Single Incision Thoracoscopic Left Lower Lobe Superior Segmentectomy for Non-Small Cell Lung Cancer

Abstract Background The relationship between lung dose-volume histogram (DVH) parameters and radiation pneumonitis (RP) associated with induction concurrent chemoradiotherapy (CCRT) followed by surgery in patients with non-small cell lung cancer (NSCLC) is unclear, particularly when concerning irradiation of the whole lung prior to resection. We performed this study to identify factors associated with grade ≥ 2 RP in such patients. Methods Patients who received induction CCRT (chemotherapy: cisplatin and docetaxel; radiotherapy: 46 Gy/23 fractions) between May 2003 and May 2017 were reviewed. The mean lung dose (MLD) and the percentage of the lung volume that received ≥5 Gy (V5) and ≥ 20 Gy (V20) were calculated. Factors associated with the development of grade ≥ 2 RP were analyzed. Results One hundred and eight patients were included in this study, 34 (31.5%) of whom experienced grade ≥ 2 RP. A V20 ≥ 21%, an MLD ≥10 Gy, and a lower lobe tumor location were significant predictors of grade ≥ 2 RP on univariate analysis (p = 0.007, 0.002, and 0.004, respectively). Moreover, an MLD ≥10 Gy and lower lobe location were significant predictors of grade ≥ 2 RP on multivariate analysis (p = 0.026 and 0.0043, respectively). The cumulative incidence rates of grade ≥ 2 RP at 6 months were 15.7 and 45.6% in patients with MLDs < 10 Gy and ≥ 10 Gy, respectively, and were 23.5 and 55.6% in patients with upper/middle lobe- vs. lower lobe-located tumors, respectively. Conclusions MLD and lower lobe location were predictors of grade ≥ 2 RP in patients who received induction CCRT. It is necessary to reduce the MLD to the greatest extent possible to prevent the occurrence of this adverse event.

Download Full-text

The role of surgery in stage I small-cell lung cancer: A national VA database analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e21109 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e21109-e21109

Author(s):

Ibrahim Azar ◽

Adam Austin ◽

Seongho Kim ◽

Hyejeong Jang ◽

Amit Chopra ◽

...

Keyword(s):

Lung Cancer ◽

Overall Survival ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Lower Lobe ◽

Small Cell ◽

Stage I ◽

Small Cell Lung ◽

Subset Analysis

e21109 Background: Historically, limited stage Small Cell Lung Cancer (SCLC) has been treated with concurrent chemoradiation (CRT). While current NCCN guidelines recommend consideration of lobectomy in node-negative cT1-T2 SCLC, real world data regarding the role of surgery in very limited SCLC is lacking. To our knowledge, only one retrospective study has evaluated the role of surgery in stage I SCLC. Methods: Data from the National VA Cancer Cube were compiled. A total of 1,028 patients with pathologically confirmed Stage I SCLC were studied. Only 661 patients that either received surgery or CRT were included. Interval-censored Weibull and Cox proportional hazard regression models were used to estimate median overall survival (OS) and hazard ratio (HR), respectively. Two survival curves were compared by a Wald test. Subset analysis was performed based on the location of the tumor in the upper vs lower lobe as delineated by ICD-10 codes C34.1 and C34.3. Results: Four-hundred and forty-two patients received concurrent CRT; while 219 underwent treatment that contained surgery (92 surgery only, 84 surgery/chemo, 39 surgery/chemo/radiation and 4 surgery/radiation). The median OS for the surgery-inclusive treatment was 3.87 years (95% CI 3.25-4.60) while median OS for the CRT cohort was 2.43 years (95% CI 2.15-2.72). HR of death for surgery-inclusive treatment when compared to CRT was 0.65 (95% CI 0.54-0.79; p < 0.001). Subset analysis based on the location of the tumor in upper lobe and lower lobe showed improved survival with surgery as compared to CRT regardless of the location. HR for upper lobe was 0.61 (95% CI 0.48-0.78; p < 0.001) and lower lobe 0.60 (95% CI 0.41-0.87; p = 0.007). Multivariable regression analysis accounting for age and ECOG-PS shows a HR 0.60 (95% CI 0.42-0.85; p = 0.004) favoring surgery. Conclusions: Surgery was used in less than a third of patients with stage I SCLC who received treatment. Surgery-inclusive multimodality treatment was associated with a longer overall survival as compared to chemoradiation, independent of age, performance status or tumor location. Our study supports a more expansive role for surgery in stage I SCLC.

Download Full-text

Metastatic Ureteral Involvement of Non-Small Cell Lung Cancer

Case Reports in Medicine ◽

10.1155/2011/394326 ◽

2011 ◽

Vol 2011 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Koichi Kodama ◽

Tetsuya Imao ◽

Kazuto Komatsu

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Malignant Tumors ◽

Lower Lobe ◽

Small Cell ◽

Small Cell Lung ◽

Primary Tumors ◽

The Right

Metastases from a variety of malignant tumors can involve the ureters, but ureteral involvement by lung cancer is extremely rare and usually described at autopsy. We report a rare case of a 76-year-old man who presented with a three-month history of right flank dullness and was noted to have a nonhomogeneous retroperitoneal mass with hydronephrosis of the right kidney on computed tomography of the abdomen. Computed tomography of the thorax showed a nodule in the lower lobe, measuring3×2 cm, in the right lung. After excluding the presence of other primary tumors and metastases, we reached a final diagnosis of solitary retroperitoneal metastasis of adenocarcinoma of the lung. Although rare, in patients of non-small cell lung cancer, presence of hydronephrosis should alert the physician to the possibility of metastasis.

Download Full-text

Lobe-specific lymph node dissection in stage IA non-small-cell lung cancer: a retrospective cohort study

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa369 ◽

2020 ◽

Author(s):

Tariq Ziad Abughararah ◽

Yong Ho Jeong ◽

Fahd Alabbood ◽

Yooyoung Chong ◽

Jae Kwang Yun ◽

...

Keyword(s):

Lung Cancer ◽

Lymph Node ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Clinical Stage ◽

Lower Lobe ◽

Small Cell ◽

Small Cell Lung ◽

Stage Ia ◽

The Impact

Abstract OBJECTIVES To investigate lymph node (LN) metastasis according to tumour location and assess the impact of lobe-specific LN dissection on survival in stage IA non-small-cell lung cancer (NSCLC). METHODS We retrospectively analysed the data of patients with clinical stage IA NSCLC treated with lobectomy and systematic LN dissection at Asan Medical Center (Seoul, Korea) between June 2005 and April 2017. Patients who received neoadjuvant therapy had multiple primary tumours or missed the follow-up during the first postoperative year were excluded. The patients were divided into five groups according to involved lung lobes: right upper lobe (RUL), right middle lobe (RML), right lower lobe (RLL), left upper lobe (LUL) and left lower lobe (LLL), which were further divided into subgroups according to LN station metastasis. Overall survival (OS) and the incidence of metastasis were calculated for each subgroup. Efficacy indices (EIs) were calculated to determine the correlation between each lung lobe and LN station, and the impact of the dissection of these stations on survival. RESULTS A total of 1202 patients were analysed. The 5-year OS in the RUL, RML, RLL, LUL and LLL groups was 74%, 88%, 78%, 80% and 75%, respectively. The incidence of single LN station metastasis was 11%, 10%, 10%, 16% and 14%, respectively. The lobe-specific LNs for RUL, RML, RLL, LUL and LLL were stations 2/3/4, 4/7, 2/4/7, 4/5/6 and 6/7/9, respectively. Moreover, the LN stations with high EIs for RUL, RML, RLL, LUL and LLL were 4, 7, 7, 5 and 7, respectively. In the RUL group, the incidence of metastasis to stations 2, 3 and 4 was 2.3%, 0.5% and 7.6%, and the EI was 0.8, 0.3 and 4.3, respectively. In RML, the incidence of metastasis to stations 4 and 7 was 4% and 6%, and the EI was 1.3 and 2.4, respectively. In RLL, the incidence of metastasis to stations 2, 4 and 7 was 4.4%, 5.6% and 8.3%, and the EI was 1.3, 1.4 and 3.3, respectively. In LUL, the incidence of metastasis to stations 4, 5 and 6 was 1.4%, 11.8% and 2.5%, and the EI was 0.4, 7.1 and 0.5, respectively. In LLL, the incidence of metastasis to stations 6, 7 and 9 was 1.1%, 5.7% and 1.7%, and the EI was 0.6, 2.3 and 0.5, respectively. Furthermore, the OS of patients with lobe-specific LN metastasis was statistically significantly different from that of the non-lobe-specific LN metastasis group with P-values of <0.001 for RUL, 0.002 for RML, 0.002 for RLL, 0.001 for LUL and 0.003 for LLL. CONCLUSIONS Our findings support the use of lobe-specific LN dissection in stage IA NSCLC. When LN stations with high EI were negative, LN metastasis in other stations was unlikely. The incidence of LN metastasis beyond lobe-specific LN stations was ∼1% in all subgroups. Dissection of non-lobe-specific LNs may not improve the OS; however, prospective randomized controlled trials are needed to modify the standard approach.

Download Full-text

Association Between Lower Lobe Location and Upstaging for Early-Stage Non-small Cell Lung Cancer

CHEST Journal ◽

10.1378/chest.125.4.1424 ◽

2004 ◽

Vol 125 (4) ◽

pp. 1424-1430 ◽

Cited By ~ 22

Author(s):

Ana T. Rocha ◽

Meg McCormack ◽

Gustavo Montana ◽

Gilbert Schreiber

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Early Stage ◽

Lower Lobe ◽

Small Cell ◽

Small Cell Lung

Download Full-text

A Rare Delayed Atypical Pseudoprogression in Nivolumab-Treated Non-Small-Cell Lung Cancer

Case Reports in Oncological Medicine ◽

10.1155/2019/8356148 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4

Author(s):

Suyanto Suyanto ◽

Daniel Yeo ◽

Sarah Khan

Keyword(s):

Lung Cancer ◽

T Cells ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Checkpoint Inhibitors ◽

Lower Lobe ◽

Small Cell ◽

Tumour Cells ◽

Tumour Regression ◽

Small Cell Lung

Immune checkpoint inhibitors such as Nivolumab work by preventing the inactivation of host T-cells by tumour cells, thereby allowing the T-cells to attack the tumour cells, which results in tumour tissue necrosis. We describe a 78-year-old woman with metastatic lung adenocarcinoma treated with Nivolumab after disease progression following first-line chemotherapy. Computed tomography (CT) after 3 cycles showed a smaller left lower lobe (LLL) primary and stable right lower lobe (RLL) metastatic lesion. CT after 9 cycles showed a reduced RLL mass and an increase in LLL primary. However, CT after 15 cycles showed that the RLL mass had further reduced in size but the LLL mass was significantly larger. The biopsy of the LLL lesion showed necrotic areas and reactive inflammatory changes, without residual malignancy. A repeat CT after further 4 cycles confirmed tumour regression in both the primary and the metastatic lesions. There was a prior reported case of pseudoprogression in a non-small-cell lung cancer patient who had 7 cycles of Nivolumab, and it was diagnosed during a further line of chemotherapy. Here, we report a patient with pseudoprogression during treatment with Nivolumab and at a much later time, after 15 cycles.

Download Full-text