Management of patients with early stage lung cancer – why do some patients not receive treatment with curative intent?

Abstract Backgrounds This study aims to understand the factors that influence whether patients receive potentially curative treatment for early stage lung cancer. Methods Patients included those diagnosed with early stage lung cancer in 2011-2018 and resident in the New Zealand Midland Cancer Network region. Logistic regression model was used to estimate the odds ratios of having curative surgery/ treatment. The Kaplan Meier method was used to examine the all-cause survival and Cox proportional hazard model was used to estimate the hazard ratio of death. Results In total 419/583 (71.9%) of patients with Stage I and II disease were treated with curative intent - 272 (46.7%) patients had curative surgery. Patients not receiving potentially curative treatment were older, were less likely to have NSCLC, had poorer lung function and were more likely to have an ECOG status of 2+. Current smokers were less likely to be treated with surgery and more likely to receive treatment with radiotherapy and chemotherapy. Those who were treated with surgery had a 2-year survival of 87.8% (95% CI: 83.8%-91.8%) and 5-year survival of 69.6% (95% CI: 63.2%-76.0%). SABR has equivalent effect on survival compared to curative surgery (hazard ratio: 0.77, 95% CI: 0.37-1.61). Conclusions The majority of patients with stage I and II lung cancer are managed with potentially curative treatment – mainly surgery and increasingly with SABR. The outcomes of those being diagnosed with stage I and II disease and receiving treatment is positive with 70% surviving 5 years.

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Management of patients with early stage lung cancer – why do some patients not receive treatment with curative intent?

10.21203/rs.2.16814/v4 ◽

2020 ◽

Author(s):

Ross Lawrenson ◽

Chunhuan Lao ◽

Leonie Brown ◽

Lucia Moosa ◽

Lynne Chepulis ◽

...

Keyword(s):

Lung Cancer ◽

Early Stage ◽

Stage I ◽

Curative Treatment ◽

Curative Surgery ◽

Early Stage Lung Cancer ◽

Curative Intent ◽

Receive Treatment ◽

To Receive ◽

Stage Lung Cancer

Abstract Backgrounds This study aims to understand the factors that influence whether patients receive potentially curative treatment for early stage lung cancer. A key question was whether indigenous Māori patients were less likely to receive treatment. Methods Patients included those diagnosed with early stage lung cancer in 2011-2018 and resident in the New Zealand Midland Cancer Network region. Logistic regression model was used to estimate the odds ratios of having curative surgery/ treatment. The Kaplan Meier method was used to examine the all-cause survival and Cox proportional hazard model was used to estimate the hazard ratio of death. Results In total 419/583 (71.9%) of patients with Stage I and II disease were treated with curative intent - 272 (46.7%) patients had curative surgery. Patients not receiving potentially curative treatment were older, were less likely to have non-small cell lung cancer (NSCLC), had poorer lung function and were more likely to have an ECOG performance status of 2+. Current smokers were less likely to be treated with surgery and more likely to receive treatment with radiotherapy and chemotherapy. Those who were treated with surgery had a 2-year survival of 87.8% (95% CI: 83.8%-91.8%) and 5-year survival of 69.6% (95% CI: 63.2%-76.0%). Stereotactic ablative body radiotherapy (SABR) has equivalent effect on survival compared to curative surgery (hazard ratio: 0.77, 95% CI: 0.37-1.61). After adjustment we could find no difference in treatment and survival between Māori and non-Māori. Conclusions The majority of patients with stage I and II lung cancer are managed with potentially curative treatment – mainly surgery and increasingly with SABR. The outcomes of those being diagnosed with stage I and II disease and receiving treatment is positive with 70% surviving 5 years.

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Management of patients with early stage lung cancer – why do some patients not receive treatment with curative intent?

10.21203/rs.2.16814/v3 ◽

2020 ◽

Author(s):

Ross Lawrenson ◽

Chunhuan Lao ◽

Leonie Brown ◽

Lucia Moosa ◽

Lynne Chepulis ◽

...

Keyword(s):

Lung Cancer ◽

Early Stage ◽

Stage I ◽

Curative Treatment ◽

Curative Surgery ◽

Early Stage Lung Cancer ◽

Curative Intent ◽

Receive Treatment ◽

To Receive ◽

Stage Lung Cancer

Abstract Backgrounds This study aims to understand the factors that influence whether patients receive potentially curative treatment for early stage lung cancer. A key question was whether indigenous Māori patients were less likely to receive treatment. Methods Patients included those diagnosed with early stage lung cancer in 2011-2018 and resident in the New Zealand Midland Cancer Network region. Logistic regression model was used to estimate the odds ratios of having curative surgery/ treatment. The Kaplan Meier method was used to examine the all-cause survival and Cox proportional hazard model was used to estimate the hazard ratio of death. Results In total 419/583 (71.9%) of patients with Stage I and II disease were treated with curative intent - 272 (46.7%) patients had curative surgery. Patients not receiving potentially curative treatment were older, were less likely to have non-small cell lung cancer (NSCLC), had poorer lung function and were more likely to have an ECOG performance status of 2+. Current smokers were less likely to be treated with surgery and more likely to receive treatment with radiotherapy and chemotherapy. Those who were treated with surgery had a 2-year survival of 87.8% (95% CI: 83.8%-91.8%) and 5-year survival of 69.6% (95% CI: 63.2%-76.0%). Stereotactic ablative body radiotherapy (SABR) has equivalent effect on survival compared to curative surgery (hazard ratio: 0.77, 95% CI: 0.37-1.61). After adjustment we could find no difference in treatment and survival between Māori and non-Māori. Conclusions The majority of patients with stage I and II lung cancer are managed with potentially curative treatment – mainly surgery and increasingly with SABR. The outcomes of those being diagnosed with stage I and II disease and receiving treatment is positive with 70% surviving 5 years.

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Management of patients with early stage lung cancer – why do some patients not receive treatment with curative intent?

BMC Cancer ◽

10.1186/s12885-020-6580-6 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Ross Lawrenson ◽

Chunhuan Lao ◽

Leonie Brown ◽

Lucia Moosa ◽

Lynne Chepulis ◽

...

Keyword(s):

Lung Cancer ◽

Early Stage ◽

Early Stage Lung Cancer ◽

Curative Intent ◽

Receive Treatment ◽

Stage Lung Cancer

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Stereotactic Body Radiation and Other Ablative Therapies

DeckerMed Surgery ◽

10.2310/surg.2340 ◽

2018 ◽

Author(s):

Praveen Sridhar ◽

Hiran C Fernando

Keyword(s):

Lung Cancer ◽

Radiation Therapy ◽

Thermal Ablation ◽

Stereotactic Body Radiation Therapy ◽

Early Stage ◽

Early Stage Lung Cancer ◽

Curative Intent ◽

Stereotactic Body Radiation ◽

Percutaneous Thermal Ablation ◽

Stage Lung Cancer

Lung cancer is the leading cause of cancer death in both men and women. This is related to the high prevalence and high mortality particularly when presenting at an advanced stage. Surgical resection remains the standard curative therapy for early-stage lung cancer. However, many patients are not able to tolerate resection secondary to poor respiratory reserve and other comorbid diseases. Stereotactic body radiation therapy (SBRT) and percutaneous thermal ablation are minimally invasive techniques that have been used to treat other solid tumors with curative intent. Over the past decade, there has been an expansion in the roles of both SBRT and thermal ablation in the treatment of early-stage lung tumors. The encouraging results from several studies have led to the incorporation of these therapies, particularly SBRT, as the standard of care for curative-intent treatment of patients with medically inoperable early-stage lung cancer. This chapter presents an overview of the approach to patient selection as well as provides a review of the current evidence for SBRT, percutaneous thermal ablation, and bronchoscopic ablation for early-stage nonsmall cell lung cancers. This review contains 3 figures, 4 tables, and 28 references Key Words: stereotactic body radiation therapy, percutaneous thermal ablation, cryoablation, microwave ablation, endoscopic ablation, bronchoscopic ablation, radiofrequency ablation, early stage NSCLC therapy

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Photodynamic therapy using Laserphyrin for centrally located early stage lung cancer

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.7229 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 7229-7229 ◽

Cited By ~ 2

Author(s):

J. Usuda ◽

H. Kato ◽

T. Okunaka ◽

K. Furukawa ◽

H. Honda ◽

...

Keyword(s):

Lung Cancer ◽

Photodynamic Therapy ◽

Early Stage ◽

Stage I ◽

University Hospital ◽

Early Stage Lung Cancer ◽

Endobronchial Ultrasonography ◽

Tokyo Medical ◽

Medical University ◽

Stage Lung Cancer

7229 Background: In central type early stage lung cancer, the tumor must be located only as far as the segmental bronchi and be carcinoma in situ or with only limited invasion into the bronchial wall. Laserphyrin (mono-L-aspartyl chlorine e6, NPe6) is a second generation photosensitize and approved by the Japanese government and has been on sale from June 2004. Methods: Four h after the administration of Laserphyrin 40 mg/m2, we irradiated using diode laser (100 mJ/cm2). Before PDT, we evaluated the tumor lesions and tumor depth using autofluorescence bronchoscopy and endobronchial ultrasonography (EBUS), and we confirmed the area of laser irradiation. Results: From February 1980 to December 2005, a total number of 204 patients with 264 lesions of centrally located early stage lung cancer underwent photodynamic therapy (PDT) in the Department of Thoracic Surgery, Tokyo Medical University Hospital. There were 185 clinical stage 0 lesions and 79 stage I lesions. CRs and PRs were obtained in 224 lesions (84.8%) and 40 lesions (15.2%) out of 264 lesions. From July 2004 to December 2005, we performed Laserphyrin-PDT for 28 lesions of centrally located early stage lung cancer in Tokyo Medical University Hospital. The rate of CR was 92.9% (26 lesions) in 28 lesions. For Laserphyrin-PDT, Skin photosensitivity was very low and the clean-up bronchoscopies were not frequently needed, and the period of hospitalization was shorter compared to that for Photofrin-PDT. Conclusions: We conclude that PDT using Laserphyrin will be a standard option for stage 0 (TisN0M0) and stage I (T1N0M0) centrally located early stage lung cancer. No significant financial relationships to disclose.

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Genomic profiling of early-stage lung cancer for patterns of recurrence.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e23126 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e23126-e23126

Author(s):

Costanzo A DiPerna ◽

Leah Fine

Keyword(s):

Lung Cancer ◽

Cancer Patients ◽

Early Stage ◽

Molecular Profiling ◽

Stage I ◽

Genomic Profiling ◽

Early Stage Lung Cancer ◽

Lung Cancer Patients ◽

Adjuvant Therapies ◽

Stage Lung Cancer

e23126 Background: Currently there is no evidence to support molecular profiling for early stage resected lung cancer patients. However, up to 50% of patients experience recurrence following resection. This is a first-of-a-kind study utilizing comprehensive genomic profiling technology to characterize genomic patterns for risk of recurrence in early stage lung cancer patients within the community hospital setting who have undergone lung surgery. Methods: A total of 60 Stage I-II lung cancer patients, all having undergone pulmonary resection, were evaluated with molecular profiling of their primary lung cancer tissue using Foundation Medicine’s FoundationOneÒ test. Patient age in years ranged from 39-86, and all patients were confirmed Stage I or II based on final pathologic analysis. Samples were taken from three community hospitals that are part of the Addario Lung Cancer Foundation Centers of Excellence program. Patients whose tumors were resected between the years of 2009-2017 were included in this combined retrospective and prospective study. Results: More than 300 genes were evaluated using FoundationOneÒ and patients were segmented to establish similarities and differences. Analysis of segments include gender, recurrence, smoking status among others. Gene patterns across segments are beginning to reveal possible predictive profiles. Final analysis will be completed shortly. Conclusions: Genomic profiling could help predict lung cancer recurrence for early stage lung cancer patients. Similarities amongst patients with recurrences imply that early genomic profiling of lung cancer patients could help predict those patients who would benefit from adjuvant therapies including conventional chemotherapy. Genomic profiling for early stage lung cancer should be studied further and in greater detail to help predict those patients who would benefit from potentially early adjuvant therapies.

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S115 Improving curative-intent treatment rates in early stage lung cancer – results from 775 patients in the NLCA spotlight audit

10.1136/thorax-2018-212555.121 ◽

2018 ◽

Author(s):

N Navani ◽

S Harden ◽

A Khakwani ◽

N Wood ◽

I Woolhouse ◽

...

Keyword(s):

Lung Cancer ◽

Early Stage ◽

Early Stage Lung Cancer ◽

Curative Intent ◽

Stage Lung Cancer

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Circulating tumor DNA (ctDNA) mutation and epigenomic patterns in early-stage lung cancer patients and its utility in identifying patients at high risk for early recurrence.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e14557 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e14557-e14557

Author(s):

Jong Ho Cho ◽

Il-Jin Kim ◽

Junghee Lee ◽

Hong Kwan Kim ◽

Jinseon Lee ◽

...

Keyword(s):

Lung Cancer ◽

Cancer Patients ◽

Somatic Mutations ◽

Early Stage ◽

Circulating Tumor Dna ◽

Stage I ◽

Early Stage Lung Cancer ◽

Lung Cancer Patients ◽

Tumor Dna ◽

Stage Lung Cancer

e14557 Background: Circulating tumor DNA (ctDNA) analysis has been successfully applied to therapy selection and treatment monitoring in advanced cancer patients. However, it is not yet established whether ctDNA can be used clinically for early cancer detection or predicting tumor recurrence in early stage lung cancer patients. Methods: We analyzed pre-operative plasma samples from 55 early stage NSCLC patients (stages I-IIIA) using next-generation sequencing to detect somatic mutations and differential epigenomics patterns, including methylation signatures. Results: Using somatic mutation analysis alone, ctDNA was detected in 42% (23/55) of patients, whereas combined mutational and epigenomic analysis detected ctDNA in 71%. ctDNA detection rate also varied markedly between lung squamous cell carcinoma (SCC) and adenocarcinoma (ADC);using combined analysis of somatic mutations and epigenomic patterns, ctDNA was detected in all SCC patients, while only 55% of ADC (12/22) were ctDNA-positive (p= 0.006). Within the ADC subgroup, ctDNA detection rates using the combined approach were dependent on disease stage: 47% (8/17) in stage I, 100% (2/2) in stage II, and 100% (2/2) in stage IIIA. Importantly, pre-operative ctDNA status was correlated with tumor recurrence post-resection; three of eight (38%) ctDNA-positive stage I ADC patients recurred within 2 years of resection, while only one of nine (11%) ctDNA-negative stage I ADC patients recurred (p= 0.29). Conclusions: Taken together, we show that the combination of somatic mutation detection and epigenomic analysis outperforms each individual biomarker in the detection of ctDNA in early stage lung cancer. Importantly, we also demonstrate that pre-operative ctDNA detection may identify a high-risk population of early stage lung cancer patients that may benefit from (neo)adjuvant therapy.

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