Radiofrequency ablation of stage IA non-small cell lung cancer in medically inoperable patients: Results from the American College of Surgeons Oncology Group Z4033 (Alliance) trial

[Lung cancer measuring 1cm or less: A miniature subset requiring surgery]

INTRODUCTION

Lung cancer measuring 1cm or less has an apparently very good outcome. However, the characteristics permitting their oncological management are unappreciated.

PATIENT AND METHOD

We reviewed 187 patients with such a cancer (145 men and 42 women, mean age 60.2years) and studied the type of surgery performed, the pTNM, and the histological features.

RESULTS

Surgery (19 wedge-resections, 12 segmentectomies, 136 lobectomies, 20 pneumonectomies) was complete (R0) in 97.3%. The tumors, each precisely defined among 98 adenocarcinomas (52.4%), 83 squamous cell carcinomas (44.4%), and 6 others, measured 1mm to 10mm:<5mm (n=41), 6 to 9mm (n=43), and 10mm (n=103). There were 161 pT1 (86.1%), 22 pT2 (11.8%) and 4 pT3; 148 pN0 (79.6%), 18 pN1 (9.7%) and 20 pN2 (10.7%). pN1 and pN2 were present in tumors<5mm (12/41, 29.3%) as well as in the others (26/146, 17.8% P=0.11). Histological examination frequently discovered visceral pleura involvement (tumors:<5mm 12.2% (5/41), 6 to 9mm 7% (3/43), 10mm 13.6% (14/103), P=0.53) and lympho-vascular invasion (12.9%). Five-year survival rate (66.4%) was adversely influenced by age, type of resection, pN and histological features. The survival rate was not better in tumor<5mm.

CONCLUSION

Surgical resection allows the local control of lung cancers<1cm and their complete histological study, a key issue in the therapy of the future, which renders surgery an absolute must even in very small tumors.

[Advances in Diagnosis and Treatment of Multiple Primary Lung Cancer]

多原发性肺癌的发病率和检出率逐年升高。目前临床上诊断多原发性肺癌(multiple primary lung cancer, MPLC)主要参照Martini-Melamed标准和美国胸科医师协会(American College of Chest Physicians, ACCP)标准, 综合考虑临床表现、影像学特征、组织学类型和分子遗传学特征。组织学类型不同的MPLC诊断相对容易, 而组织学类型相同的MPLC诊断仍相当困难。DNA倍体分析、基因突变检测、微卫星多态性分析等分子生物学技术为MPLC的正确诊断提供了新手段, 可评估各病灶的克隆性关系, 帮助鉴别MPLC与转移。MPLC的首选治疗方案为根治性手术, 术式应考虑患者肺功能储备等因素, 选择肺叶切除、肺段切除或楔形切除; 对于不能根治性切除的病灶, 可综合化疗、放疗、立体定向放疗(stereotactic ablative radiotherapy, SABR)、射频消融(radiofrequency ablation, RFA)、分子靶向治疗等。