1
|
Bonome P, Pezzulla D, Lancellotta V, Scrofani AR, Macchia G, Rodolfino E, Tagliaferri L, Kovács G, Deodato F, Iezzi R. Combination of Local Ablative Techniques with Radiotherapy for Primary and Recurrent Lung Cancer: A Systematic Review. Cancers (Basel) 2023; 15:5869. [PMID: 38136413 PMCID: PMC10741973 DOI: 10.3390/cancers15245869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/04/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
In patients with early-stage or recurrent NSCLC who are unable to tolerate surgery, a benefit could derive only from a systemic therapy or another few forms of local therapy. A systematic review was performed to evaluate the feasibility and the effectiveness of radiotherapy combined with local ablative therapies in the treatment of primary and recurrent lung cancer in terms of toxicity profile and local control rate. Six studies featuring a total of 115 patients who met eligibility criteria and 119 lesions were included. Three studies evaluated lung cancer patients with a medically inoperable condition treated with image-guided local ablative therapies followed by radiotherapy: their local control rate (LC) ranged from 75% to 91.7% with only 15 patients (19.4%) reporting local recurrence after combined modality treatment. The other three studies provided a salvage option for patients with locally recurrent NSCLC after RT: the median follow-up period varied from 8.3 to 69.3 months with an LC rate ranging from 50% to 100%. The most common complications were radiation pneumonitis (9.5%) and pneumothorax (29.8%). The proposed intervention appears to be promising in terms of toxicity profile and local control rate. Further prospective studies are need to better delineate combining LTA-RT treatment benefits in this setting.
Collapse
Affiliation(s)
- Paolo Bonome
- Radiation Oncology Unit, Responsible Research Hospital, 86100 Campobasso, Italy; (D.P.); (G.M.); (F.D.)
| | - Donato Pezzulla
- Radiation Oncology Unit, Responsible Research Hospital, 86100 Campobasso, Italy; (D.P.); (G.M.); (F.D.)
| | - Valentina Lancellotta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radioterapia Oncologica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (V.L.); (L.T.)
| | - Anna Rita Scrofani
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radiologia d’Urgenza ed Interventistica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.R.S.); (R.I.)
| | - Gabriella Macchia
- Radiation Oncology Unit, Responsible Research Hospital, 86100 Campobasso, Italy; (D.P.); (G.M.); (F.D.)
| | - Elena Rodolfino
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radiologia Addomino-Pelvica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy;
| | - Luca Tagliaferri
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radioterapia Oncologica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (V.L.); (L.T.)
| | - György Kovács
- Gemelli-INTERACTS, Università Cattolica del Sacro Cuore, 20123 Rome, Italy;
| | - Francesco Deodato
- Radiation Oncology Unit, Responsible Research Hospital, 86100 Campobasso, Italy; (D.P.); (G.M.); (F.D.)
- Radiology Institute, Università Cattolica del Sacro Cuore, 00135 Rome, Italy
| | - Roberto Iezzi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radiologia d’Urgenza ed Interventistica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (A.R.S.); (R.I.)
| |
Collapse
|
2
|
Shah IA, Seol HY, Cho Y, Ji W, Seo J, Lee C, Chon MK, Shin D, Kim JH, Choo KS, Park J, Kim J, Yoo H, Kim JH. Conversion of the bronchial tree into a conforming electrode to ablate the lung nodule in a porcine model. COMMUNICATIONS MEDICINE 2023; 3:129. [PMID: 37775526 PMCID: PMC10541426 DOI: 10.1038/s43856-023-00362-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 09/15/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Radiofrequency ablation (RFA) is one of the treatment options for lung nodules. However, the need for exact delivery of the rigid metal electrode into the center of the target mass often leads to complications or suboptimal results. To overcome these limitations, a concept of conforming electrodes using a flexible material has been tested in this study. METHODS A bronchoscopy-guided RFA (CAROL) under a temperature-controlled mode was tested in in-vivo and ex-vivo porcine lungs. Gallium-based liquid metal was used for turning the bronchial tree into temporary RF electrodes. A customized bronchoscopy-guided balloon-tipped guiding catheter (CAROL catheter) was used to make the procedure feasible under fluoroscopy imaging guidance. The computer simulation was also performed to gain further insight into the ablation results. Safety was also assessed including the liquid metal remaining in the body. RESULTS The bronchial electrode injected from the CAROL catheter was able to turn the target site bronchial air pipe into a temporally multi-tined RF electrode. The mean volume of Gallium for each effective CAROL was 0.46 ± 0.47 ml. The ablation results showed highly efficacious and consistent results, especially in the peripheral lung. Most bronchial electrodes were also retrieved by either bronchoscopic suction immediately after the procedure or by natural expectoration thereafter. The liquid metal used in these experiments did not have any significant safety issues. Computer simulation also supports these results. CONCLUSION The CAROL ablation was very effective and safe in porcine lungs showing encouraging potential to overcome the conventional approaches.
Collapse
Affiliation(s)
- Izaz Ali Shah
- Department of Electronic Engineering, Hanyang University, Seoul, 04763, Republic of Korea
| | - Hee Yun Seol
- Department of Internal Medicine, School of Medicine, Pusan National University, Pusan National University Yangsan Hospital, Research Institute for Convergence of Biomedical Science and Technology, Yangsan, Republic of Korea
| | - Youngdae Cho
- Department of Electronic Engineering, Hanyang University, Seoul, 04763, Republic of Korea
| | - Wonjun Ji
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jaeyoung Seo
- Department of R&D Center, Tau Medical Inc, Busan, Republic of Korea
| | - Cheolmin Lee
- Department of R&D Center, Tau Medical Inc, Busan, Republic of Korea
| | - Min-Ku Chon
- Department of Cardiology, School of Medicine & Cardiovascular center, Pusan National University & Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Donghoon Shin
- Department of Pathology, School of Medicine, Pusan National University & Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Justin H Kim
- Department of R&D Center, Tau Medical Inc, Busan, Republic of Korea
| | - Ki-Seok Choo
- Department of Radiology, School of Medicine & Medical Research Institute, Pusan National University & Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Junhui Park
- Major of Human Bioconvergence, College of Information Technology and Convergence, Pukyong National University, Busan, Republic of Korea
| | - Juhyung Kim
- Department of Physiology, University of Toronto, Toronto, Canada
| | - Hyoungsuk Yoo
- Department of Electronic Engineering, Hanyang University, Seoul, 04763, Republic of Korea.
| | - June-Hong Kim
- Department of Cardiology, School of Medicine & Cardiovascular center, Pusan National University & Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
| |
Collapse
|
3
|
Murphy MC, Tahir I, Saenger JA, Abrishami Kashani M, Muniappan A, Levesque VM, Shyn PB, Silverman SG, Fintelmann FJ. Safety and Effectiveness of Percutaneous Image-Guided Thermal Ablation of Juxtacardiac Lung Tumors. J Vasc Interv Radiol 2023; 34:750-758. [PMID: 36707028 DOI: 10.1016/j.jvir.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/10/2023] [Accepted: 01/15/2023] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To evaluate the safety and effectiveness of percutaneous image-guided thermal ablation (IGTA) for juxtacardiac lung tumors. MATERIALS AND METHODS This bi-institutional retrospective cohort study included 23 consecutive patients (13 [57%] male; mean age, 55 years ± 18) with 30 juxtacardiac lung tumors located ≤10 mm from the pericardium treated in 28 IGTA sessions (25 sessions of cryoablation and 3 sessions of microwave ablation) between April 2008 and August 2022. The primary outcome was any adverse cardiac event within 90 days after ablation. Secondary outcomes included noncardiac adverse events, local tumor progression-free survival (LT-PFS), and the cumulative incidence of local tumor progression with death as a competing risk. Two tumors treated without curative intent or follow-up imaging were considered in the safety analysis but not in the progression analysis. RESULTS The median imaging follow-up duration was 22 months (interquartile range [IQR], 10-53 months). Primary technical success was achieved in 25 (89%) ablations. No adverse cardiac events attributable to IGTA occurred. One patient experienced a phrenic nerve injury. The median LT-PFS duration was 59 months (IQR, 32-73 months). At 1, 3, and 5 years, LT-PFS was 90% (95% CI, 78%-100%), 74% (CI, 53%-100%), and 45% (CI, 20%-97%), respectively, and the cumulative incidence of local tumor progression was 4.3% (CI, 0.29%-19%), 11% (CI, 1.6%-30%), and 26% (CI, 3.3%-58%), respectively. CONCLUSIONS IGTA is safe and effective for lung tumors located ≤10 mm from the pericardium. No adverse cardiac events were not observed within 90 days after ablation.
Collapse
Affiliation(s)
- Mark C Murphy
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ismail Tahir
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jonathan A Saenger
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Faculty of Medicine, Sigmund Freud University, Vienna, Austria
| | - Maya Abrishami Kashani
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ashok Muniappan
- Department of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Vincent M Levesque
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Paul B Shyn
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stuart G Silverman
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Florian J Fintelmann
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
| |
Collapse
|
4
|
Bartlett EC, Rahman S, Ridge CA. Percutaneous image-guided thermal ablation of lung cancer: What is the evidence? Lung Cancer 2023; 176:14-23. [PMID: 36571982 DOI: 10.1016/j.lungcan.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/12/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
Thermal ablation techniques have now been used for more than twenty years in the treatment of primary lung tumours, predominantly non-small cell lung cancer (NSCLC). Although primarily used for the treatment of early-stage disease in non-surgical patients, thermal ablation is now also being used in selected patients with oligometastatic and oligoprogressive disease. This review discusses the techniques available for thermal ablation, the evidence for use of thermal ablation in primary lung tumours in early- and advanced-stage disease and compares thermal ablation to alternative treatment strategies.
Collapse
Affiliation(s)
- E C Bartlett
- Royal Brompton Hospital (Guy's and St Thomas' NHS Foundation Trust), Department of Radiology, Sydney Street, London SW3 6NP, United Kingdom.
| | - S Rahman
- Royal Brompton Hospital (Guy's and St Thomas' NHS Foundation Trust), Department of Radiology, Sydney Street, London SW3 6NP, United Kingdom
| | - C A Ridge
- Royal Brompton Hospital (Guy's and St Thomas' NHS Foundation Trust), Department of Radiology, Sydney Street, London SW3 6NP, United Kingdom; National Heart and Lung Institute, Imperial College, London SW3 6LY, United Kingdom
| |
Collapse
|
5
|
Current perspective on uniportal and multiportal video-assisted thoracic surgery during lobectomy for lung cancer. KARDIOCHIRURGIA I TORAKOCHIRURGIA POLSKA = POLISH JOURNAL OF CARDIO-THORACIC SURGERY 2022; 19:146-151. [PMID: 36268481 PMCID: PMC9574583 DOI: 10.5114/kitp.2022.119763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/02/2022] [Indexed: 11/23/2022]
Abstract
Non-small cell lung cancer (NSCLC) is the most typical type of lung cancer, and it is the leading cancer-related mortality globally. Lobectomy for early-stage NSCLC has been characterized in the previous decade using a wide range of methodologies. The development of video-assisted thoracoscopic surgery (VATS) allowed surgeons first to reduce the thoracotomy size, which is generally anterior, limiting it to trocar incisions or a single portal approach. This review aimed to describe current perspectives on operative outcomes, lymph node removal, oncologic outcomes, and advantages for surgeons performing uniportal VATS (uVATS) and multiportal (mVATS) lobectomy. The advantages of uVATS include comfortable operating for surgeons with a direct view and safety, and for patients more favourable operative outcomes. Also, the uVATS approach has previously been demonstrated to be effective and safe, with positive outcomes not just with respect to cosmetics but also in terms of a speedy recovery. Oncological uVATS clearance is comparable to multiportal VATS with respect to early mid-term survivability as well as nodal staging, as per retrospective comparison studies. However, the interpretation of outcomes must be made cautiously due to selection bias as well as lack of long-term follow-up; the choice of which VATS approach to utilize for patients' treatment following pulmonary resection is largely based on the preferences of the surgeon. As a result, it is difficult to say if one VATS method is better than another.
Collapse
|
6
|
Zhu S, Yang C, Chen S, Kang L, Li T, Li J, Li L. Effectiveness of a perioperative support programme to reduce psychological distress for family caregivers of patients with early-stage lung cancer: study protocol for a randomised controlled trial. BMJ Open 2022; 12:e064416. [PMID: 35998958 PMCID: PMC9403120 DOI: 10.1136/bmjopen-2022-064416] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
INTRODUCTION Family caregivers play a key role in providing ongoing long-term care and assistance to their loved ones during cancer treatment. However, family caregivers of patients with lung cancer are frequently unprepared for their roles and they may undergo psychological distress, thus reducing their own quality of life while affecting patients' health outcomes. Interventions that specifically target this population are lacking. This study aims to evaluate the effectiveness of a perioperative support programme on family caregivers of patients with early-stage lung cancer. METHODS AND ANALYSIS This study is guided by the Stress-Coping Model. Family caregivers of patients diagnosed with early-stage lung cancer and those who are scheduled for lung resection treatment will be invited to participate. Participants will be randomised to groups that either receive the perioperative support programme or usual care. The intervention consists of four face-to-face intervention sessions during the hospital stay and two weekly telephone follow-up sessions after discharge. Primary and secondary outcomes will be assessed at baseline and at 4 and 12 weeks after the intervention. Primary outcomes will include psychological distress and secondary outcomes will include caregiving burden, quality of life, coping style and social support. Generalised estimation equation model will be used to analyse the intervention effects. ETHICS AND DISSEMINATION The study was approved by the Ethics Committee of the Second Xiangya Hospital of Central South University (LYG2022003). The authors will disseminate the study's findings by publishing them in international scientific journals. TRIAL REGISTRATION NUMBER ChiCTR2200058280.
Collapse
Affiliation(s)
- Song Zhu
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, China
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Chen Yang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Shihao Chen
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Lu Kang
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, China
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Tong Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, China
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jina Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, China
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Lezhi Li
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| |
Collapse
|
7
|
Savanović M, Loi M, Rivin Del Campo E, Huguet F, Foulquier JN. Assessment of Organ Dose Reduction Using Dynamic Conformal Arc and Static Field with FFF Beams for SBRT in Lung Cancer. Cancer Invest 2022; 40:868-878. [DOI: 10.1080/07357907.2022.2103705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Milovan Savanović
- Faculty of Medicine, University of Paris-Saclay, Le Kremlin-Bicetre, France
- Department of Radiotherapy, Tenon Hospital, APHP, Sorbonne University, Paris, France
| | - Mauro Loi
- Department of Radiotherapy, Tenon Hospital, APHP, Sorbonne University, Paris, France
| | - Eleonor Rivin Del Campo
- Department of Radiotherapy, Tenon Hospital, APHP, Sorbonne University, Paris, France
- Faculty of Medicine, Sorbonne University Medical Faculty, Paris, France
| | - Florence Huguet
- Department of Radiotherapy, Tenon Hospital, APHP, Sorbonne University, Paris, France
- Faculty of Medicine, Sorbonne University Medical Faculty, Paris, France
| | - Jean-Noël Foulquier
- Department of Radiotherapy, Tenon Hospital, APHP, Sorbonne University, Paris, France
| |
Collapse
|
8
|
Chen D, Zhao M, Xiang X, Liang J. Percutaneous local tumor ablation vs. stereotactic body radiotherapy for early-stage non-small cell lung cancer: a systematic review and meta-analysis. Chin Med J (Engl) 2022; 135:00029330-990000000-00031. [PMID: 35830244 PMCID: PMC9532043 DOI: 10.1097/cm9.0000000000002131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Percutaneous local tumor ablation (LTA) and stereotactic body radiotherapy (SBRT) have been regarded as viable treatments for early-stage lung cancer patients. The purpose of this study was to compare the efficacy and safety of LTA with SBRT for early-stage non-small cell lung cancer (NSCLC). METHODS PubMed, Embase, Cochrane library, Ovid, Google scholar, CNKI, and CBMdisc were searched to identify potential eligible studies comparing the efficacy and safety of LTA with SBRT for early-stage NSCLC published between January 1, 1991, and May 31, 2021. Hazard ratios (HRs) or odds ratios (ORs) with 95% confidence intervals (CIs) were applied to estimate the effect size for overall survival (OS), progression-free survival (PFS), locoregional progression (LP), and adverse events. RESULTS Five studies with 22,231 patients were enrolled, including 1443 patients in the LTA group and 20,788 patients in the SBRT group. The results showed that SBRT was not superior to LTA for OS (HR = 1.03, 95% CI: 0.87-1.22, P = 0.71). Similar results were observed for PFS (HR = 1.09, 95% CI: 0.71-1.67, P = 0.71) and LP (HR = 0.66, 95% CI: 0.25-1.77, P = 0.70). Subgroup analysis showed that the pooled HR for OS favored SBRT in patients with tumors sized >2 cm (HR = 1.32, 95% CI: 1.14-1.53, P = 0.0003), whereas there was no significant difference in patients with tumors sized ≤2 cm (HR = 0.93, 95% CI: 0.64-1.35, P = 0.70). Moreover, no significant differences were observed for the incidence of severe adverse events (≥grade 3) (OR = 1.95, 95% CI: 0.63-6.07, P = 0.25) between the LTA group and SBRT group. CONCLUSIONS Compared with SBRT, LTA appears to have similar OS, PFS, and LP. However, for tumors >2 cm, SBRT is superior to LTA in OS. Prospective randomized controlled trials are required to determine such findings. INPLASY REGISTRATION NUMBER INPLASY202160099.
Collapse
Affiliation(s)
- Dongjie Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, Guangdong 518172, China
| | - Man Zhao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, Guangdong 518172, China
| | - Xiaoyong Xiang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, Guangdong 518172, China
| | - Jun Liang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, Guangdong 518172, China
| |
Collapse
|
9
|
Update on Image-Guided Thermal Lung Ablation: Society Guidelines, Therapeutic Alternatives, and Postablation Imaging Findings. AJR Am J Roentgenol 2022; 219:471-485. [PMID: 35319908 DOI: 10.2214/ajr.21.27099] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Percutaneous image-guided thermal ablation (IGTA) has been endorsed by multiple societies as a safe and effective lung-preserving treatment for primary lung cancer and metastases involving the lung and chest wall. This article reviews the role of IGTA in the care continuum of patients with thoracic neoplasms and discusses strategies to identify the optimal local therapy considering patient and tumor characteristics. The advantages and disadvantages of percutaneous thermal ablation compared to surgical resection and stereotactic body radiotherapy are summarized. Principles of radiofrequency ablation, microwave ablation, and cryoablation, as well as the emerging use of transbronchial thermal ablation, are described. Specific considerations are presented regarding the role of thermal ablation for early-stage non-small cell lung cancer (NSCLC), multifocal primary NSCLC, pulmonary metastases, salvage of recurrent NSCLC after surgery or radiation, and pain palliation for tumors involving the chest wall. Recent changes to professional society guidelines regarding the role of thermal ablation in the lung, including for treatment of oligometastatic disease, are highlighted. Finally, recommendations are provided for imaging follow-up after thermal ablation of lung tumors, accompanied by examples of expected postoperative findings and patterns of disease recurrence.
Collapse
|
10
|
Cho HH, Lee HY, Kim E, Lee G, Kim J, Kwon J, Park H. Radiomics-guided deep neural networks stratify lung adenocarcinoma prognosis from CT scans. Commun Biol 2021; 4:1286. [PMID: 34773070 PMCID: PMC8590002 DOI: 10.1038/s42003-021-02814-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 10/27/2021] [Indexed: 02/07/2023] Open
Abstract
Deep learning (DL) is a breakthrough technology for medical imaging with high sample size requirements and interpretability issues. Using a pretrained DL model through a radiomics-guided approach, we propose a methodology for stratifying the prognosis of lung adenocarcinomas based on pretreatment CT. Our approach allows us to apply DL with smaller sample size requirements and enhanced interpretability. Baseline radiomics and DL models for the prognosis of lung adenocarcinomas were developed and tested using local (n = 617) cohort. The DL models were further tested in an external validation (n = 70) cohort. The local cohort was divided into training and test cohorts. A radiomics risk score (RRS) was developed using Cox-LASSO. Three pretrained DL networks derived from natural images were used to extract the DL features. The features were further guided using radiomics by retaining those DL features whose correlations with the radiomics features were high and Bonferroni-corrected p-values were low. The retained DL features were subject to a Cox-LASSO when constructing DL risk scores (DRS). The risk groups stratified by the RRS and DRS showed a significant difference in training, testing, and validation cohorts. The DL features were interpreted using existing radiomics features, and the texture features explained the DL features well.
Collapse
Affiliation(s)
- Hwan-Ho Cho
- Department of Electrical and Computer Engineering, Sungkyunkwan University, Suwon, Republic of Korea
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Republic of Korea
| | - Ho Yun Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea.
| | - Eunjin Kim
- Department of Electrical and Computer Engineering, Sungkyunkwan University, Suwon, Republic of Korea
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Republic of Korea
| | - Geewon Lee
- Department of Radiology and Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Jonghoon Kim
- Department of Electrical and Computer Engineering, Sungkyunkwan University, Suwon, Republic of Korea
| | - Junmo Kwon
- Department of Electrical and Computer Engineering, Sungkyunkwan University, Suwon, Republic of Korea
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Republic of Korea
| | - Hyunjin Park
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Republic of Korea.
- School of Electronic and Electrical Engineering, Sungkyunkwan University, Suwon, Republic of Korea.
| |
Collapse
|
11
|
Choi Y, Aum J, Lee SH, Kim HK, Kim J, Shin S, Jeong JY, Ock CY, Lee HY. Deep Learning Analysis of CT Images Reveals High-Grade Pathological Features to Predict Survival in Lung Adenocarcinoma. Cancers (Basel) 2021; 13:4077. [PMID: 34439230 PMCID: PMC8391458 DOI: 10.3390/cancers13164077] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/02/2021] [Accepted: 08/09/2021] [Indexed: 01/18/2023] Open
Abstract
We aimed to develop a deep learning (DL) model for predicting high-grade patterns in lung adenocarcinomas (ADC) and to assess the prognostic performance of model in advanced lung cancer patients who underwent neoadjuvant or definitive concurrent chemoradiation therapy (CCRT). We included 275 patients with 290 early lung ADCs from an ongoing prospective clinical trial in the training dataset, which we split into internal-training and internal-validation datasets. We constructed a diagnostic DL model of high-grade patterns of lung ADC considering both morphologic view of the tumor and context view of the area surrounding the tumor (MC3DN; morphologic-view context-view 3D network). Validation was performed on an independent dataset of 417 patients with advanced non-small cell lung cancer who underwent neoadjuvant or definitive CCRT. The area under the curve value of the DL model was 0.8 for the prediction of high-grade histologic patterns such as micropapillary and solid patterns (MPSol). When our model was applied to the validation set, a high probability of MPSol was associated with worse overall survival (probability of MPSol >0.5 vs. <0.5; 5-year OS rate 56.1% vs. 70.7%), indicating that our model could predict the clinical outcomes of advanced lung cancer patients. The subgroup with a high probability of MPSol estimated by the DL model showed a 1.76-fold higher risk of death (HR 1.76, 95% CI 1.16-2.68). Our DL model can be useful in estimating high-grade histologic patterns in lung ADCs and predicting clinical outcomes of patients with advanced lung cancer who underwent neoadjuvant or definitive CCRT.
Collapse
Affiliation(s)
- Yeonu Choi
- Department of Radiology, Sungkyunkwan University School of Medicine (SKKU-SOM), Samsung Medical Center, Seoul 06351, Korea;
| | - Jaehong Aum
- Lunit Inc., Seoul 06241, Korea; (J.A.); (S.S.)
| | - Se-Hoon Lee
- Division of Hemato-Oncology, Department of Medicine, Sungkyunkwan University School of Medicine (SKKU-SOM), Samsung Medical Center, Seoul 06351, Korea;
| | - Hong-Kwan Kim
- Department of Thoracic Surgery, Sungkyunkwan University School of Medicine (SKKU-SOM), Samsung Medical Center, Seoul 06351, Korea; (H.-K.K.); (J.K.)
| | - Jhingook Kim
- Department of Thoracic Surgery, Sungkyunkwan University School of Medicine (SKKU-SOM), Samsung Medical Center, Seoul 06351, Korea; (H.-K.K.); (J.K.)
| | | | - Ji Yun Jeong
- Department of Pathology, Kyungpook National University School of Medicine, Kyungpook National University Chilgok Hospital, Daegu 41404, Korea;
| | | | - Ho Yun Lee
- Department of Radiology, Sungkyunkwan University School of Medicine (SKKU-SOM), Samsung Medical Center, Seoul 06351, Korea;
| |
Collapse
|
12
|
Rethinking a Non-Predominant Pattern in Invasive Lung Adenocarcinoma: Prognostic Dissection Focusing on a High-Grade Pattern. Cancers (Basel) 2021; 13:cancers13112785. [PMID: 34199689 PMCID: PMC8200026 DOI: 10.3390/cancers13112785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/28/2021] [Accepted: 05/30/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Prognostic considerations for non-predominant histologic patterns are necessary because most lung adenocarcinomas have a mixed histologic pattern. We aimed to identify prognostic stratification by second most predominant pattern of lung adenocarcinomas and to more accurately assess prognostic factors with CT imaging analysis, particularly enhancing non-predominant but high-grade pattern. We confirmed that the second most predominant histologic pattern can stratify lung adenocarcinoma patients according to prognosis. Especially, when the second most predominant pattern was high-grade, recurrence risk increased by 4.2-fold compared with the low-grade group. Thus, predicting the malignant potential and establishing treatment policies should not rely only on the most predominant pattern. Also, imaging parameters of higher non-contrast CT value and higher SUVmax value are associated with non-predominant but high-grade histologic pattern. Abstract Background: Prognostic considerations for non-predominant patterns are necessary because most lung adenocarcinomas (ADCs) have a mixed histologic pattern, and the spectrum of actual prognosis varies widely even among lung ADCs with the same most predominant pattern. We aimed to identify prognostic stratification by second most predominant pattern of lung ADC and to more accurately assess prognostic factors with CT imaging analysis, particularly enhancing non-predominant but high-grade pattern. Methods: In this prospective study, patients with early-stage lung ADC undergoing curative surgery underwent preoperative dual-energy CT (DECT) and positron emission tomography (PET)/CT. Histopathology of ADC, the most predominant and second most predominant histologic patterns, and preoperative imaging parameters were assessed and correlated with patient survival. Results: Among the 290 lung ADCs included in the study, 231 (79.7%) were mixed-pathologic pattern. When the most predominant histologic pattern was intermediate-grade, survival curves were significantly different among the three second most predominant subgroups (p = 0.004; low, lepidic; intermediate, acinar and papillary; high, micropapillary and solid). When the second most predominant pattern was high-grade, recurrence risk increased by 4.2-fold compared with the low-grade group (p = 0.005). To predict a non-predominant but high-grade pattern, the non-contrast CT value of tumor was meaningful with a lower HU value associated with the histologic combination of lower grade (low-grade as most predominant and intermediate-grade as second most predominant pattern, OR = 6.15, p = 0.005; intermediate-grade as most predominant and high-grade as second most predominant pattern, OR = 0.10, p = 0.033). SUVmax of the tumor was associated with the non-predominant but high-grade pattern, especially in the histologic combination of intermediate-high grade (OR = 1.14, p = 0.012). Conclusions: The second most predominant histologic pattern can stratify lung ADC patients according to prognosis. Thus, predicting the malignant potential and establishing treatment policies should not rely only on the most predominant pattern. Moreover, imaging parameters of non-contrast CT value and SUVmax could be useful in predicting a non-predominant but high-grade histologic pattern.
Collapse
|
13
|
Sato M, Yang SM, Tian D, Jun N, Lee JM. Managing screening-detected subsolid nodules-the Asian perspective. Transl Lung Cancer Res 2021; 10:2323-2334. [PMID: 34164280 PMCID: PMC8182721 DOI: 10.21037/tlcr-20-243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The broad application of low-dose computed tomography (CT) screening has resulted in the detection of many small pulmonary nodules. In Asia, a large number of these detected nodules with a radiological ground glass pattern are reported as lung adenocarcinomas or premalignant lesions, especially among female non-smokers. In this review article, we discuss controversial issues and conditions involving these subsolid pulmonary nodules that we often face in Asia, including a lack or insufficiency of current guidelines; the roles of preoperative biopsy and imaging; the location of lesions; appropriate selection of localization techniques; the roles of dissection and sampling of frozen sections and lymph nodes; multifocal lesions; and the roles of non-surgical treatment modalities. For these complex issues, we have tried to present up-to-date evidence and our own opinions regarding the management of subsolid nodules. It is our hope that this article helps surgeons and physicians to manage the complex issues involving ground glass nodules (GGNs) in a balanced manner in their daily practice and provokes further discussion towards better guidelines and/or algorithms.
Collapse
Affiliation(s)
- Masaaki Sato
- Department of Thoracic Surgery, University of Tokyo Hospital, Tokyo, Japan
| | - Shun-Mao Yang
- Department of Thoracic Surgery, University of Tokyo Hospital, Tokyo, Japan.,Department of Thoracic Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu
| | - Dong Tian
- Department of Thoracic Surgery, University of Tokyo Hospital, Tokyo, Japan.,Department of Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.,Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Nakajima Jun
- Department of Thoracic Surgery, University of Tokyo Hospital, Tokyo, Japan
| | - Jang-Ming Lee
- Department of Thoracic Surgery, National Taiwan University Hospital, Taipei
| |
Collapse
|
14
|
Yang W, An Y, Li Q, Liu C, Zhu B, Huang Q, Zhao M, Yang F, Feng H, Hu K. Co-ablation versus cryoablation for the treatment of stage III-IV non-small cell lung cancer: A prospective, noninferiority, randomized, controlled trial (RCT). Thorac Cancer 2020; 12:475-483. [PMID: 33319493 PMCID: PMC7882381 DOI: 10.1111/1759-7714.13779] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/20/2020] [Accepted: 11/25/2020] [Indexed: 12/24/2022] Open
Abstract
Background This study compared a co‐ablation (CA) system, which is a novel ablation device, with an argon‐helium cryoablation (AHC) system. We aimed to compare the efficacy and safety of CA and AHC for the treatment of stage III–IV non‐small cell lung cancer (NSCLC). Methods We conducted a multicenter randomized controlled trial (RCT) to determine whether CA was noninferior to AHC. The primary efficacy endpoints were the iceball coverage rate (ICR) and the disease control rate (DCR) one month after treatment. Noninferiority was declared if the lower limit of two‐sided 95% confidence interval (CI) was less than 10%. The ICR and DCR were identified by logistic regression. Treatment safety was assessed. Results A total of 81 patients underwent randomization (41 assigned to the CA and 40 assigned to the AHC groups)and transthoracic ablation. The ICRs in the CA and AHC groups were 99.24% ± 2.18% and 98.66% ± 3.79%, respectively. Central lesions were associated with an increased risk of an incomplete ICR. The DCRs in the CA and AHC groups were 97.6% and 95%, respectively. A smaller lesion area in the CA group was significantly correlated with a better DCR. The rate of complications was 29.26% in the CA group and 30% in the AHC group. (P = 0.943). There was less probe usage per patient in the CA group. Conclusions We determined that CA is noninferior to AHC in terms of efficacy and safety for the treatment of stage III–IV NSCLC. A smaller lesion area in the CA group was significantly correlated with a better DCR. Key points CA was noninferior to AHC for stage III–IV NSCLC.
Collapse
Affiliation(s)
- Wuwei Yang
- Department of Tumor Minimally Invasive Treatment, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yonghui An
- Department of Oncology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Quanwang Li
- Oncology Department, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Chuanbo Liu
- Oncology Department, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Baorang Zhu
- Department of Tumor Minimally Invasive Treatment, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Qianfu Huang
- Hygea Medical Technology Co., Ltd., Beijing, China
| | - Mengfei Zhao
- Hygea Medical Technology Co., Ltd., Beijing, China
| | - Fei Yang
- Hygea Medical Technology Co., Ltd., Beijing, China
| | - Huasong Feng
- Department of Respiratory Medicine, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Kaiwen Hu
- Oncology Department, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| |
Collapse
|
15
|
Kang N, Shin SH, Noh JM, Kang D, Kim H, Kwon OJ, Pyo H, Ahn YC, Kim HK, Choi YS, Kim J, Zo JI, Shim YM, Cho J, Park HY. Treatment modality and outcomes among early-stage non-small cell lung cancer patients with COPD: a cohort study. J Thorac Dis 2020; 12:4651-4660. [PMID: 33145038 PMCID: PMC7578486 DOI: 10.21037/jtd-20-667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background While there is an increasing number of early-stage non-small cell lung cancer (NSCLC) patients with chronic obstructive pulmonary disease (COPD), there are no specific clinical guidelines for treating them. This study aims to evaluate different treatment modalities and corresponding clinical outcomes among early-stage NSCLC patients with COPD. Methods We retrospectively reviewed 692 patients with stage I and II NSCLC and COPD from January 2012 to June 2014. Patients were categorized into four groups according to primary treatment modality: surgery only group (n=442), surgery with adjuvant treatment group (n=157), radiotherapy (RT) group (n=48), and supportive care (SC)-only group (n=45). Results Overall, mortality rate was the highest in the SC-only group (35.7 deaths per 100 person-years), followed by RT group (21.5 deaths per 100 person-years), surgery with adjuvant treatment group (8.9 deaths per 100 person-years) and surgery only group (7.2 deaths per 100 person-years). The adjusted hazard ratios (HR) for all-cause mortality compared to the surgery only group were 1.18 (95% CI, 0.84–1.67) in surgery with adjuvant treatment group, 1.61 (95% CI, 1.01–2.57) in RT group and 3.23 (95% CI, 1.99–5.23) in SC-only group. Conclusions Surgical resection should be considered as the first choice for early-stage NSCLC with COPD. Despite poor lung function or general patient condition, RT rather than SC can be an alternative option if surgery is not feasible. A multi-disciplinary approach and active communication between patients and physicians might be helpful for adequate decision-making regarding treatment for patients with early-stage NSCLC and COPD.
Collapse
Affiliation(s)
- Noeul Kang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sun Hye Shin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae Myoung Noh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Danbee Kang
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.,Center for Clinical Epidemiology, Samsung Medical Center, Seoul, South Korea
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - O Jung Kwon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hongryull Pyo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yong Soo Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jhingook Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae Ill Zo
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.,Center for Clinical Epidemiology, Samsung Medical Center, Seoul, South Korea.,Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hye Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| |
Collapse
|
16
|
Iguchi T, Hiraki T, Matsui Y, Mitsuhashi T, Katayama N, Katsui K, Soh J, Sakurai J, Gobara H, Toyooka S, Kanazawa S. Survival Outcomes of Treatment with Radiofrequency Ablation, Stereotactic Body Radiotherapy, or Sublobar Resection for Patients with Clinical Stage I Non-Small-Cell Lung Cancer: A Single-Center Evaluation. J Vasc Interv Radiol 2020; 31:1044-1051. [PMID: 32471699 DOI: 10.1016/j.jvir.2019.11.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 09/24/2019] [Accepted: 11/29/2019] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To retrospectively compare the outcomes of radiofrequency (RF) ablation, stereotactic body radiotherapy (SBRT), and sublobar resection (SLR) in patients with stage I non-small-cell lung cancer (NSCLC) at a single center. MATERIALS AND METHODS Overall, 289 patients (38 RF ablation, 58 SBRT, and 193 SLR) were included. Kaplan-Meier curves were generated, multiple propensity score was estimated using a multinomial logistic regression model, and relationships between treatments and outcomes were assessed using a Cox proportional hazard model. Hazard ratios (HRs) for death from any cause and disease progression or death from any cause were examined by a crude model, an inverse probability of treatment weighting (IPTW) model, and an IPTW model adjusted for missing variables. RESULTS The 5-year overall and progression-free survival rates were 58.9% and 39.9%, respectively, for RF ablation; 42.0% and 34.9%, respectively, for SBRT; and 85.5% and 75.9%, respectively, for SLR. Significantly longer survival time and lower HR were observed for SLR than other treatments. However, after statistical adjustment, these relationships were not significant except for reduced HR of disease progression or death from any cause of SLR compared to RF ablation in the IPTW model. The median hospital stays for RF ablation, SBRT, and SLR were 6.5, 6, and 16 days, respectively. Adverse events of grade 3 or higher occurred only in 11 SLR cases. CONCLUSIONS SLR achieved the longest survival. However, after statistical adjustment, there were no significant outcome differences among RF ablation, SBRT, and SLR, except for 1 model. RF ablation or SBRT may be alternative treatments for selected patients with early-stage NSCLC.
Collapse
Affiliation(s)
- Toshihiro Iguchi
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho, kita-ku Okayama 700-8558, Japan.
| | - Takao Hiraki
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho, kita-ku Okayama 700-8558, Japan
| | - Yusuke Matsui
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho, kita-ku Okayama 700-8558, Japan
| | - Toshiharu Mitsuhashi
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Norihisa Katayama
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho, kita-ku Okayama 700-8558, Japan
| | - Kuniaki Katsui
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho, kita-ku Okayama 700-8558, Japan
| | - Junichi Soh
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan; Department of General Thoracic Surgery, Okayama University Medical School, Okayama, Japan; Department of Surgery, Division of Thoracic Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Jun Sakurai
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Hideo Gobara
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho, kita-ku Okayama 700-8558, Japan
| | - Shinichi Toyooka
- Department of General Thoracic Surgery, Okayama University Medical School, Okayama, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho, kita-ku Okayama 700-8558, Japan
| |
Collapse
|
17
|
Chen S, Yang S, Xu S, Dong S. Comparison between radiofrequency ablation and sublobar resections for the therapy of stage I non-small cell lung cancer: a meta-analysis. PeerJ 2020; 8:e9228. [PMID: 32509468 PMCID: PMC7246024 DOI: 10.7717/peerj.9228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/30/2020] [Indexed: 12/16/2022] Open
Abstract
Background Sublobar resection (SLR) and radiofrequency ablation (RFA) are the two minimally invasive procedures performed for treating stage I non-small cell lung cancer (NSCLC). This study aimed to compare SLR and RFA for the treatment of stage I NSCLC using the meta-analytical method. Methods We searched PubMed and Embase for articles published till December 2019 to evaluate the comparative studies and assess the survival and progression-free survival rates and postoperative complications (PROSPERO registration number: CRD42018087587). A meta-analysis was performed by combining the outcomes of the reported incidences of short-term morbidity and long-term mortality. The fixed or random effects model was utilized to calculate the pooled odds ratios (OR) and the 95% confidence intervals. Results Four retrospective studies were considered in the course of this study. The studies included a total of 309 participants; 154 were assigned to the SLR group, and 155 were assigned to the RFA group. Moreover, there were statistically significant differences between the one- and three-year survival rates and one- and three-year progression-free survival rates for the two groups, which were in favor of the SLR group. Among the post-surgical complications, pneumothorax and pleural effusion were more common for the SLR group, while cardiac abnormalities were prevalent in the RFA group. There was no difference in prevalence of hemoptysis between SLR and RFA groups, which might be attributed to the limited study sample size. Conclusion Considering the higher survival rates and disease control in the evaluated cases, surgical resection is the preferred treatment method for stage I NSCLC. RFA can be considered a valid alternative in patients not eligible for surgery and in high-risk patients as it is less invasive and requires shorter hospital stay.
Collapse
Affiliation(s)
- Shuang Chen
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, China
| | - Shize Yang
- Department of Thoracic Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Shun Xu
- Department of Thoracic Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Siyuan Dong
- Department of Thoracic Surgery, The First Hospital of China Medical University, Shenyang, China
| |
Collapse
|
18
|
Wu J, Bai HX, Chan L, Su C, Zhang PJ, Yang L, Zhang Z. Sublobar resection compared with stereotactic body radiation therapy and ablation for early stage non-small cell lung cancer: A National Cancer Database study. J Thorac Cardiovasc Surg 2019; 160:1350-1357.e11. [PMID: 32033815 DOI: 10.1016/j.jtcvs.2019.11.132] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 11/09/2019] [Accepted: 11/26/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To compare the overall survival (OS) outcomes of sublobar resection (SLR) with stereotactic body radiation therapy (SBRT) or ablation for patients with early stage non-small cell lung cancer (NSCLC). METHODS Patients with clinical stage I (T1-T2aN0M0) NSCLC from 2004 to 2014 who were treated with SLR, SBRT, or ablation as the sole treatment were identified from the National Cancer Database. OS was estimated using the Kaplan-Meier method and evaluated by log-rank test, univariate and multivariate Cox proportional hazard regression, and propensity score-matched analysis. Relative survival analyses compared with age- and sex-matched US population were performed. RESULTS A total of 53,973 patients were identified. The 1-, 2-, 3-, and 5-year relative survival rates were 96%, 90%, 84%, and 71% for SLR (n = 30,451); 93%, 78%, 65%, and 46% for SBRT (n = 22,134); and 90%, 73%, 58%, and 37% for ablation (n = 1388). Propensity score matching resulted in 9967 patients in the SBRT group versus 9967 in the SLR group and 1062 patients in the ablation group versus 1984 in the SLR group. After matching, both SBRT (hazard ratio, 1.559; 95% confidence interval, 1.497-1.623; P < .001) and ablation (hazard ratio, 1.906; 95% confidence interval, 1.730-2.101; P < .001) were associated with shorter OS when compared with SLR. These results persisted in patients with tumor size ≤2 cm. CONCLUSIONS Preliminary results suggest SLR may be associated with longer OS in patients with early-stage NSCLC compared with SBRT or ablation. Future prospective, randomized, controlled clinical trials comparing these treatments are needed to confirm these results.
Collapse
Affiliation(s)
- Jing Wu
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Harrison X Bai
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, RI
| | - Lilian Chan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Chang Su
- Yale School of Medicine, New Haven, Conn
| | - Paul J Zhang
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Li Yang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Zishu Zhang
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
| |
Collapse
|
19
|
Chan ST, Ruan D, Shaverdian N, Raghavan G, Cao M, Lee P. Effect of Radiation Doses to the Heart on Survival for Stereotactic Ablative Radiotherapy for Early-stage Non-Small-cell Lung Cancer: An Artificial Neural Network Approach. Clin Lung Cancer 2019; 21:136-144.e1. [PMID: 31932217 DOI: 10.1016/j.cllc.2019.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/22/2019] [Accepted: 10/14/2019] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The cardiac radiation dose is an important predictor of cardiac toxicity and overall survival (OS) for patients with locally advanced non-small-cell lung cancer (NSCLC). However, radiation-induced cardiac toxicity among patients with early-stage NSCLC who have undergone stereotactic ablative radiotherapy (SABR) has been less well-characterized. Our objective was to assess the associations between cardiac radiation dosimetry and OS in patients with early-stage NSCLC undergoing SABR. MATERIALS AND METHODS From 2009 to 2014, 153 patients with early-stage NSCLC had undergone SABR at a single institution. The maximum dose, mean dose, V10Gy, V25Gy, and V50Gy to 15 cardiac substructures and the whole heart were analyzed for their association with OS using the Kaplan-Meier method. An artificial neural network (ANN) analysis was performed to modulate confounding behaviors of dosimetric variables to predict for OS. RESULTS A total of 112 patients were included in the present analysis. The right ventricle (RV) V10Gy most negatively predicted for OS, such that patients who had received a RV V10Gy dose < 4% had significantly longer OS than patients who had received a RV V10Gy does > 4% (5.3 years vs. 2.4 years). On ANN analysis, 74 input features, including cardiac dosimetry parameters, predicted for survival with a test accuracy of 64.7%. A repeat ANN analysis using dosimetry to dose neutral structure confirmed the predictive power of cardiac dosimetry. CONCLUSION Cardiac dosimetry to subvolumes of the heart was associated with decreased OS in patients with early-stage NSCLC undergoing SABR. These data support the importance of minimizing the radiation dose to cardiac substructures. Further prioritizing the heart as an organ at risk might be warranted. Additionally, cardiac follow-up should be considered.
Collapse
Affiliation(s)
- Shawna T Chan
- Department of Radiation Oncology, University of California, Los Angeles, School of Medicine, Los Angeles, CA; University of California, Irvine, School of Medicine, Irvine, CA
| | - Dan Ruan
- Department of Radiation Oncology, University of California, Los Angeles, School of Medicine, Los Angeles, CA
| | - Narek Shaverdian
- Department of Radiation Oncology, University of California, Los Angeles, School of Medicine, Los Angeles, CA; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Govind Raghavan
- Department of Radiation Oncology, University of California, Los Angeles, School of Medicine, Los Angeles, CA
| | - Minsong Cao
- Department of Radiation Oncology, University of California, Los Angeles, School of Medicine, Los Angeles, CA
| | - Percy Lee
- Department of Radiation Oncology, University of California, Los Angeles, School of Medicine, Los Angeles, CA; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA; Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX.
| |
Collapse
|
20
|
Bronchoscopic Ablative Therapies for Malignant Central Airway Obstruction and Peripheral Lung Tumors. Ann Am Thorac Soc 2019; 16:1220-1229. [DOI: 10.1513/annalsats.201812-892cme] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
|
21
|
Ridouani F, Srimathveeravalli G. Percutaneous image-guided ablation: From techniques to treatments. Presse Med 2019; 48:e219-e231. [PMID: 31447333 DOI: 10.1016/j.lpm.2019.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/11/2019] [Indexed: 02/06/2023] Open
Abstract
Image-guided ablation is performed by percutaneously introducing ablation probes to deliver energy into a tumor to destroy it in a controlled and localized fashion. Ablation modalities can be broadly classified as thermal or non-thermal based on the mechanism of tumor destruction and are performed using different types of image guidance for planning, delivering and follow-up of the treatment. Ablation is performed in a minimally invasive fashion, providing greater residual organ preservation with minimal morbidity to the patient. Image-guided ablation is being used in the clinic for the treatment of primary and metastatic tumors, and this article reviews state of the art for the treatment of malignancies in the liver, lung, kidney and musculoskeletal tissue.
Collapse
Affiliation(s)
- Fourat Ridouani
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, USA
| | - Govindarajan Srimathveeravalli
- University of Massachusetts, Institute for Applied Life Sciences, Department of Mechanical and Industrial Engineering, Amherst, USA.
| |
Collapse
|
22
|
Fehrenbach U, Feldhaus F, Kahn J, Böning G, Maurer MH, Renz D, Frost N, Streitparth F. Tumour response in non-small-cell lung cancer patients treated with chemoradiotherapy - Can spectral CT predict recurrence? J Med Imaging Radiat Oncol 2019; 63:641-649. [PMID: 31282130 DOI: 10.1111/1754-9485.12926] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 06/06/2019] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Tumour response in lung cancer treatment is monitored by measuring lesion size in computed tomography (CT). Spectral CT (SCT) offers additional information on tumour tissue besides morphology. We evaluated SCT iodine content (IC) and performed spectral slope analysis to assess the response of non-small-cell lung cancer (NSCLC) to chemoradiotherapy (CRT). METHODS Eighty-three patients with advanced NSCLC treated by CRT prospectively underwent single-phase, contrast-enhanced SCT. Evaluation of all patients included treatment response (RECIST 1.1), quantitative measurements as well as SCT IC determination and spectral slope analysis in NSCLC primaries. Measurements were performed at the maximum cross-diameter of tumours and in areas with high iodine values (hotspot analysis). Iodine difference (ΔIC) was calculated. Secondary outcome parameters were IC and spectral slopes in mediastinal lymph nodes (n = 61). RESULTS Twenty-four patients (29%) showed complete remission after CRT. Thirty-four patients (41%) had stable disease (SDSCT ) or partial regression (PRSCT ). Progressive disease (PDSCT ) was seen in 25 patients (30%). Hotspot analysis showed significantly higher iodine values in PDSCT than in SDSCT /PRSCT (P < 0.001). Ten patients (12%) with initially stable disease in SCT showed progressive disease during follow-up for up to 18 months (PDFU ). These patients also had significantly higher hotspot iodine values and ΔIC in the initial scan compared to patients with SD throughout the follow-up period (SDFU ) (29%) (P < 0.001). Enlarged lymph nodes showed significantly lower iodine content and a lower spectral slope pitch than normal-sized nodes (P = 0.003 to 0.029). CONCLUSION Spectral CT-derived iodine content of NSCLC following CRT may help in predicting recurrence. Hotspot analysis and iodine heterogeneity allow the identification of residual vascularisation as an indicator of vital tumour tissue, indicating that IC might be a suitable imaging biomarker for predicting tumour progression. Iodine content and spectral slope analysis might also help in identifying metastatic lymph nodes.
Collapse
Affiliation(s)
- Uli Fehrenbach
- Radiology, Charité University Medicine Berlin, Berlin, Germany
| | - Felix Feldhaus
- Radiology, Charité University Medicine Berlin, Berlin, Germany
| | - Johannes Kahn
- Radiology, Charité University Medicine Berlin, Berlin, Germany
| | - Georg Böning
- Radiology, Charité University Medicine Berlin, Berlin, Germany
| | - Martin H Maurer
- Radiology, University Hospital/Inselspital Bern, Bern, Switzerland
| | - Diane Renz
- Radiology, University Hospital Jena, Jena, Germany
| | - Nikolaj Frost
- Internal Medicine - Pulmonology, Charité University Medicine Berlin, Berlin, Germany
| | - Florian Streitparth
- Radiology, Charité University Medicine Berlin, Berlin, Germany.,Radiology, University Hospital Munich, Ludwig-Maximilians University (LMU), Munich, Germany
| |
Collapse
|
23
|
Majchrzak M, Brzecka A, Daroszewski C, Błasiak P, Rzechonek A, Tarasov VV, Chubarev VN, Kurinnaya AS, Melnikova TI, Makhmutova A, Klochkov SG, Somasundaram SG, Kirkland CE, Aliev G. Increased Pain Sensitivity in Obese Patients After Lung Cancer Surgery. Front Pharmacol 2019; 10:626. [PMID: 31258474 PMCID: PMC6586739 DOI: 10.3389/fphar.2019.00626] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 05/15/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Obesity and cancer are recognized worldwide health threats. While there is no reported causal relationship, the increasing frequency of both conditions results in a higher incidence of obese patients who are being treated for cancer. Physiological data indicate that there is a relationship between obesity and susceptibility to pain; however, currently, there are no specific pharmacological interventions. Objective: To evaluate the self-reported intensity of postoperative pain in obese and nonobese lung cancer who receive either thoracotomy or video-assisted thoracic surgery (VATS) surgical therapy. Material and Methods: In 50 obese [mean body mass index (BMI) of 34.1 ± 3.2 kg/m2] and 62 nonobese (mean BMI of 24.9 ± 3 kg/m2) lung cancer patients, the intensity of pain was estimated every 4 h using a visual analog scale (VAS, 0 indicating no pain and 10 indicating “worst imaginable pain”) beginning shortly after surgery (Day O) and continuing until the day of discharge (Day D). Results: The self-reported pain was more severe in obese than in nonobese patients, both at the time of the operation [Day O (4.5 ± 1.2 vs 3.4 ± 1.1; p < 0.0001)] and at the day of discharge [Day D (3.9 ± 1.4 vs 2.6 ± 0.9, p < 0.0001)]. This finding was consistent both in the patients after thoracotomy and after video-assisted thoracic surgery (VATS, p < 0.0001). The patients with severe pain shortly after surgery (VAS score >4) had significantly higher BMI (31.8 ± 5.6 kg/m2vs 28.8 ± 5.2 kg/m2, p < 0.01) and were hospitalized longer than the remaining patients (13.0 ± 13.6 days vs 9.5 ± 3.6 days, p < 0.05). Conclusion: The reported perception of pain in obese lung cancer patients is greater than in nonobese patients undergoing the same thoracic surgery. In obese patients, severe pain persisted longer. Pain management is an important consideration in the postoperative care of lung cancer patients, even more so with obese patients.
Collapse
Affiliation(s)
- Maciej Majchrzak
- Department of Thoracic Surgery, Medical University in Wroclaw, Wroclaw, Poland
| | - Anna Brzecka
- Department of Pulmonology and Lung Cancer, Medical University in Wroclaw, Wroclaw, Poland
| | - Cyryl Daroszewski
- Department of Pulmonology and Lung Cancer, Medical University in Wroclaw, Wroclaw, Poland
| | - Piotr Błasiak
- Department of Thoracic Surgery, Medical University in Wroclaw, Wroclaw, Poland
| | - Adam Rzechonek
- Department of Thoracic Surgery, Medical University in Wroclaw, Wroclaw, Poland
| | - Vadim V Tarasov
- Department of Pharmacology and Pharmacy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Vladimir N Chubarev
- Department of Pharmacology and Pharmacy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Anastasiya S Kurinnaya
- Department of Pharmacology and Pharmacy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Tatiana I Melnikova
- Department of Pharmacology and Pharmacy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Alfiya Makhmutova
- Institute of Physiologically Active Compounds, Russian Academy of Sciences, Chernogolovka, Russia
| | - Sergey G Klochkov
- Institute of Physiologically Active Compounds, Russian Academy of Sciences, Chernogolovka, Russia
| | - Siva G Somasundaram
- Department of Biological Sciences, Salem University, Salem, WV, United States
| | - Cecil E Kirkland
- Department of Biological Sciences, Salem University, Salem, WV, United States
| | - Gjumrakch Aliev
- Department of Pharmacology and Pharmacy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,Institute of Physiologically Active Compounds, Russian Academy of Sciences, Chernogolovka, Russia.,GALLY International Biomedical Research Institute, San Antonio, TX, United States
| |
Collapse
|
24
|
Berlin E, Buckstein M, Yip R, Yankelevitz DF, Rosenzweig K, Henschke CI. Definitive Radiation for Stage I Lung Cancer in a Screened Population: Results From the I-ELCAP. Int J Radiat Oncol Biol Phys 2019; 104:122-126. [PMID: 30677471 DOI: 10.1016/j.ijrobp.2019.01.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 01/07/2019] [Accepted: 01/11/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE The International Early Lung Cancer Action Program is a cohort study to assess the cure rate of participants undergoing annual low-dose computed tomography screening for lung cancer. This study compares the characteristics and outcomes of patients who received a diagnosis of clinical stage I non-small cell lung carcinoma (NSCLC) treated with definitive radiation therapy and surgical resection. METHODS AND MATERIALS Patient information was drawn from the International Early Lung Cancer Action Program database from 1992 to 2017. All instances in which treatment was performed for histologically proven stage I NSCLC using definitive radiation therapy and surgery were identified. The home institution determined radiation plans. Patient characteristics and Kaplan-Meier lung cancer-specific (LCS) long-term survival rates were compared for both types of treatment. Follow-up time was calculated from time of diagnosis until death from lung cancer, loss to follow-up, or December 31, 2017, whichever came earlier. RESULTS Among 82,628 baseline and 109,250 annual repeat screenings, 853 patients received a diagnosis of clinical stage I NSCLC, of whom 31 (3.6%) were treated by definitive radiation therapy and 702 (82.3%) by surgical resection alone. Radiation therapy prescription information was obtainable for 24 of the 31 patients: The median dose was 54.5 Gy, the median number of fractions was 5, and 17 patients were treated using stereotactic body radiation therapy. LCS survival rates were not significantly different for radiation therapy compared with surgery: 90.0% (95% confidence interval, 84.9%-100.0%) versus 94.8% (95% confidence interval, 93.0%-96.6%) (P = .09). Median follow-up time was 9.7 years for all, but it was shorter for those treated by radiation therapy than for those who underwent surgery (4.3 vs 10.0 years, P < .0001). CONCLUSIONS The majority of patients identified by computed tomography screening were treated with surgical resection. Despite being older and having more comorbidities, LCS long-term survival rates of patients treated with definitive radiation therapy were not significantly different compared with survival rates of patients treated with surgery alone. Radiation therapy appears to be a viable alternative to surgery for screen-diagnosed patients with lung cancer.
Collapse
Affiliation(s)
- Eva Berlin
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael Buckstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rowena Yip
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - David F Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kenneth Rosenzweig
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York.
| | | |
Collapse
|
25
|
Phillips JD, Bostock IC, Hasson RM, Goodney PP, Goodman DC, Millington TM, Finley DJ. National practice trends for the surgical management of lung cancer in the CMS population: an atlas of care. J Thorac Dis 2019; 11:S500-S508. [PMID: 31032068 PMCID: PMC6465423 DOI: 10.21037/jtd.2019.01.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 12/31/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND Video-assisted thoracoscopic surgery (VATS) has been established as a safe and effective alternative to an open approach for the treatment of early-stage lung cancer. Despite this, differences in utilization across the nation are present. The aims of this study were to: (I) characterize trends in the use of open surgery and VATS for the management of lung cancer across the United States, and (II) describe if particular regions of the country utilize minimally invasive surgery more frequently. METHODS We studied all Medicare beneficiaries from the ages of 65 to 99 years with full Part A and B coverage and no HMO coverage for the years of 2006 and 2014 (the most recent year available at the time of this analysis). Beneficiaries with a diagnosis of lung cancer (ICD-9 codes: 162.0 162.2 162.3 162.4 162.5 162.8 162.9) were selected. Rates of thoracoscopic surgery (CPT codes: 32663, 32666, 32667, 32668, 32669, 32670, 32671) and open lung resections (32505, 32506, 32507, 32608, 32440, 32442, 32445, 32480, 32482, 32484, 32486, 32488) were calculated by year and region. Rates in 2006 and 2014 with descriptive statistics and a univariate analysis were performed using Student's t-test and chi-square, as appropriate. A two-sided P value <0.05 was considered statistically significant. RESULTS A total of 24,368,333 and 23,921,059 beneficiaries for the years of 2006 and 2014 were analyzed. A diagnosis of lung cancer was detected in claims of 167,418 patients (0.7%) in 2006 and 167,506 patients in 2014 (0.7%), which was not significantly different (P=0.7). Among these lung cancer patients, a surgical intervention was performed in 17,249 patients (10.3%) during 2006 and 18,603 patients (11.1%) in 2014 (P=0.01). Among those undergoing surgery, a VATS approach was performed in 2,512 patients (15%) during 2006 and 9,578 patients (54%) during 2014 (P=0.001). In 2006, California, New York, and New Jersey performed the most VATS procedures, in comparison to 2014, when New York, Florida, and California performed the highest number of VATS procedures. CONCLUSIONS While the prevalence of lung cancer in the United States was unchanged between 2006 and 2014, the use of VATS techniques increased five-fold. Further studies to better understand the adoption or availability of new surgical techniques in lung cancer populations across geographic regions and patient populations are necessary.
Collapse
Affiliation(s)
- Joseph D. Phillips
- Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | | | - Rian M. Hasson
- Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Philip P. Goodney
- Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - David C. Goodman
- Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Timothy M. Millington
- Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - David J. Finley
- Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| |
Collapse
|
26
|
Wang Y, Liu B, Cao P, Wang W, Wang W, Chang H, Li D, Li X, Zhao X, Li Y. Comparison between computed tomography-guided percutaneous microwave ablation and thoracoscopic lobectomy for stage I non-small cell lung cancer. Thorac Cancer 2018; 9:1376-1382. [PMID: 30152596 PMCID: PMC6209786 DOI: 10.1111/1759-7714.12842] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 07/21/2018] [Accepted: 07/21/2018] [Indexed: 12/12/2022] Open
Abstract
Background The study was conducted to investigate the effectiveness and cost of computed tomography (CT)‐guided percutaneous microwave ablation (MWA) and thoracoscopic lobectomy for stage I non‐small cell lung cancer (NSCLC). Methods We retrospectively analyzed the data of 46 and 85 patients with stage I NSCLC treated with CT‐guided percutaneous MWA or thoracoscopic lobectomy, respectively, at our center from July 2013 to June 2015. Overall survival (OS), disease‐free survival (DFS), local control rate, hospital stay, and cost were evaluated. Survival curves were constructed using the Kaplan–Meier method and compared using the log‐rank test. Results The one and two‐year OS rates were 97.82% and 91.30% and 97.65% and 90.59% in the MWA and lobectomy groups, respectively. The one and two‐year DFS rates were 95.65% and 76.09% and 95.29% and 75.29%, respectively. No significant differences were observed in log‐rank analysis between the groups (P = 0.169). The hospital stays in the MWA and lobectomy groups were 6.62 ± 2.31 and 9.57 ± 3.19 days, respectively. The costs of MWA and lobectomy were US$3274.50 ± US$233.91 and US$4678.87 ± US$155.96, respectively. The differences were all significant (P = 0.003). Conclusion MWA and thoracoscopic lobectomy for stage I NSCLC demonstrate similar one and two‐year OS and DFS, with no significant differences between the two groups. MWA involved a shorter hospital stay and lower cost, thus should be considered a better option for patients with severe cardiopulmonary comorbidity and patients unwilling to undergo surgery.
Collapse
Affiliation(s)
- Yongzheng Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan, China.,Interventional Oncology Institute of Shandong University, Jinan, China
| | - Bin Liu
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan, China.,Interventional Oncology Institute of Shandong University, Jinan, China
| | - Pikun Cao
- School of Medicine, Shandong University, Jinan, China
| | - Wujie Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan, China.,Interventional Oncology Institute of Shandong University, Jinan, China
| | - Wei Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan, China.,Interventional Oncology Institute of Shandong University, Jinan, China
| | - Haiyang Chang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan, China.,Interventional Oncology Institute of Shandong University, Jinan, China
| | - Dong Li
- School of Medicine, Shandong University, Jinan, China
| | - Xiao Li
- School of Medicine, Shandong University, Jinan, China
| | - Xiaogang Zhao
- Department of Thoracic Surgery, The Second Hospital of Shandong University, Jinan, China
| | - Yuliang Li
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan, China.,Interventional Oncology Institute of Shandong University, Jinan, China
| |
Collapse
|
27
|
Zhao ZR, Lau RWH, Ng CSH. Catheter-based alternative treatment for early-stage lung cancer with a high-risk for morbidity. J Thorac Dis 2018; 10:S1864-S1870. [PMID: 30026973 DOI: 10.21037/jtd.2018.03.151] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The mainstream treatment modality for early stage non-small cell lung cancer (NSCLC) is surgery; however, many patients are deemed inoperable and warrant alternative therapeutic options. Several minimally invasive catheter-based therapies are emerging as viable alternatives. In this review, we evaluate the outcomes from radiofrequency ablation (RFA), microwave ablation (MWA), cryoablation (CRA) and photodynamic therapy (PDT) for early-stage lung cancer. Novel technical developments have allowed for endobronchial thermal ablation to be conducted in a hybrid theatre setting, which may optimize treatment outcomes and minimise treatment-related complications.
Collapse
Affiliation(s)
- Ze-Rui Zhao
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Rainbow W H Lau
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Calvin S H Ng
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| |
Collapse
|
28
|
Lee S, Song SY, Kim SS, Choi W, Je HU, Back GM, Cho B, Jeong SY, Choi EK. Feasible Optimization of Stereotactic Ablative Radiotherapy Dose by Tumor Size for Stage I Non–small-cell Lung Cancer. Clin Lung Cancer 2018; 19:e253-e261. [DOI: 10.1016/j.cllc.2017.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 11/06/2017] [Accepted: 11/06/2017] [Indexed: 10/18/2022]
|
29
|
Wang Q, Guo Y, Jiang S, Dong M, Kuerban K, Li J, Feng M, Chen Y, Ye L. A hybrid of coumarin and phenylsulfonylfuroxan induces caspase-dependent apoptosis and cytoprotective autophagy in lung adenocarcinoma cells. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2018; 39:160-167. [PMID: 29433677 DOI: 10.1016/j.phymed.2017.12.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 11/08/2017] [Accepted: 12/25/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND Lung adenocarcinoma is the most primary histologic subtype of non-small cell lung cancer (NSCLC). Compound 8b, a novel coumarin derivative with phenylsulfonylfuroxan group, shows significant antiproliferation activity against lung adenocarcinoma cell with low toxicity. PURPOSE This study aims to uncover the potential of compound 8b in relation to apoptosis as well as autophagy induction in lung adenocarcinoma cells. STUDY DESIGN The cytotoxicity and apoptosis of A549 and H1299 cells induced by compound 8b were detected by MTT, microscope and western blot analysis. Autophagy was determined by TEM, confocal microscopy and western blot analysis. Akt/mTOR and Erk signaling pathway were also examined by western blot analysis. RESULTS First, significant growth inhibition and caspase-dependent apoptosis were observed in compound 8b-treated A549 and H1299 cells. Then, we confirmed compound 8b-induced autophagy by autophagosomes formation, upregulated expression of autophagy-related protein LC3-II and autophagic flux. Importantly, abolishing autophagy using inhibitors and ATG5 siRNA enhanced the cytotoxicity of compound 8b, indicating the cytoprotective role of autophagy in lung adenocarcinoma. Further mechanistic investigations suggested that Akt/mTOR and Erk signaling pathways contributed to autophagy induction by compound 8b. CONCLUSION This results demonstrate that compound 8b induces caspase-dependent apoptosis as well as cytoprotective autophagy in lung adenocarcinoma cells, which may provide scientific evidence for developing this furoxan-based NO-releasing coumarin derivative as a potential anti-lung adenocarcinoma therapeutic agents.
Collapse
Affiliation(s)
- Qian Wang
- Department of Microbiological & Biochemical Pharmacy, School of Pharmacy, Fudan University, Shanghai, 201203, China
| | - Yalan Guo
- Department of Medicinal Chemistry, School of Pharmacy, Fudan University, China
| | - Shanshan Jiang
- Department of Microbiological & Biochemical Pharmacy, School of Pharmacy, Fudan University, Shanghai, 201203, China
| | - Mengxue Dong
- Department of Microbiological & Biochemical Pharmacy, School of Pharmacy, Fudan University, Shanghai, 201203, China
| | - Kudelaidi Kuerban
- Department of Microbiological & Biochemical Pharmacy, School of Pharmacy, Fudan University, Shanghai, 201203, China
| | - Jiyang Li
- Department of Microbiological & Biochemical Pharmacy, School of Pharmacy, Fudan University, Shanghai, 201203, China
| | - Meiqing Feng
- Department of Microbiological & Biochemical Pharmacy, School of Pharmacy, Fudan University, Shanghai, 201203, China
| | - Ying Chen
- Department of Medicinal Chemistry, School of Pharmacy, Fudan University, China
| | - Li Ye
- Department of Microbiological & Biochemical Pharmacy, School of Pharmacy, Fudan University, Shanghai, 201203, China.
| |
Collapse
|
30
|
Chau T, Chen AY. Successful stereotactic body radiation therapy for stage I non-small cell lung cancer with malignant hypercalcemia - Case report. JOURNAL OF RADIOSURGERY AND SBRT 2018; 5:255-258. [PMID: 29988294 PMCID: PMC6018039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 05/01/2018] [Indexed: 06/08/2023]
Abstract
In patients with lung malignancy, the development of malignant hypercalcemia (MH) carries a dismal prognosis and represents a major therapeutic challenge given that conventional medical treatments have limited durability. Robust and lasting hypercalcemic reversal and symptomatic relief have been documented following surgical tumor resection. Stereotactic body radiation therapy (SBRT) has emerged as an effective treatment modality in medically inoperable patients with Stage I non-small cell lung cancer (NSCLC). In the current report, SBRT achieved durable tumor control and calcemic correction in a medically inoperable 79 year-old man with Stage I NSCLC patient with parathyroid hormone-related peptide (PTHrP)-induced MH.
Collapse
Affiliation(s)
- Thinh Chau
- University of California, Davis School of Medicine, Sacramento, CA 95817, USA
| | - Allan Y. Chen
- University of California, Davis School of Medicine, Sacramento, CA 95817, USA
- Department of Radiation Oncology, Roseville Medical Center, The Permanente Medical Group, Roseville, CA 95678, USA
| |
Collapse
|
31
|
Yang SM, Hsu HH, Chen JS. Recent advances in surgical management of early lung cancer. J Formos Med Assoc 2017; 116:917-923. [DOI: 10.1016/j.jfma.2017.07.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/18/2017] [Accepted: 07/19/2017] [Indexed: 12/15/2022] Open
|
32
|
McMurry TL, Shah PM, Samson P, Robinson CG, Kozower BD. Treatment of stage I non–small cell lung cancer: What's trending? J Thorac Cardiovasc Surg 2017; 154:1080-1087. [DOI: 10.1016/j.jtcvs.2017.03.122] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 03/08/2017] [Accepted: 03/25/2017] [Indexed: 12/25/2022]
|
33
|
Takeda T, Itano H, Takeuchi M, Nishimi Y, Saitoh M, Takeda S. Successful treatment of limited-stage small-cell lung cancer in the right mainstem bronchus by a combination of chemotherapy and argon plasma coagulation. Respir Med Case Rep 2017; 22:175-178. [PMID: 28861333 PMCID: PMC5568879 DOI: 10.1016/j.rmcr.2017.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 08/12/2017] [Accepted: 08/14/2017] [Indexed: 11/16/2022] Open
Abstract
The current standard-of-care treatment for patients with limited-stage small-cell lung cancer (SCLC) is concurrent chemoradiotherapy for local and systemic control. However, standard-of-care treatment strategies have not been established for those with limited-stage SCLC who have a history of thoracic radiotherapy due to concerns with complications associated with radiation overdose. A 37-year-old male developed an aspergilloma in the postoperative left thoracic space after he was treated with concurrent chemoradiotherapy for mediastinal type lung adenocarcionoma and subsequent left upper lobectomy for heterochronous dual adenocarcinoma. Fiberoptic bronchoscopy was performed to examine the status of the suspected bronchopleural fistula when a polypoid mass was observed in the right mainstem bronchus. A histological examination showed that the mass was SCLC at a clinical stage of cTisN0M0, stageIA, without local invasion. Since thoracic radiotherapy was not an option due to a previous history of thoracic irradiation, a combination treatment of carboplatin and etoposide was administered for 4 cycles and resulted in good partial response. In addition, argon plasma coagulation (APC) was performed as an alternative to curative radiotherapy on day 22 of the 4th cycle. The 5th cycle was administered 7 days after APC at which the anticancer therapy was completed. The patient remains disease-free 60 months after the completion of treatment, which suggests that this combination therapy may resolve very early-stage SCLC.
Collapse
Affiliation(s)
- Takayuki Takeda
- Division of Respiratory Medicine, Department of Internal Medicine, Uji Tokushukai Medical Center, 145, Makishima-cho, Uji City, Kyoto 611-0041, Japan
| | - Hideki Itano
- Division of Thoracic Surgery, Department of General Surgery, Uji Tokushukai Medical Center, 145, Makishima-cho, Uji City, Kyoto 611-0041, Japan
| | - Mayumi Takeuchi
- Division of Respiratory Medicine, Department of Internal Medicine, Uji Tokushukai Medical Center, 145, Makishima-cho, Uji City, Kyoto 611-0041, Japan
| | - Yurika Nishimi
- Division of Respiratory Medicine, Department of Internal Medicine, Uji Tokushukai Medical Center, 145, Makishima-cho, Uji City, Kyoto 611-0041, Japan
| | - Masahiko Saitoh
- Division of Respiratory Medicine, Department of Internal Medicine, Uji Tokushukai Medical Center, 145, Makishima-cho, Uji City, Kyoto 611-0041, Japan
| | - Sorou Takeda
- Division of Respiratory Medicine, Department of Internal Medicine, Uji Tokushukai Medical Center, 145, Makishima-cho, Uji City, Kyoto 611-0041, Japan
| |
Collapse
|
34
|
Sun Y, Duan Q, Chen X, Chen W, Jin X, Wu R. Comparative efficacy and toxicity of induction chemotherapy with concurrent stereotactic body radiotherapy and stereotactic body radiotherapy with subsequent chemotherapy in patients with clinical stage T1-3N0M0 non-small cell lung carcinoma. Clin Transl Oncol 2017; 19:1498-1506. [PMID: 28589432 DOI: 10.1007/s12094-017-1694-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 05/28/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE We compared the clinical efficacy and toxicity of stereotactic body radiotherapy with induction chemotherapy and concurrent radiochemotherapy vs stereotactic body radiotherapy with subsequent chemotherapy in patients with clinical stage T1-3N0M0 non-small cell lung carcinoma. METHODS We retrospectively analyzed 38 patients with c-stage T1-3N0M0 non-small cell lung carcinoma who received stereotactic body radiotherapy. All patients received six cycles of chemotherapy. Fifteen of the patients were treated with three cycles of induction chemotherapy, one cycle of concurrent radiochemotherapy, and then two cycles of consolidation chemotherapy, while 23 patients received Sequential Radiotherapy/Chemotherapy. RESULTS Patients in the induction chemotherapy group experienced a longer duration of esophagitis (median 2 vs 0, range 0-6 vs 0-3.6 weeks, p = 0.04). We divided the patients into two groups based on their median pre-treatment tumor volume (cm3): >32.11 and ≤32.11. The tumor response rate in patients with larger tumor volume was substantially higher in the induction chemotherapy group than in the Sequential Radiotherapy/Chemotherapy group (66.67 vs 40%). Among patients with pre-treatment tumor volume (cm3) >32.11, the median local progression-free survival (LPFS) in the induction chemotherapy group and Sequential Radiotherapy/Chemotherapy group was 18 months (range 7-72 months) and 11 months (range 6-53 months), respectively. There was a statistically significant difference between the two groups (p = 0.006). CONCLUSIONS Simultaneous SBRT and chemotherapy can result in a longer duration of esophagitis. However, for patients with large tumor volume, ICT combined with concurrent radiochemotherapy may result in better local tumor response as well as longer LPFS and progression-free survival. To better elucidate the best treatment, further clinical trials are needed.
Collapse
Affiliation(s)
- Y Sun
- Department of Medical Oncology, Shengjing Hospital of China Medical University, 39 Huaxiang Road, Shenyang, 110022, People's Republic of China
| | - Q Duan
- Department of Medical Oncology, Shengjing Hospital of China Medical University, 39 Huaxiang Road, Shenyang, 110022, People's Republic of China
| | - X Chen
- Department of Medical Oncology, Shengjing Hospital of China Medical University, 39 Huaxiang Road, Shenyang, 110022, People's Republic of China
| | - W Chen
- Department of Medical Oncology, Shengjing Hospital of China Medical University, 39 Huaxiang Road, Shenyang, 110022, People's Republic of China
| | - X Jin
- Department of Medical Oncology, Shengjing Hospital of China Medical University, 39 Huaxiang Road, Shenyang, 110022, People's Republic of China
| | - R Wu
- Department of Medical Oncology, Shengjing Hospital of China Medical University, 39 Huaxiang Road, Shenyang, 110022, People's Republic of China.
| |
Collapse
|
35
|
Feng W, Li J, Han S, Tang J, Yao J, Cui Y, Wang C, Chen Z, Li X, Zhi X. [CT Guided Radiofrequency Ablation Followed Intratumoral Chemotherapy
in the Treatment of Early Stage Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017; 19:269-78. [PMID: 27215455 PMCID: PMC5973055 DOI: 10.3779/j.issn.1009-3419.2016.05.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
背景与目的 射频消融(radiofrequency ablation, RFA)已经成为无法手术的早期非小细胞肺癌(non-small cell lung cancer, NSCLC)的局部治疗方法之一。本研究观察计算机断层扫描(computed tomography, CT)引导下RFA与瘤内化疗(intratumoral chemotherapy, ITC)(RFA-ITC)的有效性和安全性。 方法 自2005年1月至2015年12月研究组前瞻性入组经病理学证实为早期NSCLC,因心肺功能较差或伴发其他疾病而无法耐受手术或拒绝手术的患者,接受RFA-ITC治疗。RFA采用导向器辅助CT引导穿刺准实时步进法,适形伞状电极、单点或多点消融,完成治疗计划并当CT显示肿瘤周围正常肺组织呈现磨玻璃样后结束消融治疗,经电极针将卡铂200 mg缓慢注射到肿瘤内。随访评估安全性和有效性。 结果 110例患者125次RFA-ITC治疗,技术成功率为100%。中位生存期为48.0个月,总生存率为55.4个月,无进展生存期为55.1个月;1年、2年、3年、5年总生存率分别为100%、90.7%、62.7%、21.9%。消融后有和无磨玻璃样改变的生存期分别是68.3个月、40.1个月,有统计学差异(P=0.001)。肿瘤的大小及有无N1分期的生存率无差异。无围手术期死亡发生,气胸、肺内出血、胸腔积液、发热、术中胸痛、皮下气肿、术中咳嗽等并发症轻微可耐受。 结论 CT引导RFA-ITC治疗不能手术的早期NSCLC,疗效好、并发症少,对患者损伤小,为不能手术治疗的早期NSCLC的治疗提供了一个良好方法。
Collapse
Affiliation(s)
- Weijian Feng
- Department of Oncology, Fuxing Hospital Affiliated to Capital Medical University, Beijing 100038, China
| | - Jin Li
- Department of Oncology, Shijiazhuang Pingan Hospital Affiliated to Hebei Medical University, Shijiazhuang 050011, China
| | - Suhong Han
- Department of Oncology, Beijing Jiangong Hospital, Beijing 100054, China
| | - Jinfeng Tang
- Department of Oncology, Fuxing Hospital Affiliated to Capital Medical University, Beijing 100038, China
| | - Jie Yao
- Department of Oncology, Fuxing Hospital Affiliated to Capital Medical University, Beijing 100038, China
| | - Yuqing Cui
- Department of Thoracic Surgery, Beijing Wujing No.2 Hospital, Beijing 100045, China
| | - Chuntang Wang
- Department of Thoracic Surgery, Dezhou Cancer Hospital, Dezhou 253000, China
| | - Zhongcheng Chen
- Department of Oncology, Baicheng City Hospital, Baicheng 137000, China
| | - Xiaoguang Li
- Department of Interventional Radiology, Beijing Union Hospital, Beijing 100005, China
| | - Xiuyi Zhi
- Department of Thoracic Surgery, Beijing Xuanwu Hospital of Capital Medical University, Beijing 100054, China
| |
Collapse
|
36
|
Surgery and Surgical Consult Rates for Early Stage Lung Cancer in Ontario: A Population-Based Study. Ann Thorac Surg 2016; 103:906-910. [PMID: 27939011 DOI: 10.1016/j.athoracsur.2016.09.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 09/05/2016] [Accepted: 09/07/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Surgery offers the best chance for survival for early (stage I and II) non-small cell lung cancer (NSCLC), but worldwide resection rates range from 49% to 77%. We investigated factors that may play a role in resection rates. METHODS Using administrative data, new diagnoses of NSCLC from 2010 through 2012 were captured. The rate of surgical consultation and resection overall and by age group were determined, as well as rates of pulmonary function testing and radiation therapy. RESULTS Of 4,309 persons diagnosed with stage I or II NSCLC between 2010 and 2012, 3,487 (80.9%) received surgical consultations, but only 58.9% (2,539) received surgery. Rates of consultation and surgery decreased with increasing patient age: only 60.3% of patients older than 80 received consultations and 29.9% had resections. Of the 1,770 patients who did not receive surgery, 948 (53.6%) received a surgical consultation, and in this group, 688 (72.5%) were treated with radiation. Of the 822 patients who did not see a surgeon, only 476 (57.9%) were treated with radiation. Pulmonary function testing was performed in 799 (84.3%) of patients who had surgical consults but in only 569 (69.2%) of those who did not see a surgeon. CONCLUSIONS Resection rates for early lung cancer appear low, which may be partly due to low rates of surgical consultation. Interestingly, patients who are seen by surgeons but who do not receive surgery are more likely to receive radiation than patients who are not referred for surgery. Further research is required to identify factors influencing resection rates.
Collapse
|
37
|
Teng F, Meng X, Wang X, Yuan J, Liu S, Mu D, Zhu H, Kong L, Yu J. Expressions of CD8+TILs, PD-L1 and Foxp3+TILs in stage I NSCLC guiding adjuvant chemotherapy decisions. Oncotarget 2016; 7:64318-64329. [PMID: 27602763 PMCID: PMC5325445 DOI: 10.18632/oncotarget.11793] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 08/13/2016] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Currently, adjuvant chemotherapy is recommended for patients with high risk stage I non-small cell lung cancer (NSCLC). However, identifying high risk patients remains a challenge. This study aims to identify the patient cohorts more likely to benefit from adjuvant chemotherapy based on the tumor micro-immune environment. RESULTS CD8+TILs significantly associated with disease-free survival (DFS) and overall survial (OS) (p=0.002; 0.040). Patients with high risk factors may also predict shorter DFS (P=0.056). When compared together, patients with high-CD8+TILs showed better DFS than patients with low-CD8+TILs, no matter their risk factors status. There's no correlation between PD-L1 expressions and survival. PD-L1 was highly expressed in men, squamous and well differentiated carcinoma. In addition, Foxp3+TILs alone didn't show any prognostic effects, but low-Foxp3/high-CD8+TILs were associated with prolonged DFS (p=0.031). METHODS A total of 126 patients with surgically resected stage I NSCLC were included to perform immunohistochemistry of CD8+ tumor infiltrating lymphocytes (TILs), programmed death ligand-1(PD-L1) and forkhead box P3 (Foxp3)+TILs. CONCLUSION CD8+TILs are effective prognostic predictors. Patients with surgically resected stage I NSCLC showing low CD8+TILs could be considered for adjuvant chemotherapy, even if they have no high risk features.
Collapse
Affiliation(s)
- Feifei Teng
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, China
| | - Xiangjiao Meng
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, China
| | - Xin Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, China
| | - Jupeng Yuan
- Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, China
| | - Sujing Liu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, China
| | - Dianbin Mu
- Department of Pathology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, China
| | - Hui Zhu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, China
| | - Li Kong
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, China
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, China
| |
Collapse
|
38
|
Ziv E, Erinjeri JP, Yarmohammadi H, Boas FE, Petre EN, Gao S, Shady W, Sofocleous CT, Jones DR, Rudin CM, Solomon SB. Lung Adenocarcinoma: Predictive Value of KRAS Mutation Status in Assessing Local Recurrence in Patients Undergoing Image-guided Ablation. Radiology 2016; 282:251-258. [PMID: 27440441 DOI: 10.1148/radiol.2016160003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Purpose To establish the relationship between KRAS mutation status and local recurrence after image-guided ablation of lung adenocarcinoma. Materials and Methods This study consisted of a HIPAA-compliant institutional review board-approved retrospective review of 56 primary lung adenocarcinomas in 54 patients (24 men, 30 women; median age, 72 years; range, 54-87 years) treated with percutaneous image-guided ablation and with available genetic mutational analysis. KRAS mutation status and additional clinical and technical variables-Eastern Cooperative Oncology Group (ECOG) status, smoking history, stage at diagnosis, status (new primary or not), history of radiation, history of surgery, prior systemic treatment, modality of ablation, size of nodule, ablation margin, and presence of ground-glass appearance-were recorded and evaluated in relation to time to local recurrence, which was calculated from the time of ablation to the first radiographic evidence of recurrence. Predictors of outcome were identified by using a proportional hazards model for both univariate and multivariate analysis, with death as a competing risk. Results Technical success was 100%. Of the 56 ablated tumors, 37 (66%) were wild type for KRAS and 19 (34%) were KRAS mutants. The 1-year and 3-year cumulative incidences of recurrence were 20% and 35% for wild-type KRAS compared with 40% and 63% for KRAS mutant tumors. KRAS mutation status was a significant predictor of local recurrence at both univariate (P = .05; subdistribution hazard ratio [sHR], 2.32) and multivariate (P = .006; sHR, 3.75) analysis. At multivariate analysis, size (P = .026; sHR, 2.54) and ECOG status (P = .012; sHR, 2.23) were also independent significant predictors, whereas minimum margin (P = .066) was not. Conclusion The results of this study show that there is a relationship between KRAS mutation status and local recurrence after image-guided ablation of lung adenocarcinoma. Specifically, KRAS mutation status of the ablated lesion is a significant predictor of time to local recurrence, independent of size and margin. © RSNA, 2016.
Collapse
Affiliation(s)
- Etay Ziv
- From the Interventional Radiology Service, Department of Radiology (E.Z., J.P.E., H.Y., F.E.B., E.N.P., S.G., W.S., C.T.S., S.B.S.), Thoracic Service, Department of Surgery (D.R.J.), and Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine (C.M.R.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Howard-118, New York, NY 10065; and the Interventional Therapy Department, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China (S.G.)
| | - Joseph P Erinjeri
- From the Interventional Radiology Service, Department of Radiology (E.Z., J.P.E., H.Y., F.E.B., E.N.P., S.G., W.S., C.T.S., S.B.S.), Thoracic Service, Department of Surgery (D.R.J.), and Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine (C.M.R.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Howard-118, New York, NY 10065; and the Interventional Therapy Department, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China (S.G.)
| | - Hooman Yarmohammadi
- From the Interventional Radiology Service, Department of Radiology (E.Z., J.P.E., H.Y., F.E.B., E.N.P., S.G., W.S., C.T.S., S.B.S.), Thoracic Service, Department of Surgery (D.R.J.), and Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine (C.M.R.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Howard-118, New York, NY 10065; and the Interventional Therapy Department, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China (S.G.)
| | - F Edward Boas
- From the Interventional Radiology Service, Department of Radiology (E.Z., J.P.E., H.Y., F.E.B., E.N.P., S.G., W.S., C.T.S., S.B.S.), Thoracic Service, Department of Surgery (D.R.J.), and Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine (C.M.R.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Howard-118, New York, NY 10065; and the Interventional Therapy Department, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China (S.G.)
| | - Elena N Petre
- From the Interventional Radiology Service, Department of Radiology (E.Z., J.P.E., H.Y., F.E.B., E.N.P., S.G., W.S., C.T.S., S.B.S.), Thoracic Service, Department of Surgery (D.R.J.), and Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine (C.M.R.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Howard-118, New York, NY 10065; and the Interventional Therapy Department, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China (S.G.)
| | - Song Gao
- From the Interventional Radiology Service, Department of Radiology (E.Z., J.P.E., H.Y., F.E.B., E.N.P., S.G., W.S., C.T.S., S.B.S.), Thoracic Service, Department of Surgery (D.R.J.), and Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine (C.M.R.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Howard-118, New York, NY 10065; and the Interventional Therapy Department, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China (S.G.)
| | - Waleed Shady
- From the Interventional Radiology Service, Department of Radiology (E.Z., J.P.E., H.Y., F.E.B., E.N.P., S.G., W.S., C.T.S., S.B.S.), Thoracic Service, Department of Surgery (D.R.J.), and Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine (C.M.R.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Howard-118, New York, NY 10065; and the Interventional Therapy Department, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China (S.G.)
| | - Constantinos T Sofocleous
- From the Interventional Radiology Service, Department of Radiology (E.Z., J.P.E., H.Y., F.E.B., E.N.P., S.G., W.S., C.T.S., S.B.S.), Thoracic Service, Department of Surgery (D.R.J.), and Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine (C.M.R.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Howard-118, New York, NY 10065; and the Interventional Therapy Department, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China (S.G.)
| | - David R Jones
- From the Interventional Radiology Service, Department of Radiology (E.Z., J.P.E., H.Y., F.E.B., E.N.P., S.G., W.S., C.T.S., S.B.S.), Thoracic Service, Department of Surgery (D.R.J.), and Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine (C.M.R.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Howard-118, New York, NY 10065; and the Interventional Therapy Department, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China (S.G.)
| | - Charles M Rudin
- From the Interventional Radiology Service, Department of Radiology (E.Z., J.P.E., H.Y., F.E.B., E.N.P., S.G., W.S., C.T.S., S.B.S.), Thoracic Service, Department of Surgery (D.R.J.), and Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine (C.M.R.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Howard-118, New York, NY 10065; and the Interventional Therapy Department, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China (S.G.)
| | - Stephen B Solomon
- From the Interventional Radiology Service, Department of Radiology (E.Z., J.P.E., H.Y., F.E.B., E.N.P., S.G., W.S., C.T.S., S.B.S.), Thoracic Service, Department of Surgery (D.R.J.), and Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine (C.M.R.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Howard-118, New York, NY 10065; and the Interventional Therapy Department, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China (S.G.)
| |
Collapse
|
39
|
Targeting asparagine and autophagy for pulmonary adenocarcinoma therapy. Appl Microbiol Biotechnol 2016; 100:9145-9161. [DOI: 10.1007/s00253-016-7640-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/12/2016] [Accepted: 05/17/2016] [Indexed: 01/22/2023]
|
40
|
Sroufe R, Kong FM(S. Triaging early-stage lung cancer patients into non-surgical pathways: who, when, and what? Transl Lung Cancer Res 2015; 4:438-47. [PMID: 26380185 PMCID: PMC4549472 DOI: 10.3978/j.issn.2218-6751.2015.07.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 07/25/2015] [Indexed: 12/25/2022]
Abstract
More lung cancer patients are being diagnosed at an earlier stage due to improved diagnostic imaging techniques, a trend that is expected to accelerate with the dissemination of lung cancer screening. Surgical resection has always been considered the standard treatment for patients with early-stage non-small cell lung cancer (NSCLC). However, non-surgical treatment options for patients with early-stage NSCLC have evolved significantly over the past decade with many new and exciting alternative treatments now available. These alternative treatments include radiofrequency ablation (RFA), microwave ablation (MWA), percutaneous cryoablation therapy (PCT), photodynamic therapy (PDT) and external beam radiation therapy (EBRT), including stereotactic body radiation therapy (SBRT) and accelerated hypofractionated radiation therapy. We describe the established alternatives to surgical resection, their advantages and disadvantages, potential complications and efficacy. We then describe the optimal treatment approach for patients with early-stage NSCLC based on tumor operability, size and location. Finally, we discuss future directions and whether any alternative therapies will challenge surgical resection as the treatment of choice for patients with operable early-stage lung cancer.
Collapse
|