351
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Backhus LM, Farjah F, Zeliadt SB, Varghese TK, Cheng A, Kessler L, Au DH, Flum DR. Predictors of imaging surveillance for surgically treated early-stage lung cancer. Ann Thorac Surg 2014; 98:1944-51; discussion 1951-2. [PMID: 25282167 DOI: 10.1016/j.athoracsur.2014.06.067] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 06/04/2014] [Accepted: 06/24/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Current guidelines recommend routine imaging surveillance for patients with non-small cell lung cancer (NSCLC) after treatment. Little is known about surveillance patterns for patients with surgically resected early-stage lung cancer in the community at large. We sought to characterize surveillance patterns in a national cohort. METHODS We conducted a retrospective study using the Surveillance, Epidemiology, and End-Results (SEER)-Medicare database (1995-2010). Patients with stage I/II NSCLC treated with surgical resection were included. Our primary outcome was receipt of imaging between 4 and 8 months after the surgical procedure. Covariates included demographics and comorbidities. RESULTS Chest radiography (CXR) was the most frequent initial modality (60%), followed by chest computed tomography (CT) (25%). Positron emission tomography (PET) was least frequent as an initial imaging modality (3%). A total of 13% of patients received no imaging within the initial surveillance period. Adherence to National Comprehensive Cancer Network (NCCN) guidelines for imaging by overall prevalence was 47% for receipt of CT; however, rates of CT increased over time from 28% to 61% (p < 0.01). Reduced rates of CT were associated with stage I disease and surgical resection as the sole treatment modality. CONCLUSIONS Imaging after definitive surgical treatment for NSCLC predominantly used CXR rather than CT. Most of this imaging is likely for surveillance, and in that context CXR has inferior detection rates for recurrence and new cancers. Adherence to guideline-recommended CT surveillance after surgical treatment is poor, but the reasons are multifactorial. Efforts to improve adherence to imaging surveillance must be coupled with greater evidence demonstrating improved long-term outcomes.
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Affiliation(s)
- Leah M Backhus
- Surgery Service, VA Puget Sound Health Care System, Seattle, Washington; Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, Washington.
| | - Farhood Farjah
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, Washington
| | - Steven B Zeliadt
- Health Services Research and Development Service, VA Puget Sound Health Care System, Seattle, Washington; Department of Health Services, School of Public Health, University of Washington, Seattle, Washington
| | - Thomas K Varghese
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, Washington
| | - Aaron Cheng
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, Washington
| | - Larry Kessler
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington
| | - David H Au
- Division of Pulmonary and Critical Care, Department of Medicine, University of Washington, Seattle, Washington
| | - David R Flum
- Department of Surgery, University of Washington, Seattle, Washington
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352
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Évolution de la double diffusion au CO et au NO au cours de la radiothérapie pulmonaire pour cancer bronchique : présentation du protocole de l’étude prospective Conort. Cancer Radiother 2014; 18:420-4. [DOI: 10.1016/j.canrad.2014.07.152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 07/18/2014] [Indexed: 10/24/2022]
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353
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354
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Louie AV, Senan S, Patel P, Ferket BS, Lagerwaard FJ, Rodrigues GB, Salama JK, Kelsey C, Palma DA, Hunink MG. When Is a Biopsy-Proven Diagnosis Necessary Before Stereotactic Ablative Radiotherapy for Lung Cancer? Chest 2014; 146:1021-1028. [DOI: 10.1378/chest.13-2924] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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355
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Teixeira SF, Alexandre de Azevedo R, Salomon MAC, Jorge SD, Levy D, Bydlowski SP, Rodrigues CP, Pizzo CR, Barbuto JAM, Ferreira AK. Synergistic anti-tumor effects of the combination of a benzofuroxan derivate and sorafenib on NCI-H460 human large cell lung carcinoma cells. Biomed Pharmacother 2014; 68:1015-22. [PMID: 25312819 DOI: 10.1016/j.biopha.2014.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 09/14/2014] [Indexed: 01/26/2023] Open
Abstract
Lung cancer is the most frequent and lethal human cancer in the world. Because is still an unsolved health issue, new compounds or therapeutic strategies are urgently needed. Furoxans are presented as potentials candidates for lung cancer treatment. Accordingly, we evaluated the efficacy of a benzofuroxan derivative, BFD-22, alone and combined with sorafenib against NCI-H460 cell line. We showed that BFD-22 has cytotoxic effects on the NCI-H460 cells. Importantly, the Combination Index (CI) evaluation revels that BFD-22 combined with sorafenib has a stronger cytotoxic effect. In addition, the combination induces apoptosis through extrinsic pathway, leading to TRAIL-R1/DR4-triggered apoptosis. Furthermore, BFD-22 combined with sorafenib increases ROS production and simultaneously reduces perlecan expression in the NCI-H460 cells. In accordance, tumor cells were arrested in the S-phase, and these anti-proliferative effects also inhibit cell migration. This is the first study reporting an advantage of BFD-22 combined with sorafenib as a new therapeutic strategy in the fight against lung cancer.
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Affiliation(s)
- Sarah Fernandes Teixeira
- Laboratory of Tumor Immunology, Department of Immunology, Institute of Biomedical Science, University of São Paulo, avenue Prof. Lineu-Prestes, 1730 São Paulo - SP, Brazil
| | - Ricardo Alexandre de Azevedo
- Laboratory of Tumor Immunology, Department of Immunology, Institute of Biomedical Science, University of São Paulo, avenue Prof. Lineu-Prestes, 1730 São Paulo - SP, Brazil
| | - Maria Alejandra Clavijo Salomon
- Laboratory of Tumor Immunology, Department of Immunology, Institute of Biomedical Science, University of São Paulo, avenue Prof. Lineu-Prestes, 1730 São Paulo - SP, Brazil
| | - Salomão Dória Jorge
- Laboratory of Tumor Immunology, Department of Immunology, Institute of Biomedical Science, University of São Paulo, avenue Prof. Lineu-Prestes, 1730 São Paulo - SP, Brazil
| | - Débora Levy
- Laboratory of Genetics and Molecular Hematology (LIM31), University of São Paulo School of Medicine, São Paulo - SP, Brazil
| | - Sérgio Paulo Bydlowski
- Laboratory of Genetics and Molecular Hematology (LIM31), University of São Paulo School of Medicine, São Paulo - SP, Brazil
| | - Cecília Pessoa Rodrigues
- Laboratory of Tumor Immunology, Department of Immunology, Institute of Biomedical Science, University of São Paulo, avenue Prof. Lineu-Prestes, 1730 São Paulo - SP, Brazil
| | - Célia Regina Pizzo
- Laboratory of Tumor Immunology, Department of Immunology, Institute of Biomedical Science, University of São Paulo, avenue Prof. Lineu-Prestes, 1730 São Paulo - SP, Brazil
| | - José Alexandre Marzagão Barbuto
- Laboratory of Tumor Immunology, Department of Immunology, Institute of Biomedical Science, University of São Paulo, avenue Prof. Lineu-Prestes, 1730 São Paulo - SP, Brazil; Cell and Molecular Therapy Center NUCEL-NETCEM, University of São Paulo, São Paulo - SP, Brazil
| | - Adilson Kleber Ferreira
- Laboratory of Tumor Immunology, Department of Immunology, Institute of Biomedical Science, University of São Paulo, avenue Prof. Lineu-Prestes, 1730 São Paulo - SP, Brazil.
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356
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DART-bid: dose-differentiated accelerated radiation therapy, 1.8 Gy twice daily: high local control in early stage (I/II) non-small-cell lung cancer. Strahlenther Onkol 2014; 191:256-63. [PMID: 25245469 DOI: 10.1007/s00066-014-0754-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 09/03/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND While surgery is considered standard of care for early stage (I/II), non-small-cell lung cancer (NSCLC), radiotherapy is a widely accepted alternative for medically unfit patients or those who refuse surgery. International guidelines recommend several treatment options, comprising stereotactic body radiation therapy (SBRT) for small tumors, conventional radiotherapy ≥ 60 Gy for larger sized especially centrally located lesions or continuous hyperfractionated accelerated RT (CHART). This study presents clinical outcome and toxicity for patients treated with a dose-differentiated accelerated schedule using 1.8 Gy bid (DART-bid). PATIENTS AND METHODS Between April 2002 and December 2010, 54 patients (median age 71 years, median Karnofsky performance score 70%) were treated for early stage NSCLC. Total doses were applied according to tumor diameter: 73.8 Gy for < 2.5 cm, 79.2 Gy for 2.5-4.5 cm, 84.6 Gy for 4.5-6 cm, 90 Gy for > 6 cm. RESULTS The median follow-up was 28.5 months (range 2-108 months); actuarial local control (LC) at 2 and 3 years was 88%, while regional control was 100%. There were 10 patients (19%) who died of the tumor, and 18 patients (33%) died due to cardiovascular or pulmonary causes. A total of 11 patients (20%) died intercurrently without evidence of progression or treatment-related toxicity at the last follow-up, while 15 patients (28%) are alive. Acute esophagitis ≤ grade 2 occurred in 7 cases, 2 patients developed grade 2 chronic pulmonary fibrosis. CONCLUSION DART-bid yields high LC without significant toxicity. For centrally located and/or large (> 5 cm) early stage tumors, where SBRT is not feasible, this method might serve as radiotherapeutic alternative to present treatment recommendations, with the need of confirmation in larger cohorts.
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357
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Yu IF, Yu YH, Chen LY, Fan SK, Chou HYE, Yang JT. A portable microfluidic device for the rapid diagnosis of cancer metastatic potential which is programmable for temperature and CO2. LAB ON A CHIP 2014; 14:3621-3628. [PMID: 25075570 DOI: 10.1039/c4lc00502c] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
If metastasis of lung cancer can be found and treated early, a victim might have an improved chance to prevail over it, but routine examinations such as chest radiography, computed tomography and biopsy cannot characterize the metastatic potential of lung cancer cells; critical diagnoses to define optimal therapeutic strategies are thus lost. We designed a portable microfluidic device for the rapid diagnosis of cancer metastatic potential. Featuring a micro system to control temperature and a bicarbonate buffered environment, our device discriminates a rate of surface detachment as an index of the migratory ability of cells cultured on pH-responsive chitosan. We labeled metastatic subpopulations of lung cancer cell lines, and verified that our device is capable of separating cells according to their metastatic ability. As only few cells are needed, a patient's specimen from biopsies, e.g. from fine-needle aspiration, can be processed on site to offer immediate information to physicians. We expect that our design will provide valuable information in pre-operative evaluations to assist the definition of therapeutic plans for lung cancer, as well as for metastatic tumors of other types.
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Affiliation(s)
- I F Yu
- Department of Mechanical Engineering, College of Engineering, National Taiwan University, Taipei 106, Taiwan.
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358
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Kerner GSMA, van Dullemen LFA, Wiegman EM, Widder J, Blokzijl E, Driever EM, van Putten JWG, Liesker JJW, Renkema TEJ, Pieterman RM, Mertens MJF, Hiltermann TJN, Groen HJM. Concurrent gemcitabine and 3D radiotherapy in patients with stage III unresectable non-small cell lung cancer. Radiat Oncol 2014; 9:190. [PMID: 25174943 PMCID: PMC4262382 DOI: 10.1186/1748-717x-9-190] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 08/16/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Stage III unresectable non-small cell lung cancer (NSCLC) is preferably treated with concurrent schedules of chemoradiotherapy, but none is clearly superior Gemcitabine is a radiosensitizing cytotoxic drug that has been studied in phase 1 and 2 studies in this setting. The aim of this study was to describe outcome and toxicity of low-dose weekly gemcitabine combined with concurrent 3-dimensional conformal radiotherapy (3D-CRT). PATIENTS & METHODS Treatment consisted of two cycles of a cisplatin and gemcitabine followed by weekly gemcitabine 300 mg/m2 during 5 weeks of 3D-CRT, 60 Gy in 5 weeks (hypofractionated-accelerated). Overall survival (OS), progression-free survival (PFS), and treatment related toxicity according to Common Toxicity Criteria of Adverse Events (CTCAE) version 3.0 were assessed. RESULTS Between February 2002 and August 2008, 318 patients were treated. Median age was 64 years (range 36-86); 72% were male, WHO PS 0/1/2 was 44/53/3%. Median PFS was 15.5 months (95% confidence interval [CI], 12.9-18.1) and median OS was 24.6 months (95% CI., 21.0-28.1). Main toxicity (CTCAE grade ≥3) was dysphagia (12.6%), esophagitis (9.6%), followed by radiation pneumonitis (3.0%). There were five treatment related deaths (1.6%), two due to esophagitis and three due to radiation pneumonitis. CONCLUSION Concurrent low-dose gemcitabine and 3D-CRT provides a comparable survival and toxicity profile to other available treatment schemes for unresectable stage III.
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Affiliation(s)
- Gerald S M A Kerner
- University of Groningen and Department of Pulmonary Diseases, University Medical Center Groningen, Hanzeplein 1, P,O, Box 30,001, Groningen 9700 RB, The Netherlands.
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359
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Dickhoff C, Hartemink K, van de Ven P, van Reij E, Senan S, Paul M, Smit E, Dahele M. Trimodality therapy for stage IIIA non-small cell lung cancer: Benchmarking multi-disciplinary team decision-making and function. Lung Cancer 2014; 85:218-23. [DOI: 10.1016/j.lungcan.2014.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 06/01/2014] [Accepted: 06/08/2014] [Indexed: 10/25/2022]
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360
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Uramoto H, Tanaka F. Recurrence after surgery in patients with NSCLC. Transl Lung Cancer Res 2014; 3:242-9. [PMID: 25806307 PMCID: PMC4367696 DOI: 10.3978/j.issn.2218-6751.2013.12.05] [Citation(s) in RCA: 220] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 12/30/2013] [Indexed: 12/14/2022]
Abstract
Surgery remains the only potentially curative modality for early-stage non-small cell lung cancer (NSCLC) patients and tissue availability is made possible. However, a proportion of lung cancer patients develop recurrence, even after curative resection. This review discusses the superiority of surgery, the reasons for recurrence, the timing and pattern of recurrence, the identification of factors related to recurrence, current provisions for treatment and perspectives about surgery for patients with NSCLC.
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Affiliation(s)
- Hidetaka Uramoto
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Fumihiro Tanaka
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
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361
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Gounant V, Khalil A, Créquit P, Lavole A, Ruppert AM, Antoine M, Milleron B, Wislez M, Carette MF, Assouad J, Cadranel J. 2014 update on non-small cell lung cancer (excluding diagnosis). Diagn Interv Imaging 2014; 95:721-5. [PMID: 25027710 DOI: 10.1016/j.diii.2014.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Lung cancer (LC) is a major public health issue because of its frequency, but especially because of the severity of this disease. The epidemiology has changed with an increased incidence in non-smokers and women. The ATS/ERS/IASLC classification of adenocarcinomas was modified in 2011, and they are now the most frequent histological subtype. More than half the cases of LC are diagnosed at the metastatic stage. Biopsies must provide tissue samples that are quantitatively large enough and of a good enough quality for diagnosis and to search for biomarkers. When the cancer seems to be localized, precise staging must be obtained. Treatment is based on the TNM classification. In localized stages, lobectomy associated with lymph node dissection is the standard therapy. Intraoperative chemotherapy improves survival in case of lymph node infiltration. Stereotactic radiation therapy and radiofrequency can be considered as specific cases. In cases with local progression, treatment is more controversial. In the presence of metastases, the goal is not a cure, but improving survival and quality of life. Numerous advances have been made with personalized treatment, (in particular in relation to the histological type and oncogenic addiction in tumors, access to new drugs, and improved management). Clinical research in thoracic cancer is very active. The fight against tobacco should remain a priority.
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Affiliation(s)
- V Gounant
- Sorbonne Universités, UPMC Université Paris 06, GRC n(o) 04, Theranoscan, 75252 Paris, France; Service de pneumologie, Centre expert en oncologie thoracique et maladies pulmonaires rares, Hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Service de chirurgie thoracique, Hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.
| | - A Khalil
- Service de radiologie, Hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - P Créquit
- Sorbonne Universités, UPMC Université Paris 06, GRC n(o) 04, Theranoscan, 75252 Paris, France; Service de pneumologie, Centre expert en oncologie thoracique et maladies pulmonaires rares, Hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - A Lavole
- Sorbonne Universités, UPMC Université Paris 06, GRC n(o) 04, Theranoscan, 75252 Paris, France; Service de pneumologie, Centre expert en oncologie thoracique et maladies pulmonaires rares, Hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - A M Ruppert
- Sorbonne Universités, UPMC Université Paris 06, GRC n(o) 04, Theranoscan, 75252 Paris, France; Service de pneumologie, Centre expert en oncologie thoracique et maladies pulmonaires rares, Hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - M Antoine
- Sorbonne Universités, UPMC Université Paris 06, GRC n(o) 04, Theranoscan, 75252 Paris, France; Service d'anatomie pathologique, Hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - B Milleron
- Service de pneumologie, Centre expert en oncologie thoracique et maladies pulmonaires rares, Hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - M Wislez
- Sorbonne Universités, UPMC Université Paris 06, GRC n(o) 04, Theranoscan, 75252 Paris, France; Service de pneumologie, Centre expert en oncologie thoracique et maladies pulmonaires rares, Hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - M F Carette
- Service de radiologie, Hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - J Assouad
- Service de chirurgie thoracique, Hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - J Cadranel
- Sorbonne Universités, UPMC Université Paris 06, GRC n(o) 04, Theranoscan, 75252 Paris, France; Service de pneumologie, Centre expert en oncologie thoracique et maladies pulmonaires rares, Hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
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362
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Wauters E, Vansteenkiste J. Unresectable stage III non-small cell lung cancer: is Tecemotide a new START for our patients? J Thorac Dis 2014; 6:574-7. [PMID: 24976973 DOI: 10.3978/j.issn.2072-1439.2014.05.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 05/04/2014] [Indexed: 11/14/2022]
Affiliation(s)
- Els Wauters
- 1 Vesalius Research Center (VRC), VIB, Leuven, Belgium ; 2 Laboratory for Translational Genetics, Department of Oncology, KU Leuven, Leuven, Belgium ; 3 Respiratory Oncology Unit, Department of Pulmonology, University Hospital KU Leuven, Leuven, Belgium
| | - Johan Vansteenkiste
- 1 Vesalius Research Center (VRC), VIB, Leuven, Belgium ; 2 Laboratory for Translational Genetics, Department of Oncology, KU Leuven, Leuven, Belgium ; 3 Respiratory Oncology Unit, Department of Pulmonology, University Hospital KU Leuven, Leuven, Belgium
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363
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McElnay P, Lim E. Adjuvant or neoadjuvant chemotherapy for NSCLC. J Thorac Dis 2014; 6 Suppl 2:S224-7. [PMID: 24868440 DOI: 10.3978/j.issn.2072-1439.2014.04.26] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 04/18/2014] [Indexed: 01/16/2023]
Abstract
In functionally fit patients with localized disease surgical resection remains the treatment of choice. There is also good evidence to support the use of chemotherapy in stages II-III. However, whether to use neoadjuvant or adjuvant therapy has been the topic of much debate. With its strong evidence base, adjuvant chemotherapy has been adopted in the European Society of Medical Oncology clinical practice guidelines for early and locally advanced stages II-III non-small-cell lung cancer (NSCLC), with consideration of adjuvant therapy in those with stage IB but with tumours >4 cm in size. There are fewer trials comparing neoadjuvant therapy plus surgery with surgery alone. Even less has been carried out directly comparing neoadjuvant with adjuvant therapy. The NATCH trial demonstrated no difference in survival between adjuvant and neoadjuvant arms, whilst others have yet to be completed. Meta-analysis also demonstrates no appreciable difference between the two methods. With such a strong body of evidence, however, postoperative delivery of chemotherapy remains the timing of choice in NSCLC.
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Affiliation(s)
- Philip McElnay
- 1 Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK ; 2 Academic Division of Thoracic Surgery, Royal Brompton Hospital, London, UK
| | - Eric Lim
- 1 Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK ; 2 Academic Division of Thoracic Surgery, Royal Brompton Hospital, London, UK
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364
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Cao C, Gupta S, Chandrakumar D, Tian DH, Black D, Yan TD. Meta-analysis of intentional sublobar resections versus lobectomy for early stage non-small cell lung cancer. Ann Cardiothorac Surg 2014; 3:134-41. [PMID: 24790836 DOI: 10.3978/j.issn.2225-319x.2014.03.08] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 03/24/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Surgical resection is the preferred treatment modality for eligible candidates with non-small cell lung cancer (NSCLC). However, the selection of sublobar resection versus lobectomy for early-stage NSCLC remains controversial. Previous meta-analyses comparing these two procedures presented data without considering the significant differences in the patient selection processes in individual studies. The present study aimed to compare the overall survival (OS) and disease-free survival (DFS) outcomes of patients who underwent sublobar resections who were also eligible for lobectomy procedures with those who underwent lobectomy. METHODS An electronic search was conducted using five online databases from their dates of inception to December 2013. Studies were selected according to predefined inclusion criteria and meta-analyzed using hazard ratio (HR) calculations. RESULTS Twelve studies met the selection criteria, including 1,078 patients who underwent sublobar resections and 1,667 patients who underwent lobectomies. From the available data, there was no significant differences in OS [HR 0.91; 95% confidence interval (CI) 0.64-1.29] or DFS (HR 0.82; 95% CI 0.60-1.12) between the two treatment arms. In addition, no significant OS difference was detected for patients who underwent segmentectomies compared to lobectomies (HR 1.04; 95% CI 0.66-1.63, P=0.86). CONCLUSIONS Using the available data in the current literature, patients who underwent sublobar resection for small, peripheral NSCLC after intentional selection rather than ineligibility for greater resections achieved similar long-term survival outcomes as those who underwent lobectomies. However, patients included for the present meta-analysis were a highly selected cohort and these results should be interpreted with caution. The importance of the patient selection process in individual studies must be acknowledged to avoid conflicting outcomes in future meta-analyses.
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Affiliation(s)
- Christopher Cao
- 1 The Collaborative Research (CORE) Group, Macquarie University, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, Australia ; 3 Faculty of Health Sciences, University of Sydney, Sydney, Australia ; 4 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Sunil Gupta
- 1 The Collaborative Research (CORE) Group, Macquarie University, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, Australia ; 3 Faculty of Health Sciences, University of Sydney, Sydney, Australia ; 4 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - David Chandrakumar
- 1 The Collaborative Research (CORE) Group, Macquarie University, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, Australia ; 3 Faculty of Health Sciences, University of Sydney, Sydney, Australia ; 4 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - David H Tian
- 1 The Collaborative Research (CORE) Group, Macquarie University, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, Australia ; 3 Faculty of Health Sciences, University of Sydney, Sydney, Australia ; 4 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Deborah Black
- 1 The Collaborative Research (CORE) Group, Macquarie University, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, Australia ; 3 Faculty of Health Sciences, University of Sydney, Sydney, Australia ; 4 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Tristan D Yan
- 1 The Collaborative Research (CORE) Group, Macquarie University, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, Australia ; 3 Faculty of Health Sciences, University of Sydney, Sydney, Australia ; 4 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
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365
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McDonald F, Popat S. Combining targeted agents and hypo- and hyper-fractionated radiotherapy in NSCLC. J Thorac Dis 2014; 6:356-68. [PMID: 24688780 DOI: 10.3978/j.issn.2072-1439.2013.12.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 12/03/2013] [Indexed: 12/12/2022]
Abstract
Radical radiotherapy remains the cornerstone of treatment for patients with unresectable locally advanced non small cell lung cancer (NSCLC) either as single modality treatment for poor performance status patients or with sequential or concomitant chemotherapy for good performance status patients. Advances in understanding of tumour molecular biology, targeted drug development and experiences of novel agents in the advanced disease setting have brought targeted agents into the NSCLC clinic. In parallel experience using modified accelerated fractionation schedules in locally advanced disease have demonstrated improved outcomes compared to conventional fractionation in the single modality and sequential chemo-radiotherapy settings. Early studies of targeted agents combined with (chemo-) radiotherapy in locally advanced disease in different clinical settings are discussed below and important areas for future studies are high-lighted.
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366
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Higuchi M, Honjo H, Shigihara T, Shishido F, Suzuki H, Gotoh M. A phase II study of radiofrequency ablation therapy for thoracic malignancies with evaluation by FDG-PET. J Cancer Res Clin Oncol 2014; 140:1957-63. [PMID: 24952227 DOI: 10.1007/s00432-014-1743-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 06/10/2014] [Indexed: 12/19/2022]
Abstract
PURPOSE Computed tomography (CT)-guided radiofrequency ablation (RFA) is safe and effective for patients with unresectable primary, recurrent, or metastatic thoracic malignancies. Several studies have shown the benefit of employing 18-fluoro-deoxyglucose positron-emission tomography (FDG-PET) to follow thoracic malignancies treated with RFA. In this prospective study, we show the safety and therapeutic efficacy of RFA and the utility of FDG-PET as tool for early detection of local recurrence. METHODS Twenty patients were enrolled in this study, and 24 lesions were ablated. Seven lesions were primary lung cancer, and 17 lesions were recurrent tumors or metastases from extrathoracic sites. Tumor size was in the range of 0.4-3.3 cm in diameter (mean: 1.5 cm). CT and FDG-PET scans were scheduled 7-14 days and 3-6 months after RFA treatment. RESULTS There were 17 adverse events (70.8 %) in 24 ablations included 13 pneumothoraces, two cases of chest pain, and two episodes of fever. With a median follow-up of 35.9 months (range 1-62 months), the overall 2-year survival rate was 84.2 %. Local recurrence occurred at four sites (2-year local control rate was 74.3 %). The FDG-PET results 7-14 days after RFA did not predict recurrence, whereas positive findings 3-6 months after RFA significantly correlated with local recurrence (p = 0.0016). CONCLUSIONS We confirmed the effectiveness of RFA for unresectable primary and secondary thoracic malignancies. FDG-PET analysis 3-6 months after ablation is a useful tool to assess local control.
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Affiliation(s)
- Mitsunori Higuchi
- Department of Thoracic Surgery, Fukushima Medical University School of Medicine, 1-Hikarigaoka, Fukushima, 960-1295, Japan,
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367
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Leighl NB, Curigliano G. Early-stage lung cancer--what do the experts recommend? Ann Oncol 2014; 25:1451-3. [PMID: 24920789 DOI: 10.1093/annonc/mdu220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- N B Leighl
- Division of Medical Oncology/Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| | - G Curigliano
- Division of Early Drug Development, European Institute of Oncology, Milan, Italy
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368
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Savran MM, Clementsen PF, Annema JT, Minddal V, Larsen KR, Park YS, Konge L. Development and Validation of a Theoretical Test in Endosonography for Pulmonary Diseases. Respiration 2014; 88:67-73. [DOI: 10.1159/000362884] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 04/04/2014] [Indexed: 11/19/2022] Open
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369
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Louie AV, Senan S. Computed tomography surveillance of patients with resected lung cancer: Recurrence or second primary lung cancer? J Thorac Cardiovasc Surg 2014; 147:1715. [PMID: 24793598 DOI: 10.1016/j.jtcvs.2014.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 01/07/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Alexander V Louie
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands; Department of Epidemiology, Harvard School of Public Health, Boston, Mass; Department of Radiation Oncology, London Regional Cancer Program, Western University, London, Ontario, Canada
| | - Suresh Senan
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
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370
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Antoniou AJ, Marcus C, Tahari AK, Wahl RL, Subramaniam RM. Follow-up or Surveillance (18)F-FDG PET/CT and Survival Outcome in Lung Cancer Patients. J Nucl Med 2014; 55:1062-8. [PMID: 24777290 DOI: 10.2967/jnumed.113.136770] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 03/14/2014] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED The value of performing follow-up PET/CT imaging more than 6 mo after the conclusion of therapy-either as a routine practice or because of clinically suspected recurrence-is not well established. The purpose of this study was to evaluate the added value of follow-up PET/CT to the clinical assessment and survival outcome of lung cancer patients. METHODS This was a retrospective study of 261 biopsy-proven lung cancer patients at a single tertiary center. In total, 488 follow-up PET/CT scans done 6 or more months after the completion of initial treatment were included in this study. Median follow-up from the completion of primary treatment was 29.3 mo (range, 6.1-295.1 mo). Overall survival (OS) benefit was measured using Kaplan-Meier plots with a Mantel-Cox log-rank test. A multivariate Cox regression model was provided with clinical covariates. RESULTS Of the 488 PET/CT scans, 281 were positive and 207 negative for recurrence. Overall median survival from the time of the PET/CT study was 48.5 mo. The median survival of PET-positive and PET-negative groups was 32.9 and 81.6 mo, respectively (P < 0.0001). A subgroup analysis demonstrated a similar difference in OS for 212 scans completed between 6 and 24 mo after treatment (P = 0.0004) and 276 scans completed after 24 mo (P = 0.0006). In the context of clinical assessment, PET/CT identified recurrence in 43.7% (107/245) of scans without prior clinical suspicion and ruled out recurrence in 15.2% (37/243) of scans with prior clinical suspicion. There was a significant difference in OS when grouped by clinical suspicion (P = 0.0112) or routine follow-up (P < 0.0001). In a multivariate Cox regression model, factors associated with OS were age (P < 0.0001) and PET/CT result (P = 0.0003). An age-stratified subgroup analysis demonstrated a significant difference in OS by PET scan result among patients younger than 60 y and between 60 and 70 y but not in those older than 70 y (P < 0.0001, P = 0.0004, and P = 0.8193, respectively). CONCLUSION (18)F-FDG PET/CT performed for follow-up more than 6 mo after the completion of primary treatment adds value to clinical judgment and is a prognostic marker of OS in lung cancer patients, regardless of the timing of the follow-up scan, and especially in patients younger than 70 y.
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Affiliation(s)
- Alexander J Antoniou
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Charles Marcus
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Abdel K Tahari
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Richard L Wahl
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Rathan M Subramaniam
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland; and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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371
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Nagel ZD, Chaim IA, Samson LD. Inter-individual variation in DNA repair capacity: a need for multi-pathway functional assays to promote translational DNA repair research. DNA Repair (Amst) 2014; 19:199-213. [PMID: 24780560 DOI: 10.1016/j.dnarep.2014.03.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Why does a constant barrage of DNA damage lead to disease in some individuals, while others remain healthy? This article surveys current work addressing the implications of inter-individual variation in DNA repair capacity for human health, and discusses the status of DNA repair assays as potential clinical tools for personalized prevention or treatment of disease. In particular, we highlight research showing that there are significant inter-individual variations in DNA repair capacity (DRC), and that measuring these differences provides important biological insight regarding disease susceptibility and cancer treatment efficacy. We emphasize work showing that it is important to measure repair capacity in multiple pathways, and that functional assays are required to fill a gap left by genome wide association studies, global gene expression and proteomics. Finally, we discuss research that will be needed to overcome barriers that currently limit the use of DNA repair assays in the clinic.
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Affiliation(s)
- Zachary D Nagel
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Center for Environmental Health Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Isaac A Chaim
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Center for Environmental Health Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Leona D Samson
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Center for Environmental Health Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Biology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
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372
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Mattonen SA, Huang K, Ward AD, Senan S, Palma DA. New techniques for assessing response after hypofractionated radiotherapy for lung cancer. J Thorac Dis 2014; 6:375-86. [PMID: 24688782 PMCID: PMC3968559 DOI: 10.3978/j.issn.2072-1439.2013.11.09] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 11/07/2013] [Indexed: 12/25/2022]
Abstract
Hypofractionated radiotherapy (HFRT) is an effective and increasingly-used treatment for early stage non-small cell lung cancer (NSCLC). Stereotactic ablative radiotherapy (SABR) is a form of HFRT and delivers biologically effective doses (BEDs) in excess of 100 Gy10 in 3-8 fractions. Excellent long-term outcomes have been reported; however, response assessment following SABR is complicated as radiation induced lung injury can appear similar to a recurring tumor on CT. Current approaches to scoring treatment responses include Response Evaluation Criteria in Solid Tumors (RECIST) and positron emission tomography (PET), both of which appear to have a limited role in detecting recurrences following SABR. Novel approaches to assess response are required, but new techniques should be easily standardized across centers, cost effective, with sensitivity and specificity that improves on current CT and PET approaches. This review examines potential novel approaches, focusing on the emerging field of quantitative image feature analysis, to distinguish recurrence from fibrosis after SABR.
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373
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Califano R, Karamouzis MV, Banerjee S, de Azambuja E, Guarneri V, Hutka M, Jordan K, Kamposioras K, Martinelli E, Corral J, Postel-Vinay S, Preusser M, Porcu L, Torri V. Use of adjuvant chemotherapy (CT) and radiotherapy (RT) in incompletely resected (R1) early stage Non-Small Cell Lung Cancer (NSCLC): a European survey conducted by the European Society for Medical Oncology (ESMO) young oncologists committee. Lung Cancer 2014; 85:74-80. [PMID: 24746176 DOI: 10.1016/j.lungcan.2014.03.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 03/02/2014] [Accepted: 03/05/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Early stage Non-Small Cell Lung Cancer (NSCLC) is potentially curable with surgery. ESMO guidelines recommend cisplatin-based adjuvant chemotherapy (CT) for completely resected stage II-III NSCLC. There is limited evidence for the use of adjuvant CT and/or radiotherapy (RT) in incompletely resected (R1) early stage NSCLC. MATERIALS AND METHODS A European survey of thoracic oncologists was conducted to evaluate use of adjuvant CT and RT for R1-resected NSCLC and to identify factors influencing treatment decisions. Demographics and information on clinical stage, regimens, cycles planned, radiotherapy sites, multidisciplinary management and discussion about inconclusive evidence with the patient were collected. Univariate and multivariate analyses were performed. RESULTS 768 surveys were collected from 41 European countries. 82.9% of participants were medical oncologists; 49.3% ESMO members; 37.1% based in University Hospitals; 32.6% practicing oncology for over 15 years and 81.4% active in research. 91.4% of participants prescribed adjuvant CT and mostly cisplatin/vinorelbine (81.2%) or cisplatin/gemcitabine (42.9%). 85% discussed limited clinical evidence with the patient. In the univariate analysis, a statistically significant association with CT prescription was found for medical oncology specialty (p<0.001), ESMO membership (p<0.001), activity in clinical research (p=0.002) and increased frequency of ESMO guidelines consultation (p for trend <0.001). 48.3% of participants prescribed adjuvant RT and its prescription were associated with radiation oncology specialty (p<0.001), not being an ESMO member (p<0.001), years practicing specialty (p for trend=0.001), workload of lung cancer patients (p for trend=0.027) and decreased frequency in consulting ESMO guidelines (p<0.001). In the multivariate analysis, medical oncology and radiation oncology were the best discriminator for prescription of adjuvant CT and RT, respectively. CONCLUSION This survey demonstrates that adjuvant CT and RT are commonly used in clinical practice for R1-resected NSCLC despite limited evidence. Prospective trials are necessary to clarify optimal management in this setting.
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Affiliation(s)
- R Califano
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom; Department of Medical Oncology, University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom.
| | - M V Karamouzis
- Molecular Oncology Unit, Department of Biological Chemistry, School of Medicine, University of Athens, Athens, Greece
| | - S Banerjee
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - E de Azambuja
- Institut Jules Bordet and L' Université Libre de Brussels (U.L.B.), Brussels, Belgium
| | - V Guarneri
- University of Padova, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - M Hutka
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - K Jordan
- University Hospital of Halle, Halle, Germany
| | - K Kamposioras
- Department of Medical Oncology, University Hospital of Larissa, Larissa, Greece
| | - E Martinelli
- Department of Internal and Experimental Medicine "F. Magrassi and A. Lanzara", Second University of Naples, Naples, Italy
| | - J Corral
- Instituto de Biomedicina de Sevilla and Hospital Universitario Virgen del Rocio, Seville, Spain
| | | | - M Preusser
- Department of Medicine I and Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria
| | - L Porcu
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - V Torri
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
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374
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Vansteenkiste J, Crinò L, Dooms C, Douillard JY, Faivre-Finn C, Lim E, Rocco G, Senan S, Van Schil P, Veronesi G, Stahel R, Peters S, Felip E. 2nd ESMO Consensus Conference on Lung Cancer: early-stage non-small-cell lung cancer consensus on diagnosis, treatment and follow-up. Ann Oncol 2014; 25:1462-74. [PMID: 24562446 DOI: 10.1093/annonc/mdu089] [Citation(s) in RCA: 342] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] 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 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 early-stage disease.
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Affiliation(s)
- J Vansteenkiste
- Respiratory Oncology Unit (Pulmonology), University Hospital KU Leuven, Leuven, Belgium
| | - L Crinò
- Department of Oncology, Santa Maria Della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - C Dooms
- Respiratory Oncology Unit (Pulmonology), University Hospital KU Leuven, Leuven, Belgium
| | - J Y Douillard
- Department of Medical Oncology, Integrated Centers of Oncology R. Gauducheau, St Herblain, France
| | - C Faivre-Finn
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester
| | - E Lim
- Imperial College and the Academic Division of Thoracic Surgery, Royal Brompton Hospital, London, UK
| | - G Rocco
- Department of Thoracic Surgery and Oncology, National Cancer Institute, Pascale Foundation, IRCCS, Naples, Italy
| | - S Senan
- Department of Radiation Oncology, VU University Medical Centre, Amsterdam, The Netherlands
| | - P Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem (Antwerp), Belgium
| | - G Veronesi
- Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - R Stahel
- Clinic of Oncology, University Hospital, Zürich
| | - S Peters
- Department of Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - E Felip
- Department of Medical Oncology, Vall D'Hebron University Hospital, Barcelona, Spain
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375
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Specenier P. Induction chemotherapy in head and neck cancer: are we too ambitious? Future Oncol 2014; 10:337-40. [DOI: 10.2217/fon.13.262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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376
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Stereotactic Body Radiotherapy for Stage I NSCLC: The Challenge of Evidence-Based Medicine. J Thorac Oncol 2014; 9:e17-8. [DOI: 10.1097/jto.0000000000000080] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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377
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Adam V, Wauters I, Vansteenkiste J. Melanoma-associated antigen-A3 vaccination in the treatment of non-small-cell lung cancer. Expert Opin Biol Ther 2014; 14:365-76. [DOI: 10.1517/14712598.2014.880421] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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378
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von Bartheld MB, van Breda A, Annema JT. Complication rate of endosonography (endobronchial and endoscopic ultrasound): a systematic review. ACTA ACUST UNITED AC 2014; 87:343-51. [PMID: 24434575 DOI: 10.1159/000357066] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 10/24/2013] [Indexed: 01/28/2023]
Abstract
BACKGROUND Endosonography [endoscopic ultrasound (EUS)-guided fine needle aspiration and endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration] is increasingly used for lung cancer staging and the assessment of sarcoidosis. Serious adverse events (SAE) have been reported in case reports, but the true incidence of complications is yet unknown. OBJECTIVES To assess the rate of SAE related to endosonography and to investigate associated risk factors. MATERIALS AND METHODS PubMed, EMBASE and Cochrane libraries were searched for eligible references up to April 2012 and these included studies reporting on linear EUS or EBUS for the analysis of mediastinal/hilar nodal or central intrapulmonary lesions. Case series describing complications were excluded. Reported complications were classified into SAE or minor adverse events (AE). RESULTS 190 studies met the inclusion criteria. Information on follow-up was missing in half of the studies. In 16,181 patients, 23 SAE (0.14%) and 35 AE (0.22%) were reported. No mortality was observed. SAE were more frequent in patients investigated with EUS (0.30%) than in those investigated with EBUS (0.05%). Infectious SAE were most prevalent (0.07%) and predominantly occurred in patients with cystic lesions and sarcoidosis. In lung cancer patients, complications were rare. DISCUSSION Endosonography for intrathoracic nodal assessment seems safe for lung cancer patients and mortality has not been reported. For cystic lesions and sarcoidosis, there may be a small, but nonnegligible risk of infectious complications. The true incidence of SAE might be higher as accurate documentation of complications is missing in most studies.
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Affiliation(s)
- M B von Bartheld
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
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379
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Denis F, Viger L, Charron A, Voog E, Dupuis O, Pointreau Y, Letellier C. Detection of lung cancer relapse using self-reported symptoms transmitted via an internet web-application: pilot study of the sentinel follow-up. Support Care Cancer 2014; 22:1467-73. [PMID: 24414998 DOI: 10.1007/s00520-013-2111-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 12/25/2013] [Indexed: 12/22/2022]
Abstract
PURPOSE We aimed to investigate whether patient self-evaluated symptoms transmitted via Internet can be used between planned visits to provide an early indication of disease relapse in lung cancer. METHODS Between 2/2013 and 8/2013, 42 patients with lung cancer having access to Internet were prospectively recruited to weekly fill a form of 11 self-assessed symptoms called "sentinel follow-up". Data were sent to the oncologist in real-time between planned visits. An alert email was sent to oncologist when self-scored symptoms matched some predefined criteria. Follow-up visit and imaging were then organized after a phone call for confirming suspect symptoms. Weekly and monthly compliances, easiness with which patients used the web-application and the accuracy of the sentinel follow-up for relapse detection were assessed and compared to a routine visit and imaging follow-up. RESULTS Median follow-up duration was 18 weeks (8-32). Weekly and monthly average compliances were 79 and 94 %, respectively. Sixty percents of patients declared to be less anxious during the few days before planned visit and imaging with the sentinel follow-up than without. Sensitivity, specificity, positive, and negative predictive values provided by the sentinel (planned imaging) follow-up were 100 %(84 %), 89 %(96 %), 81 %(91 %), and 100 %(93 %), respectively and well correlated with relapse (pχ (2) < 0.001). On average, relapses were detectable 5 weeks earlier with sentinel than planned visit. CONCLUSION An individualized cancer follow-up that schedule visit and imaging according to the patient status based on weekly self-reported symptoms transmitted via Internet is feasible with high compliance. It may even provide earlier detection of lung cancer relapse and care.
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Affiliation(s)
- Fabrice Denis
- Private Institut of Cancer, 9 rue Beauverger, Le Mans, France,
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380
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Biswas T, Sharma N, Machtay M. Controversies in the management of stage III non-small-cell lung cancer. Expert Rev Anticancer Ther 2014; 14:333-47. [PMID: 24397773 DOI: 10.1586/14737140.2014.867809] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Lung cancer remains the leading cause of death in the USA and is the most common cancer both in incidence and in mortality globally (1.35 million deaths annually). Non-small-cell lung cancer accounts for >80% of all lung cancers [1] . About 35-45% of non-small-cell lung cancer patients present with locally advanced non-metastatic stage III disease. However, confirmed stage III disease represents a very heterogeneous group ranging from borderline surgical candidate with minimal mediastinal involvement to bulky mediastinal nodes or contralateral nodal involvement with significant controversy regarding optimal management in these various situations. This article specifically addresses the role of surgery, radiotherapy and chemotherapy in multimodal approach to treat stage III patients with N2/N3 involvement and controversies surrounding these recommendations.
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Affiliation(s)
- Tithi Biswas
- University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA
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381
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A Brief Report of 10-Year Trends in the Use of Stereotactic Lung Radiotherapy at a Dutch Academic Medical Center. J Thorac Oncol 2014; 9:114-7. [DOI: 10.1097/jto.0000000000000012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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382
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Frauenfelder T, Puhan M, Lazor R, von Garnier C, Bremerich J, Niemann T, Christe A, Montet X, Gautschi O, Weder W, Kohler M. Early Detection of Lung Cancer: A Statement from an Expert Panel of the Swiss University Hospitals on Lung Cancer Screening. Respiration 2014; 87:254-64. [DOI: 10.1159/000357049] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 10/19/2013] [Indexed: 11/19/2022] Open
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383
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Daly ME, Beckett LA, Chen AM. Does early posttreatment surveillance imaging affect subsequent management following stereotactic body radiation therapy for early-stage non-small cell lung cancer? Pract Radiat Oncol 2013; 4:240-6. [PMID: 25012832 DOI: 10.1016/j.prro.2013.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 08/26/2013] [Accepted: 08/27/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE Uncertainty exists regarding the optimal surveillance imaging strategy following stereotactic body radiation therapy (SBRT) for early-stage non-small cell lung cancer (NSCLC), particularly with respect to timing. We sought to determine how routine use of early (<6 months) posttreatment imaging affects subsequent management. METHODS AND MATERIALS The records of all patients treated with SBRT between January 2007 and January 2013 for early-stage NSCLC were reviewed. Eligible patients underwent ≥ 1 early (defined as within 6 months following SBRT) surveillance imaging study. Radiographic findings and subsequent diagnostic or therapeutic interventions were identified. Proportions and exact 95% confidence intervals (CI) with early posttreatment surveillance findings and altered treatment were calculated, and cases were examined descriptively. RESULTS Sixty-two patients with 67 lung tumors underwent 92 early surveillance imaging studies (86 computed tomographic [CT] and 6 positron emission/CT) at a median of 2.1 months (range, 0.1-5.9 months). New lung nodules were identified in 8 patients (13%), leading to a diagnosis of metastatic disease treated with systemic therapy in 2 patients and biopsy proven solitary lung recurrence in 2 patients, both treated successfully with local therapy. Tumor growth meeting Response Evaluation Criteria in Solid Tumors (RECIST) criteria was identified in 1 patient, who was followed with subsequent radiographic regression. In aggregate, the treatment of 4 patients (6.5%, 95% CI 1.7%-15.2%) was altered by early imaging; 2 (3.2%, 95% CI 0.4%-10.8%) with a potentially curative intervention. No predictors for utility of early surveillance were identified. CONCLUSIONS Imaging within 6 months following SBRT for early-stage NSCLC resulted in a definitive intervention in approximately 3% of patients. In the era of cost-effective health care, a first scan at 6 months posttreatment may be adequate for most patients. Larger scale prospective studies are needed to address the optimal surveillance regimen following SBRT and to identify patients who may benefit from more aggressive surveillance regimens.
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Affiliation(s)
- Megan E Daly
- Department of Radiation Oncology, University of California Davis, Comprehensive Cancer Center, Sacramento, California.
| | - Laurel A Beckett
- Department of Biostatistics, University of California Davis, Comprehensive Cancer Center, Sacramento, California
| | - Allen M Chen
- Department of Radiation Oncology, University of California Davis, Comprehensive Cancer Center, Sacramento, California
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