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Hou T, Peng W, Ho MH, Takemura N, Lin CC. Factors associated with cancer-related cognitive impairment in patients with lung cancer: A systematic review. Eur J Oncol Nurs 2024; 71:102657. [PMID: 38959560 DOI: 10.1016/j.ejon.2024.102657] [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: 05/01/2024] [Revised: 06/28/2024] [Accepted: 06/29/2024] [Indexed: 07/05/2024]
Abstract
PURPOSE Cognitive impairment is common in lung cancer patients and impacts their quality of life. Little is known about the etiology of cognitive impairment in lung cancer patients. However, the associated factors of cognitive impairment among lung cancer patients have not been systematically reviewed. This review aimed to summarize the factors related to cognitive impairment among lung cancer patients. METHODS PubMed, EMBASE, PsycINFO, CINAHL Plus, and Web of Science were searched to retrieve articles published from data inception until January 21, 2024, focusing on factors associated with cognitive impairment among lung cancer patients. Critical appraisal was undertaken by two reviewers independently using the Newcastle-Ottawa Scale. RESULTS A total of 17 observational studies were included. The results showed that 20 factors are associated with cognitive impairment, including psychological factors (loneliness, fatigue, anxiety, depression, high symptom burden, and baseline cognitive impairment), lifestyle and functional factors (daily step counts, smoking, and activities of daily living or instrumental activities of daily living impairments), medical treatment factors (cranial irradiation, chemotherapy, lobar resection, postoperative delirium, and on medication), and neuroimmunological factors (have neuronal autoantibodies, altered Default Mode Network connectivity, dysregulation in glutamate and glutamate metabolism, mitochondrial dysfunction, blood-brain barrier leakage, and reduced T-lymphocytes). CONCLUSION This is the first study to systematically review 20 factors associated with cognitive impairment among lung cancer patients, encompassing psychology, lifestyle and functional, medical treatment, and neuroimmunological factors. These findings can help clinicians identify at-risk patients and develop evidence-based interventions to prevent cognitive impairment among lung cancer patients.
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Affiliation(s)
- Tianxue Hou
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong Special Administrative Region of China.
| | - Wenting Peng
- The de Tornyay Center for Healthy Aging, School of Nursing, University of Washington-Seattle, Washington, United States.
| | - Mu-Hsing Ho
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong Special Administrative Region of China.
| | - Naomi Takemura
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong Special Administrative Region of China.
| | - Chia-Chin Lin
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong Special Administrative Region of China.
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Li F, Li F, Zhao D, Lu H. Predictors of cancer-specific survival and overall survival among patients aged ≥60 years with lung adenocarcinoma using the SEER database. J Int Med Res 2024; 52:3000605241240993. [PMID: 38606733 PMCID: PMC11015783 DOI: 10.1177/03000605241240993] [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: 12/09/2023] [Accepted: 03/04/2024] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVE We developed a simple, rapid predictive model to evaluate the prognosis of older patients with lung adenocarcinoma. METHODS Demographic characteristics and clinical information of patients with lung adenocarcinoma aged ≥60 years were retrospectively analyzed using Surveillance, Epidemiology, and End Results (SEER) data. We built nomograms of overall survival and cancer-specific survival using Cox single-factor and multi-factor regression. We used the C-index, calibration curve, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA) to evaluate performance of the nomograms. RESULTS We included 14,117 patients, divided into a training set and validation set. We used the chi-square test to compare baseline data between groups and found no significant differences. We used Cox regression analysis to screen out independent prognostic factors affecting survival time and used these factors to construct the nomogram. The ROC curve, calibration curve, C-index, and DCA curve were used to verify the model. The final results showed that our predictive model had good predictive ability, and showed better predictive ability compared with tumor-node-metastasis (TNM) staging. We also achieved good results using data of our center for external verification. CONCLUSION The present nomogram could accurately predict prognosis in older patients with lung adenocarcinoma.
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Affiliation(s)
- Feiyang Li
- Ward 2, Department of Medical Oncology, Lixin People’s Hospital of Bozhou City, Anhui Province, China
| | - Fang Li
- Ward 1, Department of Medical Oncology, Affiliated Hospital of Qinghai University, Qinghai Province, China
| | - Dong Zhao
- Ward 2, Department of Medical Oncology, Lixin People’s Hospital of Bozhou City, Anhui Province, China
| | - Haowei Lu
- Ward 2, Department of Medical Oncology, Lixin People’s Hospital of Bozhou City, Anhui Province, China
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Zhang Q, Wu X, Yang H, Luo P, Wei N, Wang S, Zhao X, Wang Z, Herth FJF, Zhang X. Advances in the Treatment of Pulmonary Nodules. Respiration 2024; 103:134-145. [PMID: 38382478 DOI: 10.1159/000535824] [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: 10/04/2023] [Accepted: 12/11/2023] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Early detection and accurate diagnosis of pulmonary nodules are crucial for improving patient outcomes. While surgical resection of malignant nodules is still the preferred treatment option, it may not be feasible for all patients. We aimed to discuss the advances in the treatment of pulmonary nodules, especially stereotactic body radiotherapy (SBRT) and interventional pulmonology technologies, and provide a range of recommendations based on our expertise and experience. SUMMARY Interventional pulmonology is an increasingly important approach for the management of pulmonary nodules. While more studies are needed to fully evaluate its long-term outcomes and benefits, the available evidence suggests that this technique can provide a minimally invasive and effective alternative for treating small malignancies in selected patients. We conducted a systematic literature review in PubMed, designed a framework to include the advances in surgery, SBRT, and interventional pulmonology for the treatment of pulmonary nodules, and provided a range of recommendations based on our expertise and experience. KEY MESSAGES As such, alternative therapeutic options such as SBRT and ablation are becoming increasingly important and viable. With recent advancements in bronchoscopy techniques, ablation via bronchoscopy has emerged as a promising option for treating pulmonary nodules. This study reviewed the advances of interventional pulmonology in the treatment of peripheral lung cancer patients that are not surgical candidates. We also discussed the challenges and limitations associated with ablation, such as the risk of complications and the potential for incomplete nodule eradication. These advancements hold great promise for improving the efficacy and safety of interventional pulmonology in treating pulmonary nodules.
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Affiliation(s)
- Quncheng Zhang
- Department of Respiratory and Critical Care Medicine, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Xuan Wu
- Department of Respiratory and Critical Care Medicine, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China,
| | - Huizhen Yang
- Department of Respiratory and Critical Care Medicine, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Peiyuan Luo
- Department of Respiratory and Critical Care Medicine, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Nan Wei
- Department of Respiratory and Critical Care Medicine, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Shuai Wang
- Department of Respiratory and Critical Care Medicine, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Xingru Zhao
- Department of Respiratory and Critical Care Medicine, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Ziqi Wang
- Department of Respiratory and Critical Care Medicine, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Felix J F Herth
- Department of Pneumology and Respiratory Care Medicine, Thoraxklinik and Translational Lung Research Center, University of Heidelberg, Heidelberg, Germany
| | - Xiaoju Zhang
- Department of Respiratory and Critical Care Medicine, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
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Onishi H, Shioyama Y, Matsumoto Y, Matsuo Y, Miyakawa A, Yamashita H, Matsushita H, Aoki M, Nihei K, Kimura T, Ishiyama H, Murakami N, Nakata K, Takeda A, Uno T, Nomiya T, Taguchi H, Seo Y, Komiyama T, Marino K, Aoki S, Matsuda M, Akita T, Saito M. Real-World Results of Stereotactic Body Radiotherapy for 399 Medically Operable Patients with Stage I Histology-Proven Non-Small Cell Lung Cancer. Cancers (Basel) 2023; 15:4382. [PMID: 37686657 PMCID: PMC10486748 DOI: 10.3390/cancers15174382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/10/2023] [Accepted: 08/19/2023] [Indexed: 09/10/2023] Open
Abstract
Surgery is the standard treatment for stage I non-small cell lung cancer (NSCLC); however, no clear randomized trial demonstrates its superiority to stereotactic body radiotherapy (SBRT) regarding survival. We aimed to retrospectively evaluate the treatment outcomes of SBRT in operable patients with stage I NSCLC using a large Japanese multi-institutional database to show real-world outcome. Exactly 399 patients (median age 75 years; 262 males and 137 females) with stage I (IA 292, IB 107) histologically proven NSCLC (adenocarcinoma 267, squamous cell carcinoma 96, others 36) treated at 20 institutions were reviewed. SBRT was prescribed at a total dose of 48-70 Gy in 4-10 fractions. The median follow-up period was 38 months. Local progression-free survival rates were 84.2% in all patients and 86.1% in the T1, 78.6% in T2, 89.2% in adenocarcinoma, and 70.5% in squamous cell subgroups. Overall 3-year survival rates were 77.0% in all patients: 90.7% in females, 69.6% in males, and 41.2% in patients with pulmonary interstitial changes. Fatal radiation pneumonitis was observed in two patients, all of whom had pulmonary interstitial changes. This real-world evidence will be useful in shared decision-making for optimal treatment, including SBRT for operable stage I NSCLC, particularly in older patients.
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Affiliation(s)
- Hiroshi Onishi
- Department of Radiology, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi 409-3898, Japan; (T.K.); (K.M.); (S.A.); (M.M.); (T.A.); (M.S.)
| | - Yoshiyuki Shioyama
- Ion Beam Therapy Center, SAGA-HIMAT Foundation, 3049 Harakoga-machi, Tosu 841-0071, Japan
| | - Yasuo Matsumoto
- Department of Radiation Oncology, Niigata Cancer Center Hospital, 2-15-3 Kawagishi, Chuo-ku, Niigata 951-8566, Japan;
| | - Yukinori Matsuo
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan;
| | - Akifumi Miyakawa
- Department of Radiology, School of Medicine, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan;
| | - Hideomi Yamashita
- Department of Radiology, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan;
| | - Haruo Matsushita
- Department of Radiation Oncology, School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Miyagi, Japan;
| | - Masahiko Aoki
- Department of Radiation Oncology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki City 036-8562, Aomori, Japan;
| | - Keiji Nihei
- Department of Radiation Oncology, Tokyo Metropolitan Cancer, Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan;
| | - Tomoki Kimura
- Department of Radiation Oncology, Hiroshima University, 1-2-3, Kasumi Minami-ku, Hiroshima 734-8551, Japan;
| | - Hiromichi Ishiyama
- Department of Radiation Oncology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara 252-0375, Kanagawa, Japan;
| | - Naoya Murakami
- Department of Radiation Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan;
| | - Kensei Nakata
- Department of Radiation Oncology, Sapporo Medical University, S1W17, Chuo-ku, Sapporo 060-8556, Hokkaido, Japan;
| | - Atsuya Takeda
- Radiation Oncology Center, Ofuna Chuo Hospital, 6-2-24 Ofuna, Kamakura 247-0056, Kanagawa, Japan;
| | - Takashi Uno
- Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba City 260-8670, Chiba, Japan;
| | - Takuma Nomiya
- Department of Radiation Oncology, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata-shi 990-9585, Yamagata, Japan;
| | - Hiroshi Taguchi
- Department of Radiation Oncology, Hokkaido University Hospital, North-14 West-5, Kita-ku, Sapporo 060-8648, Japan;
| | - Yuji Seo
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamada-oka, Suita 565-0871, Osaka, Japan;
| | - Takafumi Komiyama
- Department of Radiology, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi 409-3898, Japan; (T.K.); (K.M.); (S.A.); (M.M.); (T.A.); (M.S.)
| | - Kan Marino
- Department of Radiology, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi 409-3898, Japan; (T.K.); (K.M.); (S.A.); (M.M.); (T.A.); (M.S.)
| | - Shinichi Aoki
- Department of Radiology, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi 409-3898, Japan; (T.K.); (K.M.); (S.A.); (M.M.); (T.A.); (M.S.)
| | - Masaki Matsuda
- Department of Radiology, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi 409-3898, Japan; (T.K.); (K.M.); (S.A.); (M.M.); (T.A.); (M.S.)
| | - Tomoko Akita
- Department of Radiology, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi 409-3898, Japan; (T.K.); (K.M.); (S.A.); (M.M.); (T.A.); (M.S.)
| | - Masahide Saito
- Department of Radiology, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi 409-3898, Japan; (T.K.); (K.M.); (S.A.); (M.M.); (T.A.); (M.S.)
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Aoki S, Onishi H, Karube M, Yamamoto N, Yamashita H, Shioyama Y, Matsumoto Y, Matsuo Y, Miyakawa A, Matsushita H, Ishikawa H. Comparative Analysis of Photon Stereotactic Radiotherapy and Carbon-Ion Radiotherapy for Elderly Patients with Stage I Non-Small-Cell Lung Cancer: A Multicenter Retrospective Study. Cancers (Basel) 2023; 15:3633. [PMID: 37509294 PMCID: PMC10377658 DOI: 10.3390/cancers15143633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/04/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
The emergence of an aging society and technological advances have made radiotherapy, especially stereotactic body radiotherapy (SBRT), a common alternative to surgery for elderly patients with early stage non-small-cell lung cancer (NSCLC). Carbon-ion radiotherapy (CIRT) is also an attractive treatment option with potentially lower toxicity for elderly patients with comorbidities. We compared the clinical outcomes of the two modalities using Japanese multicenter data. SBRT (n = 420) and single-fraction CIRT (n = 70) data for patients with stage I NSCLC from 20 centers were retrospectively analyzed. Contiguous patients ≥ 80 years of age were enrolled, and overall survival (OS), disease-specific survival (DSS), local control (LC), and adverse event rates were compared. The median age was 83 years in both groups and the median follow-up periods were 28.5 and 42.7 months for SBRT and CIRT, respectively. The 3-year OS, DSS, and LC rates were 76.0% vs. 72.3% (p = 0.21), 87.5% vs. 81.6% (p = 0.46), and 79.2% vs. 78.2% (p = 0.87), respectively, for the SBRT vs. CIRT groups. Regarding toxicity, 2.9% of the SBRT group developed grade ≥ 3 radiation pneumonitis, whereas none of the CIRT group developed grade ≥ 2 radiation pneumonitis. SBRT and CIRT in elderly patients showed similar survival and LC rates, although CIRT was associated with less severe radiation pneumonitis.
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Affiliation(s)
- Shuri Aoki
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba 263-8555, Japan
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, Yamanashi 400-0016, Japan
| | - Masataka Karube
- Department of Radiology, Teikyo University Mizonokuchi Hospital, Kanagawa 213-8507, Japan
| | - Naoyoshi Yamamoto
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba 263-8555, Japan
| | - Hideomi Yamashita
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | | | - Yasuo Matsumoto
- Department of Radiation Oncology, Niigata Cancer Center Hospital, Niigata 951-8133, Japan
| | - Yukinori Matsuo
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto 606-8501, Japan
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osaka 577-8502, Japan
| | - Akifumi Miyakawa
- Department of Radiology, Graduate School of Medical Sciences, Nagoya City University, Aichi 467-8501, Japan
| | - Haruo Matsushita
- Department of Radiation Oncology, Graduate School of Medicine, Tohoku University, Sendai 980-8577, Japan
| | - Hitoshi Ishikawa
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba 263-8555, Japan
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Panagopoulos N, Grapatsas K, Leivaditis V, Galanis M, Dougenis D. Are Extensive Open Lung Resections for Elderly Patients with Lung Cancer Justified? Curr Oncol 2023; 30:5470-5484. [PMID: 37366897 DOI: 10.3390/curroncol30060414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/29/2023] [Accepted: 06/03/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Older patients with malignancies are more comorbid than younger ones and are usually undertreated only because of their age. The aim of this study is to investigate the safety of open anatomical lung resections for lung cancer in elderly patients. METHODS We retrospectively analyzed all patients who underwent lung resection for lung cancer in our institution and categorized them into two groups: the elderly group (≥70 years old) and the control (<70). RESULTS In total, 135 patients were included in the elderly group and 375 in the control. Elderly patients were more frequently diagnosed with squamous cell carcinoma (59.3% vs. 51.5%, p = 0.037), higher differentiated tumors (12.6% vs. 6.4%, p = 0.014), and at an earlier stage (stage I: 55.6% for elderly vs. 36.6%, p = 0.002). Elderly patients were more vulnerable to postoperative pneumonia (3.7% vs. 0.8%, p = 0.034), lung atelectasis (7.4% vs. 2.9%, p = 0.040), and pleural empyema (3.2% vs. 0%, p = 0.042), however, with no increased 30-day-mortality (5.2% for elderly vs. 2.7%, p = 0.168). Survival was comparable in both groups (43.4 vs. 45.3 months, p = 0.579). CONCLUSIONS Elderly patients should not be excluded from open major lung resections as the survival benefit is not reduced in selected patients.
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Affiliation(s)
| | - Konstantinos Grapatsas
- Department of Thoracic Surgery, University Medicine Essen-Ruhrlandklinik, 45239 Essen, Germany
| | - Vasileios Leivaditis
- Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, 67655 Kaiserslautern, Germany
| | - Michail Galanis
- Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
| | - Dimitrios Dougenis
- Department of Cardiothoracic Surgery, Attikon University Hospital of Athens, 12462 Athens, Greece
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Guo Q, Hu S, Ye J, Su L, Wang S, Zhang D, Zhang Y, Qiu S, Zhu L, Ruan L, Wan B, Zou S, Zhang W, Yu D, Xu J, Zhang H, Wei Y. Surgery offers survival advantage over radiotherapy in patients who are 80 years and older with Stage I and II NSCLC: A retrospective cohort study of 7,045 patients. Front Surg 2022; 9:1018320. [PMID: 36268213 PMCID: PMC9577077 DOI: 10.3389/fsurg.2022.1018320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Elderly people are less likely than younger patients to undergo curative surgery for early-stage lung cancer because of the greater risk of surgery and postoperative complications. We investigated the relationship between treatment modality and the risk of all-cause and lung cancer-specific mortality to compare the efficacy of surgical treatment with radiotherapy in patients with stage I and II non-small cell lung cancer (NSCLC) who were ≥80 years old. Methods We extracted data from the most recent Surveillance, Epidemiology, and End Results 9 registry study database (2010-2017). We mainly selected patients with stage I and II NSCLC who were ≥80 years old, and after screening, 7,045 cases were selected for our study. We used univariate analysis, stratified analysis, and multiple regression equation analysis to examine all-cause mortality and lung cancer-specific mortality in different treatment modalities. The overall and stratified populations' survival curves were plotted using the Kaplan-Meier method. The competing risk regression method of Fine and Gray was used to estimate mortality specific to lung cancer. Results In the fully adjusted model, all-cause mortality was 1.97 times higher in the radiotherapy-only group (hazard ration (HR) = 1.97, 95% confidence interval (CI) = 1.81-2.14, p < 0.0001) than in the surgery-only group. The lung cancer-specific mortality rate was 1.22 times higher in the radiotherapy-only group (HR = 1.22, 95% CI = 1.13-1.32, p < 0.0001) than in the surgery-only group. The median overall survival (OS) in the surgery-only, radiation therapy-only, surgery plus radiation therapy, and no-treatment groups were 58 months, 31 months, 36 months, and 10 months, respectively. Median lung cancer-specific survival was 61 months, 32 months, 38 months, and 11 months, respectively. The surgery-only group had the highest 1-year OS (0.8679,95% CI = 0.8537-0.8824) and 5-year OS (0.4873, 95% CI = 0.4632-0.5126). Conclusions Surgery had a higher overall and lung cancer-specific survival rate than radiotherapy and no treatment in the elderly early-stage NSCLC population. For patients with stage I and stage II NSCLC at advanced ages, surgical treatment might have a greater potential survival benefit.
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Affiliation(s)
- Qiang Guo
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Sheng Hu
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jiayue Ye
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lang Su
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Silin Wang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Deyuan Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yang Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shengyu Qiu
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lingxiao Zhu
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Liancheng Ruan
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Bingen Wan
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Sheng Zou
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wenxiong Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Dongliang Yu
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jianjun Xu
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Huiliang Zhang
- Department of Thoracic Surgery, XinSteel Center Hosptial, Xinyu, China,Correspondence: Yiping Wei Huiliang Zhang
| | - Yiping Wei
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China,Correspondence: Yiping Wei Huiliang Zhang
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8
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Topolnitskiy EB, Shefer NA. [Immediate results of angio- and bronchoplastic lobectomies for non-small cell lung carcinoma in patients over 70 years old]. Khirurgiia (Mosk) 2022:48-54. [PMID: 35658136 DOI: 10.17116/hirurgia202206148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study the immediate results of angio- and bronchoplastic lobectomies for non-small cell lung carcinoma (NSCLC) in patients over 70 years old. MATERIAL AND METHODS Thirty-one extended angio- and/or bronchoplastic lobectomies were performed in patients with NSCLC over 70 years old between January 2015 and December 2020. Mean age of patients was 74.5 ± 3.2 years. NSCLC stage IA was found in 5 (16.1%) cases, IB - 11 (35.5%), IIA - 12 (38.7%), IIB - 3 (9.7%) patients. Squamous cell carcinoma was diagnosed in 19 (61.3%) patients, adenocarcinoma - in other ones (n=12). All patients had concomitant diseases with predominance of cardiorespiratory pathology. Severity of postoperative complications was assessed according to the Clavien - Dindo grading system. RESULTS Mean Charlson index was 5.34 ± 1.46 scores. ASA grade III was observed in 21 patients, grade IV - in 10 patients. Postoperative complications occurred in 12 (38.7%) patients, mortality rate was 6.4%. Prolonged air discharge through pleural drainage tubes (12.9%) and paroxysms of atrial fibrillation (16.1%) were the most common complications. Cardiac arrhythmia is a serious and fatal complication. CONCLUSION Anatomical lung resections for NSCLC in patients over 70 years old have certain features of surgical technique and postoperative management. Prevention and prediction of postoperative complications along with rational perioperative management are of priority importance for increasing the safety of these interventions. Angio- and/or bronchoplastic lobectomy should be considered as the only surgical option characterized by high quality and satisfactory immediate results. This procedure is an adequate alternative to pneumonectomy.
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Affiliation(s)
- E B Topolnitskiy
- Siberian State Medical University, Tomsk, Russia.,Tomsk Regional Clinical Hospital, Tomsk, Russia.,Tomsk Regional Oncology Center, Tomsk, Russia
| | - N A Shefer
- Tomsk Regional Clinical Hospital, Tomsk, Russia.,Tomsk Regional Oncology Center, Tomsk, Russia
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9
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Quality of Life in Octogenarians After Lung Resection Compared to Younger Patients. Clin Lung Cancer 2021; 23:e118-e130. [PMID: 34340923 DOI: 10.1016/j.cllc.2021.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/19/2021] [Accepted: 05/28/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION To evaluate postoperative outcome and quality of life (QOL), comparing patients <80 years old to patients ≥ 80. PATIENTS AND METHODS EORTC questionnaires, QLQ-C30 and QLQ-LC13 was used to assess QOL, in patients after surgery. Results were evaluated according to 3 age groups: <70, 70 to 79, and ≥80. RESULTS 106 patients were enrolled with 33 (<70), 25 (70-79), and 48 (≥80) patients per group. The median age was 74 years. 79% of patients had minimally invasive procedures, including 91% of those ≥80. Fifteen patients underwent wedge resections. Complication rates (18%, 32%, and 29%, P = .4) and median length of stay (4, 6, and 5 days, P = .2) were similar in all age groups, with no hospital mortality. One hundred one patients completed the questionnaires. Global QOL was highest among octogenarians. Overall functional and role QOL was higher among octogenarians than 70- to 79-year-olds, with emotional QOL higher than those <70 (P < .05). Social QOL in octogenarians was marginally lower than younger patients. Lung-specific symptom scores were at least 1.5 times lower than those <80 (P = .052). Patients aged 70 to 79 had the worst symptomatic and emotional effect on QOL. Surgical access and preoperative performance status did not affect final QOL across all age groups (P = .9 and P = .065). Among anatomical lung resections, QOL was higher in octogenarians than those 70 to 79 in all domains, and similar or higher than those <70 in most domains. CONCLUSION Quality of life among octogenarians after surgery remains similar to younger patients even after anatomical lung resection. Surgery in octogenarians is safe, with minimal impact on postoperative QOL.
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Topolnitskiy EB, Borodina YA. [Immediate results of surgical treatment of advanced age patients with non-small cell lung cancer]. Khirurgiia (Mosk) 2020:23-28. [PMID: 33047582 DOI: 10.17116/hirurgia202010123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study the immediate results of surgical treatment of advanced age patients with non-small cell lung cancer (NSCLC). MATERIAL AND METHODS We included 190 elderly and senile patients with NSCLC who underwent surgery at the thoracic department of the Tomsk Regional Clinical Hospital in 2010-2018. There were 149 men and 41 women. Cancer stage I was observed in 67 (35%) cases, stage II - 49 (26%) patients, stage III - 69 (37%) patients, stage IV - 5 (2%) patients. Squamous cell cancer was diagnosed in 94 patients, adenocarcinoma - 78 patients, large cell lung cancer - 18 patients. Paraneoplastic inflammatory complications occurred in 26% of patients, concomitant diseases - in 99% of patients. The research included anatomic lung resection with systematic mediastinal lymph node dissection and the absence of tumor at the resection line. There were 118 lobectomies and 47 pneumonectomies. In 74 cases, combined procedures were carried out. Lobectomy with pulmonary artery resection was performed in 18 patients, lobectomy with bronchial resection - in 10 cases. Twenty-five patients underwent video-assisted lobectomy. CONCLUSION An acceptable morbidity and mortality allow you to expand the indications for radical surgery in geriatric patients with NSCLC. However, we must establish strict indications for pneumonectomy. Bronchial and angioplastic lobectomy may be an alternative to pneumonectomy in NSCLC patients.
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Affiliation(s)
- E B Topolnitskiy
- Siberian State Medical University, Tomsk, Russia.,Regional Clinical Hospital, Tomsk, Russia
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11
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Photodynamic-based therapeutic modalities to fight against cancer – A review from synergistic viewpoint. J Drug Deliv Sci Technol 2019. [DOI: 10.1016/j.jddst.2019.02.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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12
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Changes in treatment patterns and survival in elderly patients with stage I non–small-cell lung cancer with the introduction of stereotactic body radiotherapy and video-assisted thoracic surgery. Eur J Cancer 2018; 101:30-37. [DOI: 10.1016/j.ejca.2018.06.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 06/08/2018] [Accepted: 06/14/2018] [Indexed: 12/29/2022]
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13
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Spaggiari L, Petrella F, Maione P, Gridelli C. Lung cancer resection in octogenarian patients. J Thorac Dis 2018; 10:S1995-S1997. [PMID: 30023101 DOI: 10.21037/jtd.2018.05.39] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Lorenzo Spaggiari
- Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Francesco Petrella
- Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Paolo Maione
- Division of Medical Oncology, 'S. G. Moscati' Hospital, Avellino, Italy
| | - Cesare Gridelli
- Division of Medical Oncology, 'S. G. Moscati' Hospital, Avellino, Italy
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Detillon DD, Veen EJ. Postoperative Outcome After Pulmonary Surgery for Non-Small Cell Lung Cancer in Elderly Patients. Ann Thorac Surg 2018; 105:287-293. [DOI: 10.1016/j.athoracsur.2017.07.032] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 07/08/2017] [Accepted: 07/17/2017] [Indexed: 11/30/2022]
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Qu X, Wang K, Zhang T, Shen H, Dong W, Liu Q, Du J. Long-term outcomes of stage I NSCLC (≤3 cm) patients following segmentectomy are equivalent to lobectomy under analogous extent of lymph node removal: a PSM based analysis. J Thorac Dis 2017; 9:4561-4573. [PMID: 29268526 DOI: 10.21037/jtd.2017.10.129] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Segmentectomy has the advantage of less complications, but might have less lymph node sampling and higher risk of recurrence. We aimed to compare treatment outcome between two surgical options, and explore the effect of regional lymph node removal on the prognostic difference. Methods We retrospectively analyzed data of stage I non-small cell lung cancer (NSCLC) (≤3 cm in size) patients who underwent either segmentectomy, or lobectomy, collected from the Surveillance, Epidemiology and End Results (SEER) database, from 2003 to 2013. The primary endpoints were overall survival (OS) and lung cancer-specific survival (LCSS). We also collected data from Shandong Provincial Hospital as validation. Results Ultimately 1,156 patients treated by segmentectomy and 17,748 patients treated by lobectomy from SEER database were included in the analysis. Overall, segmentectomy was inferior to lobectomy in terms of OS [hazard ratio (HR): 1.316 (1.186-1.461), P<0.001] and LCSS [HR: 1.310 (1.142-1.504), P<0.001]. When the removal of regional lymph nodes (LN) was taken into consideration, no significant difference was found in OS and LCSS, in any Scope of Regional Lymph Node Surgery layer (0, 1-3, more than 3, and biopsy/sentinel layer, all P>0.05). After propensity score matching (PSM), there was no difference between segmentectomy and lobectomy in OS [HR: 1.081 (0.937-1.248), P=0.286] and LCSS [HR: 1.039 (0.861-1.253), P=0.692]. Only sex, age, histology, summary stage, differentiation, tumor size, and radiation still remained as independent prognostic factors for both OS and LCSS. For validation part, there was no significantly prognostic difference between lobectomy and sublobectomy group in overall (P=0.132) and each regional LN removed layer (0, 1-3, more than 3 layers: all P>0.05). Conclusions Segmentectomy with proper lymph node resection or sampling could be a good alternative to lobectomy.
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Affiliation(s)
- Xiao Qu
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Kai Wang
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China.,Department of Healthcare Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Tiehong Zhang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Hongchang Shen
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Wei Dong
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Qi Liu
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Jiajun Du
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China.,Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
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Prediction of Surgical Outcome by Modeling Based on Risk Factors of Morbidity After Pulmonary Resection for Lung Cancer in Older Adults. Ann Thorac Surg 2016; 102:971-978. [PMID: 27283110 DOI: 10.1016/j.athoracsur.2016.03.116] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/26/2016] [Accepted: 03/30/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Surgical treatment for older patients with lung cancer presents more challenges compared with general population. The aim of the study was to predict surgical outcome after pulmonary resection in older patients with lung cancer by developing a clinical model. METHODS Clinical records of 525 patients who were older than 70 years of age and who underwent pulmonary resection for lung cancer in a single center were reviewed. Patients were divided into three ordered categories of surgical outcome according to the Clavien-Dindo classification. By using a development cohort of 401 patients, an ordinal logistic regression was performed to develop a prediction model for surgical outcome. The model was internally validated by the bootstrap method and was externally validated by another cohort of 124 patients. Two previous models were tested as benchmarks of our model. RESULTS The model was developed based on five risk factors of morbidity: American Society of Anesthesiologists classification (p < 0.001), pulmonary disease (p = 0.001), tumor size (p = 0.011), tumor location (p = 0.015), and surgical approach (p = 0.036). The c-statistic of the model was 0.75 (95% confidence interval: 0.69 to 0.80), which was similar to the bootstrapping one (0.75; 95% confidence interval: 0.68 to 0.80). The Hosmer-Lemeshow test showed a strong goodness of fit of the model (p = 0.674). In external validation, the performance of our model was superior to that of the two previous models. CONCLUSIONS Our model displayed an acceptable ability to predict surgical outcome in older patients undergoing pulmonary resection for lung cancer. Use of the model can be helpful in decision making about surgical treatment in this special population.
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Yang F, Sui X, Chen X, Zhang L, Wang X, Wang S, Wang J. Sublobar resection versus lobectomy in Surgical Treatment of Elderly Patients with early-stage non-small cell lung cancer (STEPS): study protocol for a randomized controlled trial. Trials 2016; 17:191. [PMID: 27053091 PMCID: PMC4823889 DOI: 10.1186/s13063-016-1312-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 03/23/2016] [Indexed: 12/25/2022] Open
Abstract
Background The appropriateness of lobectomy for all elderly patients is controversial. Meanwhile, sublobar resection is associated with reduced operative risk, better preservation of pulmonary function, and a better quality of life, constituting a potential alternative to standard lobectomy for elderly patients with early-stage non-small cell lung cancer (NSCLC). To date, no randomized trial comparing sublobar resection and lobectomy focusing on elderly patients has been reported. We hypothesized that for patients at least 70 years old with clinical stage T1N0M0 NSCLC, sublobar resection is non-inferior to lobectomy for 3-year disease-free survival (DFS). Methods/design This is a prospective, randomized, controlled multicenter non-inferiority trial with two study arms: sublobar resection and lobectomy groups. Comprehensive geriatric assessments will be acquired for each patient. A total of 339 subjects will be enrolled on the basis of power calculations, and participants followed up every 6 months post-operation for 3 years. In case of relapse, survival follow-up will be continued until 5 years or death. Pulmonary function testing will be performed at 6, 12, and 36 months post-operation. The primary outcome is 3-year DFS; secondary endpoints include peri-operative complications and mortality, hospitalization time, post-operative ventilator time, overall survival, 3-year recurrence rates, post-operative pulmonary function, quality of life, geriatric assessment data, and 4-year mortality index. Discussion The present study is the only prospective, multicenter, randomized controlled trial comparing sublobar resection and lobectomy for elderly patients. The therapeutic outcomes of sublobar resection will be evaluated in comparison with lobectomy for elderly patients (≥70 years) with early-stage NSCLC. Trial registration number NCT02360761: 01/24/2015 (ClinicalTrials.gov)
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Affiliation(s)
- Fan Yang
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, #11 Xizhimen South Avenue, Beijing, 100044, China
| | - Xizhao Sui
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, #11 Xizhimen South Avenue, Beijing, 100044, China.
| | - Xiuyuan Chen
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, #11 Xizhimen South Avenue, Beijing, 100044, China
| | - Lixue Zhang
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, #11 Xizhimen South Avenue, Beijing, 100044, China
| | - Xun Wang
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, #11 Xizhimen South Avenue, Beijing, 100044, China
| | - Shaodong Wang
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, #11 Xizhimen South Avenue, Beijing, 100044, China
| | - Jun Wang
- Department of Thoracic Surgery, Center for Mini-invasive Thoracic Surgery, People's Hospital, Peking University, #11 Xizhimen South Avenue, Beijing, 100044, China
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Demirci NY, Ulger S, Yilmaz U, Aydogdu K, Yilmaz A, Erdogan Y. Radical Oncological Surgery and Adjuvan Therapy in Non- Small Cell Lung Cancer Patients over 70 years of Age. Asian Pac J Cancer Prev 2015; 16:4711-4. [PMID: 26107228 DOI: 10.7314/apjcp.2015.16.11.4711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The incidence of lung cancer increases with age. Approximately 50% of non-small cell lung cancer (NSCLC) patients are over 70 years old. Because of the increasing elderly population, treatment approaches in this age group continue to be studied similar to groups of young people. MATERIALS AND METHODS In the current study, 26 patients who underwent radical surgery and adjuvan chemoradiation at Ataturk Chest Diseases and Chest Surgery Training and Research Hospital were evaluated retrospectively. RESULTS Of 21 patients (81%) were male and the average age was 74.4. Lobectomy was performed in 18 cases, pneumonectomy in 3, sleeve lobectomy in 3 and bilobectomy in 2. There was no perioperative or early period mortality. Overall survival was 24.5 months. CONCLUSIONS From our study, lung cancer surgery and adjuvant therapy can be performed safely with low morbidity in the elderly.
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Affiliation(s)
- Nilgun Yilmaz Demirci
- Gazi University, Faculty of Medicine Chest Disease Department, Ankara Turkey E-mail :
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Vergnenegre A, Corre R, Lena H, Le Caer H. Management of elderly patients. Transl Lung Cancer Res 2015; 2:200-7. [PMID: 25806233 DOI: 10.3978/j.issn.2218-6751.2013.02.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 02/19/2013] [Indexed: 11/14/2022]
Abstract
SUMMARY Elderly patients are often excluded from clinical trials, yet more than two-thirds of patients diagnosed with lung cancer are over 65 years old. It is therefore important to develop specific tools and trials for this specific patient population. METHODS This chapter first examines the management specificities of elderly patients. Randomized trials specifically involving elderly patients are then described, and likely future developments are considered. RESULTS Older people have several specificities. In addition to traditional criteria such as age and performance status, other important factors include the number of comorbidities and age-related changes such as cognitive deficits and depression. Specific indices taking these factors into account have been published and validated. Single-agent therapy has been widely used to treat metastatic lung cancer in the elderly, following publication of negative results from randomized phase III trials of combination chemotherapy. Recently, however, a trial of doublet therapy gave positive results, in a subgroup of independent older patients. The benefit of patient selection based on a combination of these indices has been demonstrated in open-label and randomized trials. These results must now be confirmed in phase III trials including the use of tyrosine kinase inhibitors combined with chemotherapy. CONCLUSIONS Indices based on a combination of age-related factors, together with judicious use of biological markers, will further improve the prognosis of elderly lung cancer patients.
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Affiliation(s)
- Alain Vergnenegre
- Service de Pathologie Respiratoire, CHU - Limoges, France ; ; Groupe Français de Pneumo - Cancerologie (GFPC), France
| | - Romain Corre
- Groupe Français de Pneumo - Cancerologie (GFPC), France ; ; Service de Pneumologie CHU - Rennes, France
| | - Hervé Lena
- Groupe Français de Pneumo - Cancerologie (GFPC), France ; ; Service de Pneumologie CHU - Rennes, France
| | - Hervé Le Caer
- Groupe Français de Pneumo - Cancerologie (GFPC), France ; ; Service de Pneumologie CH - Draguignan, France
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Bravo-Iñiguez C, Perez Martinez M, Armstrong KW, Jaklitsch MT. Surgical Resection of Lung Cancer in the Elderly. Thorac Surg Clin 2014; 24:371-81. [DOI: 10.1016/j.thorsurg.2014.07.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Darling G, Malthaner R, Dickie J, McKnight L, Nhan C, Hunter A, McLeod RS. Quality Indicators for Non-Small Cell Lung Cancer Operations With Use of a Modified Delphi Consensus Process. Ann Thorac Surg 2014; 98:183-90. [DOI: 10.1016/j.athoracsur.2014.03.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 02/26/2014] [Accepted: 03/04/2014] [Indexed: 11/25/2022]
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22
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Rivera C, Gisselbrecht M, Pricopi C, Fabre E, Mordant P, Badia A, Le Pimpec-Barthes F, Riquet M. [Lung cancer in the elderly: what about surgery?]. REVUE DE PNEUMOLOGIE CLINIQUE 2014; 70:69-78. [PMID: 24581796 DOI: 10.1016/j.pneumo.2013.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 09/02/2013] [Accepted: 09/10/2013] [Indexed: 06/03/2023]
Abstract
Geriatric oncology is a rapidly expanding domain because of the deep epidemiological changes of the last decades related to the ageing of the population. Lung cancer treatment in patients 75 years and over is a major issue of thoracic oncology. Curative surgery remains the treatment offering the best survival rates to the patient whatever his age. The important variability observed within the elderly forces us to take into account their specificities, in particular for ageing physiology and associated comorbidities. Thus, preoperative workup permitting to assess the resectability of the tumor but also the operability of the patient is all the more essential in the advanced age that it must be adapted to the particular characteristics of the elderly. Thanks to recent data of the literature, morbidity and mortality associated to surgical treatment are now better characterized and considered as acceptable in accordance with long-term survival. Clinical investigation remains essential to acquire a better knowledge of potential benefit of multimodal treatments in the elderly, for which very few data are available.
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Affiliation(s)
- C Rivera
- Service de chirurgie thoracique, université Paris 5, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - M Gisselbrecht
- Service de gériatrie, université Paris 5, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - C Pricopi
- Service de chirurgie thoracique, université Paris 5, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - E Fabre
- Service d'oncologie médicale, université Paris 5, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - P Mordant
- Service de chirurgie thoracique, université Paris 5, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - A Badia
- Service de chirurgie thoracique, université Paris 5, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - F Le Pimpec-Barthes
- Service de chirurgie thoracique, université Paris 5, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - M Riquet
- Service de chirurgie thoracique, université Paris 5, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France.
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Oksholm T, Miaskowski C, Kongerud JS, Cooper B, Paul SM, Laerum L, Rustoen T. Does age influence the symptom experience of lung cancer patients prior to surgery? Lung Cancer 2013; 82:156-61. [DOI: 10.1016/j.lungcan.2013.06.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 06/22/2013] [Accepted: 06/25/2013] [Indexed: 11/15/2022]
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Zhang J, Xue ZQ, Chu XY, Wang YX, Zhao JH, Xu C, Yin LG. Surgical treatment and prognosis of octogenarians with non-small cell lung cancer. ASIAN PAC J TROP MED 2012; 5:465-8. [DOI: 10.1016/s1995-7645(12)60079-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 04/15/2012] [Accepted: 06/15/2012] [Indexed: 11/26/2022] Open
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Safety and prognosis of limited surgery for octogenarians with non-small-cell lung cancer. Gen Thorac Cardiovasc Surg 2012; 60:97-103. [PMID: 22327854 DOI: 10.1007/s11748-011-0880-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 08/30/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE Curative lobectomy and systematic lymph node dissection for lung cancer in elderly patients are often associated with increased risk of postoperative morbidity and decreased quality of life. Conversely, avoiding surgery may mean not curing the cancer. We retrospectively examined data on surgery for octogenarians with clinical stage I non-small-cell lung cancer (NSCLC) to assess the safety and prognosis for patients who underwent radical or limited surgery. METHODS Subjects comprised 44 octogenarians who underwent surgery for clinical stage I NSCLC from 1996 to 2008. Preoperative co-morbidities, surgical procedures, postoperative morbidity, and prognoses were compared between radical and limited surgery. RESULTS A total of 14 patients (32%) underwent complete lobectomy and systematic lymph node dissection (radical surgery), and 30 patients (68%) underwent segmentectomy or wedge resection or limited lymph node dissection (limited surgery). No significant differences in preoperative clinicopathological features were seen between groups except that significantly more clinical stage IA patients were in the limited surgery group than in the radical group. Surgical time was significantly shorter with limited surgery. Frequencies of postoperative morbidity and recurrence were similar for each type of surgery. Overall and disease-specific 5-year survival rates did not differ significantly between groups. CONCLUSION Limited surgery is less invasive and is associated with the same prognosis as radical surgery for octogenarians with NSCLC. Limited surgery for this cohort thus appears reasonable to prevent postoperative morbidity, particularly for patients with poor pulmonary reserve.
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Gray SW, Landrum MB, Lamont EB, McNeil BJ, Jaklitsch MT, Keating NL. Improved outcomes associated with higher surgery rates for older patients with early stage nonsmall cell lung cancer. Cancer 2011; 118:1404-11. [PMID: 21800285 DOI: 10.1002/cncr.26363] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 05/10/2011] [Accepted: 05/20/2011] [Indexed: 11/12/2022]
Abstract
BACKGROUND Although surgery offers the greatest chance of a cure for patients with early stage nonsmall cell lung cancer (NSCLC), older and sicker patients often fail to undergo resection. The benefits of surgery in older patients and patients with multiple comorbidities are uncertain. METHODS The authors identified a national cohort of 17,638 Medicare beneficiaries aged ≥66 years living in Surveillance, Epidemiology, and End Results (SEER) areas who were diagnosed with stage I or II NSCLC during 2001 to 2005. Areas with high and low rates of curative surgery for early stage lung cancer were compared to estimate the effectiveness of surgery in older and sicker patients. Logistic regression models were used to assess mortality according to the quintile of area-level surgery rates, adjusting for potential confounders. RESULTS Less than 63% of patients underwent surgery in low-surgery areas, whereas >79% underwent surgery in high-surgery areas. High-surgery areas operated on more patients of advanced age and patients with chronic obstructive pulmonary disease than low-surgery areas. The adjusted all-cause 1 year mortality was 18% in high-surgery areas versus 22.8% in low-surgery areas (adjusted odds ratio [OR], 0.89; 95% confidence interval [CI], 0.86-0.93) for each 10% increase in the surgery rate).The 1-year lung-cancer-specific mortality similarly was lower in high-surgery areas (12%) versus low-surgery areas (16.9%; adjusted OR, 0.86; 95% CI, 0.82-0.91) for each 10% increase in the surgery rate. CONCLUSIONS Higher rates of surgery for stage I/II NSCLC were associated with improved survival, even when older patients and sicker patients underwent resection. The authors concluded that more work is needed to identify and reduce barriers to surgery for early stage NSCLC.
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Affiliation(s)
- Stacy W Gray
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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Pallis AG, Scarci M. Are we treating enough elderly patients with early stage non-small cell lung cancer? Lung Cancer 2011; 74:149-54. [PMID: 21696842 DOI: 10.1016/j.lungcan.2011.05.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 05/24/2011] [Accepted: 05/25/2011] [Indexed: 10/18/2022]
Abstract
Despite the fact that non-small-cell lung cancer (NSCLC) is very common in the older population, these patients are frequently underrepresented in clinical trials evaluating new anti-cancer agents, and thus it is difficult to reach evidence-based recommendations for this special population. The purpose of the present paper is to present the currently available evidence regarding treatment of early-stages of NSCLC in older patients. Although, age is still considered as a negative factor influencing treatment decisions and curative cancer-directed surgery is often omitted in the older population several studies support that surgical resection is feasible in the older patient and that age per se is not a contraindication for various surgical procedures. Pneumonectomy is associated with a higher mortality in the older population and this issue should be taken into account when deciding whether a patient is suitable for pneumonectomy. Older patients should be considered for adjuvant chemotherapy after surgical resection although little information is available regarding the real benefit and tolerability of these regimens for patients over 75 years of age. Given the lack of demonstrated benefit for the use of adjuvant RT it is also not recommended in older population.
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Affiliation(s)
- A G Pallis
- Department of Medical Oncology, University General Hospital of Heraklion, Voutes-Stavrakion Embranchement, 71305 Heraklion, Greece.
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Subotic D, Mandaric D, Radosavljevic G, Stojsic J, Gajic M. Lung function changes and complications after lobectomy for lung cancer in septuagenarians. Ann Thorac Med 2011; 4:54-9. [PMID: 19561925 PMCID: PMC2700480 DOI: 10.4103/1817-1737.49413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Accepted: 11/21/2008] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND: In septuagenarians, lobectomy is the preferable operation, with lower morbidity than for pneumonectomy. However, the 1-year impact of lobectomy on lung function has not been well studied in elderly patients. MATERIALS AND METHODS: Retrospective study including 30 patients 70 years or older (study group), 25 patients with chronic obstructive pulmonary disease (COPD) under 70 years (control group 1), and 22 patients under 70 years with normal lung function (control group 2) operated for lung cancer in a 2-year period. The study and control groups were compared related to lung function changes after lobectomy, operative morbidity, and mortality. RESULTS: Postoperative lung function changes in the elderly followed the similar trend as in patients with COPD. There were no significant differences between these two groups related to changes in forced expiratory volume in the first second (FEV1) and vital capacity (VC). Unlike that, the pattern of the lung function changes in the elderly was significantly different compared with patients with normal lung function. The mean postoperative decrease in FEV1 was 14.16% in the elderly, compared with a 29.23% decrease in patients with normal lung function (P < 0.05). In the study and control groups, no patients died within the first 30 postoperative days. The operative morbidity in the elderly group was significantly lower than in patients with COPD (23.3% vs. 60%). CONCLUSIONS: The lung function changes after lobectomy in the elderly are similar to those in patients with COPD. The explanation for such a finding needs further investigation. Despite a high proportion of concomitant diseases, the age itself does not carry a prohibitively high risk of operative mortality and morbidity.
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Affiliation(s)
- Dragan Subotic
- Institute for Lung Diseases, Clinical Center of Serbia, Belgrade, Serbia.
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Yagui-Beltrán A, Jablons DM. Optimal surgical management of Stage I non-small-cell lung cancer in an increasingly aging population: challenges and recent progress. Expert Rev Respir Med 2010; 1:343-53. [PMID: 20477174 DOI: 10.1586/17476348.1.3.343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Lung cancer remains the main cause of cancer deaths in the USA. The dismal prognosis for non-small-cell lung cancer (NSCLC) despite current advances in chemotherapy is disappointing. In an increasingly aging population, computed tomography screening allows the detection of very early Stage I NSCLC lesions. Although many retrospective trials have indicated better prognosis for those undergoing lobectomy versus sublobar resection (anatomical segmentectomy or wedge resection), the issue remains equivocal. This is particularly true for patients with significant comorbid cardiorespiratory disease compromising postoperative recovery. This review will describe landmark retrospective studies related to the topic, in an attempt to highlight the difficulties associated with surgical decision making. Key factors in the characteristics of the lesions will be examined equally with the ultimate objective of allowing the decision of lobectomy versus sublobar resection to be centered around the need of the individual patient per se. This review article will also provide an insight into ongoing randomized, prospective clinical trials on the subject, investigating into some of the emerging technologies from the laboratory and the clinic that will hopefully enable the provision of a solidly acceptable treatment plan for the Stage I NSCLC patient, with maximum survival rates and low disease recurrence.
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Affiliation(s)
- Adam Yagui-Beltrán
- University of California San Francisco, Department of Surgery, UCSF Comprehensive Cancer Center, 2340 Sutter Street, Room S341, San Francisco, CA 94143-0128, USA.
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Andrade RS, Maddaus MA. Thoracoscopic Lobectomy for Stage I Non-Small Cell Lung Cancer. Semin Thorac Cardiovasc Surg 2010; 22:14-21. [DOI: 10.1053/j.semtcvs.2010.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2010] [Indexed: 11/11/2022]
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Rogers SO, Gray SW, Landrum MB, Klabunde CN, Kahn KL, Fletcher RH, Clauser S, Tisnado D, Doucette W, Keating NL. Variations in surgeon treatment recommendations for lobectomy in early-stage non-small-cell lung cancer by patient age and comorbidity. Ann Surg Oncol 2010; 17:1581-8. [PMID: 20162461 DOI: 10.1245/s10434-010-0946-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND Prior research suggests that older patients are less likely to undergo resection of early-stage non-small-cell lung carcinomas (NSCLCs). We surveyed surgeons to understand how their recommendations for lobectomy were influenced by age, the presence and severity of smoking-related lung disease, or by characteristics of the surgeons and their practices. METHODS We surveyed surgeons caring for NSCLC patients regarding whether they would recommend lobectomy for hypothetical patients with early-stage NSCLC who varied by age (55 vs. 80 years) and comorbid illness (none, moderate, severe chronic obstructive pulmonary disease [COPD]). Ordinal logistic regression was used to identify the importance of patient, surgeon, and practice characteristics on surgery recommendations. RESULTS Surgeons recommended lobectomy for nearly all patients who were 55 years old with no comorbidity (adjusted proportion 98.6%), 55 years old with moderate COPD (adjusted proportion 97.8%), or 80 years old with no comorbidity (adjusted proportion 98.1%). Fewer recommended lobectomy for 80-year-old patients with moderate COPD (adjusted proportion 82.3%), and far fewer recommended lobectomy for severe COPD, irrespective of age (adjusted rate 18.7% for the 55-year-old patient and 6.1% for the 80-year-old patient) (P < 0.002). Surgeons who enroll patients onto clinical trials (P = 0.03) were more likely than others to recommend lobectomy, but no other surgeon characteristic predicted recommendations. CONCLUSIONS Lower rates of lobectomy among older patients do not seem to be explained by age-related biases among surgeons for otherwise healthy patients.
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Affiliation(s)
- Selwyn O Rogers
- Department of Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA.
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Pallis AG, Gridelli C, van Meerbeeck JP, Greillier L, Wedding U, Lacombe D, Welch J, Belani CP, Aapro M. EORTC Elderly Task Force and Lung Cancer Group and International Society for Geriatric Oncology (SIOG) experts' opinion for the treatment of non-small-cell lung cancer in an elderly population. Ann Oncol 2009; 21:692-706. [PMID: 19717538 DOI: 10.1093/annonc/mdp360] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Non-small-cell lung cancer (NSCLC) represents a common health issue in the elderly population. Nevertheless, the paucity of large, well-conducted prospective trials makes it difficult to provide evidence-based clinical recommendations for these patients. The present paper reviews the currently available evidence regarding treatment of all stages of NSCLC in elderly patients. Surgery remains the standard for early-stage disease, though pneumonectomy is associated with higher incidence of postoperative mortality in elderly patients. Given the lack of demonstrated benefit for the use of adjuvant radiotherapy, it is also not recommended in elderly patients. Elderly patients seem to derive the same benefit from adjuvant chemotherapy as younger patients do, with no significant increase in toxicity. For locally advanced NSCLC, concurrent chemoradiotherapy may be offered to selected elderly patients as there is a higher risk for toxicity reported in the elderly population. Third-generation single-agent treatment is considered the standard of care for patients with advanced/metastatic disease. Platinum-based combination chemotherapy needs to be evaluated in prospective trials. Unfortunately, with the exception of advanced/metastatic NSCLC, prospective elderly-specific NSCLC trials are lacking and the majority of recommendations made are based on retrospective data, which might suffer from selection bias. Prospective elderly-specific trials are needed.
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Affiliation(s)
- A G Pallis
- EORTC Headquarters, EORTC-ETF, Brussels, Belgium.
| | - C Gridelli
- Division of Medical Oncology, "S.G. Moscati" Hospital, Avellino, Italy
| | - J P van Meerbeeck
- Department of Respiratory Medicine & Thoracic Oncology, Ghent University Hospital, Gent, Belgium; EORTC Lung Cancer Group, Brussels, Belgium
| | - L Greillier
- EORTC Lung Cancer Group, Brussels, Belgium; Department of Thoracic Oncology, Assistance Publique-Hôpitaux de Marseille, Faculté de Médecine, Université de la Méditerranée, Marseille, France
| | - U Wedding
- Department of Hematology, Oncology, Palliative Care, University Hospital Jena, Jena, Germany
| | - D Lacombe
- EORTC Headquarters, EORTC-ETF, Brussels, Belgium
| | - J Welch
- EORTC Headquarters, EORTC Lung Cancer Group, Brussels, Belgium
| | - C P Belani
- Department of Medicine, Penn State Cancer Hershey Institute, Hershey, USA
| | - M Aapro
- IMO Clinique de Genolier, Genolier, Switzerland
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Jaklitsch M, Billmeier S. Preoperative Evaluation and Risk Assessment for Elderly Thoracic Surgery Patients. Thorac Surg Clin 2009; 19:301-12. [DOI: 10.1016/j.thorsurg.2009.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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The perioperative complications for elderly patients with lung cancer associated with a pulmonary resection under general anesthesia. J Thorac Oncol 2009; 4:193-7. [PMID: 19179895 DOI: 10.1097/jto.0b013e318194fc4f] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Surgery for elderly patients with lung cancer is relatively common due to the increasing elderly population. This study evaluated the perioperative complications associated with surgery in patients over 70 years of age with lung cancer. PATIENTS AND METHODS A single-center retrospective evaluation was conducted of perioperative complications (1996-2006) in lung cancer surgical patients. We reviewed and analyzed the clinical records of 364 consecutive patients over 70 years of age and 392 control patients. RESULTS The mean age of the elderly group was 75.5 years old and that of the control group was 59.4 years. A segmental or wedge resection was performed more frequently for the elderly group than in the control group, whereas pneumonectomies and lobectomies were performed more frequently in the control group. Preoperative comorbidities such as cardiac and thoracic diseases were more frequently recognized in the elderly group than in the control group. The quantity of propofol used as induction anesthesia in the elderly group was significantly smaller than that of the control group, furthermore, the operation time and operation room stay time of the elderly group were significantly shorter than that of the control group, however, extubation time was significantly prolonged. The ratio of thoracic complications in the elderly group was higher than that in the control group. The ratio of pulmonary leakage in the elderly group was higher than in the control group; however, there was no significant difference in length of stay in the hospital, the ratio of operative death and hospital death between the two groups. CONCLUSIONS Elderly patients more frequently have perioperative complications than younger patients; however, there was no statistical difference in mortality. A pulmonary resection for elderly patients may therefore be as feasible as in younger patients.
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Merrot O, Poupart M, Pignat JC. [Oncologic surgery in the elderly patient: an ethical or a surgical problem?]. JOURNAL DE CHIRURGIE 2008; 145:213-214. [PMID: 18772727 DOI: 10.1016/s0021-7697(08)73748-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Critical Review of Nonsurgical Treatment Options for Stage I Non‐Small Cell Lung Cancer. Oncologist 2008; 13:309-19. [DOI: 10.1634/theoncologist.2007-0195] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Surgical Treatment for Octogenarians with Lung Cancer: Results from a Population-Based Series of 124 Patients. J Thorac Oncol 2007; 2:1013-7. [DOI: 10.1097/jto.0b013e3181559fdf] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Ikeda N, Hayashi A, Iwasaki K, Kajiwara N, Uchida O, Kato H. Surgical strategy for non-small cell lung cancer in octogenarians. Respirology 2007; 12:712-8. [PMID: 17875060 DOI: 10.1111/j.1440-1843.2007.01125.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES This study was conducted to determine the optimal surgical strategy for octogenarians with non-small cell lung cancer. METHODS An observational study of 73 patients aged 80 years and over who underwent surgery for non-small cell lung cancer. Postoperative survival, mortality and morbidity were analysed. RESULTS The age of the patients ranged from 80 to 89 with a mean of 83. Cancer types included adenocarcinoma (n = 46), squamous cell carcinoma (n = 22) and large cell carcinoma (n = 5). Lobectomy was performed in 47 patients and limited surgery in 26. The 5-year survival rate was 57.4% in pathological stage I, 88.9% in stage II and 18.2% in stage III, respectively. The 5-year survival rate of patients with stage I disease treated by limited resection (58.8%) was similar to that of patients treated by lobectomy (54.9%). Limited resection for stage IA showed slightly better survival than lobectomy (69.4% vs 48.2%, P = 0.10), however, lobectomy was superior to limited resection for stage IB (63.2% vs 16.7%, P = 0.07). Postoperative complications occurred in 27 patients (37%) and nine patients (12%) had multiple complications. There were three postoperative deaths (4.1%). CONCLUSION The early detection of the disease, hopefully in stage IA enables surgical treatment by limited resection of patients aged 80 years and over. A favourable prognosis as well as low morbidity can be anticipated in such cases.
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Affiliation(s)
- Norihiko Ikeda
- Department of Thoracic Oncology and Surgery, International University of Health and Welfare, Mita Hospital, Japan.
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Audisio RA, Zbar AP, Jaklitsch MT. Surgical management of oncogeriatric patients. J Clin Oncol 2007; 25:1924-9. [PMID: 17488992 DOI: 10.1200/jco.2006.10.2533] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Major changes are taking place at a great pace in modern medicine, and surgical oncologists are at the forefront when new skills are to be tested and implemented. Perhaps the most significant change we are facing relates to the aging of our population, with most solid tumors presenting at age 70 years (+/- 5 years). The demographics and epidemiological details are covered in the appropriate sections of this special issue, but it is important to realize how such a shift influences our day-to-day practice. These principally are occurring in improved anesthetic care, minimally invasive surgery, nonoperative therapies, risk assessment, and quality-of-life estimates.
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Patel N, Adatia R, Mellemgaard A, Jack R, Møller H. Variation in the use of chemotherapy in lung cancer. Br J Cancer 2007; 96:886-90. [PMID: 17342091 PMCID: PMC2360093 DOI: 10.1038/sj.bjc.6603659] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2006] [Revised: 01/25/2007] [Accepted: 01/29/2007] [Indexed: 11/26/2022] Open
Abstract
Factors influencing the use of chemotherapy for the initial (6 months) treatment of lung cancer in South East England were investigated. The variables explored as possibly influencing the use of chemotherapy were sex, age, the year of diagnosis, the type of lung cancer, the stage, the index of multiple deprivation and the cancer network of residence. Chi2 analysis and multivariate logistic regression models were used to examine the effect of each of the variables on the use of chemotherapy. The results showed a highly significant trend in use of chemotherapy over time; the adjusted proportion of patients receiving chemotherapy increasing from 13.6% in 1994 to 29.3% in 2003. However, age, cancer network and type of lung cancer had the strongest influence on the use of chemotherapy. This finding is important when we consider that the NHS Cancer Plan aims at improving inequalities in cancer care in the UK.
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Affiliation(s)
- N Patel
- King's College London, Pharmaceutical Science Research Division, Franklin-Wilkins Building, 150 Stamford Street, London SE1 9NH, UK.
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Abstract
PURPOSE OF REVIEW The aim of this review is to analyze recent evidence for optimal treatment of elderly patients with non-small cell lung cancer, focusing on surgery, and possibly to foresee the future strategies to apply in these patients. RECENT FINDINGS Surgery in elderly patients affected by non-small cell lung cancer is safe and feasible when careful preoperative respiratory and cardiac studies have been carried out and the disease has been properly staged. The surgical treatment is not to be denied in elderly patients due to age per se, but when a major contraindication to surgery has been recognized. Long term survival for elderly patients with early stage lung cancer treated by anatomical pulmonary resection is comparable to the survival rate of younger patients. Pneumonectomy, extended surgical procedure or preoperative induction chemotherapy are major risk factors for an increased postoperative morbidity and mortality rate. When co-morbidities are present or a patient is 80 years or older, there is evidence that a non-anatomical resection can be performed without affecting long-term results. SUMMARY Due to the aging of the general population, elderly patients will become a large percentage of the cases of non-small cell lung cancer to be treated. Implementing preoperative cardiologic studies and redefining selective respiratory criteria specifically could dramatically improve results.
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Affiliation(s)
- Lorenzo Spaggiari
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
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Bernardi D, Errante D, Tirelli U, Salvagno L, Bianco A, Fentiman IS. Insight into the treatment of cancer in older patients: Developments in the last decade. Cancer Treat Rev 2006; 32:277-88. [PMID: 16698183 DOI: 10.1016/j.ctrv.2006.03.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2005] [Revised: 03/17/2006] [Accepted: 03/20/2006] [Indexed: 11/15/2022]
Abstract
In the last decades there has been an increased interest in the treatment of elderly cancer patients and a change in attitude of both clinicians and their patients has occurred. Drugs are now available that might be considered "elderly-friendly" and the enormous advances in surgical procedures and supportive treatments over the recent years have enabled adverse effects to be minimized. A Geriatric Assessment is increasingly used as a tool to define those patients who are more suitable for aggressive chemotherapy or, on the contrary, palliative treatment. For almost all cancers, older patients are better treated today than they were in the past, even though we are still far from optimal management. Despite the perceived barriers to including elderly patients in clinical trials, there are few data to support excluding them. We must not permit increased age in cancer patients to continue to be an important and independent risk factor for receiving inadequate care.
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Affiliation(s)
- Daniele Bernardi
- Division of Medical Oncology, Ospedale Civile, Via Forlanini 71, 31029 Vittorio Veneto (TV), Italy.
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Ketchedjian A, Daly B, Landreneau R, Fernando H. Sublobar resection for the subcentimeter pulmonary nodule. Semin Thorac Cardiovasc Surg 2005; 17:128-33. [PMID: 16087080 DOI: 10.1053/j.semtcvs.2005.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2005] [Accepted: 04/25/2005] [Indexed: 11/11/2022]
Abstract
Several studies have demonstrated an increased local recurrence rate with sublobar resection (SR) when compared with lobar resection for the treatment of non-small-cell lung cancer (NSCLC). Therefore, lobectomy has remained the gold standard therapy for NSCLC with lesser resection reserved as a compromise operation for high-risk patients. The increased identification of small NSCLC tumors by CT scan is leading many surgeons to question the appropriateness of lobectomy for these tumors. There has been increasing interest by many surgeons to use SR as intentional therapy for patients with small peripheral NSCLC. This article reviews the recent literature and evidence supporting intentional SR for NSCLC. Although lobectomy should continue to be regarded as the procedure of choice for NSCLC, we believe that a subset of patients with favorable characteristics may be appropriately treated with intentional SR as long as good assessment of nodal involvement is made. Future investigation is required to better define when SR is appropriate.
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Affiliation(s)
- Ara Ketchedjian
- Department of Cardiothoracic Surgery, Boston Medical Center, Boston University, Boston, Massachusetts 02118, USA
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Birim O, Kappetein AP, van Klaveren RJ, Bogers AJJC. Prognostic factors in non-small cell lung cancer surgery. Eur J Surg Oncol 2005; 32:12-23. [PMID: 16297591 DOI: 10.1016/j.ejso.2005.10.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2005] [Accepted: 10/04/2005] [Indexed: 11/17/2022] Open
Abstract
AIMS Complete surgical resection of primary tumours remains the treatment with the greatest likelihood for survival in early-stage non-small cell lung cancer (NSCLC). Although TNM stage is the most important prognostic parameter in NSCLC, additional parameters are required to explain the large variability in postoperative outcome. The present review aims at providing an overview of the currently known prognostic markers for postoperative outcome. METHODS We performed an electronic literature search on the MEDLINE database to identify relevant studies describing the risk factors in NSCLC surgery. The references reported in all the identified studies were used for completion of the literature search. RESULTS Poor pulmonary function, cardiovascular disease, male gender, advanced age, TNM stage, non-squamous cell histology, pneumonectomy, low hospital volume and little experience of the surgeon were identified as risk factors for postoperative outcome. However, with the exception of TNM stage and extent of resection, the literature demonstrates conflicting results on the prognostic power of most factors. The role of molecular biological factors, neoadjuvant treatment and adjuvant treatment is not well investigated yet. CONCLUSIONS The advantage of knowing about the existence of comorbidity and prognostic risk factors may provide the clinician with the ability to identify poor prognostic patients and establish the most appropriate treatment strategy. The assessment of prognostic factors remains an area of active investigation and a promising field of research in optimising therapy of NSCLC patients.
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Affiliation(s)
- O Birim
- Department of Cardio-Thoracic Surgery, Erasmus MC, Rotterdam, The Netherlands
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Abstract
Global growth of the elderly population is requiring health care providers to cater to an expanding elderly cancer subpopulation. Surgeons are called upon to provide optimal cancer management for this heterogeneous group in par with care provided for younger patients, an ethical dilemma that is compounded by an ill-understood tumor biology. Delivery of suboptimal surgical cancer treatment due to ageist attitudes and personal beliefs is no longer acceptable. Cancer surgeons have to offer optimal surgery in consideration of individualized operative risk. The need for a tool to assess operative risk and predict postoperative outcome is obvious. This article wishes to raise awareness among surgeons about epidemiology, physiologic changes, performance status and comorbidities, and patterns of care and ways to improve them. We visit existing tools to assess operative risk, reveal interim results from the Preoperative Assessment of Cancer in Elderly (PACE) study, and discuss the future of oncogeriatrics.
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Sawada S, Komori E, Nogami N, Bessho A, Segawa Y, Shinkai T, Nakata M, Yamashita M. Advanced Age Is Not Correlated With Either Short-term or Long-term Postoperative Results in Lung Cancer Patients In Good Clinical Condition. Chest 2005; 128:1557-63. [PMID: 16162758 DOI: 10.1378/chest.128.3.1557] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVES Several investigators have reported that operative mortality in the elderly is acceptable. However, their patients are potentially biased with regard to some factors such as performance status (PS) and comorbidity. In this study, we discuss surgical indications for the elderly and effects on perioperative mortality and prognosis. STUDY DESIGN A retrospective study was carried out by reviewing the records of 1,114 patients who were referred for treatment of non-small cell lung cancer between January 1993 and December 2002. The patients were classified into younger (< or = 75 years of age) and elderly (> or = 76 years of age) groups. The histologic subtype, TNM stage, Eastern Cooperative Oncology Group PS, and treatment were reviewed for members of each group, and the proportion of patients who underwent surgery was compared between the two groups. The surgical procedures, perioperative mortality, and prognosis of the two groups were also compared. RESULTS There was a significant difference in the histologic distribution with no difference in TNM staging between the two groups. Regarding treatment, 51.0% of those in the younger group and 36.1% of those in the elderly group underwent surgery. The proportion of elderly patients who underwent surgery was significantly lower than that of the younger patients, mainly due to worse PS and comorbidity in the elderly patients. The perioperative mortality rates for the younger and elderly groups were 0.9% and 4.1%, respectively, with no significant difference, and the overall survival was similar between the two groups. CONCLUSIONS When compared to younger patients, fewer elderly patients underwent surgery because of worse PS and comorbidity. However, in elderly patients with good PS and no comorbidity, the rate of perioperative mortality and the prognosis were similar to those in the younger patients. Therefore, advanced age only is not a negative factor for surgery in elderly patients.
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Affiliation(s)
- Shigeki Sawada
- Department of Thoracic Surgery, National Hospital Organization Shikoku Cancer Center, Horinouchi 13, Matsuyama, Ehime, 790-0007, Japan
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Ramesh HSJ, Pope D, Gennari R, Audisio RA. Optimising surgical management of elderly cancer patients. World J Surg Oncol 2005; 3:17. [PMID: 15788092 PMCID: PMC1079964 DOI: 10.1186/1477-7819-3-17] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2004] [Accepted: 03/23/2005] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND: Elderly population is on rise. It is an ethical dilemma how aggressive one should be when it comes to treat cancer in elderly. Presumed fear of increased postoperative morbidity and mortality has resulted in delivery of sub-optimal cancer surgery. METHODS: In this review article we visit physiology of the aged, tools available to assess surgical risks in oncogeriatric patients, and current practice in the management of common cancers encountered in surgical oncology, with the view of increasing awareness on optimising surgical management of senior patients with cancer. A pubmed search for cancer, surgery, elderly, was carried out. RESULTS: Cancer is on rise with increasing age predominantly affecting breast, gastrointestinal tract and lung. Increasingly more surgeons are offering surgery to elderly cancer patient but selection bias is prevalent. Available data reflect short and long-term outcome of cancer surgery in elderly is not greatly different to that of younger patient. Declining physiological reserve along with inability to respond adequately to physiological stress are salient age related changes. Comprehensive Geriatric Assessment (CGA) is not tested in surgical patient. There is need for a tool to define individualised operative risk. Preoperative assessment of cancer in elderly is designed to offer this information based on functional status of an individual utilising currently available tools of risk assessment. CONCLUSION: All elderly cancer patients should be offered optimal treatment depending on their functional status not on chronological age. Oncogeriatric patient would benefit from dedicated multidisciplinary approach. Recruitment of elderly cancer patients to more clinical trials is needed to enhance our knowledge and to offer optimum treatment to this unique subgroup.
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Affiliation(s)
| | | | | | - Riccardo A Audisio
- Dept. of Surgery, Whiston Hospital, Prescot, UK & University of Liverpool, Liverpool, UK
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Wiener DC, Argote-Greene LM, Ramesh H, Audisio RA, Jaklitsch MT. Choices in the management of asymptomatic lung nodules in the elderly. Surg Oncol 2004; 13:239-48. [PMID: 15615662 DOI: 10.1016/j.suronc.2004.10.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
More than half of all lung cancer cases are diagnosed in patients older than 65 years of age. Risk of death after thoracotomy also increases over the age of 65. As a result, surgical intervention for lung cancer is often considered too risky in elderly patients, leaving the caregiver with a treatment dilemma when confronted with an abnormal radiographic finding. Advances in preoperative risk assessment, surgical and anesthetic techniques, radiation oncology, and locally ablative techniques have resulted in improved survival with a significant decrease in post-procedure mortality and morbidity for the aged population. On this basis, we believe treatment options for incidental pulmonary nodules found on chest roentgenograms should be discussed with patients and interventional work up pursued. It is no longer reasonable to deny elderly patients the benefits of surgical intervention simply on the basis of age. Every effort should be made to assess risk and optimize treatment for this large and growing segment of the population.
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Affiliation(s)
- Daniel C Wiener
- Department of General Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
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Abstract
Oncology in elderly and frail patients is a subject of increasing importance due to demographic developments in our society. So far, patient age has been highly important for the indication of oncologic operations. This paradigm needs to be changed, since preoperative diagnostics, operative techniques, and postoperative intensive care have improved substantially over the past years. Reviewing the literature, we found that oncologic operations can be performed safely with the same morbidity, mortality, and length of hospital stay as with younger patients. Pre-existing comorbidities are the most important factor in elderly patients. Procedures must be safe and palliation needs to be effective more than curative procedures. To conclude: an surgery should always be considered in the therapeutic strategy for elderly and frail patients.
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Affiliation(s)
- N Senninger
- Klinik und Poliklinik für Allgemeine Chirurgie, Westfälische Wilhelms-Universität, Münster.
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