Challenging pretreatment aspects of lung cancer in Georgia

Lung cancer (LC) continues to be a significant worldwide public health issue. There are several publications addressing specifics of LC worldwide, but none concerning Georgia- a country with high number of smoking population and LC cases. Based on the above facts we conducted the first study in the country that aims both evaluating current pretreatment LC challenges, including barriers for early diagnostics and indicating the future strategies for improved LC care We first analyzed LC statistics and the smoking patterns in the country. Further, we identified other challenging issues in pretreatment diagnostics and staging aspects and finally, provided a survey among LC specialists all over the country to evaluate the situation regarding access and use of radiology investigations and other staging procedures. The survey questionnaire was distributed among LC specialists in main cancer hospitals (n=13) across the country. We identify multiple health challenges. Still there are a high number of smokers in the country which clearly indicates that additional measures focusing on smoking cessation are urgently needed. This is further materialized in the fact that the majority of patients with LC are diagnosed with either locally advanced or metastatic disease. Activation of preventive programs and implementation of LC screening for early detection should hopefully lead to further reduction of national LC mortality rates. We underline the urgent need for implementation of country-adapted diagnostic and therapeutic guidelines and protocols as well as enforcing multidisciplinary team meetings. The great need to introduce screening programs in high risk groups, improve access to modern treatment modalities and standardize national diagnostic and treatment protocols are of paramount importance for better LC care.

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The Role of Surgery in Lung Cancer Treatment: Present Indications and Future Perspectives—State of the Art

Cancers ◽

10.3390/cancers13153711 ◽

2021 ◽

Vol 13 (15) ◽

pp. 3711

Author(s):

François Montagne ◽

Florian Guisier ◽

Nicolas Venissac ◽

Jean-Marc Baste

Keyword(s):

Lung Cancer ◽

Residual Disease ◽

State Of The Art ◽

Locally Advanced ◽

Small Cell Lung ◽

Lung Cancers ◽

Screening Programs ◽

Systemic Therapies

Non-small cell lung cancers (NSCLC) are different today, due to the increased use of screening programs and of innovative systemic therapies, leading to the diagnosis of earlier and pre-invasive tumors, and of more advanced and controlled metastatic tumors. Surgery for NSCLC remains the cornerstone treatment when it can be performed. The role of surgery and surgeons has also evolved because surgeons not only perform the initial curative lung cancer resection but they also accompany and follow-up patients from pre-operative rehabilitation, to treatment for recurrences. Surgery is personalized, according to cancer characteristics, including cancer extensions, from pre-invasive and local tumors to locally advanced, metastatic disease, or residual disease after medical treatment, anticipating recurrences, and patients’ characteristics. Surgical management is constantly evolving to offer the best oncologic resection adapted to each NSCLC stage. Today, NSCLC can be considered as a chronic disease and surgery is a valuable tool for the diagnosis and treatment of recurrences, and in palliative conditions to relieve dyspnea and improve patients’ comfort.

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Lung cancer in Kazakhstan: age-gender features

Oncologia i radiologia Kazakhstana ◽

10.52532/2663-4864-2020-1-55-3-8 ◽

2020 ◽

Vol 55 (1) ◽

pp. 3-8

Author(s):

D. R. KAIDAROVA ◽

O. V. SHATKOVSKAYA ◽

Zh. Zh. ZHOLDYBAY ◽

A. Zh. ZHYLKAIDAROVA ◽

A. S. PANINA

Keyword(s):

Lung Cancer ◽

Age Groups ◽

Risk Groups ◽

Pilot Projects ◽

Men And Women ◽

Screening Programs ◽

Incidence And Mortality ◽

Gender And Age ◽

Gender Characteristics ◽

Gender Features

Relevance: Over the years, lung cancer (LC) remains the leading cause of cancer deaths in Kazakhstan. In 2018, LC was diagnosed in 3741 people in the RK, and 2377 dies from LC. The purpose of this study was to assess the age-gender characteristics of morbidity and mortality from LC in Kazakhstan based on statistical and literature data. Results: The conducted analysis by gender and age showed a consistent and significant increase in LC mortality in the RK, starting from the age of 40-44 years. The highest incidence and mortality were registered in the age groups of 65-69 years and 70+ years. In general, in all age categories, the incidence and mortality in men exceeded the incidence and mortality in women by 4.5–5.3 times. The highest mortality in men and women of all ages was registered in 2009 (34.3‰ and 6.9‰, respectively), the lowest – in 2019 (20.8‰ in men and 4.6‰ in women). Conclusions: The results of the assessment can be used to improve early diagnosis of LC and in the preparation of national screening programs and regional pilot projects for LC prevention and the identification of risk groups. The use of the results will contribute to increasing the effectiveness of treatment, improving the five-year survival of patients, reducing the level of neglect and mortality from LC.

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The effect of different treatment modalities on survival in elderly patients with locally advanced non-small cell lung cancer

Pulmonology ◽

10.1016/j.pulmoe.2019.11.007 ◽

2021 ◽

Vol 27 (1) ◽

pp. 26-34 ◽

Cited By ~ 1

Author(s):

A. Sakin ◽

S. Sahin ◽

M.M. atci ◽

A. Sakin ◽

N. Yasar ◽

...

Keyword(s):

Lung Cancer ◽

Elderly Patients ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Locally Advanced ◽

Small Cell ◽

Treatment Modalities ◽

Small Cell Lung

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ANALYSIS OF TREATMENT OUTCOMES IN LOCALLY ADVANCED CERVICAL CARCINOMA - AN INSTITUTIONAL STUDY

10.36106/ijsr/6204770 ◽

2021 ◽

pp. 55-57

Author(s):

S. Selvalakshmi

Keyword(s):

Treatment Failure ◽

Cervical Carcinoma ◽

Locally Advanced ◽

Disease Free Survival ◽

Treatment Modalities ◽

Early Age ◽

Carcinoma Cervix ◽

Free Survival ◽

Screening Programs ◽

Advanced Cervical Carcinoma

Introduction:Carcinoma cervix is the second most common cancer among women in India. Carcinoma cervix is associated with many risk factors such as multi parity, early age at marriage, early age at coitus and the most important basic cause is poor socioeconomic status, illiteracy, lack of proper self-hygiene, lack of awareness of screening programs and treatment modalities. The main objective of this study is to analyze various outcomes following treatment of locally advanced carcinoma cervix and also to determine the causes of treatment failure so as to improve disease free survival, progression free survival and overall survival. Materials And Methods: A retrospective study was conducted among 191 locally advanced cervical carcinoma patients treated in the Department of Radiotherapy, Stanley Medical College and Hospital, Chennai during the period between 2015 and 2019. Various parameters of our study included age distribution, chief complaints at presentation, histopathological types and grades, staging, type of treatment, details of brachytherapy, response assessment and follow up. Results: Majority of them belong to stage II(50%) followed by stage III (41%). 14 patients belong to stage IV and only 4 patients belong to stage I. Among them 102 patients (53.4%) showed complete response and 34 patients (17.8%) showed partial response. Discussion: Most of the patients were in 4th and 5th decade which is very close to TNCRPregistry. Stage grouping of patients is considered most signicant in assessing the outcome of the treatment wherein it was found necessary to identify and present the symptoms at early stage to fasten the treatment and aim at complete cure. Conclusion: This study brings a clear picture of the possible reasons for treatment failure in locally advanced cervical carcinoma and highlights necessary steps to be implemented in improving infrastructure facilities in Government hospitals that would result in better treatment for poor patients with maximum benets.

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Epidemiology, treatment, and outcomes in locally advanced spindle cell lung cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e21048 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e21048-e21048

Author(s):

Michelle Sterpi ◽

Shivani Handa ◽

Kathan Mehta ◽

Anup Kasi

Keyword(s):

Lung Cancer ◽

Overall Survival ◽

Adjuvant Chemotherapy ◽

Surgical Resection ◽

Cell Lung Cancer ◽

Spindle Cell ◽

Locally Advanced ◽

Treatment Modalities ◽

Adjuvant Setting ◽

Poorly Differentiated

e21048 Background: Spindle cell lung cancer (SpCC) is a rare type of NSCLC which portends a poor prognosis. Due to the rarity of diagnosis, there is a dearth of information about the epidemiology and overall survival for these patients. Methods: We performed a retrospective analysis using the SEER database from 1975-2016 to study the demographics, treatment modalities and outcomes for patients with locally advanced SpCC. Data regarding age, sex, race, pathological grade, staging, treatment, overall and disease specific survival was extracted. Hazards ratios were calculated to identify any difference in mortality between patients who received surgery alone versus those who received adjuvant chemotherapy or radiation. Results: A total of 936 cases of SpCC were identified, out of which 367 (39%) patients had locally advanced disease. 84% cases were diagnosed after the age of 60, with peak incidence occurring in the 70-74 age group. 87% were Caucasians, and 56% were males. 68% of the tumors were poorly differentiated. In terms of the treatment modalities for locally advanced SpCC, surgical resection was performed only in 58.5% cases. 27% patients received systemic chemotherapy, out of which 50% was in the adjuvant setting after surgery. 32 % patients received radiation therapy, only 38.5% of which was in the adjuvant setting. No statistically significant difference in mortality was seen in patients who received surgery alone vs adjuvant RT vs adjuvant chemotherapy. However, pts who did not receive surgery had a higher odds of mortality (OR = 4.2, p value 0.0001). Similarly, pts who only received chemotherapy alone had a higher odds of mortality vs those who received chemotherapy along with surgery (OR = 3.4, p-0.045), Overall survival was 25% for patients with localized disease, 9.5% for regional and only 2.6% for distant metastatic disease. For locally advanced SpCC, the observed cumulative 1-year survival was 54.8 % and declined to 29.2% after 5 years. Conclusions: Majority of the spindle cell carcinoma cases are poorly differentiated and present at an advanced stage at the time of diagnosis. For locally advanced SpCC, surgical resection can improve survival. Randomized trials are needed to test efficacy of adjuvant therapies.

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High dose rate endobronchial brachytherapy in the management of advanced lung cancer - comparison according to the presence of lung atelectasis

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh210608090b ◽

2021 ◽

pp. 90-90

Author(s):

Marko Bojovic ◽

Nensi Lalic ◽

Tatjana Boskovic ◽

Miroslav Ilic ◽

Olivera Ivanov ◽

...

Keyword(s):

Lung Cancer ◽

Dose Rate ◽

Combined Treatment ◽

Locally Advanced ◽

Progression Free Survival ◽

High Dose Rate ◽

Treatment Modalities ◽

Advanced Lung Cancer ◽

High Dose ◽

Before And After

Introduction/Objective. Locally advanced lung cancer (LC) is often accompanied with atelectasis of either a part or the entire lung. The aim of this study was to establish the benefits of brachytherapy on the patients? quality of life (QoL), the length of the progression free survival (PFS), and the overall survival (OS) as related to the presence or absence of atelectasis after the applied treatment. Methods. The total of 100 patients with locally advanced LC or endobronchial metastasis of other malignancy were treated with the high dose rate endobronchial brachytherapy (HDR-EBB) in 2017. For observing the patients? clinical characteristics, the PFS and OS, the patients were classified into four groups according to the presence of atelectasis before and after HDR-EBB. Results. After HDR-EBB alone or combined with other treatment modalities, a statistically significant symptom alleviation was registered for all the symptoms except cough (p<0.05). The significantly highest PFS value was registered among the patients with atelectasis prior but not after HDR-EBB. The longest survival was registered in the patients who had atelectasis prior to, but not after HDR-EBB, as well as among the patients without of atelectasis either before or after EBB. Conclusion. HDR-EBB is an efficient method that improved the QoL of most patients. There were improved rates of re-aeration after HDR-EBB treatment alone and as a part of combined treatment. Re-aeration after EBB is a positive prognostic factor with respect to PFS and OS of these patients.

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A competing risk nomogram predicting cause-specific mortality in patients with lung adenosquamous carcinoma

BMC Cancer ◽

10.1186/s12885-020-06927-w ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Xiao Wu ◽

Wenfeng Yu ◽

R. H. Petersen ◽

Hongxu Sheng ◽

Yiqing Wang ◽

...

Keyword(s):

Lung Cancer ◽

Risk Model ◽

Adenosquamous Carcinoma ◽

Model Performance ◽

Risk Groups ◽

High Risk Group ◽

Competing Risk ◽

Predictive Tool ◽

Treatment Protocols ◽

Specific Mortality

Abstract Background Adenosquamous carcinoma (ASC) is an uncommon histological subtype of lung cancer. The purpose of this study was to assess the cumulative incidences of lung cancer-specific mortality (LC-SM) and other cause-specific mortality (OCSM) in lung ASC patients, and construct a corresponding competing risk nomogram for LC-SM. Methods Data on 2705 patients with first primary lung ASC histologically diagnosed between 2004 and 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The cumulative incidence function (CIF) was utilized to calculate the 3-year and 5-year probabilities of LC-SM and OCSM, and a competing risk model was built. Based on the model, we developed a competing risk nomogram to predict the 3-year and 5-year cumulative probabilities of LC-SM and the corresponding concordance indexes (C-indexes) and calibration curves were derived to assess the model performance. To evaluate the clinical usefulness of the nomogram, decision curve analysis (DCA) was conducted. Furthermore, patients were categorized into three groups according to the tertile values of the nomogram-based scores, and their survival differences were assessed using CIF curves. Results The 3-year and 5-year cumulative mortalities were 49.6 and 55.8% for LC-SM and 8.2 and 11.8% for OCSM, respectively. In multivariate analysis, increasing age, male sex, no surgery, and advanced T, N and M stages were related to a significantly higher likelihood of LC-SM. The nomogram showed good calibration, and the 3-year and 5-year C-indexes for predicting the probabilities of LC-SM in the validation cohort were both 0.79, which were almost equal to those of the ten-fold cross validation. DCA demonstrated that using the nomogram gained more benefit when the threshold probabilities were set within the ranges of 0.24–0.89 and 0.25–0.91 for 3-year and 5-year LCSM, respectively. In both the training and validation cohorts, the high-risk group had the highest probabilities of LC-SM, followed by the medium-risk and low-risk groups (both P < 0.0001). Conclusions The competing risk nomogram displayed excellent discrimination and calibration for predicting LC-SM. With the aid of this individualized predictive tool, clinicians can more expediently devise appropriate treatment protocols and follow-up schedules.

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New treatment modalities in the early stage and locally advanced non-small cell lung cancer

Klinicka onkologie ◽

10.48095/ccko2021s43 ◽

2021 ◽

Vol 34 (Suppl 1) ◽

Author(s):

Daniel Krejčí ◽

Ferdinand Třebický ◽

Jan Fanta ◽

Petr Opálka ◽

Norbert Pauk

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Early Stage ◽

Locally Advanced ◽

Small Cell ◽

Treatment Modalities ◽

Small Cell Lung ◽

New Treatment

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A Competing Risk Nomogram Predicting Cause-specific Mortality in Patients with Lung Adenosquamous Carcinoma

10.21203/rs.3.rs-15998/v2 ◽

2020 ◽

Author(s):

Xiao Wu ◽

Wenfeng Yu ◽

RH Petersen ◽

Hongxu Sheng ◽

Yiqing Wang ◽

...

Keyword(s):

Lung Cancer ◽

Risk Model ◽

Adenosquamous Carcinoma ◽

Model Performance ◽

Risk Groups ◽

High Risk Group ◽

Competing Risk ◽

Predictive Tool ◽

Treatment Protocols ◽

Specific Mortality

Abstract Background: Adenosquamous carcinoma (ASC) is an uncommon histological subtype of lung cancer. The purpose of this study was to assess the cumulative incidences of lung cancer-specific mortality (LC-SM) and other cause-specific mortality (OCSM) in lung ASC patients, and construct a corresponding competing risk nomogram for LC-SM. Methods: Data on 2,705 patients with first primary lung ASC histologically diagnosed between 2004 and 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The cumulative incidence function (CIF) was utilized to calculate the 3-year and 5-year probabilities of LC-SM and OCSM, and a competing risk model was built. Based on the model, we developed a competing risk nomogram to predict the 3-year and 5-year cumulative probabilities of LC-SM and the corresponding concordance indexes (C-indexes) and calibration curves were derived to assess the model performance. To evaluate the clinical usefulness of the nomogram, decision curve analysis (DCA) was conducted. Furthermore, patients were categorized into three groups according to the tertile values of the nomogram-based scores, and their survival differences were assessed using CIF curves. Results: The 3-year and 5-year cumulative mortalities were 49.6% and 55.8% for LC-SM and 8.2% and 11.8% for OCSM, respectively. In multivariate analysis, increasing age, male sex, no surgery, and advanced T, N and M stages were related to a significantly higher likelihood of LC-SM. The nomogram showed good calibration, and the 3-year and 5-year C-indexes for predicting the probabilities of LC-SM in the validation cohort were both 0.79, which were almost equal to those of the ten-fold cross validation. DCA demonstrated that using the nomogram gained more benefit when the threshold probabilities were set within the ranges of 0.24-0.89 and 0.25-0.91 for 3-year and 5-year LCSM, respectively. In both the training and validation cohorts, the high-risk group had the highest probabilities of LC-SM, followed by the medium-risk and low-risk groups (both P<0.0001). Conclusions: The competing risk nomogram displayed excellent discrimination and calibration for predicting LC-SM. With the aid of this individualized predictive tool, clinicians can more expediently devise appropriate treatment protocols and follow-up schedules.

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