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Ichinokawa H, Takamochi K, Fukui M, Hattori A, Matsunaga T, Suzuki K. Investigating the predictive factors of thoracic aortic invasion and surgical outcomes in patients with primary lung cancer: A retrospective study. Thorac Cancer 2024; 15:1263-1270. [PMID: 38623823 PMCID: PMC11128368 DOI: 10.1111/1759-7714.15311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/04/2024] [Accepted: 04/08/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND This study aimed to investigate predictors of thoracic aortic invasion in lung cancer patients using preoperative clinical and imaging characteristics and elucidate surgical outcomes in cases of aortic invasion. METHODS Of the 4751 lung cancer patients who underwent surgery at our hospital, we included 126 (6.8%) who underwent left-sided surgery and in whom tumor appeared to be in contact with the thoracic aorta on preoperative imaging. The patients were divided into two groups: group A, 23 patients (18%) who underwent combined aortic resection (+); group B, 103 patients (82%) who did not undergo combined aortic resection (-). RESULTS The percentage of aortic invasion for tumor diameter <3 cm, 3-4 cm, 4-5 cm, 5-7 cm, and >7 cm was 0%, 13%, 23%, 16%, and 35%, respectively. The percentages of aortic invasion were 27%, 16%, and 0% for tumor localization in the upper division, S6, and S10, respectively. Multivariate analysis revealed that aortic depression due to tumor or loss of fatty tissue between tumor and mediastinum in the chest CT significantly predicted aortic invasion (odds ratio = 23.83, 16.66). Group A demonstrated significantly more blood loss, longer operative time, prolonged hospital stay, and increased percentage of recurrent nerve palsy (13%) compared to group B. The 1-, 3-, and 5-year survival rates for patients in group A were 53.4%, 24.3%, and 24.3%, respectively. CONCLUSION If the chest CT of a patient demonstrates aortic depression due to tumor or loss of fatty tissue between tumor and mediastinum, aortic complications should be considered when planning surgery.
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Affiliation(s)
- Hideomi Ichinokawa
- Department of General Thoracic SurgeryJuntendo University HospitalTokyoJapan
| | - Kazuya Takamochi
- Department of General Thoracic SurgeryJuntendo University HospitalTokyoJapan
| | - Mariko Fukui
- Department of General Thoracic SurgeryJuntendo University HospitalTokyoJapan
| | - Aritoshi Hattori
- Department of General Thoracic SurgeryJuntendo University HospitalTokyoJapan
| | - Takeshi Matsunaga
- Department of General Thoracic SurgeryJuntendo University HospitalTokyoJapan
| | - Kenji Suzuki
- Department of General Thoracic SurgeryJuntendo University HospitalTokyoJapan
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2
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Tankel J, Mouhanna J, Katz A, Fiset PO, Rayes R, Siblini A, Lee E, Seely A, Najmeh S, Cools-Lartigue J, Sirois C, Mulder D, Ferri L, Spicer J. The 8th Edition TNM Stage Reclassification of T4 Non-Small Cell Lung Cancer: A Granular Examination of Short and Long-Term Outcomes. Clin Lung Cancer 2023; 24:551-557. [PMID: 37258384 DOI: 10.1016/j.cllc.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 12/29/2022] [Accepted: 04/03/2023] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Whilst the American Joint Committee on Cancer 7th edition (AJCC7) classified pT4 non-small-cell lung cancers (NSCLC) as those with extra-pulmonary invasion, the revised 8th edition (AJCC8) included tumors > 7cm regardless of extra-pleural spread. We examined perioperative and long-term outcomes of classical T4 definitions with patients whose tumors were greater than 7cm without extra-pulmonary invasion. MATERIALS AND METHODS A retrospective single center cohort study was performed. All consecutive patients with pT4 lesions between 2011 and 2018 were identified based on either the AJCC7 or AJCC8 classification. Clinicopathological variables were extracted and compared in a univariate manner. A multivariate Cox regression analysis was performed to assess factors associated with overall survival. RESULTS Forty patients were allocated to AJCC7 and 118 to AJCC8. Patients in the former were more likely to have positive lymph nodes, synchronous metastasis, multifocal disease and lymphovascular invasion. AJCC7 patients were more likely to undergo pneumonectomy despite significantly more being treated with neoadjuvant therapy. Ninety-day mortality was higher in the AJCC7 group. There was no difference in long-term overall survival. On multivariate analysis male gender, squamous cell histology and increasing tumor size were associated with an increased risk of death. CONCLUSION Although long-term outcomes were similar, the heterogenicity within the AJCC8 classification emphasizes the need to contextualize the perioperative outcomes for patients with pT4 NSCLC. These data are important for future iterations of the TNM classification in view of emerging neoadjuvant options for patients with cT4 operable NSCLC.
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Affiliation(s)
- James Tankel
- Department of Thoracic Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Jack Mouhanna
- Department of Thoracic Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Amit Katz
- Department of Thoracic Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Pierre-Olivier Fiset
- Department of Pathology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Roni Rayes
- Department of Thoracic Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Aya Siblini
- Department of Thoracic Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Emma Lee
- Department of Thoracic Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Andrew Seely
- Department of Thoracic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Sara Najmeh
- Department of Thoracic Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Jonathan Cools-Lartigue
- Department of Thoracic Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Christian Sirois
- Department of Thoracic Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - David Mulder
- Department of Thoracic Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Lorenzo Ferri
- Department of Thoracic Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Jonathan Spicer
- Department of Thoracic Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada.
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Bashour SI, Ost DE. An update on bronchopleural fistulae following cancer-related surgery. Curr Opin Pulm Med 2023; 29:223-231. [PMID: 37102602 DOI: 10.1097/mcp.0000000000000966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
PURPOSE OF REVIEW Bronchopleural fistulae (BPF) are rare complications in cancer-related surgery but impart significant morbidity and mortality. BPF may be difficult to identify, with a broad differential diagnosis at presentation, so it is critical to be aware of newer diagnostic and therapeutic approaches for this disease entity. RECENT FINDINGS Multiple novel diagnostic and therapeutic interventions are featured in this review. Reports of newer bronchoscopic techniques to localize BPF, as well as approaches for bronchoscopic management, like stent deployment, endobronchial valve placement, or alternative interventions when indicated are discussed, paying particular attention to factors that influence procedure selection. SUMMARY Management of BPF remains highly variable, but several novel approaches have shown improved identification and outcomes. Although a multidisciplinary approach is imperative, an understanding of these newer techniques is important to provide optimal care for patients.
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Affiliation(s)
- Sami I Bashour
- Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Towe CW, Worrell SG, Bachman K, Sarode AL, Perry Y, Linden PA. Neoadjuvant Treatment Is Associated With Superior Outcomes in T4 Lung Cancers With Local Extension. Ann Thorac Surg 2020; 111:448-455. [PMID: 32663471 DOI: 10.1016/j.athoracsur.2020.05.084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 05/01/2020] [Accepted: 05/11/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Neoadjuvant chemoradiation is associated with improved survival of superior sulcus cancers, but little data exists regarding clinical T4 lung cancers with mediastinal invasion. We hypothesized that neoadjuvant treatment would be associated with improved survival in T4 lung cancer patients with mediastinal invasion. METHODS Clinical T4-N0/1-M0 non-small cell lung cancers from 2006-2015 were identified in the National Cancer Database. Patients with T4 extension to mediastinal structures undergoing lobectomy, bilobectomy, or pneumonectomy were included. Neoadjuvant treatment was defined as preoperative chemotherapy and/or radiation. Patients receiving surgery >120 days after radiation were excluded. Study endpoints were pathologic margin status and overall survival. To adjust for heterogeneity, a 1:1 propensity match analysis was performed. RESULTS A total of 1101 patients with cT4N0/1M0 cancers were analyzed; 595 (54.0%) received primary surgery and 506 (46.0%) received neoadjuvant treatment. Neoadjuvant therapy was associated with fewer positive surgical margins (46 of 506 [9.3%] vs 186 of 595 [33.1%], P < .001). Multivariate analysis showed an association of neoadjuvant therapy with a lower rate of positive margin (odds ratio 0.220, P < .001). Overall survival was longer among patients receiving neoadjuvant treatment (65.9 vs 27.5 months, P < .001). Propensity matching identified 331 matched pairs of patients. Among these, positive margins were less likely after receiving neoadjuvant treatment (10.5% vs 31.3%, P < .001). Overall survival among the matched pairs was improved in those receiving neoadjuvant treatment (57.0 vs 27.5 months, P < .001). CONCLUSIONS In the NCDB, T4N0/1 mediastinal invasion patients who receive neoadjuvant treatment have decreased rates of positive surgical margins and improved overall survival. The use of neoadjuvant treatment should be considered in these patients.
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Affiliation(s)
- Christopher W Towe
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve School of Medicine, Cleveland, Ohio.
| | - Stephanie G Worrell
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve School of Medicine, Cleveland, Ohio
| | - Katelynn Bachman
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve School of Medicine, Cleveland, Ohio
| | - Anuja L Sarode
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve School of Medicine, Cleveland, Ohio
| | - Yaron Perry
- Division of Thoracic Surgery, University of Buffalo and Jacobs SOM and Biomedical Sciences, Buffalo, New York
| | - Philip A Linden
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve School of Medicine, Cleveland, Ohio
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Tanahashi M, Niwa H, Yukiue H, Suzuki E, Yoshii N, Watanabe T, Kaminuma Y, Chiba K, Tsuchida H, Yobita S. Feasibility and prognostic benefit of induction chemoradiotherapy followed by surgery in patients with locally advanced non-small cell lung cancer. J Thorac Dis 2020; 12:2644-2653. [PMID: 32642172 PMCID: PMC7330299 DOI: 10.21037/jtd.2020.03.17] [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: 12/25/2022]
Abstract
Background The optimal treatment for patients with resectable non-small cell lung cancer (NSCLC) involving adjacent organs (T3 or T4) and/or cN2 remains unclear. We investigated whether or not induction chemoradiotherapy (ICRT) followed by surgery improves the survival. Methods We retrospectively analyzed 84 patients with NSCLC involving the adjacent organs and/or cN2 who underwent ICRT followed by surgery at our hospital from 2006 to 2018. Presurgical treatment consisted of 2 courses of platinum-doublet and concurrent radiotherapy (40–50 Gy) to the tumor and involved field. Results All 84 patients completed ICRT. One patient died after completion of ICRT due to bacterial pneumonia. Radiological responses to ICRT were a complete response (CR), n=1; partial response (PR), n=48; stable disease (SD), n=32; and progressive disease (PD), n=2 (overall response rate: 58.3%). Eighty-one patients underwent radical surgery. The procedures included lobectomy, n=66; bilobectomy, n=7; pneumonectomy, n=6; and segmentectomy, n=2 (including 49 extended resections). Seventy-three patients (90%) underwent complete resection. The postoperative morbidity rate was 30%. The 30- and 90-day mortality rates were 1.2% and 2.4%, respectively. A pathological CR (Ef3) and major response (Ef2) were achieved in 17 (21.0%) and 38 (46.9%) patients, respectively; a minor response (Ef1) was observed in 26 (32%). The 5-year overall survival (OS) and recurrence-free survival (RFS) rates were 58.0% and 45.6%, respectively. The median survival time was 73.2 months. Based on the response to ICRT, patients with radiological CR or PR showed better 5-year OS than those with SD (63.7% vs. 40.0%, P=0.020). Patients with Ef3 or Ef2 demonstrated a much better 5-year OS than those with Ef1 (65.0% vs. 24.4%, P=0.005). Conclusions ICRT followed by surgery for patients with NSCLC involving the adjacent organs and/or cN2 was feasible and improved the survival. A CR/PR or Ef2/Ef3 after ICRT led to a better prognosis.
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Affiliation(s)
- Masayuki Tanahashi
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Hiroshi Niwa
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Haruhiro Yukiue
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Eriko Suzuki
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Naoko Yoshii
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Takuya Watanabe
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Yasunori Kaminuma
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Kensuke Chiba
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Hiroyuki Tsuchida
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Shogo Yobita
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, Hamamatsu, Japan
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Kanzaki R, Ose N, Funaki S, Shintani Y, Minami M, Suzuki O, Kida H, Ogawa K, Kumanogoh A, Okumura M. The Outcomes of Induction Chemoradiotherapy Followed by Surgery for Clinical T3-4 Non-Small Cell Lung Cancer. Technol Cancer Res Treat 2020; 18:1533033819871327. [PMID: 31455166 PMCID: PMC6712766 DOI: 10.1177/1533033819871327] [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: 12/25/2022] Open
Abstract
Purpose: Information on the short- and long-term outcomes of induction chemoradiotherapy followed by surgery for cT3-4 non-small cell lung cancer is limited. We analyzed the short- and long-term outcomes of induction chemoradiotherapy followed by surgery for cT3-4 non-small cell lung cancer. Methods: Patients with non-small cell lung cancer who underwent induction chemoradiotherapy followed by surgery for cT3-4 non-small cell lung cancer were retrospectively reviewed (initial treatment group, n = 31). Their results were compared to those patients who underwent surgery as an initial treatment during the same period (initial surgery group, n = 35). Results: Downstaging was achieved in 14 (45%) patients in the initial treatment group. R0 resection was achieved in 28 (90%) patients in the initial treatment group and 31 (88%) patients in the initial surgery group. The 90-day mortality rate was 3% in each group. Postoperative complications occurred in 16 (52%) patients in the initial treatment group and 13 (37%) patients in the initial surgery group. The 5-year overall survival rate of the initial treatment group was significantly higher than that of the initial surgery group (62.6% vs 43.5%, P = .04). The 5-year overall survival rates of the initial treatment N0-1 group and the initial surgery N0-1 group were 88.9% and 49.3%, respectively; the difference was statistically significant (P = .02). Multivariate analysis using 4 factors (age [≤65 vs >65], cN [cN0-1 vs cN2], general condition [chemoradiotherapy fit vs chemoradiotherapy unfit], and treatment mode [induction chemoradiotherapy followed by surgery vs surgery as an initial treatment]) revealed that treatment mode (induction chemoradiotherapy followed by surgery) and cN status (cN0-1) were significantly associated with good overall survival and disease-free survival. Conclusions: Induction chemoradiotherapy followed by surgery for cT3-4 non-small cell lung cancer could be performed with an acceptable degree of surgical risk. At present, it is thought to be one of the reasonable treatment approaches for selected patients with cT3-4 disease, even those with a cN0-1 status.
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Affiliation(s)
- Ryu Kanzaki
- 1 Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Naoko Ose
- 1 Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Soichiro Funaki
- 1 Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasushi Shintani
- 1 Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masato Minami
- 1 Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Osamu Suzuki
- 2 Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroshi Kida
- 3 Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuhiko Ogawa
- 2 Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Atsushi Kumanogoh
- 3 Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Meinoshin Okumura
- 1 Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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7
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Muñoz-Largacha JA, Rao SR, Brinckerhoff LH, Daly BD, Fernando HC, Litle VR, Suzuki K. Induction chemoradiation is associated with improved survival in chest wall invasion lung cancer. TUMORI JOURNAL 2019; 105:331-337. [PMID: 30905273 DOI: 10.1177/0300891619839283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine if induction chemotherapy with concurrent high-dose radiation followed by resection is associated with improved survival in patients with nonsuperior sulcus lung cancer with chest wall invasion. METHODS We performed a retrospective review of clinical T3 (chest wall invasion) N0/N1 patients with non-small cell lung cancer who underwent surgical resection between January 1, 1992, and January 31, 2017. Exclusion criteria included superior sulcus tumors and resection performed for palliation/recurrence. Patients undergoing induction chemoradiation followed by surgical resection were compared to those undergoing resection first or those receiving induction radiation followed by resection. Overall survival was calculated using the Kaplan-Meier method. RESULTS Thirty-four patients were included in the analysis, with 5-year overall survival (OS) of 30%. By clinical stage, 31 (91%) were IIB (T3N0) and 3 (9%) were IIIA (T3N1). Sixteen patients (47%) received induction chemoradiation before surgery. Of the remaining 18 patients, 5 (15%) received induction radiation followed by surgery, and 13 (38%) underwent surgery as the first treatment. Three patients belonging to the group not receiving induction chemoradiation died within 30 days after surgery and were excluded from survival analysis. In the remaining 31 patients, induction chemoradiation was associated with improved 5-year OS (53% for induction chemoradiation vs 7% for others; P<0.01). Disease recurrence was evident in 9 cases, 2 (12.5%) in the induction chemoradiation group and 7 (46.6%) in the others (median disease-free time 103.0 months for induction chemoradiation group vs 8.0 months for others; P<0.01). CONCLUSION In patients with nonsuperior sulcus lung cancer with chest wall invasion, induction chemoradiation therapy followed by resection is associated with improved OS.
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Affiliation(s)
- Juan A Muñoz-Largacha
- 1 Department of Surgery, Division of Thoracic Surgery, Boston University School of Medicine, Boston, MA
| | - Sowmya R Rao
- 2 Department of Surgery, Division of Biostatistics, Boston University School of Medicine, Boston, MA
| | - Laurence H Brinckerhoff
- 3 Department of Surgery, Division of Thoracic Surgery, Tufts University School of Medicine, Boston, MA
| | - Benedict D Daly
- 1 Department of Surgery, Division of Thoracic Surgery, Boston University School of Medicine, Boston, MA
| | - Hiran C Fernando
- 4 Thoracic Surgery, Inova Fairfax Medical Campus, Virginia Commonwealth University, Falls Church, VA
| | - Virginia R Litle
- 1 Department of Surgery, Division of Thoracic Surgery, Boston University School of Medicine, Boston, MA
| | - Kei Suzuki
- 1 Department of Surgery, Division of Thoracic Surgery, Boston University School of Medicine, Boston, MA
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8
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Pikin OV, Ryabov AB, Glushko VA, Kolbanov KI, Amiraliev AM, Vursol DA, Bagrov VA, Barmin VV. [Surgery for non-small cell lung carcinoma after previous chemoradiotherapy alone]. Khirurgiia (Mosk) 2018:28-31. [PMID: 28008899 DOI: 10.17116/hirurgia201611228-31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To investigate early and remote results of surgery in patients with recurrent non-small cell lung carcinoma (NSCLC) after previous chemoradiotherapy alone. MATERIAL AND METHODS The retrospective study included 14 NSCLC patients (10 men and 4 women, mean age 52.6 years) who were operated in thoracic department for the period June 2008 - December 2013. Histologically squamous cell carcinoma prevailed (64.3%). Prior to surgery stage IIB was diagnosed in 2 patients, IIIA in 11 and IIIB in 1 patient. The dose of radiotherapy ranged from 45 to 70 Gr (median 58Gr). The average number of chemotherapy cycles was 3.8 per patient. Pneumonectomy was performed in all patients except one who underwent left-sided lower lobectomy. In all cases bronchial stump was covered by vascularized muscle flap (intercostal, latissimus dorsi). Postoperative complications were classified by TMM system (Thoracic Morbidity and Mortality System). RESULTS Postoperative complications were observed in 7 (50.0%) patients including level II in 2 cases, IIIA in 1 case, IVA in 3 patients and V (death) in 1 (7.1%) patient. Postoperative stages of lung cancer were IB in 2 cases, IIA in 1, IIB in 5, IIIA in 4 and IIIB in 2 patients. Overall 1, 2 and 3-year survival rate was 89.1%, 82.0% and 48.0% respectively (median 35.0 months). Recurrence-free survival was 84.2%, 72.0% and 24.8%, respectively (median 28.0 months). Overall and recurrence-free 5-year survival rate was 10.8%. CONCLUSION «Salvage» surgery may be recommended as individual approach in patients with reccurent lung cancer after previous chemoradiotherapy.
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Affiliation(s)
- O V Pikin
- P.A. Hertzen Moscow Research Institute of Oncology, Russian Federation, Moscow
| | - A B Ryabov
- P.A. Hertzen Moscow Research Institute of Oncology, Russian Federation, Moscow
| | - V A Glushko
- P.A. Hertzen Moscow Research Institute of Oncology, Russian Federation, Moscow
| | - K I Kolbanov
- P.A. Hertzen Moscow Research Institute of Oncology, Russian Federation, Moscow
| | - A M Amiraliev
- P.A. Hertzen Moscow Research Institute of Oncology, Russian Federation, Moscow
| | - D A Vursol
- P.A. Hertzen Moscow Research Institute of Oncology, Russian Federation, Moscow
| | - V A Bagrov
- P.A. Hertzen Moscow Research Institute of Oncology, Russian Federation, Moscow
| | - V V Barmin
- P.A. Hertzen Moscow Research Institute of Oncology, Russian Federation, Moscow
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Ziu M, Traylor JI, Paxman J, Gorrebeeck A, Fortes DL. Utilizing Stereotactic Spine Navigation for Posterior Partial Vertebrectomy in an En Bloc Resection of a Superior Pulmonary Sulcus Tumor Invading the Thoracic Vertebrae: A Technical Note. Cureus 2018; 10:e3303. [PMID: 30456002 PMCID: PMC6239614 DOI: 10.7759/cureus.3303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Prior to the development of en bloc techniques, vertebral invasion by non-small cell lung cancer (NSCLC) had been considered a relative contraindication to surgical intervention. However, reports in the literature have demonstrated increased progression-free survival with the use of neoadjuvant chemotherapy followed by anterior en bloc resection of the residual tumor. Stereotactic spine navigation has been shown to improve accuracy during complex vertebral osteotomies, improving patient outcomes. We report a 53-year-old woman with an NSCLC in the left upper lobe, a periosteum attachment of the second and third thoracic vertebrae (T2 and T3, respectively), and an infiltration of the corresponding nerve roots. We describe a surgical approach for the resection of NSCLC with vertebral infiltration utilizing stereotactic spine navigation and intraoperative computed tomography (CT) (O-Arm, Medtronic, Minneapolis, Minnesota, US) for a posterior approach laminectomy, osteotomy, and partial vertebrectomy, followed by trans-thoracic en bloc resection of a superior pulmonary sulcus tumor with nerve root infiltration. Posterior approach vertebral osteotomy and en bloc resection for superior sulcus NSCLC infiltrating the vertebrae utilizing stereotactic spine navigation and intraoperative CT (O-Arm) is a viable alternative to the traditional anterior approach.
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Affiliation(s)
- Mateo Ziu
- Department of Surgery & Perioperative Care, The University of Texas at Austin, Dell Medical School, Austin, USA
| | - Jeffrey I Traylor
- Medical Student, The University of Texas at Austin, Dell Medical School, Austin, USA
| | - Jason Paxman
- Medical Student, The University of Texas at Austin, Dell Medical School, Austin, USA
| | - Allison Gorrebeeck
- Department of Internal Medicine, Dell Seton Medical Center at The University of Texas, Austin, USA
| | - Daniel L Fortes
- Department of Surgery and Perioperative Care, The University of Texas at Austin, Austin, USA
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10
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Park B, Cho JH, Kim HK, Choi YS, Zo JI, Shim YM, Kim J. Long-term survival in locally advanced non-small cell lung cancer invading the great vessels and heart. Thorac Cancer 2018; 9:598-605. [PMID: 29602232 PMCID: PMC5928382 DOI: 10.1111/1759-7714.12625] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 02/12/2018] [Accepted: 02/13/2018] [Indexed: 11/30/2022] Open
Abstract
Background The aim of this study was to analyze the surgical outcomes of locally advanced lung cancer invading the great vessels or heart, according to the extension of cancer invasion. Methods From 1995 to 2015, 59 patients who were surgically treated and pathologically diagnosed with T4N0–1 non‐small cell lung cancer with invasion to the great vessels or heart were enrolled. Surgical outcomes were compared between patient groups with and without intrapericardial invasion. Results The median age was 64 years (interquartile range [IQR] 57–68) and 56 patients (95%) were male. In‐hospital mortality was 9% and median overall survival was 30 months (IQR 12–83). One and five‐year overall survival rates were 75% and 44%, respectively. The median overall survival in patients with lung cancer invasion to the intrapericardial space (n = 45) was 27 months (IQR 10–63), while it was 42 months (IQR 18–104) in patients without intrapericardial invasion (n = 14). Median disease‐free survival was significantly poorer in patients with intrapericardial invasion (12 months; IQR 6–55), especially in patients with heart invasion (n = 11, 7 months, IQR 5–27), than in patients without intrapericardial invasion (30 months, IQR 13–103). Conclusion Patients with lung cancer invading the intrapericardial space showed worse surgical outcomes in both overall and disease‐free survival. Therefore, surgical management should be carefully considered in patients with intrapericardial invasion.
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Affiliation(s)
- Byungjoon Park
- Department of Thoracic and Cardiovascular Surgery, Chung-Ang University Hospital, Seoul, South Korea
| | - Jong Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South 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
| | - Jae Il 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
| | - Jhingook Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Anderson KL, Mulvihill MS, Yerokun BA, Speicher PJ, D'Amico TA, Tong BC, Berry MF, Hartwig MG. Induction chemotherapy for T3N0M0 non-small-cell lung cancer increases the rate of complete resection but does not confer improved survival. Eur J Cardiothorac Surg 2017; 52:370-377. [PMID: 28402406 DOI: 10.1093/ejcts/ezx091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 02/10/2017] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES The objective of this study was to evaluate outcomes of induction therapy prior to an operation in patients with cT3 non-small-cell lung cancer (NSCLC). METHODS Patients diagnosed with cT3N0M0 NSCLC from 2006 to 2011 in the National Cancer Database who were treated with lobectomy or pneumonectomy were stratified by treatment strategy: an operation first versus induction chemotherapy. Propensity scores were developed and matched cohorts were generated. Short-term outcomes included margin status, 30- and 90-day mortality rates, readmission and length of stay. Survival analyses using Kaplan-Meier methods were performed on both the unadjusted and propensity matched cohorts. RESULTS A total of 3791 cT3N0M0 patients were identified for inclusion, of which 580 (15%) were treated with induction chemotherapy. Prior to adjustment, patients treated with induction chemotherapy were younger, had a higher comorbidity burden and were more likely to have private insurance (all P < 0.001). Following matching, patients receiving induction chemotherapy were more likely to subsequently undergo an open procedure (87.3 vs 77.8%, P = 0.005). These patients were more likely to obtain R0 resection (93.1% vs 90.0%, P = 0.04) and were thereby less likely to have positive margins at the time of resection (6.9% vs 10.0%, P = 0.03). Patients who received induction therapy had higher rates of 90-day mortality (6.6% vs 3.4%) but there was no difference in long-term survival between the groups. CONCLUSIONS Despite yielding increased rates of R0 resection, induction chemotherapy for cT3N0M0 NSCLC is not associated with improved survival and should not be considered routinely. Further studies are warranted to elucidate cohorts that may benefit from induction therapy.
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Affiliation(s)
| | | | | | - Paul J Speicher
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Thomas A D'Amico
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Betty C Tong
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Mark F Berry
- Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA, USA
| | - Matthew G Hartwig
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, USA
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Dickhoff C, Hartemink K, van de Ven P, van Reij E, Senan S, Paul M, Smit E, Dahele M. Trimodality therapy for stage IIIA non-small cell lung cancer: Benchmarking multi-disciplinary team decision-making and function. Lung Cancer 2014; 85:218-23. [DOI: 10.1016/j.lungcan.2014.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 06/01/2014] [Accepted: 06/08/2014] [Indexed: 10/25/2022]
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Outcome of surgical resection as a first line therapy in T3 non-small cell lung cancer patients. World J Surg 2014; 37:2574-80. [PMID: 23942531 DOI: 10.1007/s00268-013-2174-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The T3 category of the 7th Edition of the TNM classification of non-small cell lung cancer (NSCLC) has added two factors that do not appear in the 6th Edition, large tumor size (>7 cm) and pulmonary metastasis of the same lobe. These factors are considered to have different biological and clinical features. In the present study we assessed the outcome of surgical resection as a first line therapy for T3 NSCLC. METHODS A total of 145 patients who were diagnosed according to the TNM 7th Edition with pathologic T3 NSCLC received surgical resection in our institution as a first line treatment. The outcomes of their treatment were analyzed. RESULTS The 5-year survival rate was 46.9 %. On the basis of the 6th TNM Edition, the 5-year survival rate was 63.1 % for patients diagnosed with T2 disease (large tumor size), 44.3 % for patients diagnosed with T3 disease, and 33.1 % for patients diagnosed with T4 disease (pulmonary metastasis of the same lobe). There were no significant correlations between these categories and overall survival (OS). Nevertheless, 6th Edition T factors were found to be significantly correlated with lymph node status (p < 0.01). The univariate analyses showed that age, lymph node metastasis, and curative resection had significant effects on OS. In addition, the multivariate analysis identified age and N factor as independent prognostic factors in this cohort. CONCLUSIONS Indications for surgical resection as a first line therapy in T3 NSCLC should be based on N factors and patient age. Lymph node metastasis, especially N2 disease, was increasingly frequent in patients with 6th Edition T classifications.
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Arslan D, Bozcuk H, Gunduz S, Tural D, Tattli AM, Uysal M, Goksu SS, Bassorgun CI, Koral L, Coskun HS, Ozdogan M, Savas B. Survival Results and Prognostic Factors in T4 N0-3 Non-small Cell Lung Cancer Patients According to the AJCC 7thEdition Staging System. Asian Pac J Cancer Prev 2014; 15:2465-72. [DOI: 10.7314/apjcp.2014.15.6.2465] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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15
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Predictors of survival in postinduction therapy surgical T4N0-2 non-small cell lung cancer. Ann Thorac Surg 2013; 96:2284. [PMID: 24296212 DOI: 10.1016/j.athoracsur.2013.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 03/31/2013] [Accepted: 05/14/2013] [Indexed: 11/22/2022]
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Kuzmik GA, Detterbeck FC, Decker RH, Boffa DJ, Wang Z, Oliva IB, Kim AW. Pulmonary resections following prior definitive chemoradiation therapy are associated with acceptable survival. Eur J Cardiothorac Surg 2013; 44:e66-70. [PMID: 23557918 DOI: 10.1093/ejcts/ezt184] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The benefits of salvage resection for lung cancer recurrence following high-dose curative-intent chemoradiation therapy are unclear. We assessed survival after salvage lung resection following definitive chemoradiation. METHODS Medical records of patients undergoing lung cancer resections at our institution following definitive chemoradiation therapy were reviewed from June 2006 to August 2012. A multivariate Cox proportional model was used to assess the factors associated with improved survival. RESULTS Fourteen patients had chemoradiation therapy before lung resection (pneumonectomy, lobectomy or segmentectomy). Pretherapy cancer stage was Stage III in 11 patients, Stage IV in 2 and Stage II in 1. Postoperative 2-year survival was 49%. Patients had a median disease-free interval before resection of 33 months. No variables were found to be associated with improved post-chemoradiation survival from the time of definitive treatment or postoperative survival. Complications occurred in 6 (43%) patients, with 2 of those complications directly attributable to post-chemoradiation changes. There were no perioperative deaths within 90 days. CONCLUSIONS Salvage lung resection for recurrent lung cancer following definitive chemoradiation therapy is feasible and is associated with postoperative survival and complication rates that are reasonable.
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Shiraishi T, Hiratsuka M, Yanagisawa J, Miyahara S, Yoshida Y, Makimoto Y, Hamatake D, Yamashita SI, Iwasaki A. Pulmonary resection after chemoradiotherapy for advanced non-small cell lung cancer: the impact of presurgical radiation therapy. Surg Today 2013; 44:123-30. [DOI: 10.1007/s00595-013-0520-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Accepted: 10/26/2012] [Indexed: 10/27/2022]
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Lococo F, Cesario A, Margaritora S, Dall'Armi V, Nachira D, Cusumano G, Meacci E, Granone P. Induction therapy followed by surgery for T3-T4/N0 non-small cell lung cancer: long-term results. Ann Thorac Surg 2012; 93:1633-40. [PMID: 22480394 DOI: 10.1016/j.athoracsur.2012.01.109] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Revised: 01/24/2012] [Accepted: 01/31/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of this study was to analyze the impact of the induction chemoradiotherapy (IT) on the survival pattern in T3/T4-N0 non-small cell lung cancer (NSCLC) patients. METHODS The data of 71 patients treated from January 1992 to May 2007 were reviewed. Of these, 31 patients received IT prior to surgery (IT group: T3, 20 patients; and T4, 11 patients), and 40 directly underwent surgery (S group: T3, 34 patients; and T4, 6 patients). Survival rates were compared using the Kaplan-Meier analysis and the Cox proportional hazards models. RESULTS Mean ages were 62.5±9.9 years in the IT group and 67.7±7.1 in the S group. All patients but 1 completed the IT treatment and 27 patients (87%) were operated. A radical resection was possible in 21 patients (78%). In the IT group a complete pathologic response was obtained in 6 patients (22%), where 8 patients ended up in pI stage, 7 in pII stage, and 6 in pIII stage. The overall 5-year survival (long-term survival [LTS]) and disease-free 5-year survival (DFS) for the entire cohort were 40% and 34%, respectively. No significant differences were found when LTS in the IT group (44%) and in the S group (37%) were compared. At multivariate analysis, the completeness of resection was the only independent predictive factor (hazard ratio [HR]=5.18; 95% confidence interval [CI]=2.55 to 10.28) while Cox multivariate analysis (on the IT group only) confirmed the critical role of the pathologic downstaging (HR=4.62; 95% CI=1.54 to 13.89). CONCLUSIONS A multimodal strategy with IT treatment followed by surgery is a safe and reasonable treatment in T3/T4-N0 NSCLC patients, but no clear evidence of prognostic improvement may be assumed at the present time. Nevertheless, patients with radical resection and complete pathologic response have a very rewarding survival.
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Affiliation(s)
- Filippo Lococo
- Department of General Thoracic Surgery, Catholic University, Rome, Italy.
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Daly BDT, Cerfolio RJ, Krasna MJ. Role of surgery following induction therapy for stage III non-small cell lung cancer. Surg Oncol Clin N Am 2012; 20:721-32. [PMID: 21986268 DOI: 10.1016/j.soc.2011.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Over the last 30 years neoadjuvant treatment of stage IIIA non-small cell lung cancer (NSCLC) followed by surgical resection for stage IIIB disease has significantly improved the overall results of treatment for patients with stage III NSCLC as well as for those with locally invasive tumors. Different chemotherapy regimens have been used, although in most studies some combination of drugs that include cisplatin is the standard. Radiation when given as part of the induction protocol appears to offer a higher rate of resection and complete resection, and higher doses of radiation are associated with better nodal downstaging. Resection in patients with persistent N2 disease and pneumonectomy following induction therapy remain controversial. Resection in patients with persistent N2 disease and pneumonectomy following induction therapy remain controversial.
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Affiliation(s)
- Benedict D T Daly
- Cardiothoracic Surgery Boston Medical Center, 88 East Newton Street Robinson B402, Boston, MA 02118, USA.
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Rocco G, Morabito A, Muto P. Induction therapy for lung cancer: sailing across the pillars of Hercules. Thorac Surg Clin 2011; 22:67-75, vi. [PMID: 22108690 DOI: 10.1016/j.thorsurg.2011.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
In spite of numerous clinical trials, the jury is still out on the value of induction therapy for locally advanced lung cancer. We elected to address this topic from the multifaceted views of the clinicians often involved in lung cancer management and according the most recent views on locally advanced NSCLC. The concept of a prognostic stratification of N2 disease subsets, especially single vs multiple zone, has been introduced and this may lead to a new interpretation of locally advanced NSCLC. Ten crucial issues were identified that may have an impact on the approach to patients with locally advanced lung cancer in everyday practice.
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Affiliation(s)
- Gaetano Rocco
- Lung Cancer Multidisciplinary Team, Division of Thoracic Surgery, Department of Thoracic Surgery and Oncology, National Cancer Institute, Pascale Foundation, Naples, Italy.
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