301
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De Ruysscher D, Peeters S, Troost EG. Approaches in patients with locally advanced NSCLC: a radiation oncologist's perspective. Lung Cancer 2015. [DOI: 10.1183/2312508x.10010314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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302
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Xu X, Ye X, Liu G, Zhang T. Targeted percutaneous microwave ablation at the pulmonary lesion combined with mediastinal radiotherapy with or without concurrent chemotherapy in locally advanced non-small cell lung cancer evaluation in a randomized comparison study. Med Oncol 2015; 32:227. [PMID: 26243048 DOI: 10.1007/s12032-015-0672-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 07/23/2015] [Indexed: 12/22/2022]
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303
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Patterns of Disease Recurrence after SABR for Early Stage Non–Small-Cell Lung Cancer: Optimizing Follow-Up Schedules for Salvage Therapy. J Thorac Oncol 2015. [DOI: 10.1097/jto.0000000000000576] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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304
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Eberhardt WEE, De Ruysscher D, Weder W, Le Péchoux C, De Leyn P, Hoffmann H, Westeel V, Stahel R, Felip E, Peters S. 2nd ESMO Consensus Conference in Lung Cancer: locally advanced stage III non-small-cell lung cancer. Ann Oncol 2015; 26:1573-88. [PMID: 25897013 DOI: 10.1093/annonc/mdv187] [Citation(s) in RCA: 273] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 04/09/2015] [Indexed: 12/25/2022] Open
Abstract
To complement the existing treatment guidelines for all tumour types, ESMO organises consensus conferences to focus on specific issues in each type of tumour. The 2nd ESMO Consensus Conference on Lung Cancer was held on 11-12 May 2013 in Lugano. A total of 35 experts met to address several questions on non-small-cell lung cancer (NSCLC) in each of four areas: pathology and molecular biomarkers, first-line/second and further lines of treatment in advanced disease, early-stage disease and locally advanced disease. For each question, recommendations were made including reference to the grade of recommendation and level of evidence. This consensus paper focuses on locally advanced disease.
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Affiliation(s)
- W E E Eberhardt
- Department of Medical Oncology, West German Cancer Centre, University Hospital, University Duisburg-Essen, Ruhrlandklinik, Essen, Germany
| | - D De Ruysscher
- Department of Radiation Oncology, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - W Weder
- Division of Thoracic Surgery, University Hospital Zürich, Zürich, Switzerland
| | - C Le Péchoux
- Department of Radiation Oncology, Gustave Roussy Cancer Institute, Villejuif, France
| | - P De Leyn
- Department of Thoracic Surgery, University Hospitals, KU Leuven, Leuven, Belgium
| | - H Hoffmann
- Department of Thoracic Surgery, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - V Westeel
- Department of Chest Disease, University Hospital, Besançon, France
| | - R Stahel
- Clinic of Oncology, University Hospital Zürich, Zürich, Switzerland
| | - E Felip
- Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - S Peters
- Département d'Oncologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
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305
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Moschini I, Dell'Anna C, Losardo PL, Bordi P, D'Abbiero N, Tiseo M. Radiotherapy of non-small-cell lung cancer in the era of EGFR gene mutations and EGF receptor tyrosine kinase inhibitors. Future Oncol 2015; 11:2329-42. [DOI: 10.2217/fon.15.156] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Non-small-cell lung cancer (NSCLC) occurs, approximately, in 80–85% of all cases of lung cancer. The majority of patients present locally advanced or metastatic disease when diagnosed, with poor prognosis. The discovery of activating mutations in the EGFR gene has started a new era of personalized treatment for NSCLC patients. To improve the treatment outcome in patients with unresectable NSCLC and, in particular, EGFR mutated, a combined strategy of radiotherapy and medical treatment can be undertaken. In this review we will discuss preclinical data regarding EGF receptor (EGFR) tyrosine kinase inhibitors (TKIs) and radiotherapy, available clinical trials investigating efficacy and toxicity of combined treatment (thoracic or whole brain radiotherapy and EGFR-TKIs) and, also, the role of local radiation in mutated EGFR patients who developed EGFR-TKI resistance.
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Affiliation(s)
| | | | | | - Paola Bordi
- Medical Oncology Unit, University Hospital of Parma, Italy
| | | | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Italy
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306
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Abstract
The purpose of this article is to provide an update on evidence-based methods for mediastinal staging in patients with lung cancer. This is a review of the recently published studies and a summary of relevant guidelines addressing the role of CT scan, PET scan, endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA), and mediastinoscopy as pertinent to lung cancer staging and restaging. The focus is on how these diagnostic methods fit into the best algorithm for patients with chest imaging abnormalities suspected of malignant disease. Several studies, meta-analyses, and systematic reviews specifically targeted the role of PET scan, EBUS-TBNA, and mediastinoscopy for detecting mediastinal lymph node involvement in patients suffering from lung cancer. Based on the recommendations from the currently published guidelines, algorithms of care are proposed for staging and restaging of the mediastinum.
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307
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De Tollenaere C, Lievens Y, Vandecasteele K, Vermaelen K, Surmont V. Unresectable stage III non-small-cell lung cancer: Have we made any progress? World J Respirol 2015; 5:140-151. [DOI: 10.5320/wjr.v5.i2.140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 03/27/2015] [Accepted: 06/08/2015] [Indexed: 02/06/2023] Open
Abstract
Lung cancer is responsible for the most cancer deaths worldwide with an incidence that is still rising. One third of patients have unresectable stage IIIA or stage IIIB disease. The standard of care for locally advanced disease in patients with good performance status consists of combined modality therapy in particular concurrent chemoradiotherapy. But despite a lot of efforts done in the past, local control and survival of patients with unresectable stage III non-small-cell lung cancer (NSCLC) remains poor. Improving outcomes for patients with unresectable stage III NSCLC has therefore been an area of ongoing research. Research has focused on improving systemic therapy, improving radiation therapy or adding a maintenance therapy to consolidate the initial therapy. Also implementation of newer targeted therapies and immunotherapy has been investigated as well as the option of prophylactic cranial irradiation. This article reviews the latest literature on improving local control and preventing distant metastases. It seems that we have reached a plateau with conventional chemotherapy. Radiotherapy dose escalation did not improve outcome although increasing radiation dose-intensity with new radiotherapy techniques and the use of newer agents, e.g., immunotherapy might be promising. In the future well-designed clinical trials are necessary to prove those promising results.
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308
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Oberije C, De Ruysscher D, Houben R, van de Heuvel M, Uyterlinde W, Deasy JO, Belderbos J, Dingemans AMC, Rimner A, Din S, Lambin P. A Validated Prediction Model for Overall Survival From Stage III Non-Small Cell Lung Cancer: Toward Survival Prediction for Individual Patients. Int J Radiat Oncol Biol Phys 2015; 92:935-44. [PMID: 25936599 PMCID: PMC4786012 DOI: 10.1016/j.ijrobp.2015.02.048] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 02/18/2015] [Accepted: 02/26/2015] [Indexed: 12/25/2022]
Abstract
PURPOSE Although patients with stage III non-small cell lung cancer (NSCLC) are homogeneous according to the TNM staging system, they form a heterogeneous group, which is reflected in the survival outcome. The increasing amount of information for an individual patient and the growing number of treatment options facilitate personalized treatment, but they also complicate treatment decision making. Decision support systems (DSS), which provide individualized prognostic information, can overcome this but are currently lacking. A DSS for stage III NSCLC requires the development and integration of multiple models. The current study takes the first step in this process by developing and validating a model that can provide physicians with a survival probability for an individual NSCLC patient. METHODS AND MATERIALS Data from 548 patients with stage III NSCLC were available to enable the development of a prediction model, using stratified Cox regression. Variables were selected by using a bootstrap procedure. Performance of the model was expressed as the c statistic, assessed internally and on 2 external data sets (n=174 and n=130). RESULTS The final multivariate model, stratified for treatment, consisted of age, gender, World Health Organization performance status, overall treatment time, equivalent radiation dose, number of positive lymph node stations, and gross tumor volume. The bootstrapped c statistic was 0.62. The model could identify risk groups in external data sets. Nomograms were constructed to predict an individual patient's survival probability (www.predictcancer.org). The data set can be downloaded at https://www.cancerdata.org/10.1016/j.ijrobp.2015.02.048. CONCLUSIONS The prediction model for overall survival of patients with stage III NSCLC highlights the importance of combining patient, clinical, and treatment variables. Nomograms were developed and validated. This tool could be used as a first building block for a decision support system.
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Affiliation(s)
- Cary Oberije
- Radiation Oncology, Research Institute GROW of Oncology, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Dirk De Ruysscher
- Radiation Oncology, Research Institute GROW of Oncology, Maastricht University Medical Center, Maastricht, The Netherlands; Universitaire Ziekenhuizen Leuven, KU Leuven, Belgium
| | - Ruud Houben
- Radiation Oncology, Research Institute GROW of Oncology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Michel van de Heuvel
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Wilma Uyterlinde
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Jose Belderbos
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Anne-Marie C Dingemans
- Department of Pulmonology, University Hospital Maastricht, Research Institute GROW of Oncology, Maastricht, The Netherlands
| | | | - Shaun Din
- Memorial Sloan Kettering Cancer Center, New York
| | - Philippe Lambin
- Radiation Oncology, Research Institute GROW of Oncology, Maastricht University Medical Center, Maastricht, The Netherlands
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309
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Adebahr S, Collette S, Shash E, Lambrecht M, Le Pechoux C, Faivre-Finn C, De Ruysscher D, Peulen H, Belderbos J, Dziadziuszko R, Fink C, Guckenberger M, Hurkmans C, Nestle U. LungTech, an EORTC Phase II trial of stereotactic body radiotherapy for centrally located lung tumours: a clinical perspective. Br J Radiol 2015; 88:20150036. [PMID: 25873481 PMCID: PMC4628529 DOI: 10.1259/bjr.20150036] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 04/02/2015] [Accepted: 04/13/2015] [Indexed: 12/16/2022] Open
Abstract
Evidence supports stereotactic body radiotherapy (SBRT) as a curative treatment option for inoperable early stage non-small-cell lung cancer (NSCLC) resulting in high rates of tumour control and low risk of toxicity. However, promising results are mainly derived from SBRT of peripheral pulmonary lesions, whereas SBRT for the central tumours can lead to severe radiation sequelae owing to the spatial proximity to the serial organs at risk. Robust data on the tolerance of mediastinal structures to high-dose hypofractionated radiation are limited; furthermore, there are many open questions regarding the efficiency, safety and response assessment of SBRT in inoperable, centrally located early stage NSCLC, which are addressed in a prospective multicentre study [sponsored by the European Organization for Research and Treatment of Cancer (EORTC 22113-08113-LungTech)]. In this review, we summarize the current status regarding SBRT for centrally located early stage NSCLC that leads to the rationale of the LungTech trial. Outline and some essential features of the study with focus on a summary of current experiences in dose/fraction-toxicity coherences after SBRT to the mediastinal structures that lead to LungTech normal tissue constraints are provided.
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Affiliation(s)
- S Adebahr
- Department of Radiation Oncology, University Medical Center Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Partner Site Freiburg, Germany
| | | | - E Shash
- EORTC Headquarters, Brussels, Belgium
| | - M Lambrecht
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, Netherlands
| | - C Le Pechoux
- Department of Radiotherapy, Institut Gustave Roussy, Villejuif, France
| | - C Faivre-Finn
- Institute of Cancer Sciences, Radiotherapy Related Research, The Christie NHS Foundation Trust and University of Manchester, Manchester, UK
| | - D De Ruysscher
- KU Leuven–University of Leuven, University Hospitals Leuven, Department of Radiation Oncology, Leuven, Belgium
| | - H Peulen
- Department of Radiation Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - J Belderbos
- Department of Radiation Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - R Dziadziuszko
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - C Fink
- Department of Radiology, Allgemeines Krankenhaus Celle, Celle, Germany
| | - M Guckenberger
- Department of Radiation Oncology, University of Zurich, Zurich, Switzerland
| | - C Hurkmans
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, Netherlands
| | - U Nestle
- Department of Radiation Oncology, University Medical Center Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Partner Site Freiburg, Germany
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310
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Imaging surveillance and survival for surgically resected non-small-cell lung cancer. J Surg Res 2015; 200:171-6. [PMID: 26231974 DOI: 10.1016/j.jss.2015.06.048] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 05/29/2015] [Accepted: 06/19/2015] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The importance of imaging surveillance after treatment for lung cancer is not well characterized. We examined the association between initial guideline recommended imaging surveillance and survival among early-stage resected non-small-cell lung cancer (NSCLC) patients. METHODS A retrospective study was conducted using Surveillance, Epidemiology, and End Results-Medicare data (1995-2010). Surgically resected patients, with stage I and II NSCLC, were categorized by imaging received during the initial surveillance period (4-8 mo) after surgery. Primary outcome was overall survival. Secondary treatment interventions were examined as intermediary outcomes. RESULTS Most (88%) patients had at least one outpatient clinic visit, and 24% received an initial computerized tomography (CT) during the first surveillance period. Five-year survival by initial surveillance imaging was 61% for CT, 58% for chest radiography, and 60% for no imaging. After adjustment, initial CT was not associated with improved overall survival (hazard ratio [HR], 1.04; 95% confidence interval [CI] 0.96-1.14). On subgroup analysis, restricted to patients with demonstrated initial postoperative follow-up, CT was associated with a lower overall risk of death for stage I patients (HR, 0.85; 95% CI, 0.74-0.98), but not for stage II (HR, 1.01; 95% CI, 0.71-1.42). There was no significant difference in rates of secondary interventions predicted by type of initial imaging surveillance. CONCLUSIONS Initial surveillance CT is not associated with improved overall or lung cancer-specific survival among early-stage NSCLC patients undergoing surgical resection. Stage I patients with early follow-up may represent a subpopulation that benefits from initial surveillance although this may be influenced by healthy patient selection bias.
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311
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Kadota K, Buitrago D, Lee MC, Villena-Vargas J, Sima CS, Jones DR, Travis WD, Adusumilli PS. Tumoral CD10 expression correlates with high-grade histology and increases risk of recurrence in patients with stage I lung adenocarcinoma. Lung Cancer 2015; 89:329-36. [PMID: 26141216 DOI: 10.1016/j.lungcan.2015.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 05/26/2015] [Accepted: 06/05/2015] [Indexed: 01/15/2023]
Abstract
OBJECTIVE CD10 (neutral endopeptidase) is expressed in various normal and tumor cells, and its biological function can be controlled through enzymatic activity and signaling pathways. We investigated whether CD10 expression predicted disease recurrence and whether it correlated with histologic subtypes of stage I lung adenocarcinoma. MATERIALS AND METHODS We reviewed tumor slides of resected pathologic stage I lung adenocarcinomas (1995-2009). Tumors were classified according to the IASLC/ATS/ERS classification. CD10 immunohistochemistry was performed using tissue microarrays (n=915). We combined the intensity (0-3) and distribution scores (0-2) for CD10 to create a total score (0-5). Risk of recurrence was estimated using competing risks methods. RESULTS In the training cohort (n=313), risk of recurrence of patients with high tumoral CD10 (score>1, n=57) was significantly higher (5-year cumulative incidence of recurrence [CIR], 37%) than in those with low CD10 (score≤1; n=256; 5-year CIR, 16%; P<0.001); this finding was confirmed in the validation cohort (n=602, P=0.036). High tumoral CD10 was associated with higher risk of recurrence in acinar (P=0.007) and papillary predominant tumors (P=0.022). High tumoral CD10 was most frequently identified in micropapillary predominant (41%) and solid predominant tumors (34%). On multivariate analysis of intermediate-grade tumors, high tumoral CD10 remained a significant independent risk factor of recurrence (hazard ratio, 1.88; P=0.025). CONCLUSION In stage I lung adenocarcinoma, tumoral CD10 correlated with high-grade histology and was an independent predictor of recurrence in intermediate-grade tumors.
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Affiliation(s)
- Kyuichi Kadota
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Department of Diagnostic Pathology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Daniel Buitrago
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Ming-Ching Lee
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Institute of Clinical Medicine; National Yang-Ming University, Taipei, Taiwan
| | - Jonathan Villena-Vargas
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Camelia S Sima
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - David R Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Prasad S Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
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312
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Kidane B, Toyooka S, Yasufuku K. MDT lung cancer care: Input from the Surgical Oncologist. Respirology 2015; 20:1023-33. [DOI: 10.1111/resp.12567] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 03/12/2015] [Accepted: 04/15/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Biniam Kidane
- Division of Thoracic Surgery; University of Toronto; Toronto Ontario Canada
- Division of Thoracic Surgery; Toronto General Hospital; University Health Network; Toronto Ontario Canada
| | - Shinichi Toyooka
- Department of Thoracic Surgery; Okayama University Hospital; Okayama Japan
- Department of Clinical Genomic Medicine; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; Okayama Japan
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery; University of Toronto; Toronto Ontario Canada
- Division of Thoracic Surgery; Toronto General Hospital; University Health Network; Toronto Ontario Canada
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314
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Stereotactic Ablative Radiation Therapy for the Treatment of Early-stage Non–Small-Cell Lung Cancer: CEPO Review and Recommendations. J Thorac Oncol 2015; 10:872-82. [DOI: 10.1097/jto.0000000000000524] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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315
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Vilmann P, Frost Clementsen P, Colella S, Siemsen M, De Leyn P, Dumonceau JM, Herth FJ, Larghi A, Vazquez-Sequeiros E, Hassan C, Crombag L, Korevaar DA, Konge L, Annema JT. Combined endobronchial and esophageal endosonography for the diagnosis and staging of lung cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline, in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg 2015; 48:1-15. [DOI: 10.1093/ejcts/ezv194] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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316
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Current radiation therapy techniques for lung cancer and its importance for suitable radiological assessment of treatment response in lung cancer. Clin Transl Oncol 2015; 17:495-6. [DOI: 10.1007/s12094-015-1286-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 03/20/2015] [Indexed: 11/26/2022]
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317
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Differences between pulmonologists, thoracic surgeons and radiation oncologists in deciding on the treatment of stage I non-small cell lung cancer: A binary choice experiment. Radiother Oncol 2015; 115:361-6. [DOI: 10.1016/j.radonc.2015.05.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 04/20/2015] [Accepted: 05/14/2015] [Indexed: 12/25/2022]
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318
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Vilmann P, Clementsen PF, Colella S, Siemsen M, De Leyn P, Dumonceau JM, Herth FJ, Larghi A, Vazquez-Sequeiros E, Hassan C, Crombag L, Korevaar DA, Konge L, Annema JT. Combined endobronchial and oesophageal endosonography for the diagnosis and staging of lung cancer. Eur Respir J 2015; 46:40-60. [DOI: 10.1183/09031936.00064515] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 04/27/2015] [Indexed: 12/25/2022]
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319
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Hilbe W, Pall G, Kocher F, Pircher A, Zabernigg A, Schmid T, Schumacher M, Jamnig H, Fiegl M, Gächter A, Freund M, Kendler D, Manzl C, Zelger B, Popper H, Wöll E. Multicenter Phase II Study Evaluating Two Cycles of Docetaxel, Cisplatin and Cetuximab as Induction Regimen Prior to Surgery in Chemotherapy-Naive Patients with NSCLC Stage IB-IIIA (INN06-Study). PLoS One 2015; 10:e0125364. [PMID: 26020783 PMCID: PMC4447267 DOI: 10.1371/journal.pone.0125364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 03/09/2015] [Indexed: 11/23/2022] Open
Abstract
Background Different strategies for neoadjuvant chemotherapy in patients with early stage NSCLC have already been evaluated. The aim of this study was to evaluate the tolerability and efficacy of a chemoimmunotherapy when limited to two cycles. Methods Between 01/2007 and 03/2010 41 patients with primarily resectable NSCLC stage IB to IIIA were included. Treatment consisted of two cycles cisplatin (40 mg/m2 d1+2) and docetaxel (75 mg/m2 d1) q3 weeks, accompanied by the administration of cetuximab (400 mg/m2 d1, then 250 mg weekly). The primary endpoint was radiological response according to RECIST. Results 40 patients were evaluable for toxicity, 39 for response. The main grade 3/4 toxicities were: neutropenia 25%, leucopenia 11%, febrile neutropenia 6%, nausea 8% and rash 8%. 20 patients achieved a partial response, 17 a stable disease, 2 were not evaluable. 37 patients (95%) underwent surgery and in three of them a complete pathological response was achieved. At a median follow-up of 44.2 months, 41% of the patients had died, median progression-free survival was 22.5 months. Conclusions Two cycles of cisplatin/ docetaxel/ cetuximab showed promising efficacy in the neoadjuvant treatment of early-stage NSCLC and rapid operation was possible in 95% of patients. Toxicities were manageable and as expected. Trial Registration EU Clinical Trials Register; Eudract-Nr: 2006-004639-31
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Affiliation(s)
- Wolfgang Hilbe
- Medical University Innsbruck, Department of Internal Medicine V (Haematology and Oncology), Innsbruck, Austria
- * E-mail:
| | - Georg Pall
- Medical University Innsbruck, Department of Internal Medicine V (Haematology and Oncology), Innsbruck, Austria
| | - Florian Kocher
- Medical University Innsbruck, Department of Internal Medicine V (Haematology and Oncology), Innsbruck, Austria
- Tyrolean Cancer Research Institute, Innsbruck, Austria
| | - Andreas Pircher
- Medical University Innsbruck, Department of Internal Medicine V (Haematology and Oncology), Innsbruck, Austria
| | - August Zabernigg
- Department of Internal Medicine, County Hospital Kufstein, Kufstein, Austria
| | - Thomas Schmid
- Department of Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Michael Schumacher
- Department of Pneumology, General Hospital, Elisabethinen Linz, Linz, Austria
| | - Herbert Jamnig
- Department of Pneumology, County Hospital Natters, Natters, Austria
| | - Michael Fiegl
- Medical University Innsbruck, Department of Internal Medicine V (Haematology and Oncology), Innsbruck, Austria
| | - Anne Gächter
- Medical University Innsbruck, Department of Internal Medicine V (Haematology and Oncology), Innsbruck, Austria
| | - Martin Freund
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Dorota Kendler
- Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Claudia Manzl
- Department of Pathology, Medical University Innsbruck, Innsbruck, Austria
| | - Bettina Zelger
- Department of Pathology, Medical University Innsbruck, Innsbruck, Austria
| | - Helmut Popper
- Department of Pathology, Medical University Innsbruck, Innsbruck, Austria
- Department of Pathology, Medical University Graz, Graz, Austria
| | - Ewald Wöll
- Department of Internal Medicine, Saint Vincent Hospital Zams, Zams, Austria
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Sanz Rubiales Á, del Valle Rivero ML, Fiorini Talavera AB, Fernández González M. Platinum derivatives alone, a reasonable option to treat locally advanced non-small cell lung cancer with chemo-radiotherapy. Lung Cancer 2015; 89:84-5. [PMID: 25982010 DOI: 10.1016/j.lungcan.2015.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 04/16/2015] [Accepted: 04/26/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Álvaro Sanz Rubiales
- Medical Oncology, Hospital Universitario del Río Hortega, Valladolid 47013, Spain.
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321
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Vansteenkiste J, Craps J, De Brucker N, Wauters I. Immunotherapy for non-small-cell lung cancer: the past 10 years. Future Oncol 2015; 11:2681-2695. [PMID: 26039564 DOI: 10.2217/fon.15.116] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT In the past decade, the approach to patients with metastatic non-small-cell lung cancer has relied on chemotherapy and on targeted agents for molecularly selected subgroups of patients. Recent work has introduced immunotherapy as another area of progress, and likely as a new treatment paradigm in the near future. While the large Phase III studies with cancer vaccination with the current technologies remain at present disappointing, the immunomodulation strategies with immune checkpoint inhibitors have delivered remarkable results in expanded Phase I studies and are now intensively studied in large Phase III studies. This review summarizes the past decade of immunotherapy for non-small-cell lung cancer, gives an updated overview of trials in this field, and the context of future development in this exciting field.
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Affiliation(s)
- Johan Vansteenkiste
- Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospitals KU Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Julie Craps
- Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospitals KU Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Nele De Brucker
- Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospitals KU Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Isabelle Wauters
- Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospitals KU Leuven, Herestraat 49, B-3000 Leuven, Belgium
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A brief report on outcomes of stereotactic ablative radiotherapy for a second primary lung cancer: evidence in support of routine CT surveillance. J Thorac Oncol 2015; 9:1222-5. [PMID: 25157777 DOI: 10.1097/jto.0000000000000218] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
New guidelines recommend the use of CT surveillance after a curative treatment for lung cancer as survivors have a 3-6% risk per person year of developing a second primary lung cancer. Our analysis of 107 patients with second primary lung cancer treated by stereotactic ablative radiotherapy showed a comparable 3 years overall survival (60%) and local control rate (89%) as for an initial lung cancer. Toxicity was uncommon, despite the fact that 73% of patients had undergone a prior (bi)lobectomy. Our findings indicate that CT surveillance is also appropriate in patients who may be unfit, or unwilling, to undergo surgery.
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323
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McElnay PJ, Choong A, Jordan E, Song F, Lim E. Outcome of surgery versus radiotherapy after induction treatment in patients with N2 disease: systematic review and meta-analysis of randomised trials. Thorax 2015; 70:764-8. [DOI: 10.1136/thoraxjnl-2014-206292] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 04/03/2015] [Indexed: 11/03/2022]
Abstract
ObjectiveChemoradiotherapy is often considered the ‘standard of care’ for patients with N2 disease. The aim was to evaluate survival outcomes of patients with N2 disease in multimodality trials of chemotherapy, radiotherapy and surgery.MethodsSystematic review and meta-analyses (random and fixed effects) were performed. Searches of Medline and Embase (1980–2013) were conducted. Abstracts from thoracic scientific meetings were searched. Reference lists of all relevant studies were reviewed. All studies of patients with N2 disease who received induction chemotherapy or chemoradiotherapy and randomised to surgery or radiotherapy were included. No language restrictions were imposed. The main outcome was overall survival.Results805 publications were identified. 519 and 281 were excluded because they were not primary results from randomised trials (or did not include N2 disease) or did not compare surgery with radiotherapy, respectively. The final six trials consisted of 868 patients. In four trials, patients received induction chemotherapy and in two trials patients received induction chemoradiotherapy. The HR comparing patients randomised to surgery after chemotherapy was 1.01 (95% CI 0.82 to 1.23; p=0.954) whereas for patients randomised to surgery after chemoradiotherapy was 0.87 (0.74 to 1.02; p=0.078). The overall HR of all pooled trials was 0.92 (0.81 to 1.04; p=0.179).ConclusionsIn trials where patients received surgery as part of bimodality (with chemotherapy) or trimodality (with chemoradiotherapy) treatment, overall survival was not significantly better than radiotherapy (with chemotherapy) or combination chemoradiotherapy alone.
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324
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Franks K, Jain P, Snee M. Stereotactic Ablative Body Radiotherapy for Lung Cancer. Clin Oncol (R Coll Radiol) 2015; 27:280-9. [DOI: 10.1016/j.clon.2015.01.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 01/20/2015] [Indexed: 02/08/2023]
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325
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Doleschel D, Rix A, Arns S, Palmowski K, Gremse F, Merkle R, Salopiata F, Klingmüller U, Jarsch M, Kiessling F, Lederle W. Erythropoietin improves the accumulation and therapeutic effects of carboplatin by enhancing tumor vascularization and perfusion. Am J Cancer Res 2015; 5:905-18. [PMID: 26000061 PMCID: PMC4440446 DOI: 10.7150/thno.11304] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 02/27/2015] [Indexed: 11/05/2022] Open
Abstract
Recombinant human erythropoietin (rhuEpo) is currently under debate for the treatment of chemotherapy-induced anemia due to clinical trials showing adverse effects in Epo-treated patients and the discovery of the erythropoietin-receptor (EpoR) in tumor and endothelial cells. Here, using Epo-Cy5.5 as theranostic near-infrared fluorescent probe we analyzed the effects of rhuEpo as co-medication to carboplatin in non-small-cell-lung-cancer (NSCLC)-xenografts with different tumor cell EpoR-expression (H838 ~8-fold higher than A549). Nude mice bearing subcutaneous A549 and H838 NSCLC-xenografts received either only carboplatin or carboplatin and co-medication of rhuEpo in two different doses. Tumor sizes and relative blood volumes (rBV) were longitudinally measured by 3D-contrast-enhanced ultrasound (3D-US). Tumoral EpoR-levels were determined by combined fluorescence molecular tomography (FMT)/ micro computed tomography (µCT) hybrid imaging. We found that rhuEpo predominantly acted on the tumor endothelium. In both xenografts, rhuEpo co-medication significantly increased vessel densities, diameters and the amount of perfused vessels. Accordingly, rhuEpo induced EpoR-phoshorylation and stimulated proliferation of endothelial cells. However, compared with solely carboplatin-treated tumors, tumor growth was significantly slower in the groups co-medicated with rhuEpo. This is explained by the Epo-mediated vascular remodeling leading to improved drug delivery as obvious by a more than 2-fold higher carboplatin accumulation and significantly enhanced tumor apoptosis. In addition, co-medication of rhuEpo reduced tumor hypoxia and diminished intratumoral EpoR-levels which continuously increased during carboplatin (Cp) -treatment. These findings suggest that co-medication of rhuEpo in well balanced doses can be used to improve the accumulation of anticancer drugs. Doses and indications may be personalized and refined using theranostic EpoR-probes.
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Prognostic Significance of the Number of Metastatic pN2 Lymph Nodes in Stage IIIA-N2 Non-Small-Cell Lung Cancer After Curative Resection. Clin Lung Cancer 2015; 16:e203-12. [PMID: 25997733 DOI: 10.1016/j.cllc.2015.04.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 04/04/2015] [Accepted: 04/14/2015] [Indexed: 11/24/2022]
Abstract
UNLABELLED Stage IIIA-N2 non-small cell lung cancer (NSCLC) shows prognostic heterogeneity. We investigated the prognostic relevance of the number of metastatic pN2 nodes in patients with IIIA-N2 NSCLC. The criteria for the number of pN2 used in this study were significantly associated with the survival outcomes after surgery and may improve the accuracy of prognostic prediction in this subgroup of patients. INTRODUCTION There have been controversies regarding the prognostic relevance of the number of positive N2 nodes in pathologic stage IIIA-N2 non-small-cell lung cancer (NSCLC). We examine prognosis of patients with pathologic stage IIIA-N2 with classifying the number of positive N2 nodes into subgroups. METHODS From January 1997 to December 2004, 250 patients were diagnosed with pathologic stage IIIA-N2 disease. All patients underwent mediastinal lymph node dissection. After excluding 44 patients with preoperative chemotherapy, incomplete resection, and postsurgical mortality, 206 patients were included in the analysis. Patients were classified according to the number of positive N2 lymph nodes (N2a: 1 [n = 83], N2b: 2-4 [n = 82], N2c: ≥ 5 [n = 41]), and its correlation with survival outcomes were investigated. RESULTS With a median follow-up of 96.3 months, 5-year disease-free survival (DFS) was 27.2% (95% confidence interval [CI], 21.6-33.7), and 5-year overall survival (OS) was 37.7% (95% CI, 31.5-44.7) in all patients. The number of metastatic N2 lymph nodes was associated with DFS (P < .001) and OS (P = .01). In the N2a, N2b, and N2c groups, 5-year DFS rates were 38%, 24%, and 5%, respectively, and 5-year OS rates were 47%, 35%, and 24%, respectively. In a multivariate analysis, the number of metastatic N2 lymph nodes was an independent prognostic factor for DFS and OS. CONCLUSION Stratification of patients according to the number of metastatic N2 lymph nodes may improve the accuracy of prognostic prediction among patients with curatively resected stage IIIA-N2 NSCLC.
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Mavridis K, Gueugnon F, Petit-Courty A, Courty Y, Barascu A, Guyetant S, Scorilas A. The oncomiR miR-197 is a novel prognostic indicator for non-small cell lung cancer patients. Br J Cancer 2015; 112:1527-35. [PMID: 25867273 PMCID: PMC4453672 DOI: 10.1038/bjc.2015.119] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/04/2015] [Accepted: 03/08/2015] [Indexed: 01/16/2023] Open
Abstract
Background: MicroRNA expression signatures can promote personalised care for non-small cell lung cancer (NSCLC) patients. Our aim was to evaluate the previously unexplored prognostic potential of miR-197, a key oncogenic molecule for NSCLC. Methods: Total RNA isolation (n=124 NSCLC and n=21 tumour-adjacent normal tissues), was performed using the QIAsymphony SP workstation. The quantity and quality of RNA were assessed by spectrophotometric analysis and an Agilent 2100 bioanalyzer. Polyadenylation and reverse transcription were subsequently carried out. MiR-197 expression levels were measured by qPCR, after quality control (inter-assay CV=7.8%). Internal validation procedures were followed by assigning training and test sets and robust biostatistical analyses were performed, including bootstrap resampling. Results: MiR-197 is associated with larger tumours (P=0.042) and the squamous cell carcinoma histotype (P=0.032). Interestingly, after adjusting for important prognostic indicators, miR-197 expression was identified as a novel independent predictor of unfavourable prognosis for NSCLC patients (HR=1.97, 95% CI=1.10–3.38, P=0.013). We also demonstrate that miR-197 retains its prognostic performance in both early-stage I (P=0.045) and more advanced-stage individuals (P=0.036). Conclusions: The cost-effective expression analysis of miR-197 could constitute a novel molecular tool for NSCLC management.
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Affiliation(s)
- K Mavridis
- Department of Biochemistry and Molecular Biology, University of Athens, Panepistimiopolis, 15701 Athens, Greece
| | - F Gueugnon
- Centre d'Etude des Pathologies Respiratoires, INSERM UMR1100, F-37032 Tours, France
| | - A Petit-Courty
- Centre d'Etude des Pathologies Respiratoires, INSERM UMR1100, F-37032 Tours, France
| | - Y Courty
- Centre d'Etude des Pathologies Respiratoires, INSERM UMR1100, F-37032 Tours, France
| | - A Barascu
- Centre d'Etude des Pathologies Respiratoires, INSERM UMR1100, F-37032 Tours, France
| | - S Guyetant
- Centre d'Etude des Pathologies Respiratoires, INSERM UMR1100, F-37032 Tours, France
| | - A Scorilas
- Department of Biochemistry and Molecular Biology, University of Athens, Panepistimiopolis, 15701 Athens, Greece
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329
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Lau WFE, Ware R, Herth FJF. Diagnostic evaluation for interventional bronchoscopists and radiologists in lung cancer practice. Respirology 2015; 20:705-14. [PMID: 25823583 DOI: 10.1111/resp.12518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 01/28/2015] [Accepted: 02/05/2015] [Indexed: 12/20/2022]
Abstract
The global epidemic of lung cancer shows no signs of abating. It is generally accepted that accurate and cost-efficient diagnostic evaluation is the first important step to achieve the best outcomes of treatment. This is true in the context of disease confirmation, treatment planning, treatment monitoring, detection of and management of treatment failure or prognostication. Fortunately, major advances in the diagnostic evaluation of lung cancer have been made in the past three decades allowing more patients to get the appropriate treatment at the right time. This paper outlines how computed tomography, positron emission tomography/computed tomography and endobronchial ultrasound contribute to lung cancer management and discuss their strengths and weaknesses and their complimentary roles at different stages of lung cancer management. Due to financial constraint and reimbursement restrictions, not all clinically important advances in the diagnostic evaluation of lung cancer have been readily accepted into routine clinical care. This enforces the need to maintain ongoing dialogue between cancer clinicians, imaging specialists and health-care economists.
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Affiliation(s)
- W F Eddie Lau
- Department of Radiology, Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Rob Ware
- Centre for Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Felix J F Herth
- Department of Pneumology and Critical Care Medicine Thoraxklinik and Translational Lung Resarch Center (TLRCH), Member of the German Lung Research Foundation (DZL), University of Heidelberg, Heidelberg, Germany
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Horita N, Woo T, Miyazawa N, Kaneko T. Pre-operative chemotherapy for non-small cell lung carcinoma. Transl Lung Cancer Res 2015; 4:8-14. [PMID: 25806341 DOI: 10.3978/j.issn.2218-6751.2014.07.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 07/01/2014] [Indexed: 11/14/2022]
Abstract
The roll by the cytotoxic chemotherapy and its efficacy in the treatment of non-small cell carcinoma (NSCLC) was not clearly identified until the 1980s when studies showed that cisplatin was beneficial in the treatment of NSCLC. The first randomized controlled trial (RCT) to evaluate the efficacy of post-operative (adjuvant) chemotherapy using the cisplatin regimen for resectable NSCLC was reported in 1988. Since then, an increasing number of RCTs have been carried out to evaluate post-operative chemotherapy. Pre-operative (neo-adjuvant) chemotherapy is a relatively new treatment strategy, as its name indicates. Compared with post-operative chemotherapy, fewer RCTs have been carried out to evaluate pre-operative chemotherapy. Given the inconsistency of the results from the RCTs, at least 12 meta-analyses have been published. Most of these meta-analyses reported overall survival (OS) benefit with hazard ratios (HRs) in the range of 0.81 to 0.89 in favor of pre-operative chemotherapy. An individual patient data meta-analysis by Burdett in 2014 indicates that the option of pre-operative chemotherapy + surgery is associated with better OS (HR 0.87, 95% CI, 0.78-0.96, P=0.007) and recurrence-free survival (RFS) (HR 0.85, 95% CI, 0.76-0.94, P=0.002) survival for operable NSCLC when compared with treatment with surgery alone. Although the current consensus recommends the use of post-operative chemotherapy, pre-operative chemotherapy has equivalent efficacy. Both strategies should be regarded as the first choice treatment options. Despite Burdett's comment, indication of pre-operative chemotherapy for stage IA disease should be judged carefully.
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Affiliation(s)
- Nobuyuki Horita
- 1 Department of Respiratory Medicine, 2 Department of Cardiovascular Thoracic Surgery, Saiseikai Yokohamashi Nanbu Hospital, Yokohama 234-8503, Japan ; 3 Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tetsukan Woo
- 1 Department of Respiratory Medicine, 2 Department of Cardiovascular Thoracic Surgery, Saiseikai Yokohamashi Nanbu Hospital, Yokohama 234-8503, Japan ; 3 Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Naoki Miyazawa
- 1 Department of Respiratory Medicine, 2 Department of Cardiovascular Thoracic Surgery, Saiseikai Yokohamashi Nanbu Hospital, Yokohama 234-8503, Japan ; 3 Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takeshi Kaneko
- 1 Department of Respiratory Medicine, 2 Department of Cardiovascular Thoracic Surgery, Saiseikai Yokohamashi Nanbu Hospital, Yokohama 234-8503, Japan ; 3 Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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331
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Roesch J, Andratschke N, Guckenberger M. SBRT in operable early stage lung cancer patients. Transl Lung Cancer Res 2015; 3:212-24. [PMID: 25806303 DOI: 10.3978/j.issn.2218-6751.2014.08.06] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 08/12/2014] [Indexed: 12/25/2022]
Abstract
Since decades the gold standard for treatment of early stage non-small cell lung cancer (NSCLC) is surgical lobectomy plus mediastinal lymph node dissection. Patients in worse health status are treated with sublobar resection or radiation treatment. With development of stereotactic-body-radiotherapy (SBRT), outcome of patients treated with radiation was substantially improved. Comparison of SBRT and surgical techniques is difficult due to the lack of randomized trials. However, all available evidence in form of case control studies of population based studies show equivalence between sublobar resection and SBRT indicating that SBRT-when performed by a trained and experienced team-should be offered to all high-risk surgical patients. For patients not willing to take the risk of lobectomy and therefore refusing surgery, SBRT is an excellent treatment option.
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Affiliation(s)
- Johannes Roesch
- Department of Radiation Oncology, University Hospital Zurich, Zürich, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, Zürich, Switzerland
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Carnio S, Novello S, Papotti M, Loiacono M, Scagliotti GV. Prognostic and predictive biomarkers in early stage non-small cell lung cancer: tumor based approaches including gene signatures. Transl Lung Cancer Res 2015; 2:372-81. [PMID: 25806256 DOI: 10.3978/j.issn.2218-6751.2013.10.05] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 10/10/2013] [Indexed: 12/26/2022]
Abstract
In early stage non-small cell lung cancer (NSCLC) large randomized trials have demonstrated that in patients with radically resected disease adjuvant chemotherapy improves 5-year survival rates. However, a customization of systemic treatment is needed to avoid treatments in patients cured by surgery alone or to justify the use of adjuvant chemotherapy in high risk patients, including those in stage IA. Recently, the possibility of identifying prognostic and predictive factors related to the genetic signatures of the tumor that could affect adjuvant and neo-adjuvant treatment choices for resectable non-small cell lung cancer (NSCLC) has been of interest. This review summarizes the current status and future opportunities for clinical application of genotyping and genomic tests in early NSCLC.
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Affiliation(s)
- Simona Carnio
- University of Torino, Department of Oncology, Torino, Italy
| | - Silvia Novello
- University of Torino, Department of Oncology, Torino, Italy
| | - Mauro Papotti
- University of Torino, Department of Oncology, Torino, Italy
| | - Marco Loiacono
- University of Torino, Department of Oncology, Torino, Italy
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333
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Mokhles S, Verstegen N, Maat AP, Birim Ö, Bogers AJ, Mokhles MM, Lagerwaard FJ, Senan S, Takkenberg JJ. Comparison of clinical outcome of stage I non-small cell lung cancer treated surgically or with stereotactic radiotherapy: Results from propensity score analysis. Lung Cancer 2015; 87:283-9. [DOI: 10.1016/j.lungcan.2015.01.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 11/05/2014] [Accepted: 01/08/2015] [Indexed: 01/24/2023]
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Garrido P, Engel-Riedel W, Serke M, Giraud P, Ricardi U, Vallejo C, Visseren-Grul C, Ameryckx S, Soldatenkova V, Chouaki N, Novello S. Final results from a Phase II study of pemetrexed and cisplatin with concurrent thoracic radiation after Pem-Cis induction in patients with unresectable locally advanced non-squamous non-small cell lung cancer (NSCLC). Lung Cancer 2015; 88:160-6. [PMID: 25758556 DOI: 10.1016/j.lungcan.2015.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 02/06/2015] [Accepted: 02/16/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVES This single-arm multicenter Phase II study investigated the efficacy and safety of pemetrexed (Pem) and cisplatin (Cis) induction chemotherapy (CT) followed by full-dose Pem-Cis plus concurrent radiotherapy (RT) in patients with locally advanced non-squamous NSCLC. MATERIALS AND METHODS Patients with unresectable Stage III non-squamous NSCLC received two 21-day cycles of Pem 500 mg/m(2) (vitamin/folic acid supplementation and dexamethasone prophylaxis per Pem-label)+Cis 75 mg/m(2) on Day 1. Eligible patients who had not progressed continued with 2 further cycles of full-dose Pem-Cis plus concurrent RT (2 Gy/fraction, 5 days/week, 66 Gy total). Primary endpoint was the 1-year progression-free survival (PFS) rate. RESULTS Of 90 patients enrolled (all treated; median age 61 years, male/female 57%/43%, ECOG performance status 0/1 66%/34%, adenocarcinoma 90%, Stage III 36%/62%), 75 (83%) completed induction CT and started concurrent CT+RT. 64 (71%) patients received all 4 CT cycles and an RT dose ≥60 Gy. The 1-year PFS rate was 51.3% (95%CI: 42.0, 60.5). Median PFS was 10.6 months (95%CI: 8.6, 17.3), median OS was 26.2 months (95%CI: 16.7, not estimable). One patient died from enteritis (treatment-related) during Cycle 4. Four patients discontinued due to treatment-related adverse events, 1 on induction CT (renal failure), 3 on concurrent CT+RT (1 hypoacusis, 2 acute esophagitis). During induction CT, 18.9% of patients reported Grade 3/4 CTCAEs, only neutropenia (2.2%) and syncope (2.2%) were reported by >1 patient. During concurrent CT+RT, 41.3% of patients reported G3/4 CTCAEs, mainly esophagitis (12.0%), neutropenia (10.7%), and leukopenia (9.3%). CONCLUSION In this study of Pem-Cis induction CT followed by full-dose Pem-Cis with concurrent RT, median PFS was 10.6 months and toxicity was manageable, in line with previous data on Pem-Cis plus RT.
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Affiliation(s)
- Pilar Garrido
- Medical Oncology Department, University Hospital Ramon y Cajal, Madrid, Spain.
| | | | - Monika Serke
- Thoracic Oncology Department, Hemer Lung Clinic, Hemer, Germany
| | - Philippe Giraud
- Department of Oncology Radiotherapy, Paris Descartes University, Georges Pompidou European Hospital, Paris, France
| | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Turin, Italy
| | - Carmen Vallejo
- Department of Oncology Radiotherapy, University Hospital Ramon y Cajal, Madrid, Spain
| | | | - Sophie Ameryckx
- Clinical Trial Management, Oncology, Lilly S.A. Eli Lilly Benelux N.V., Brussels, Belgium
| | | | - Nadia Chouaki
- Medical Oncology Department, Eli Lilly and Company, Neuilly-sur-Seine, France
| | - Silvia Novello
- Department of Oncology, University of Turin, S. Luigi Hospital, Orbassano (TO), Italy
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Janssen-Heijnen MLG, van Erning FN, De Ruysscher DK, Coebergh JWW, Groen HJM. Variation in causes of death in patients with non-small cell lung cancer according to stage and time since diagnosis. Ann Oncol 2015; 26:902-907. [PMID: 25672893 DOI: 10.1093/annonc/mdv061] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 01/25/2015] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Many patients with non-small cell lung cancer (NSCLC) die within the first few years of diagnosis, and considerable excess mortality remains even after 5 years. We investigated the death rate and the distribution of causes of death for NSCLC patients by age and stage at diagnosis during long-term follow-up. PATIENTS AND METHODS All 72 021 patients aged 45-89 years diagnosed with stage I-III NSCLC between 1989 and 2008 in the Netherlands and who died up till 2011 were derived from the Netherlands Cancer Registry and linked with the database of Statistics Netherlands for underlying causes of death. Mortality ratios and proportional distribution of causes of death were calculated during 5 time periods after diagnosis of NSCLC (up to 15 years). RESULTS Median follow-up was 9.6 years (range: 0-23 years). Lung cancer was the predominant cause of death in the first 6 years after diagnosis (being 80%-85% and ∼90% up to 3 years for localized and locally advanced disease, respectively, and ∼60%-75% and ∼75%-85% during years 4-6 for both stage groups, respectively). Thereafter, lung cancer as cause of death proportionally decreased with time since diagnosis, but remained over 30%. Hence, cardiovascular diseases and chronic obstructive pulmonary diseases (COPD) became more important causes of death, especially for patients aged >60 years at diagnosis (up to 34% for cardiovascular diseases and up to 19% for COPD). CONCLUSIONS With time, the relative contribution of cardiovascular and COPD causes of death increased, although the absolute contribution of lung cancer remained high in non-metastatic NSCLC. Therefore, managing morbidity of these diseases remains relevant.
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Affiliation(s)
- M L G Janssen-Heijnen
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo; Department of Epidemiology, Maastricht University Medical Center, GROW School for Oncology and Developmental Biology, Maastricht.
| | - F N van Erning
- Department of Research, Comprehensive Cancer Centre The Netherlands, Eindhoven, The Netherlands
| | - D K De Ruysscher
- Department of Radiation Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - J W W Coebergh
- Department of Research, Comprehensive Cancer Centre The Netherlands, Eindhoven, The Netherlands; Department of Public Health, Erasmus University Medical Centre, Rotterdam
| | - H J M Groen
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Sakamoto T, Kodani M, Takata M, Chikumi H, Nakamoto M, Nishii-Ito S, Ueda Y, Izumi H, Makino H, Touge H, Takeda K, Yamasaki A, Yanai M, Tanaka N, Igishi T, Shimizu E. A novel point-of-care system for high-speed real-time polymerase chain reaction testing for epidermal growth factor receptor mutations in bronchial lavage fluids after transbronchial biopsy in patients with non-small cell lung cancer. Int J Oncol 2015; 46:1473-80. [PMID: 25651992 PMCID: PMC4356493 DOI: 10.3892/ijo.2015.2875] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 12/10/2014] [Indexed: 12/17/2022] Open
Abstract
Epidermal growth factor receptor (EGFR) gene mutation testing is essential for choosing appropriate treatment options in patients with advanced non-small cell lung cancer (NSCLC). However, a time delay occurs between histological diagnosis and molecular diagnosis in clinical situations. To minimize this delay, we developed a novel point-of-care test for EGFR mutations, based on a high-speed real-time polymerase chain reaction (PCR) system designated here as ultrarapid PCR combined with highly accurate bronchoscopic sampling. We investigated whether our system for detecting EGFR mutations was valid by comparing test results with those obtained using a commercialized EGFR mutation test. We obtained small amounts of bronchial lavage fluids after transbronchial biopsies (TBBs) were performed on enrolled patients (n=168) who underwent endobronchial ultrasonography using a guide sheath (EBUS-GS). EGFR mutation analysis was performed by ultrarapid PCR immediately after EBUS-GS-TBBs were obtained (on the same day). After pathological diagnoses of NSCLC, EGFR mutation status in formalin-fixed, paraffin- embedded samples was confirmed by the PCR-invader method, and the concordance rates between the PCR methods were compared. The total diagnostic yield of EBUS-GS-TBB was 91.0%. The positive concordance rates for detecting 19del and L858R with the ultrarapid PCR and PCR-invader methods were both 100%. Negative concordance rates were 97.2 and 98.1%, respectively. We also demonstrated a dramatic effect of early erlotinib administration, based on ultrarapid PCR results, for a 52-year-old woman suffering from respiratory failure due to severe intrapulmonary metastases with poor performance status. In conclusion, ultrarapid PCR combined with EBUS-GS-TBB enabled rapid and reliable point-of-care testing for EGFR mutations.
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Affiliation(s)
- Tomohiro Sakamoto
- Division of Medical Oncology and Molecular Respirology, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Masahiro Kodani
- Division of Medical Oncology and Molecular Respirology, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Miyako Takata
- Division of Medical Oncology and Molecular Respirology, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Hiroki Chikumi
- Division of Medical Oncology and Molecular Respirology, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Masaki Nakamoto
- Division of Medical Oncology and Molecular Respirology, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Shizuka Nishii-Ito
- Division of Medical Oncology and Molecular Respirology, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Yasuto Ueda
- Division of Medical Oncology and Molecular Respirology, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Hiroki Izumi
- Division of Medical Oncology and Molecular Respirology, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Haruhiko Makino
- Division of Medical Oncology and Molecular Respirology, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Hirokazu Touge
- Division of Medical Oncology and Molecular Respirology, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Kenichi Takeda
- Division of Medical Oncology and Molecular Respirology, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Akira Yamasaki
- Division of Medical Oncology and Molecular Respirology, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Masaaki Yanai
- Division of Medical Oncology and Molecular Respirology, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Natsumi Tanaka
- Division of Medical Oncology and Molecular Respirology, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Tadashi Igishi
- Division of Medical Oncology and Molecular Respirology, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Eiji Shimizu
- Division of Medical Oncology and Molecular Respirology, Faculty of Medicine, Tottori University, Yonago, Japan
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337
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Louie AV, Senan S. Treatment for High-Risk Patients With Early-Stage Non–Small-Cell Lung Cancer. J Clin Oncol 2015; 33:377. [DOI: 10.1200/jco.2014.58.1314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Alexander V. Louie
- VU University Medical Center, Amsterdam, the Netherlands; London University of Western Ontario, London, Canada; and Harvard School of Public Health, Harvard University, Boston, MA
| | - Suresh Senan
- VU University Medical Center, Amsterdam, the Netherlands
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Louie AV, Palma DA, Dahele M, Rodrigues GB, Senan S. Management of early-stage non-small cell lung cancer using stereotactic ablative radiotherapy: Controversies, insights, and changing horizons. Radiother Oncol 2015; 114:138-47. [DOI: 10.1016/j.radonc.2014.11.036] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 11/18/2014] [Accepted: 11/20/2014] [Indexed: 12/17/2022]
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Fang HY, Hsiao FY, Huang HC, Lin YS, Chen CY, Shieh SH, Chen PR, Chen CK, Chien CR. Cost and effectiveness of video-assisted thoracoscopic surgery for clinical stage I non-small cell lung cancer: a population-based analysis. J Thorac Dis 2015; 6:1690-6. [PMID: 25589961 DOI: 10.3978/j.issn.2072-1439.2014.10.27] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 09/25/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Video-assisted thoracoscopic surgery (VATS) is a minimally invasive alternative to conventional surgery (CS). We aimed to estimate the short-term cost-effectiveness of VATS vs. CS for clinical stage I non-small cell lung cancer (NSCLC-c-stage-I) patients from the payer's perspective (National Health Insurance). METHODS We identified NSCLC-c-stage-I patients diagnosed and received surgery within 2007-2009 through a comprehensive population-based database containing cancer and death registries, and reimbursement data. The duration of interest was 1 year. We included potential confounding covariables through literature searching and our own experience, and used a propensity score to construct a 1:1 population for adjustment. RESULTS Our study population constituted 966 patients. The mean hospital stay [days, standard deviation (SD)] were 14.4 [7] and 16.1 (7.7) for VATS and CS respectively (P=0.002). The mean cost (2013 USD) and survival (year) was $22,316 vs. $21,976 and 0.98 vs. 0.974 for VATS vs. CS. The probability for VATS to be cost-effective (i.e., positive net benefit) was 0.49 & 0.56 at willingness-to-pay (WTP) 50,000 & 100,000 USD/life-year, respectively. CONCLUSIONS We provide the first empirical evidence that when compared to CS, VATS was potentially cost-effective in the short term (1 year) within the common WTP levels in Taiwan.
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Affiliation(s)
- Hsin-Yuan Fang
- 1 Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan ; 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ; 3 Graduate Institute of Clinical Pharmacy, College of Medicine, 4 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan ; 6 Division of Trauma, Emergency Surgery, and Critical Care, China Medical University Hospital, Taichung, Taiwan ; 7 Department of Health Services Administration, College of Health Care, China Medical University, Taichung, Taiwan ; 8 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Fei-Yuan Hsiao
- 1 Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan ; 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ; 3 Graduate Institute of Clinical Pharmacy, College of Medicine, 4 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan ; 6 Division of Trauma, Emergency Surgery, and Critical Care, China Medical University Hospital, Taichung, Taiwan ; 7 Department of Health Services Administration, College of Health Care, China Medical University, Taichung, Taiwan ; 8 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Hsu-Chih Huang
- 1 Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan ; 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ; 3 Graduate Institute of Clinical Pharmacy, College of Medicine, 4 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan ; 6 Division of Trauma, Emergency Surgery, and Critical Care, China Medical University Hospital, Taichung, Taiwan ; 7 Department of Health Services Administration, College of Health Care, China Medical University, Taichung, Taiwan ; 8 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Yu-Sen Lin
- 1 Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan ; 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ; 3 Graduate Institute of Clinical Pharmacy, College of Medicine, 4 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan ; 6 Division of Trauma, Emergency Surgery, and Critical Care, China Medical University Hospital, Taichung, Taiwan ; 7 Department of Health Services Administration, College of Health Care, China Medical University, Taichung, Taiwan ; 8 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Yi Chen
- 1 Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan ; 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ; 3 Graduate Institute of Clinical Pharmacy, College of Medicine, 4 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan ; 6 Division of Trauma, Emergency Surgery, and Critical Care, China Medical University Hospital, Taichung, Taiwan ; 7 Department of Health Services Administration, College of Health Care, China Medical University, Taichung, Taiwan ; 8 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Shwn-Huey Shieh
- 1 Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan ; 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ; 3 Graduate Institute of Clinical Pharmacy, College of Medicine, 4 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan ; 6 Division of Trauma, Emergency Surgery, and Critical Care, China Medical University Hospital, Taichung, Taiwan ; 7 Department of Health Services Administration, College of Health Care, China Medical University, Taichung, Taiwan ; 8 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Pin-Ru Chen
- 1 Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan ; 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ; 3 Graduate Institute of Clinical Pharmacy, College of Medicine, 4 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan ; 6 Division of Trauma, Emergency Surgery, and Critical Care, China Medical University Hospital, Taichung, Taiwan ; 7 Department of Health Services Administration, College of Health Care, China Medical University, Taichung, Taiwan ; 8 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Chein-Kuang Chen
- 1 Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan ; 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ; 3 Graduate Institute of Clinical Pharmacy, College of Medicine, 4 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan ; 6 Division of Trauma, Emergency Surgery, and Critical Care, China Medical University Hospital, Taichung, Taiwan ; 7 Department of Health Services Administration, College of Health Care, China Medical University, Taichung, Taiwan ; 8 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Ru Chien
- 1 Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan ; 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ; 3 Graduate Institute of Clinical Pharmacy, College of Medicine, 4 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan ; 6 Division of Trauma, Emergency Surgery, and Critical Care, China Medical University Hospital, Taichung, Taiwan ; 7 Department of Health Services Administration, College of Health Care, China Medical University, Taichung, Taiwan ; 8 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
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Eberhardt WEE. Concurrent chemoradiotherapy in stage III non-small-cell lung cancer: what is the best regimen? J Clin Oncol 2015; 33:532-3. [PMID: 25559800 DOI: 10.1200/jco.2014.58.9812] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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342
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Kapfhammer A, Winkens T, Lesser T, Reissig A, Steinert M, Freesmeyer M. Enhancing 18F-FDG-PET/CT analysis in lung cancer patients. Nuklearmedizin 2015; 54:247-54. [DOI: 10.3413/nukmed-0763-15-08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/29/2015] [Indexed: 11/20/2022]
Abstract
SummaryAim: To retrospectively evaluate the feasibility and value of CT-CT image fusion to assess the shift of peripheral lung cancers with/-out chest wall infiltration, comparing computed tomography acquisitions in shallow-breathing (SB-CT) and deep-inspiration breath-hold (DIBH-CT) in patients undergoing FDG-PET/ CT for lung cancer staging. Methods: Image fusion of SB-CT and DIBH-CT was performed with a multimodal workstation used for nuclear medicine fusion imaging. The distance of intrathoracic landmarks and the positional shift of tumours were measured using semitransparent overlay of both CT series. Statistical analyses were adjusted for confounders of tumour infiltration. Cutoff levels were calculated for prediction of no-/infiltration. Results: Lateral pleural recessus and diaphragm showed the largest respiratory excursions. Infiltrating lung cancers showed more limited respiratory shifts than non-infiltrating tumours. A large respiratory tumour-motility accurately predicted non-infiltration. However, the tumour shifts were limited and variable, limiting the accuracy of prediction. Conclusion: This pilot fusion study proved feasible and allowed a simple analysis of the respiratory shifts of peripheral lung tumours using CT-CT image fusion in a PET/CT setting. The calculated cutoffs were useful in predicting the exclusion of chest wall infiltration but did not accurately predict tumour infiltration. This method can provide additional qualitative information in patients with lung cancers with contact to the chest wall but unclear CT evidence of infiltration undergoing PET/CT without the need of additional investigations. Considering the small sample size investigated, further studies are necessary to verify the obtained results.
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343
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Hopmans W, Damman OC, Timmermans DRM, Haasbeek CJA, Slotman BJ, Senan S. Communicating cancer treatment information using the Web: utilizing the patient's perspective in website development. BMC Med Inform Decis Mak 2014; 14:116. [PMID: 25481306 PMCID: PMC4271466 DOI: 10.1186/s12911-014-0116-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 11/20/2014] [Indexed: 01/04/2023] Open
Abstract
Background Online cancer information can support patients in making treatment decisions. However, such information may not be adequately tailored to the patient’s perspective, particularly if healthcare professionals do not sufficiently engage patient groups when developing online information. We applied qualitative user testing during the development of a patient information website on stereotactic ablative radiotherapy (SABR), a new guideline-recommended curative treatment for early-stage lung cancer. Methods We recruited 27 participants who included patients referred for SABR and their relatives. A qualitative user test of the website was performed in 18 subjects, followed by an additional evaluation by users after website redesign (N = 9). We primarily used the ‘thinking aloud’ approach and semi-structured interviewing. Qualitative data analysis was performed to assess the main findings reported by the participants. Results Study participants preferred receiving different information that had been provided initially. Problems identified with the online information related to comprehending medical terminology, understanding the scientific evidence regarding SABR, and appreciating the side-effects associated with SABR. Following redesign of the website, participants reported fewer problems with understanding content, and some additional recommendations for better online information were identified. Conclusions Our findings indicate that input from patients and their relatives allows for a more comprehensive and usable website for providing treatment information. Such a website can facilitate improved patient participation in treatment decision-making for cancer.
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Affiliation(s)
- Wendy Hopmans
- Department of Public and Occupational Health, EMGO+ Institute for Health and care research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. .,Department of Radiation Oncology, VU University Medical Center, De Boelelaan 1117, 1007MB, Amsterdam, The Netherlands.
| | - Olga C Damman
- Department of Public and Occupational Health, EMGO+ Institute for Health and care research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Danielle R M Timmermans
- Department of Public and Occupational Health, EMGO+ Institute for Health and care research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Cornelis J A Haasbeek
- Department of Radiation Oncology, VU University Medical Center, De Boelelaan 1117, 1007MB, Amsterdam, The Netherlands.
| | - Ben J Slotman
- Department of Radiation Oncology, VU University Medical Center, De Boelelaan 1117, 1007MB, Amsterdam, The Netherlands.
| | - Suresh Senan
- Department of Radiation Oncology, VU University Medical Center, De Boelelaan 1117, 1007MB, Amsterdam, The Netherlands.
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Shaikh T, Turaka A. Predictors and management of chest wall toxicity after lung stereotactic body radiotherapy. Cancer Treat Rev 2014; 40:1215-20. [DOI: 10.1016/j.ctrv.2014.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 08/19/2014] [Accepted: 09/07/2014] [Indexed: 12/24/2022]
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Schneider L, Farrokhyar F, Schieman C, Hanna WC, Shargall Y, Finley CJ. The burden of death following discharge after lobectomy. Eur J Cardiothorac Surg 2014; 48:65-70. [DOI: 10.1093/ejcts/ezu427] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 09/25/2014] [Indexed: 02/06/2023] Open
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De Ruysscher D, Faivre-Finn C, Le Pechoux C, Peeters S, Belderbos J. High-dose re-irradiation following radical radiotherapy for non-small-cell lung cancer. Lancet Oncol 2014; 15:e620-e624. [PMID: 25456380 DOI: 10.1016/s1470-2045(14)70345-6] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
As the prognosis of lung cancer patients improves, more patients are at risk of developing local recurrence or a new primary tumour in previously irradiated areas. Technological advances in radiotherapy and imaging have made treatment of patients with high-dose re-irradiation possible, with the aim of long-term disease-free survival and even cure. However, high-dose re-irradiation with overlapping volumes of previously irradiated tissues is not without risks. Late, irreversible, and potentially serious normal tissue damage may occur because of injury to surrounding thoracic structures and organs at risk. In this Review, we aimed to report the efficacy and toxic effects of high-dose re-irradiation for locoregional recurrent non-small-cell lung cancer. Our findings indicate that high-dose re-irradiation might be beneficial in selected patients; however, patients and physicians should be aware of the scarcity of high-quality data when considering this treatment.
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Affiliation(s)
- Dirk De Ruysscher
- Radiation Oncology, University Hospitals Leuven/KU Leuven, Leuven, Belgium.
| | - Corinne Faivre-Finn
- Radiation Related Research, The Christie NHS Foundation Trust and University of Manchester, Manchester, UK
| | - Cecile Le Pechoux
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Stéphanie Peeters
- Radiation Oncology, University Hospitals Leuven/KU Leuven, Leuven, Belgium
| | - José Belderbos
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
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347
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Mattonen SA, Palma DA, Haasbeek CJA, Senan S, Ward AD. Early prediction of tumor recurrence based on CT texture changes after stereotactic ablative radiotherapy (SABR) for lung cancer. Med Phys 2014; 41:033502. [PMID: 24593744 DOI: 10.1118/1.4866219] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Benign computed tomography (CT) changes due to radiation induced lung injury (RILI) are common following stereotactic ablative radiotherapy (SABR) and can be difficult to differentiate from tumor recurrence. The authors measured the ability of CT image texture analysis, compared to more traditional measures of response, to predict eventual cancer recurrence based on CT images acquired within 5 months of treatment. METHODS A total of 24 lesions from 22 patients treated with SABR were selected for this study: 13 with moderate to severe benign RILI, and 11 with recurrence. Three-dimensional (3D) consolidative and ground-glass opacity (GGO) changes were manually delineated on all follow-up CT scans. Two size measures of the consolidation regions (longest axial diameter and 3D volume) and nine appearance features of the GGO were calculated: 2 first-order features [mean density and standard deviation of density (first-order texture)], and 7 second-order texture features [energy, entropy, correlation, inverse difference moment (IDM), inertia, cluster shade, and cluster prominence]. For comparison, the corresponding response evaluation criteria in solid tumors measures were also taken for the consolidation regions. Prediction accuracy was determined using the area under the receiver operating characteristic curve (AUC) and two-fold cross validation (CV). RESULTS For this analysis, 46 diagnostic CT scans scheduled for approximately 3 and 6 months post-treatment were binned based on their recorded scan dates into 2-5 month and 5-8 month follow-up time ranges. At 2-5 months post-treatment, first-order texture, energy, and entropy provided AUCs of 0.79-0.81 using a linear classifier. On two-fold CV, first-order texture yielded 73% accuracy versus 76%-77% with the second-order features. The size measures of the consolidative region, longest axial diameter and 3D volume, gave two-fold CV accuracies of 60% and 57%, and AUCs of 0.72 and 0.65, respectively. CONCLUSIONS Texture measures of the GGO appearance following SABR demonstrated the ability to predict recurrence in individual patients within 5 months of SABR treatment. Appearance changes were also shown to be more accurately predictive of recurrence, as compared to size measures within the same time period. With further validation, these results could form the substrate for a clinically useful computer-aided diagnosis tool which could provide earlier salvage of patients with recurrence.
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Affiliation(s)
- Sarah A Mattonen
- Department of Medical Biophysics, The University of Western Ontario, London, Ontario N6A 5C1, Canada
| | - David A Palma
- Department of Medical Biophysics, The University of Western Ontario, London, Ontario N6A 5C1, Canada; Department of Oncology, The University of Western Ontario, London, Ontario N6A 4L6, Canada; and Division of Radiation Oncology, London Regional Cancer Program, London, Ontario N6A 4L6, Canada
| | - Cornelis J A Haasbeek
- Department of Radiation Oncology, VU University Medical Center, Amsterdam 1081 HV, The Netherlands
| | - Suresh Senan
- Department of Radiation Oncology, VU University Medical Center, Amsterdam 1081 HV, The Netherlands
| | - Aaron D Ward
- Department of Medical Biophysics, The University of Western Ontario, London, Ontario N6A 5C1, Canada and Department of Oncology, The University of Western Ontario, London, Ontario N6A 4L6, Canada
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Stereotactic Ablative Radiation Therapy for Subcentimeter Lung Tumors: Clinical, Dosimetric, and Image Guidance Considerations. Int J Radiat Oncol Biol Phys 2014; 90:843-9. [DOI: 10.1016/j.ijrobp.2014.06.064] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 06/20/2014] [Accepted: 06/23/2014] [Indexed: 12/21/2022]
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349
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Lungscape: Resected Non–Small-Cell Lung Cancer Outcome by Clinical and Pathological Parameters. J Thorac Oncol 2014; 9:1675-84. [DOI: 10.1097/jto.0000000000000320] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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350
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Zhou X, Chen R, Xie W, Ni Y, Liu J, Huang G. Relationship between 18F-FDG accumulation and lactate dehydrogenase A expression in lung adenocarcinomas. J Nucl Med 2014; 55:1766-71. [PMID: 25342384 DOI: 10.2967/jnumed.114.145490] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
UNLABELLED (18)F-FDG PET has been widely used in the management of malignant tumors. Lactate dehydrogenase A (LDHA) plays an important role in the development, invasion, and metastasis of malignancies. However, the relationship between (18)F-FDG accumulation and LDHA expression has not been investigated. METHODS Retrospective analysis was conducted for 51 patients with lung adenocarcinomas who underwent (18)F-FDG PET. The relationship between maximum standardized uptake value and the expression of LDHA, glucose transporter 1 (GLUT1), and hexokinase 2 (HK2) were examined. RNA interference was used to analyze the role of LDHA in tumor metabolism and growth in A549 cells. The AKT, also known as protein kinase B, pathway was also investigated to evaluate the molecular mechanisms of the relationship between LDHA expression and (18)F-FDG uptake. RESULTS Maximum standardized uptake value was significantly higher in the LDHA high-expression group than the LDHA low-expression group (P = 0.018). GLUT1 expression in lung adenocarcinomas was positively correlated with (18)F-FDG accumulation and LDHA expression whereas HK2 expression was not. Knockdown of LDHA led to a significant decrease in GLUT1 expression, (18)F-FDG uptake, and cell proliferation. The activated form of AKT was also decreased after LDHA knockdown. CONCLUSION LDHA increases (18)F-FDG accumulation into non-small cell lung cancer, possibly by upregulation of GLUT1 expression but not HK2 expression. LDHA may modulate (18)F-FDG uptake in lung adenocarcinomas via the AKT-GLUT1 pathway. These results indicate that (18)F-FDG PET/CT may predict LDHA expression levels and response to anti-LDHA therapy in lung adenocarcinomas.
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Affiliation(s)
- Xiang Zhou
- Department of Nuclear Medicine, Ren ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ruohua Chen
- Department of Nuclear Medicine, Ren ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wenhui Xie
- Department of Nuclear Medicine, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yicheng Ni
- Theragnostic Laboratory, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Belgium; and
| | - Jianjun Liu
- Department of Nuclear Medicine, Ren ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Gang Huang
- Department of Nuclear Medicine, Ren ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China Department of Cancer Metabolism, Institute of Health Sciences, Chinese Academy of Sciences and Shanghai Jiao Tong University School of Medicine, Shanghai, China
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