplement histology for strongly discriminating NSCLC clonal relationships in clinical practice.

Clinical significance of tumor cavitation in surgically resected early-stage primary lung cancer

Lung Cancer ◽  
2017 ◽  
Vol 112 ◽  
pp. 57-61 ◽  
Author(s):  
Kenji Tomizawa ◽  
Shigeki Shimizu ◽  
Shuta Ohara ◽  
Toshio Fujino ◽  
Masaya Nishino ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Clinical Significance ◽  
Early Stage ◽  
Primary Lung Cancer

Surgical outcomes for early-stage non-small cell lung cancer at facilities with stereotactic body radiation therapy programs.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 8538-8538
Author(s):  
Yusef Syed ◽  
William A. Stokes ◽  
Onkar Khullar ◽  
Nikhil Sebastian ◽  
Manali Rupji ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Radiation Therapy ◽  
Stereotactic Body Radiation Therapy ◽  
Operative Mortality ◽  
Early Stage ◽  
Mortality Rates ◽  
Small Cell ◽  
Small Cell Lung ◽  
Early Stage Nsclc ◽  
Interaction Testing

8538 Background: Patients undergoing surgery for early-stage non-small cell lung cancer (NSCLC) may be at high-risk for post-operative mortality. Access to stereotactic body radiation therapy (SBRT) offers a less invasive alternative for this population that may facilitate more appropriate patient selection for surgery. Methods: An analysis of all patients with early-stage NSCLC reported to the National Cancer Database between 2004-2015 was performed. Post-operative mortality rates were derived using vital status data. Utilization of SBRT was defined by each facility’s SBRT Experience in years and SBRT-to-Surgery volume ratios, defined by quartiles. Multivariable logistic regression with backward elimination was used to test for independence of associations between exposures of interest and post-operative mortality. Interaction testing was performed to assess the statistical relationship of covariates found to have independent associations. Results: The study cohort consisted of 202,542 patients who underwent surgical resection of clinical stage T1-T2 NSCLC (AJCC 7th edition). The 90-day post-operative mortality rate declined significantly during the study period from 4.6% to 2.6% (p < 0.001). During this period, the proportion of facilities that utilized SBRT increased from 3.3% to 77.5% (p < 0.001) and the proportion of patients treated with SBRT increased significantly from 0.7% to 15.4% (p < 0.001). Lower 90-day post-operative mortality rates were observed at facilities with greater than six years of SBRT experience (OR 0.84, CI 0.76-0.94, p = 0.003) and SBRT-to-Surgery volume ratios above 17% (OR 0.85, CI 0.79-0.92, p < 0.001). Additional covariates associated with 90-day mortality included higher surgical volume, geographic region, year of diagnosis, age, sex, race, insurance status, facility type, Charlson-Deyo score, clinical T stage, histology, anatomic location, surgery type, and prior malignancy. Interaction testing between these covariates was negative, demonstrating that higher SBRT Experience and SBRT-to-Surgery volume ratios were independently associated with lower 90-day surgical mortality. Conclusions: Patients who underwent surgery for early-stage NSCLC at facilities with higher SBRT Experience and SBRT-to-Surgery volume ratios had lower rates of post-operative mortality. These findings suggest that the availability of SBRT may be a surrogate for a more comprehensive and safer approach to matching patients to surgery or SBRT. The observation of higher post-operative mortality rates at facilities without an SBRT program deserves further study.

Sign in / Sign up

Export Citation Format

Share Document