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Fischer T, Hartmann O, Reissland M, Prieto-Garcia C, Klann K, Pahor N, Schülein-Völk C, Baluapuri A, Polat B, Abazari A, Gerhard-Hartmann E, Kopp HG, Essmann F, Rosenfeldt M, Münch C, Flentje M, Diefenbacher ME. PTEN mutant non-small cell lung cancer require ATM to suppress pro-apoptotic signalling and evade radiotherapy. Cell Biosci 2022; 12:50. [PMID: 35477555 PMCID: PMC9044846 DOI: 10.1186/s13578-022-00778-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 03/27/2022] [Indexed: 12/13/2022] Open
Abstract
Background Despite advances in treatment of patients with non-small cell lung cancer, carriers of certain genetic alterations are prone to failure. One such factor frequently mutated, is the tumor suppressor PTEN. These tumors are supposed to be more resistant to radiation, chemo- and immunotherapy. Results We demonstrate that loss of PTEN led to altered expression of transcriptional programs which directly regulate therapy resistance, resulting in establishment of radiation resistance. While PTEN-deficient tumor cells were not dependent on DNA-PK for IR resistance nor activated ATR during IR, they showed a significant dependence for the DNA damage kinase ATM. Pharmacologic inhibition of ATM, via KU-60019 and AZD1390 at non-toxic doses, restored and even synergized with IR in PTEN-deficient human and murine NSCLC cells as well in a multicellular organotypic ex vivo tumor model. Conclusion PTEN tumors are addicted to ATM to detect and repair radiation induced DNA damage. This creates an exploitable bottleneck. At least in cellulo and ex vivo we show that low concentration of ATM inhibitor is able to synergise with IR to treat PTEN-deficient tumors in genetically well-defined IR resistant lung cancer models.
Supplementary Information The online version contains supplementary material available at 10.1186/s13578-022-00778-7.
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Affiliation(s)
- Thomas Fischer
- Department of Radiation Oncology, University Hospital Würzburg, Würzburg, Germany.,Department of Biochemistry and Molecular Biology, Protein Stability and Cancer Group, University of Würzburg, Würzburg, Germany.,Comprehensive Cancer Centre Mainfranken, Würzburg, Germany
| | - Oliver Hartmann
- Department of Biochemistry and Molecular Biology, Protein Stability and Cancer Group, University of Würzburg, Würzburg, Germany.,Mildred Scheel Early Career Center, Würzburg, Germany
| | - Michaela Reissland
- Department of Biochemistry and Molecular Biology, Protein Stability and Cancer Group, University of Würzburg, Würzburg, Germany.,Mildred Scheel Early Career Center, Würzburg, Germany
| | - Cristian Prieto-Garcia
- Department of Biochemistry and Molecular Biology, Protein Stability and Cancer Group, University of Würzburg, Würzburg, Germany.,Mildred Scheel Early Career Center, Würzburg, Germany
| | - Kevin Klann
- Protein Quality Control Group, Institute of Biochemistry II, Goethe University, Frankfurt, Germany
| | - Nikolett Pahor
- Department of Biochemistry and Molecular Biology, Protein Stability and Cancer Group, University of Würzburg, Würzburg, Germany.,Mildred Scheel Early Career Center, Würzburg, Germany
| | | | - Apoorva Baluapuri
- Department of Biochemistry and Molecular Biology, Cancer Systems Biology Group, Würzburg, Germany
| | - Bülent Polat
- Department of Radiation Oncology, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Cancer Centre Mainfranken, Würzburg, Germany
| | - Arya Abazari
- Department of Radiation Oncology, University Hospital Würzburg, Würzburg, Germany
| | - Elena Gerhard-Hartmann
- Comprehensive Cancer Centre Mainfranken, Würzburg, Germany.,Institute for Pathology, University of Würzburg, Würzburg, Germany
| | | | - Frank Essmann
- Institute for Clinical Pharmacology, Robert Bosch Hospital, Stuttgart, Germany
| | - Mathias Rosenfeldt
- Comprehensive Cancer Centre Mainfranken, Würzburg, Germany.,Institute for Pathology, University of Würzburg, Würzburg, Germany
| | - Christian Münch
- Protein Quality Control Group, Institute of Biochemistry II, Goethe University, Frankfurt, Germany
| | - Michael Flentje
- Department of Radiation Oncology, University Hospital Würzburg, Würzburg, Germany
| | - Markus E Diefenbacher
- Department of Biochemistry and Molecular Biology, Protein Stability and Cancer Group, University of Würzburg, Würzburg, Germany. .,Mildred Scheel Early Career Center, Würzburg, Germany. .,Comprehensive Cancer Centre Mainfranken, Würzburg, Germany. .,Lehrstuhl für Biochemie und Molekularbiologie, Biozentrum, Am Hubland, 97074, Würzburg, Germany.
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2
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Chen A, Wu DL, Shi J, Narva S, Zhao XY, Wu YL, Zhang W. Design, synthesis and biological evaluation of 2-methyl-(1,1′-biphenyl)-pyrimidine conjugates. Bioorg Med Chem Lett 2020; 30:127328. [DOI: 10.1016/j.bmcl.2020.127328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 12/24/2022]
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Liu JC, Narva S, Zhou K, Zhang W. A Review on the Antitumor Activity of Various Nitrogenous-based Heterocyclic Compounds as NSCLC Inhibitors. Mini Rev Med Chem 2019; 19:1517-1530. [DOI: 10.2174/1389557519666190312152358] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/28/2019] [Accepted: 03/06/2019] [Indexed: 11/22/2022]
Abstract
At present, cancers have been causing deadly fears to humans and previously unpredictable
losses to health. Especially, lung cancer is one of the most common causes of cancer-related mortality
accounting for approximately 15% of all cancer cases worldwide. While Non-Small Cell Lung Carcinomas
(NSCLCs) makes up to 80% of lung cancer cases. The patient compliance has been weakening
because of serious drug resistance and adverse drug effects. Therefore, there is an urgent need for the
development of novel structural agents to inhibit NSCLCs. Nitrogen-containing heterocyclic compounds
exhibit wide range of biological properties, especially antitumor activity. We reviewed some
deadly defects of clinical medicines for the lung cancer therapy and importance of nitrogen based heterocyclic
derivatives against NSCLCs. Nitrogen heterocycles exhibit significant antitumor activity
against NSCLCs. Nitrogen heterocyclic hybrids could be developed as multi-target-directed NSCLC
inhibitors and it is believed that the review is significant for rational designs and new ideas in the development
of nitrogen heterocyclic-based drugs.
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Affiliation(s)
- Jia-Chun Liu
- Laboratory of Chemical Biology and Molecular Drug Design, College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, 310014, China
| | - Suresh Narva
- Laboratory of Chemical Biology and Molecular Drug Design, College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, 310014, China
| | - Kang Zhou
- Laboratory of Chemical Biology and Molecular Drug Design, College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, 310014, China
| | - Wen Zhang
- Laboratory of Chemical Biology and Molecular Drug Design, College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, 310014, China
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Abstract
OBJECTIVE The purpose of this article is to summarize the clinical utility of 18F-FDG PET/CT in the evaluation of lung cancer recurrence with an emphasis on typical anatomic and metabolic patterns of recurrence, expected posttherapeutic changes, and common pitfalls of FDG PET/CT. FDG PET/CT is useful in assessing therapeutic response and in determining the extent of recurrent disease and provides a guide for targeted biopsy. CONCLUSION FDG PET/CT plays a crucial role in the evaluation of therapeutic response in lung cancer and guides management.
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5
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Zhou K, Liu J, Xiong X, Cheng M, Hu X, Narva S, Zhao X, Wu Y, Zhang W. Design, synthesis of 4,5-diazafluorene derivatives and their anticancer activity via targeting telomeric DNA G-quadruplex. Eur J Med Chem 2019; 178:484-499. [PMID: 31202994 DOI: 10.1016/j.ejmech.2019.06.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/02/2019] [Accepted: 06/03/2019] [Indexed: 01/19/2023]
Abstract
In our work, 19 novel 4,5-diazafluorene derivatives (11a-d, 12a-d, 13a-d, 14a-c, 15c, 16a-c) bearing a 1,3-disubstituted pyrazol/thioxothiazolidinone or thioxothiazolidinone-oxadiazole moieties were designed, synthesized, preliminarily explored for their antitumor activities and in vitro mechanism. All compounds showed different values of antiproliferative activity against A549, AGS, HepG2 and MCF-7 cell lines through CCK-8. Especially, the compound 14c exhibited the strongest activity and best selectivity against A549 cells with an IC50 1.13 μM and an SI value of 7.01 relative to MRC-5 cells, which was better than cisplatin (SI = 1.80) as a positive control. Experimental results at extracellular level demonstrated that compounds 14a-c could strongly interact with the G-quadruplex(es) formed in a 26 nt telomeric G-rich DNA, in particular, the 14c exhibits quite strong binding affinity with an association equilibrium constant (KA) of 7.04(±0.16) × 107 M-1 and more than 1000-fold specificity to G4-DNA over ds-DNA and Mut-DNA at the compound/G4-DNA ratio of 1:1. Further trap assay ascertained that compounds 14a-c owned strong inhibitory ability of telomerase activity in A549 cells, suggesting that these compounds have great possibility to target telomeric G-quadruplexes and consequently indirectly inhibit the telomerase activity. In addition, it is worthy of note that the remarkable inhibitory effects of 14a-c on the mobility of tested cancer cells were observed by wound healing assays. Furthermore, molecular docking and UV-Vis spectral results unclose the rationale for the interaction of compounds with such G-quadruplex(es). These results indicate that the growth and metastasis inhibition of cancer cells mediated by these 4,5-diazafluorene derivatives possibly result from their interaction with telomeric G-quadruplexes, suggesting that 4,5-diazafluorene derivatives, especially 14c, possess potential as anticancer drugs.
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Affiliation(s)
- Kang Zhou
- Lab of Chemical Biology and Molecular Drug Design, College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, 310014, China; Lab of Chemical Biology and Molecular Drug Design, Institute of Drug Development & Chemical Biology, Zhejiang University of Technology, Hangzhou, 310014, China
| | - Jiachun Liu
- Lab of Chemical Biology and Molecular Drug Design, College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, 310014, China; Lab of Chemical Biology and Molecular Drug Design, Institute of Drug Development & Chemical Biology, Zhejiang University of Technology, Hangzhou, 310014, China
| | - Xuqiong Xiong
- Lab of Chemical Biology and Molecular Drug Design, College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, 310014, China; Lab of Chemical Biology and Molecular Drug Design, Institute of Drug Development & Chemical Biology, Zhejiang University of Technology, Hangzhou, 310014, China
| | - Mei Cheng
- Lab of Chemical Biology and Molecular Drug Design, College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, 310014, China; Lab of Chemical Biology and Molecular Drug Design, Institute of Drug Development & Chemical Biology, Zhejiang University of Technology, Hangzhou, 310014, China
| | - Xiaolin Hu
- Lab of Chemical Biology and Molecular Drug Design, College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, 310014, China; Lab of Chemical Biology and Molecular Drug Design, Institute of Drug Development & Chemical Biology, Zhejiang University of Technology, Hangzhou, 310014, China
| | - Suresh Narva
- Lab of Chemical Biology and Molecular Drug Design, College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, 310014, China; Lab of Chemical Biology and Molecular Drug Design, Institute of Drug Development & Chemical Biology, Zhejiang University of Technology, Hangzhou, 310014, China
| | - Xiaoyin Zhao
- Lab of Chemical Biology and Molecular Drug Design, College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, 310014, China; Lab of Chemical Biology and Molecular Drug Design, Institute of Drug Development & Chemical Biology, Zhejiang University of Technology, Hangzhou, 310014, China
| | - Yanling Wu
- Lab of Molecular Immunology, Virus Inspection Department, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, 310051, China.
| | - Wen Zhang
- Lab of Chemical Biology and Molecular Drug Design, College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, 310014, China; Lab of Chemical Biology and Molecular Drug Design, Institute of Drug Development & Chemical Biology, Zhejiang University of Technology, Hangzhou, 310014, China.
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Liu J, Chen M, Wang Y, Zhao X, Wang S, Wu Y, Zhang W. Synthesis and the interaction of 2-(1 H -pyrazol-4-yl)-1 H -imidazo[4,5-f][1,10]phenanthrolines with telomeric DNA as lung cancer inhibitors. Eur J Med Chem 2017; 133:36-49. [DOI: 10.1016/j.ejmech.2017.03.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 02/04/2017] [Accepted: 03/15/2017] [Indexed: 01/16/2023]
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7
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Jiménez-Bonilla JF, Quirce R, Martínez-Rodríguez I, De Arcocha-Torres M, Carril JM, Banzo I. The Role of PET/CT Molecular Imaging in the Diagnosis of Recurrence and Surveillance of Patients Treated for Non-Small Cell Lung Cancer. Diagnostics (Basel) 2016; 6:diagnostics6040036. [PMID: 27706025 PMCID: PMC5192511 DOI: 10.3390/diagnostics6040036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 09/08/2016] [Accepted: 09/22/2016] [Indexed: 12/28/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) is the leading cause of cancer mortality worldwide and its prognosis remains poor. Molecular imaging with 18F-FDG PET/CT can metabolically characterize the nature of lesions as benign or malignant, allowing a better staging at the diagnosis of this kind of patient. This advantage can also be applied in the re-staging due to the suspicion of recurrent disease. Many patients have a recurrence of the disease, including surgically treated patients. In the current context, with new personalized oncological treatments, the surveillance for recurrence and its accurate diagnosis are crucial to improve their survival. In this paper, we revise the current knowledge about the clinical and molecular factors related to the recurrent disease. In the context of new, promising, available personalized treatments, the role of molecular imaging with PET/CT and 18F-FDG and non-18F-FDG radiotracers in the follow-up of NSCLC-treated patients is especially attractive and interesting.
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Affiliation(s)
- Julio Francisco Jiménez-Bonilla
- Nuclear Medicine Department, University Hospital Marqués de Valdecilla, Molecular Imaging IDIVAL, University of Cantabria, 39008 Santander, Spain.
| | - Remedios Quirce
- Nuclear Medicine Department, University Hospital Marqués de Valdecilla, Molecular Imaging IDIVAL, University of Cantabria, 39008 Santander, Spain.
| | - I Martínez-Rodríguez
- Nuclear Medicine Department, University Hospital Marqués de Valdecilla, Molecular Imaging IDIVAL, University of Cantabria, 39008 Santander, Spain.
| | - María De Arcocha-Torres
- Nuclear Medicine Department, University Hospital Marqués de Valdecilla, Molecular Imaging IDIVAL, University of Cantabria, 39008 Santander, Spain.
| | - José Manuel Carril
- Nuclear Medicine Department, University Hospital Marqués de Valdecilla, Molecular Imaging IDIVAL, University of Cantabria, 39008 Santander, Spain.
| | - Ignacio Banzo
- Nuclear Medicine Department, University Hospital Marqués de Valdecilla, Molecular Imaging IDIVAL, University of Cantabria, 39008 Santander, Spain.
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8
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Erb CT, Su KW, Soulos PR, Tanoue LT, Gross CP. Surveillance Practice Patterns after Curative Intent Therapy for Stage I Non-Small-Cell Lung Cancer in the Medicare Population. Lung Cancer 2016; 99:200-7. [PMID: 27565940 PMCID: PMC5003420 DOI: 10.1016/j.lungcan.2016.07.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 06/24/2016] [Accepted: 07/17/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Recurrence after treatment for non-small cell lung cancer (NSCLC) is common, and routine imaging surveillance is recommended by evidence-based guidelines. Little is known about surveillance patterns after curative intent therapy for early stage NSCLC. We sought to understand recent practice patterns for surveillance of stage I NSCLC in the first two years after curative intent therapy in the Medicare population. MATERIALS AND METHODS Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database we selected patients diagnosed with stage I NSCLC between 1998 and 2008. We studied adherence to surveillance guidelines based on specialty society recommendations for chest radiography and computed tomography (CT) scanning. We also tracked the use of Positron Emission Tomography (PET) scans, which are not recommended for surveillance. We calculated the percent of patients who received guideline-adherent surveillance imaging and used logistic regression to determine associations between patient and provider factors and guideline adherence. RESULTS Overall, 61.4% of patients received guideline-adherent surveillance during the initial 2 years after treatment. Use of CT scans in the first year after treatment increased from 47.4% in 1998-78.5% in 2008, and PET use increased from 5.8% to 28.9%. Adherence with surveillance imaging was associated with younger age, higher income, more comorbidities, access to primary care, and receipt of SBRT as the primary treatment. CONCLUSIONS Adherence to specialty society guidelines for surveillance after treatment for stage I NSCLC was poor in this population of Medicare beneficiaries, with less than two-thirds of patients receiving recommended imaging, and almost 30% receiving non-recommended PET scans.
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Affiliation(s)
- Christopher T Erb
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Kevin W Su
- Yale University School of Medicine, New Haven, CT, United States
| | - Pamela R Soulos
- Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT, United States
| | - Lynn T Tanoue
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Cary P Gross
- Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT, United States.
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Tang C, Liao Z, Hess K, Chance WW, Zhuang Y, Jensen G, Xu T, Komaki R, Gomez DR. Prognosis and predictors of site of first metastasis after definitive radiation therapy for non-small cell lung cancer. Acta Oncol 2016; 55:1022-8. [PMID: 27055359 DOI: 10.3109/0284186x.2016.1154602] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background and purpose Evidence suggests that distinct biologic phenomenon produce different patterns of distant metastatic (DM) failures. We attempted to identify prognostically poor sites of first DM and to define factors predictive of their development. Methods and materials A total of 1074 patients treated with ≥60 Gy definitive radiation for initially non-metastatic non-small cell lung cancer (NSCLC) were analyzed. Uni- and multivariate Cox regression was utilized to associate clinical factors with DM site, and metastatic site with overall survival (OS). To account for competing events, multivariate Fine and Gray regression was utilized to identify treatment and disease factors predictive of site-specific metastases. Results Sites of first DM associated with worse survival were liver (median OS: 5 months after DM) and bone (median OS: 6.7 months after DM). Multivariate regression identified non-squamous histology to be associated with first DM within the liver (HR = 2.04, 95% CI 1.16-3.60, p = 0.01), while delay between diagnosis and RT (third vs. first tertile: HR = 2.3, 95% CI 1.26-4.21, p = 0.007) in addition to advanced stage (stage III vs. II/I: HR = 2.37, 95% CI 1.11-5.06, p = 0.03) were associated with first DM within bone. Conclusions Liver and bone as site of first DM is associated with worse prognosis and are predicted by different disease and treatment factors.
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Affiliation(s)
- Chad Tang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Zhongxing Liao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kenneth Hess
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - William W. Chance
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yan Zhuang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Garrett Jensen
- Department of Baylor School of Medicine, Houston, Texas, USA
| | - Ting Xu
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ritsuko Komaki
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Daniel R. Gomez
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Gómez A, González JA, Couñago F, Vallejo C, Casas F, de Dios NR. Evidence-based recommendations of postoperative radiotherapy in lung cancer from Oncologic Group for the Study of Lung Cancer (Spanish Radiation Oncology Society). Clin Transl Oncol 2015; 18:331-41. [PMID: 26280402 DOI: 10.1007/s12094-015-1374-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 08/04/2015] [Indexed: 12/25/2022]
Abstract
Locally advanced non-small cell lung cancer (NSCLC) is a diversified illness in which postoperative radiation therapy (PORT) for complete resection with positive hiliar (pN1) and/or mediastinal (pN2) lymph nodes is controversial. Although several studies have shown that PORT has beneficial effects, randomized trials are needed to demonstrate its impact on overall survival. In this review, the Spanish Radiation Oncology Group for Lung Cancer describes the most relevant literature on PORT in NSCLC patients stage pN1-2. In addition, we have outlined the current recommendations of different national and international clinical guidelines and have also specified practical issues regarding treatment volume definition, doses and fractionation.
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Affiliation(s)
- A Gómez
- Radiation Oncology Department, Hospital Universitario Santiago de Compostela, Tr Choupana s/n, 15706, Santiago De Compostela, Spain
| | - J A González
- Radiation Oncology Department, Instituto Oncológico Cartuja, Unidad Regional de Sevilla, Grupo IMO, Américo Vespucio 31-33, 41092, Seville, Spain
| | - F Couñago
- Radiation Oncology Department, Hospital Universitario Quirón Madrid, Diego de Velázquez, 1, Pozuelo De Alarcón, 28223, Madrid, Spain
| | - C Vallejo
- Radiation Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Carretera de Colmenar KM 9,1, 28034, Madrid, Spain
| | - F Casas
- Radiation Oncology Department, Hospital Clínic Barcelona, Villarroel 150, 08036, Barcelona, Spain
| | - N Rodríguez de Dios
- Department of Radiation Oncology, Hospital de la Esperanza, Parc de Salut Mar, San josé de la Montaña 12, 08024, Barcelona, Spain.
- IMIM (Hospital del Mar Medical Research Institut), Barcelona, Spain.
- Universitat Pompeu Fabra, Barcelona, Spain.
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Park S, Cho S, Yum SW, Kim K, Jheon S. Comprehensive analysis of metastatic N1 lymph nodes in completely resected non-small-cell lung cancer. Interact Cardiovasc Thorac Surg 2015; 21:624-9. [DOI: 10.1093/icvts/ivv209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 06/30/2015] [Indexed: 11/12/2022] Open
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ACR Appropriateness Criteria(®) induction and adjuvant therapy for N2 non-small-cell lung cancer. Am J Clin Oncol 2015; 38:197-205. [PMID: 25803563 DOI: 10.1097/coc.0000000000000154] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The integration of chemotherapy, radiation therapy (RT), and surgery in the management of patients with stage IIIA (N2) non-small-cell lung carcinoma is challenging. The American College of Radiology (ACR) Appropriateness Criteria Lung Cancer Panel was charged to update management recommendations for this clinical scenario. The Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. There is limited level I evidence to guide patient selection for induction, postoperative RT (PORT), or definitive RT. Literature interpretation is complicated by inconsistent diagnostic procedures for N2 disease, disease heterogeneity, and pooled analysis with other stages. PORT is an appropriate therapy following adjuvant chemotherapy in patients with incidental pN2 disease. In patients with clinical N2 disease who are potential candidates for a lobectomy, both definitive and induction concurrent chemotherapy/RT are appropriate treatments. In N2 patients who require a pneumonectomy, definitive concurrent chemotherapy/RT is most appropriate although induction concurrent chemotherapy/RT may be considered in expert hands. Induction chemotherapy followed by surgery +/- PORT may also be an option in N2 patients. For preoperative RT and PORT, 3-dimensional conformal techniques and intensity-modulated RT are most appropriate.
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13
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Varlotto JM, Yao AN, DeCamp MM, Ramakrishna S, Recht A, Flickinger J, Andrei A, Reed MF, Toth JW, Fizgerald TJ, Higgins K, Zheng X, Shelkey J, Medford-Davis LN, Belani C, Kelsey CR. Nodal stage of surgically resected non-small cell lung cancer and its effect on recurrence patterns and overall survival. Int J Radiat Oncol Biol Phys 2015; 91:765-73. [PMID: 25752390 DOI: 10.1016/j.ijrobp.2014.12.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 12/08/2014] [Accepted: 12/11/2014] [Indexed: 01/01/2023]
Abstract
PURPOSE Current National Comprehensive Cancer Network guidelines recommend postoperative radiation therapy (PORT) for patients with resected non-small cell lung cancer (NSCLC) with N2 involvement. We investigated the relationship between nodal stage and local-regional recurrence (LR), distant recurrence (DR) and overall survival (OS) for patients having an R0 resection. METHODS AND MATERIALS A multi-institutional database of consecutive patients undergoing R0 resection for stage I-IIIA NSCLC from 1995 to 2008 was used. Patients receiving any radiation therapy before relapse were excluded. A total of 1241, 202, and 125 patients were identified with N0, N1, and N2 involvement, respectively; 161 patients received chemotherapy. Cumulative incidence rates were calculated for LR and DR as first sites of failure, and Kaplan-Meier estimates were made for OS. Competing risk analysis and proportional hazards models were used to examine LR, DR, and OS. Independent variables included age, sex, surgical procedure, extent of lymph node sampling, histology, lymphatic or vascular invasion, tumor size, tumor grade, chemotherapy, nodal stage, and visceral pleural invasion. RESULTS The median follow-up time was 28.7 months. Patients with N1 or N2 nodal stage had rates of LR similar to those of patients with N0 disease, but were at significantly increased risk for both DR (N1, hazard ratio [HR] = 1.84, 95% confidence interval [CI]: 1.30-2.59; P=.001; N2, HR = 2.32, 95% CI: 1.55-3.48; P<.001) and death (N1, HR = 1.46, 95% CI: 1.18-1.81; P<.001; N2, HR = 2.33, 95% CI: 1.78-3.04; P<.001). LR was associated with squamous histology, visceral pleural involvement, tumor size, age, wedge resection, and segmentectomy. The most frequent site of LR was the mediastinum. CONCLUSIONS Our investigation demonstrated that nodal stage is directly associated with DR and OS but not with LR. Thus, even some patients with, N0-N1 disease are at relatively high risk of local recurrence. Prospective identification of risk factors for local recurrence may aid in selecting an appropriate population for further study of postoperative radiation therapy.
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Affiliation(s)
- John M Varlotto
- Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts.
| | - Aaron N Yao
- Department of Healthcare Policy and Research, Virginia Commonwealth University, Richmond, Virginia
| | - Malcolm M DeCamp
- Division of Thoracic Surgery, Department of Surgery, Northwestern Memorial Hospital, Chicago, Illinois; Northwestern University School of Medicine, Chicago, Illinois
| | | | - Abe Recht
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - John Flickinger
- Department of Radiation Oncology, Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | | | - Michael F Reed
- Pennsylvania State University College of Medicine, Hershey, Pennsylvania; Heart and Vascular Institute, Pennsylvania State University-Hershey, Hershey, Pennsylvania
| | - Jennifer W Toth
- Pennsylvania State University College of Medicine, Hershey, Pennsylvania; Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Pennsylvania State University-Hershey, Hershey, Pennsylvania
| | - Thomas J Fizgerald
- Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - Kristin Higgins
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Xiao Zheng
- Department of Healthcare Policy and Research, Virginia Commonwealth University, Richmond, Virginia
| | - Julie Shelkey
- Department of Anesthesiology, Columbia University, New York, New York
| | | | - Chandra Belani
- Pennsylvania State University-Hershey Cancer Institute, Hershey, Pennsylvania
| | - Christopher R Kelsey
- Department of Radiation Oncology, Duke University Cancer Institute, Durham, North Carolina
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14
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Inge LJ, Friel JM, Richer AL, Fowler AJ, Whitsett T, Smith MA, Tran NL, Bremner RM. LKB1 inactivation sensitizes non-small cell lung cancer to pharmacological aggravation of ER stress. Cancer Lett 2014; 352:187-95. [PMID: 25011082 DOI: 10.1016/j.canlet.2014.06.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 06/05/2014] [Accepted: 06/22/2014] [Indexed: 11/15/2022]
Abstract
Five-year survival rates for non-small cell lung cancer (NSCLC) have seen minimal improvement despite aggressive therapy with standard chemotherapeutic agents, indicating a need for new treatment approaches. Studies show inactivating mutations in the LKB1 tumor suppressor are common in NSCLC. Genetic and mechanistic analysis has defined LKB1-deficient NSCLC tumors as a phenotypically distinct subpopulation of NSCLC with potential avenues for therapeutic gain. In expanding on previous work indicating hypersensitivity of LKB1-deficient NSCLC cells to 2-deoxy-D-glucose (2DG), we find that 2DG has in vivo efficacy in LKB1-deficient NSCLC using transgenic murine models of NSCLC. Deciphering of the molecular mechanisms behind this phenotype reveals that loss of LKB1 in NSCLC cells imparts increased sensitivity to pharmacological compounds that aggravate ER stress. In comparison to NSCLC cells with functional LKB1, treatment of NSCLC cells lacking LKB1 with the ER stress activators (ERSA), tunicamycin, brefeldin A or 2DG, resulted in aggravation of ER stress, increased cytotoxicity, and evidence of ER stress-mediated cell death. Based upon these findings, we suggest that ERSAs represent a potential treatment avenue for NSCLC patients whose tumors are deficient in LKB1.
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Affiliation(s)
- Landon J Inge
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States.
| | - Jacqueline M Friel
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
| | - Amanda L Richer
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
| | - Aaron J Fowler
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
| | - Timothy Whitsett
- Cancer and Cell Biology Division, The Translational Genomics Research Institute, Phoenix, AZ, United States
| | - Michael A Smith
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
| | - Nhan L Tran
- Cancer and Cell Biology Division, The Translational Genomics Research Institute, Phoenix, AZ, United States
| | - Ross M Bremner
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
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15
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Risk factors for locoregional recurrence in patients with resected N1 non-small cell lung cancer: a retrospective study to identify patterns of failure and implications for adjuvant radiotherapy. Radiat Oncol 2013; 8:286. [PMID: 24321392 PMCID: PMC3922909 DOI: 10.1186/1748-717x-8-286] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 12/06/2013] [Indexed: 12/25/2022] Open
Abstract
Background Meta-analysis of randomized trials has shown that postoperative radiotherapy (PORT) had a detrimental effect on overall survival (OS) in patients with resected N1 non–small cell lung cancer (NSCLC). Conversely, the locoregional recurrence (LR) rate is reported to be high without adjuvant PORT in these patients. We have evaluated the pattern of failure, actuarial risk and risk factors for LR in order to identify the subset of N1 NSCLC patients with the highest risk of LR. These patients could potentially benefit from PORT. Methods We conducted a retrospective study on 199 patients with pathologically confirmed T1–3N1M0 NSCLC who underwent surgery. None of the patients had positive surgical margins or received preoperative therapy or PORT. The median follow-up was 53.8 months. Complete mediastinal lymph node (MLN) dissection and examination was defined as ≥3 dissected and examined MLN stations; incomplete MLN dissection or examination (IMD) was defined as <3 dissected or examined MLN stations. The primary end point of this study was freedom from LR (FFLR). Differences between patient groups were compared and risk factors for LR were identified by univariate and multivariate analyses. Results LR was identified in 41 (20.6%) patients, distant metastasis (DM) was identified in 79 (39.7%) patients and concurrent LR and DM was identified in 25 (12.6%) patients. The 3- and 5-year OS rates in patients with resected N1 NSCLC were 78.4% and 65.6%, respectively. The corresponding FFLR rates were 80.8% and 77.3%, respectively. Univariate analyses identified that nonsmokers, ≤23 dissected lymph nodes, visceral pleural invasion and lymph node ratio >10% were significantly associated with lower FFLR rates (P < 0.05). Multivariate analyses further confirmed positive lymph nodes at station 10 and IMD as risk factors for LR (P < 0.05). The 5-year LR rate was highest in patients with both these risk factors (48%). Conclusions The incidence of LR in patients with surgically resected T1–3N1M0 NSCLC is high. Patients with IMD and positive lymph nodes at station 10 have the highest risk of LR, and may therefore benefit from adjuvant PORT. Further investigations of PORT in this subset of patients are warranted.
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16
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Varlotto JM, Medford-Davis LN, Recht A, Flickinger J, Yao N, Hess C, Reed MF, Toth J, Zander DS, DeCamp MM. Identification of Stage I Non-small Cell Lung Cancer Patients at High Risk for Local Recurrence Following Sublobar Resection. Chest 2013; 143:1365-1377. [DOI: 10.1378/chest.12-0710] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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17
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Varlotto J, Recht A, Medford-Davis LN, Flickinger JC, DeCamp M. Locoregional recurrence of early-stage surgically resected non-small-cell lung cancer: the importance of close follow-up and consistent definitions. Ann Oncol 2013; 24:1711-2. [PMID: 23553061 DOI: 10.1093/annonc/mdt143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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Current World Literature. Curr Opin Oncol 2013; 25:205-208. [DOI: 10.1097/cco.0b013e32835ec49f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Lopez Guerra JL, Gomez DR, Lin SH, Levy LB, Zhuang Y, Komaki R, Jaen J, Vaporciyan AA, Swisher SG, Cox JD, Liao Z, Rice DC. Risk factors for local and regional recurrence in patients with resected N0-N1 non-small-cell lung cancer, with implications for patient selection for adjuvant radiation therapy. Ann Oncol 2013; 24:67-74. [PMID: 23002278 PMCID: PMC3525136 DOI: 10.1093/annonc/mds274] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 06/14/2012] [Accepted: 06/20/2012] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the actuarial risk of local and regional failure in patients with completely resected non-small-cell lung cancer (NSCLC), and to assess surgical and pathological factors affecting this risk. PATIENTS AND METHODS Between January 1998 and December 2009, 1402 consecutive stage I-III (N0-N1) NSCLC patients underwent complete resection without adjuvant radiation therapy. The median follow-up was 42 months. RESULTS Local-regional recurrence was identified in 9% of patients, with local failure alone in 3% of patients, regional failure alone in 4% of patients, and both local and regional failure simultaneously in 2% of patients. Patients who had local failure were found to be at increased risk of mortality. By multivariate analyses, three variables were shown to be independently significant risk factors for local [surgical procedure (single/multiple wedges+segmentectomy versus lobectomy+bilobectomy+pneumonectomy), tumor size>2.7 cm, and visceral pleural invasion] and regional (pathologic N1 stage, visceral pleural invasion, and lymphovascular space invasion, LVI) recurrence, respectively. CONCLUSION Patients with N0-N1 disease have low rates of locoregional recurrence after surgical resection. However, several prognostic factors can be identified that increase this risk and identify patients who may benefit from adjuvant treatment.
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Affiliation(s)
- J. L. Lopez Guerra
- Departments ofRadiation Oncology
- Department of Radiation Oncology, Instituto Madrileño de Oncologia/Grupo IMO, Madrid, Spain
| | | | | | | | | | | | - J. Jaen
- Department of Radiation Oncology, Instituto Madrileño de Oncologia/Grupo IMO, Madrid, Spain
| | - A. A. Vaporciyan
- Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - S. G. Swisher
- Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA
| | | | - Z. Liao
- Departments ofRadiation Oncology
| | - D. C. Rice
- Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA
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Ohri N, Lu B, Werner-Wasik M. Occult nodal metastasis in non-small-cell lung cancer: implications for the radiation oncologist. J Clin Oncol 2012; 30:2423. [PMID: 22614992 DOI: 10.1200/jco.2011.41.2148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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21
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Higgins KA, Chino JP, Berry M, Ready N, Boyd J, Yoo DS, Kelsey CR. Local Failure in Resected N1 Lung Cancer: Implications for Adjuvant Therapy. Int J Radiat Oncol Biol Phys 2012; 83:727-33. [DOI: 10.1016/j.ijrobp.2011.07.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Revised: 07/01/2011] [Accepted: 07/22/2011] [Indexed: 10/14/2022]
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22
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Medford-Davis L, Decamp M, Recht A, Flickinger J, Belani CP, Varlotto J. Surgical management of early-stage non-small cell lung carcinoma and the present and future roles of adjuvant therapy: a review for the radiation oncologist. Int J Radiat Oncol Biol Phys 2012; 84:1048-57. [PMID: 22632771 DOI: 10.1016/j.ijrobp.2012.03.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 01/28/2012] [Accepted: 03/16/2012] [Indexed: 12/30/2022]
Abstract
We review the evidence for optimal surgical management and adjuvant therapy for patients with stages I and II non-small cell lung cancer (NSCLC) along with factors associated with increased risks of recurrence. Based on the current evidence, we recommend optimal use of mediastinal lymph node dissection, adjuvant chemotherapy, and post-operative radiation therapy, and make suggestions for areas to explore in future prospective randomized clinical trials.
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Affiliation(s)
- Laura Medford-Davis
- Department of Emergency Medicine, Ben Taub General Hospital, Houston, TX, USA
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