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Yun J, Cho JH, Hong TH, Yang K, Ahn YC, Kim HK. Sublobar Resection versus Stereotactic Body Radiation Therapy for Clinical Stage I Non-Small Cell Lung Cancer: A Study Using Data from the Korean Nationwide Lung Cancer Registry. Cancer Res Treat 2023; 55:1171-1180. [PMID: 37080606 PMCID: PMC10582525 DOI: 10.4143/crt.2022.1581] [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: 12/04/2022] [Accepted: 04/15/2023] [Indexed: 04/22/2023] Open
Abstract
PURPOSE Stereotactic body radiotherapy (SBRT) had been increasingly recognized as a favorable alternative to surgical resection in patients with high risk for surgery. This study compared survival outcomes between sublobar resection (SLR) and SBRT for clinical stage I non-small cell lung cancer (NSCLC). MATERIALS AND METHODS Data were obtained from the Korean Association of Lung Cancer Registry, a sampled nationwide database. This study retrospectively reviewed 382 patients with clinical stage I NSCLC who underwent curative SLR or SBRT from 2014 to 2016. RESULTS Of the patients, 43 and 339 underwent SBRT and SLR, respectively. Patients in the SBRT group were older and had worse pulmonary function. The 3-year overall survival (OS) rate was significantly better in the SLR group compared with the SBRT group (86.6% vs. 57%, log-rank p < 0.001). However, after adjusting for age, sex, tumor size, pulmonary function, histology, smoking history, and adjuvant therapy, treatment modality was not an independent prognostic factor for survival (hazard ratio, 0.99; 95% confidence interval, 0.43 to 2.77; p=0.974). We performed subgroup analysis in the following high-risk populations: patients who were older than 75 years; patients who were older than 70 years and had diffusing capacity of lung for carbon monoxide ≤ 80%. In each subgroup, there were no differences in OS and recurrence-free survival between patients who underwent SLR and those who received SBRT. CONCLUSION In our study, there were no significant differences in terms of survival or recurrence between SBRT and SLR in medically compromised stage I NSCLC patients. Our findings suggest that SBRT could be considered as a potential treatment option for selected patients.
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Affiliation(s)
- Jeonghee Yun
- Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Jong Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Tae Hee Hong
- Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Kyungmi Yang
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Seoul,
Korea
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2
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Kunkyab T, Mou B, Jirasek A, Haston C, Andrews J, Thomas S, Hyde D. Radiomic analysis for early differentiation of lung cancer recurrence from fibrosis in patients treated with lung stereotactic ablative radiotherapy. Phys Med Biol 2023; 68:165015. [PMID: 37164024 DOI: 10.1088/1361-6560/acd431] [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: 09/02/2022] [Accepted: 05/10/2023] [Indexed: 05/12/2023]
Abstract
Objective. The development of radiation-induced fibrosis after stereotactic ablative radiotherapy (SABR) can obscure follow-up images and delay detection of a local recurrence in early-stage lung cancer patients. The objective of this study was to develop a radiomics model for computer-assisted detection of local recurrence and fibrosis for an earlier timepoint (<1 year) after the SABR treatment.Approach. This retrospective clinical study included CT images (n= 107) of 66 patients treated with SABR. A z-score normalization technique was used for radiomic feature standardization across scanner protocols. The training set for the radiomics model consisted of CT images (66 patients; 22 recurrences and 44 fibrosis) obtained at 24 months (median) follow-up. The test set included CT-images of 41 patients acquired at 5-12 months follow-up. Combinations of four widely used machine learning techniques (support vector machines, gradient boosting, random forests (RF), and logistic regression) and feature selection methods (Relief feature scoring, maximum relevance minimum redundancy, mutual information maximization, forward feature selection, and LASSO) were investigated. Pyradiomics was used to extract 106 radiomic features from the CT-images for feature selection and classification.Main results. An RF + LASSO model scored the highest in terms of AUC (0.87) and obtained a sensitivity of 75% and a specificity of 88% in identifying a local recurrence in the test set. In the training set, 86% accuracy was achieved using five-fold cross-validation. Delong's test indicated that AUC achieved by the RF+LASSO is significantly better than 11 other machine learning models presented here. The top three radiomic features: interquartile range (first order), Cluster Prominence (GLCM), and Autocorrelation (GLCM), were revealed as differentiating a recurrence from fibrosis with this model.Significance. The radiomics model selected, out of multiple machine learning and feature selection algorithms, was able to differentiate a recurrence from fibrosis in earlier follow-up CT-images with a high specificity rate and satisfactory sensitivity performance.
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Affiliation(s)
- Tenzin Kunkyab
- Department of Physics, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | | | - Andrew Jirasek
- Department of Physics, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Christina Haston
- Department of Physics, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Jeff Andrews
- Department of Statistics, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | | | - Derek Hyde
- Department of Physics, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
- BC Cancer-Kelowna, Canada
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Wang F, Lin H, Su Q, Li C. Cuproptosis-related lncRNA predict prognosis and immune response of lung adenocarcinoma. World J Surg Oncol 2022; 20:275. [PMID: 36050740 PMCID: PMC9434888 DOI: 10.1186/s12957-022-02727-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 08/09/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Lung adenocarcinoma (LUAD) accounts for 50% of lung cancers, with high mortality and poor prognosis. Long non-coding RNA (lncRNA) plays a vital role in the progression of tumors. Cuproptosis is a newly discovered form of cell death that is highly investigated. Therefore, in the present study, we aimed to investigate the role of cuproptosis-related lncRNA signature in clinical prognosis prediction and immunotherapy and the relationship with drug sensitivity. MATERIAL AND METHODS Genomic and clinical data were obtained from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases, and cuproptosis-related genes were obtained from cuproptosis-related studies. The prognostic signature was constructed by co-expression analysis and Cox regression analysis. Patients were divided into high and low risk groups, and then, a further series of model validations were carried out to assess the prognostic value of the signature. Subsequently, lncRNAs were analyzed for gene ontology (GO), Kyoto Encyclopedia of Genes and Genomes Enrichment (KEGG), immune-related functions, and tumor mutation burden (TMB). Finally, we used tumor immune dysfunction and exclusion (TIDE) algorithms on immune escape and immunotherapy of cuproptosis-related lncRNAs, thereby identifying its sensitivity toward potential drugs for LUAD. RESULTS A total of 16 cuproptosis-related lncRNAs were obtained, and a prognostic signature was developed. We found that high-risk patients had worse overall survival (OS) and progression-free survival (PFS) and higher mortality. Independent prognostic analyses, ROC, C-index, and nomogram showed that the cuproptosis-related lncRNAs can accurately predict the prognosis of patients. The nomogram and heatmap showed a distinct distribution of the high- and low-risk cuproptosis-related lncRNAs. Enrichment analysis showed that the biological functions of lncRNAs are associated with tumor development. We also found that immune-related functions, such as antiviral activity, were suppressed in high-risk patients who had mutations in oncogenes. OS was poorer in patients with high TMB. TIDE algorithms showed that high-risk patients have a greater potential for immune escape and less effective immunotherapy. CONCLUSION To conclude, the 16 cuproptosis-related lncRNAs can accurately predict the prognosis of patients with LUAD and may provide new insights into clinical applications and immunotherapy.
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Affiliation(s)
- Fangwei Wang
- grid.412594.f0000 0004 1757 2961Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nan’ning, China
| | - Hongsheng Lin
- grid.256607.00000 0004 1798 2653Department of Microbiology, School of Basic Medical Sciences, Guangxi Medical University, Nan’ning, China
| | - Qisheng Su
- grid.412594.f0000 0004 1757 2961Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nan’ning, China
| | - Chaoqian Li
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nan'ning, China.
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Chen B, Ying X, Bao L. MGMT gene promoter methylation in humoral tissue as biomarker for lung cancer diagnosis: An update meta-analysis. Thorac Cancer 2021; 12:3194-3200. [PMID: 34651448 PMCID: PMC8636218 DOI: 10.1111/1759-7714.14186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 01/12/2023] Open
Abstract
Objective To investigate O‐6‐methylguanine‐DNA methyltransferase (MGMT) gene promoter methylation in humoral tissue as biomarker for lung cancer diagnosis by pooling relevant open published data. Methods Clinical studies relevant to MGMT gene promoter methylation and lung cancer were systematic electronic searched in the databases of Medline, EMBASE, Ovid, Web of Science, and CNKI. Data of true positive (tp), false positive (fp), false negative (fn), and true negative (tn) were extracted from the included studies and made combination. The diagnostic sensitivity, specificity, diagnostic odds ratio (DOR) and summary receiver operating characteristic (SROC) of MGMT gene methylation for lung cancer diagnosis were pooled. Results Twelve studies were included in the meta‐analysis. The diagnostic sensitivity, specificity, DOR were 0.39 (95% CI = 0.31–0.49) 0.92 (95% CI = 0.77–0.97), and 4.20 (95% CI = 2.09–8.44), respectively under random effect model. The SROC of MGMT gene methylation for lung cancer diagnosis was 0.58 (95% CI = 0.53–0.62). Conclusion MGMT methylation rate was higher in plasma and bronchoalveolar lavage fluid (BLAF) of lung cancer cases compared to controls. High diagnostic specificity indicated that MGMT methylation in plasma and BLAF can be applied as lung cancer confirmation test.
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Affiliation(s)
- Bizheng Chen
- Department of Radiotherapy, Lishui Central Hospital, Lishui, Zhejiang Province, China
| | - Xiaozhen Ying
- Department of Radiotherapy, Lishui Central Hospital, Lishui, Zhejiang Province, China
| | - Liming Bao
- Department of Radiotherapy, Lishui Central Hospital, Lishui, Zhejiang Province, China
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5
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Wang D, Bi L, Ran J, Zhang L, Xiao N, Li X. Gas6/Axl signaling pathway promotes proliferation, migration and invasion and inhibits apoptosis in A549 cells. Exp Ther Med 2021; 22:1321. [PMID: 34630675 DOI: 10.3892/etm.2021.10756] [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: 07/27/2019] [Accepted: 02/23/2021] [Indexed: 12/15/2022] Open
Abstract
Several studies have demonstrated that growth arrest-specific protein 6 (Gas6) and Axl are highly expressed in various tumor tissues, such as renal cell and esophageal carcinoma. However, the effect of the Gas6/Axl signaling pathway on lung adenocarcinoma is still unclear. The aim of the present study was to investigate the effect of the Gas6/Axl signaling pathway on lung adenocarcinoma cells and its mechanism of action, which may provide a novel target for the clinical treatment of lung adenocarcinoma. Human lung adenocarcinoma tissues were used to examine the activation of the Gas6/Axl signaling pathway. In addition, the human lung adenocarcinoma cell line A549 was employed to study the effects of the Gas6/Axl signaling pathway on the proliferation, migration, invasion and apoptosis of lung adenocarcinoma cells. Recombinant human Gas6 protein and inhibitor TP-0903 were used to activate and inhibit the Gas6/Axl signaling pathway, respectively. The results revealed that Gas6 and Axl expression level was increased in human lung adenocarcinoma tissues compared with adjacent healthy tissues. After inhibition of the Gas6/Axl signaling pathway with TP-0903, p21, p53, caspase 3, caspase 8 and caspase 9 exhibited higher expression level in A549 cells. The opposite effect was observed when the Gas6/Axl signaling pathway was activated. In addition, the migratory and invasive ability of A549 cells was determined via wound-healing and Transwell invasion assays. The results indicated that the migratory and invasive ability of A549 cells was significantly increased when the Gas6/Axl signaling pathway was activated and inhibition of Gas6/Axl signaling pathway caused the opposite results. Activity of Gas6/Axl signaling pathway was shown to be positively associated with cell proliferation by Cell Counting Kit 8 and clone formation assays. In conclusion, the Gas6/Axl signaling pathway was revealed to promote the proliferation, migration and invasion and inhibit the apoptosis of lung adenocarcinoma cells, which serve important roles in the progression of lung adenocarcinoma.
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Affiliation(s)
- Dong Wang
- Department of Tuberculosis, Affiliated Hospital of Hebei University, Baoding, Hebei 071000, P.R. China
| | - Lixin Bi
- Department of Tuberculosis, Affiliated Hospital of Hebei University, Baoding, Hebei 071000, P.R. China
| | - Jingping Ran
- Clinical Laboratory, Affiliated Hospital of Hebei University, Baoding, Hebei 071000, P.R. China
| | - Lei Zhang
- Department of Medical Oncology, Affiliated Hospital of Hebei University, Baoding, Hebei 071000, P.R. China
| | - Na Xiao
- Department of Medical Oncology, Affiliated Hospital of Hebei University, Baoding, Hebei 071000, P.R. China
| | - Xiaoli Li
- Department of Medical Oncology, Affiliated Hospital of Hebei University, Baoding, Hebei 071000, P.R. China
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6
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Abstract
Radiation treatment of early stage nonsmall cell lung cancer has evolved over the past 2 decades to progressively more hypofractionated treatment courses. Results comparable to surgical resection are seen with stereotactic body radiotherapy, which is now the standard of care for medically inoperable patients, and a treatment option for operable patients as well. Understanding of the optimal radiation dose and fractionation are evolving, especially for central tumors which have higher treatment toxicity than peripheral tumors.
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Affiliation(s)
- Anna Wrona
- Medical University of Gdansk, Department of Oncology and Radiotherapy, Gdansk, Poland
| | - Francoise Mornex
- Radiation Oncology Department, CHU Lyon, Université Claude Bernard Lyon1, Lyon, France.
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7
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Cho BJ, de Perrot M. Radiotherapy in the era of immunotherapy: teaching an old dog new tricks. Eur Respir J 2020; 56:56/1/2000320. [DOI: 10.1183/13993003.00320-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/28/2020] [Indexed: 11/05/2022]
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8
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Zhang C, Song Q, Zhang L, Wu X. Development of a nomogram for preoperative prediction of lymph node metastasis in non-small cell lung cancer: a SEER-based study. J Thorac Dis 2020; 12:3651-3662. [PMID: 32802444 PMCID: PMC7399438 DOI: 10.21037/jtd-20-601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Lymph node dissection is an important part of lung cancer surgery. Preoperational evaluation of lymph node metastases decides which dissection pattern should be chosen. The present study aimed to develop a nomogram to predict lymph node metastases on the basis of clinicopathological features of non-small cell lung cancer (NSCLC) patients. Methods A total of 35,138 patients diagnosed with NSCLC from 2010–2015 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were randomly divided into training cohort and validation cohort. Possible risk factors were included and analyzed by logistic regression models. A nomogram was then constructed and validated. Results 21.83% of all patients were confirmed with positive lymph node metastasis. Age at diagnosis, sex, stage, T status, tumor size, grade and laterality were identified as predicting factors for lymph node involvement. These variables were included to build the nomogram. The AUC of the model was 0.696 (95% CI, 0.617 to 0.775). The model was further validated in the validation set with AUC 0.693 (95% CI, 0.628 to 0.758). The model presented with good prediction accuracy in both training cohort and validation cohort. Conclusions We developed a convenient clinical prediction model for regional lymph node metastases in NSCLC patients. The nomogram will help physicians to determine which patients will receive the most benefit from lymph node dissection.
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Affiliation(s)
- Chufan Zhang
- Departmemt of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qian Song
- Departmemt of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Institute of Digestive Disease and Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong, China
| | - Lanlin Zhang
- Departmemt of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xianghua Wu
- Departmemt of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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9
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Recent developments and advances in secondary prevention of lung cancer. Eur J Cancer Prev 2020; 29:321-328. [PMID: 32452945 DOI: 10.1097/cej.0000000000000586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Lung cancer prevention may include primary prevention strategies, such as corrections of working conditions and life style - primarily smoking cessation - as well as secondary prevention strategies, aiming at early detection that allows better survival rates and limited resections. This review summarizes recent developments and advances in secondary prevention, focusing on recent technological tools for an effective early diagnosis.
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Ijsseldijk MA, Shoni M, Siegert C, Wiering B, van Engelenburg AKC, Tsai TC, Ten Broek RPG, Lebenthal A. Oncologic Outcomes of Surgery Versus SBRT for Non-Small-Cell Lung Carcinoma: A Systematic Review and Meta-analysis. Clin Lung Cancer 2020; 22:e235-e292. [PMID: 32912754 DOI: 10.1016/j.cllc.2020.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/21/2020] [Accepted: 04/25/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The optimal treatment of stage I non-small-cell lung carcinoma is subject to debate. The aim of this study was to compare overall survival and oncologic outcomes of lobar resection (LR), sublobar resection (SR), and stereotactic body radiotherapy (SBRT). METHODS A systematic review and meta-analysis of oncologic outcomes of propensity matched comparative and noncomparative cohort studies was performed. Outcomes of interest were overall survival and disease-free survival. The inverse variance method and the random-effects method for meta-analysis were utilized to assess the pooled estimates. RESULTS A total of 100 studies with patients treated for clinical stage I non-small-cell lung carcinoma were included. Long-term overall and disease-free survival after LR was superior over SBRT in all comparisons, and for most comparisons, SR was superior to SBRT. Noncomparative studies showed superior long-term overall and disease-free survival for both LR and SR over SBRT. Although the papers were heterogeneous and of low quality, results remained essentially the same throughout a large number of stratifications and sensitivity analyses. CONCLUSION Results of this systematic review and meta-analysis showed that LR has superior outcomes compared to SBRT for cI non-small-cell lung carcinoma. New trials are underway evaluating long-term results of SBRT in potentially operable patients.
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Affiliation(s)
- Michiel A Ijsseldijk
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands; Division of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Melina Shoni
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Charles Siegert
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA; Division of Thoracic Surgery, West Roxbury Veterans Administration, West Roxbury, MA
| | - Bastiaan Wiering
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands
| | | | - Thomas C Tsai
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Richard P G Ten Broek
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands; Division of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Abraham Lebenthal
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA; Division of Thoracic Surgery, West Roxbury Veterans Administration, West Roxbury, MA; Harvard Medical School, Boston, MA
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Yamamoto Y, Kanzaki R, Ose N, Funakoshi Y, Ikeda N, Takami K, Iwasaki T, Iwazawa T, Yokouchi H, Shiono H, Kodama K, Shintani Y. Lung Cancer Surgery for Patients on Hemodialysis: A Decade of Experience at Multicenter Institutions. Ann Thorac Surg 2020; 109:1558-1565. [DOI: 10.1016/j.athoracsur.2019.11.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 10/31/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022]
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12
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Li H, Shen Y, Wu Y, Cai S, Zhu Y, Chen S, Chen X, Chen Q. Stereotactic Body Radiotherapy Versus Surgery for Early-Stage Non-Small-Cell Lung Cancer. J Surg Res 2019; 243:346-353. [PMID: 31277011 DOI: 10.1016/j.jss.2019.04.083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/09/2019] [Accepted: 04/26/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Surgery is the gold standard therapy for patients with early-stage non-small-cell lung cancer (NSCLC). However, stereotactic body radiotherapy (SBRT) may provide as an alternative for patients who are medically inoperable or refuse surgical resection. The optimal treatment (SBRT or surgery) for patients with early-stage NSCLC is not clear. METHODS A systematic search was performed from PubMed, MEDLINE, Embase, and the Cochrane Library. Study heterogeneity and publication bias were estimated. RESULTS Fourteen cohort studies involving 1438 participants (719 who received SBRT and 719 who received surgery) were included in the meta-analysis. The main bias sources between the two groups, such as age, gender, tumor diameter, forced expiratory volume in 1 s, and Charlson comorbidity index were matched. The surgery was associated with a better overall survival (OS) and long-term distant control (DC) for early-stage NSCLC. The pooled OR and 95% confidence interval (CI) for 1-y, 3-y, 5-y OS, and 5-y DC were 1.56 (1.12-2.15), 1.86 (1.50-2.31), 2.43 (1.80-3.28), and 2.74 (1.12-6.67), respectively. No difference was found between the treatments in the 1-y and 3-y disease-free survival; 1-y, 3-y and 5-y locoregional control; or 1-y and 3-y DC. CONCLUSIONS Our results found a superior OS and long-term DC for early-stage NSCLC after surgery compared with SBRT after propensity score matching.
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Affiliation(s)
- Hui Li
- Department of Cardiothoracic Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yefeng Shen
- Department of Cardiothoracic Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yuanzhou Wu
- Department of Cardiothoracic Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shaoru Cai
- Special Medical Service Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yaru Zhu
- Department of Cardiothoracic Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Siping Chen
- Department of Gynaecology and Obstetrics, Meizhou People's Hospital Affiliated to Sun Yat-sen University, Meizhou, China
| | - Xin Chen
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
| | - Qunqing Chen
- Department of Cardiothoracic Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
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Kwak YK, Park HH, Choi KH, Park EY, Sung SY, Lee SW, Hong JH, Lee HC, Yoo IR, Kim YS. SUVmax Predicts Disease Progression after Stereotactic Ablative Radiotherapy in Stage I Non-small Cell Lung Cancer. Cancer Res Treat 2019; 52:85-97. [PMID: 31122008 PMCID: PMC6962475 DOI: 10.4143/crt.2019.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 05/16/2019] [Indexed: 12/16/2022] Open
Abstract
Purpose Fluorodeoxyglucose positron emission tomography–computed tomography (PET-CT) is gaining evidence as a predictive factor in non-small cell lung cancer (NSCLC). Stereotactic ablative radiotherapy (SABR) is the standard treatment in early-stage NSCLC when a patient is unsuitable for surgery. We performed a study to assess the prognostic clinical significance of PET-CT after SABR in early-stage NSCLC. Materials and Methods Seventy-six patients with stage I NSCLC treated with SABR were investigated. Total radiation dose ranged from 36 to 63 Gy in three to eight fractions depending on tumor location and size. Respiratory motion control was implemented at simulation and during treatment. PET-CT prior to SABR was performed in 66 patients (86.8%). Results Median follow-up time was 32 months (range, 5 to 142 months). Local control rate at 1, 2, and 5 years were 95.9%, 92.8%, and 86.7%, respectively. Overall survival (OS) at 1, 2, and 5 years were 91.0%, 71.3%, and 52.1% respectively. Cause-specific survival at 1, 2, and 5 years were 98.6%, 93.1%, and 84.3% respectively. Tumor size and pre-SABR maximal standardized uptake value (SUVmax) demonstrated statistical significance in the Kaplan-Meier survival analyses with log-rank test. In multivariate analyses pre-SABR SUVmax remained statistically significant in correlation to OS (p=0.024; hazard ratio [HR], 3.2; 95% confidence interval [CI], 1.2 to 8.8) and with marginal significance in regards to regional progression-free survival (p=0.059; HR, 32.5; 95% CI, 2.6 to 402.5). Conclusion Pre-SABR SUVmax demonstrated a predictive power in statistical analyses. Tumors with SUVmax above 6 at diagnosis were associated with inferior outcomes.
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Affiliation(s)
- Yoo-Kang Kwak
- Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hee Hyun Park
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyu Hye Choi
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Young Park
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soo Yoon Sung
- Department of Radiation Oncology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sea-Won Lee
- Department of Radiation Oncology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Hyun Hong
- Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyo Chun Lee
- Department of Radiation Oncology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ie Ryung Yoo
- Department of Nuclear Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yeon Sil Kim
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Hamakawa H, Takahashi Y, Sakanoue I, Saito T, Date N, Tomii K, Katakami N, Imagunbai T, Kokubo M. Salvage Pulmonary Operations Following Stereotactic Body Radiotherapy for Small Primary and Metastatic Lung Tumors: Evaluation of the Operative Procedures. Technol Cancer Res Treat 2019; 17:1533033818807431. [PMID: 30415605 PMCID: PMC6259072 DOI: 10.1177/1533033818807431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Stereotactic body radiotherapy is an alternative treatment option for small-sized, primary lung cancers and pulmonary metastatic diseases. In the case of local relapse after stereotactic body radiotherapy, salvage pulmonary resection is considered cautiously. However, no study has described the difficulty of the salvage operations. This study aimed to assess the difficulty associated with salvage operative procedures. Eight patients who developed local relapse after stereotactic body radiotherapy and had undergone salvage pulmonary operations were enrolled in this study (stereotactic body radiotherapy group). Additionally, 439 patients who underwent video-assisted thoracoscopic lobectomy without previous stereotactic body radiotherapy were enrolled as the standard operative control group (non-stereotactic body radiotherapy group). In the stereotactic body radiotherapy group, 1 of the 8 patients had undergone lobectomy with composite resection of the third and fourth ribs. Of the 8 patients, 6 had undergone video-assisted thoracoscopic lobectomy and 1 had been inoperable because of rapid tumor progression. The operation time and the incision length of the utility port were apt to be longer in the stereotactic body radiotherapy group than in the non-stereotactic body radiotherapy group. On the contrary, the duration of drain placement and the length of hospital stay after the operation were not different. Thus, the salvage pulmonary operations were performed in the usual video-assisted thoracoscopic lobectomy approach, but slightly complicated than the standard video-assisted thoracoscopic lobectomy. Although to decide the indication of salvage operation might be difficult, it could be a feasible treatment option in local relapse after stereotactic body radiotherapy.
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Affiliation(s)
- Hiroshi Hamakawa
- 1 Department of Thoracic Surgery, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Yutaka Takahashi
- 1 Department of Thoracic Surgery, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Ichiro Sakanoue
- 1 Department of Thoracic Surgery, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Tomoki Saito
- 1 Department of Thoracic Surgery, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Naoki Date
- 1 Department of Thoracic Surgery, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Keisuke Tomii
- 2 Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Nobuyuki Katakami
- 3 Department of Medical Oncology, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Toshiyuki Imagunbai
- 4 Department of Therapeutic Radiology, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Masaki Kokubo
- 4 Department of Therapeutic Radiology, Kobe City Medical Center General Hospital, Hyogo, Japan
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15
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Blom EF, Ten Haaf K, Arenberg DA, de Koning HJ. Treatment capacity required for full-scale implementation of lung cancer screening in the United States. Cancer 2019; 125:2039-2048. [PMID: 30811590 PMCID: PMC6541509 DOI: 10.1002/cncr.32026] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 01/10/2019] [Accepted: 01/29/2019] [Indexed: 12/17/2022]
Abstract
Background Full‐scale implementation of lung cancer screening in the United States will increase detection of early stages. This study was aimed at assessing the capacity required for treating those cancers. Methods A well‐established microsimulation model was extended with treatment data from the National Cancer Database. We assessed how treatment demand would change when implementing lung cancer screening in 2018. Three policies were assessed: 1) annual screening of current smokers and former smokers who quit fewer than 15 years ago, aged 55 to 80 years, with a smoking history of at least 30 pack‐years (US Preventive Services Task Force [USPSTF] recommendations); 2) annual screening of current smokers and former smokers who quit fewer than 15 years ago, aged 55 to 77 years, with a smoking history of at least 30 pack‐years (Centers for Medicare and Medicaid Services [CMS] recommendations); and 3) annual screening of current smokers and former smokers who quit fewer than 10 years ago, aged 55 to 75 years, with a smoking history of at least 40 pack‐years (the most cost‐effective policy in Ontario [Ontario]). The base‐case screening adherence was a constant 50%. Sensitivity analyses assessed other adherence levels, including a linear buildup to 50% between 2018 and 2027. Results The USPSTF policy would require 37.0% more lung cancer surgeries in 2015‐2040 than no screening, 2.2% less radiotherapy, and 5.4% less chemotherapy; 5.7% more patients would require any therapy. The increase in surgical demand would be 96.1% in 2018, 46.0% in 2023, 38.3% in 2028, and 24.9% in 2040. Adherence strongly influenced results. By 2018, surgical demand would range from 52,619 (20% adherence) to 96,121 (80%). With a gradual buildup of adherence, the increase in surgical demand would be 9.6% in 2018, 38.3% in 2023, 42.0% in 2028, and 24.4% in 2040. Results for the CMS and Ontario policies were similar, although the changes in comparison with no screening were smaller. Conclusions Full‐scale implementation of lung cancer screening causes a major increase in surgical demand, with a peak within the first 5 years. A gradual buildup of adherence can spread this peak over time. Careful surgical capacity planning is essential for successfully implementing screening. Full‐scale implementation of lung cancer screening in the United States will lead to a major increase in the demand for thoracic surgery. Careful surgical capacity planning is essential for successfully implementing screening.
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Affiliation(s)
- Erik F Blom
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Kevin Ten Haaf
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Douglas A Arenberg
- Division of Pulmonary & Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
| | - Harry J de Koning
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
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16
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Berman AT, Jabbour SK, Vachani A, Robinson C, Choi JI, Mohindra P, Rengan R, Bradley J, Simone CB. Empiric Radiotherapy for Lung Cancer Collaborative Group multi-institutional evidence-based guidelines for the use of empiric stereotactic body radiation therapy for non-small cell lung cancer without pathologic confirmation. Transl Lung Cancer Res 2019; 8:5-14. [PMID: 30788230 PMCID: PMC6351405 DOI: 10.21037/tlcr.2018.12.12] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 12/20/2018] [Indexed: 12/15/2022]
Abstract
The standard of care for managing early stage non-small cell lung cancer (NSCLC) is definitive surgical resection. Stereotactic body radiation therapy (SBRT) has become the standard treatment for patient who are medically inoperable, and it is increasingly being considered as an option in operable patients. With the growing use of screening thoracic CT scans for patients with a history of heavy smoking, as well as improved imaging capabilities, the discovery of small lung nodes has become a common dilemma. As a result, clinicians are increasingly faced with managing lung nodules in patients in whom diagnostic biopsy is not safe or feasible. Herein, we describe the scope of the problem, tools available for predicting the probability that a lung nodule is a malignancy, staging procedures, benefits of pathology-proven and empiric SBRT, considerations of safety based on location of the lesion of concern, and overall efficacy of SBRT.
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Affiliation(s)
- Abigail T. Berman
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Salma K. Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
| | - Anil Vachani
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Cliff Robinson
- Department of Radiation Oncology, Washington University, St. Louis, MO, USA
| | - J. Isabelle Choi
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Pranshu Mohindra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ramesh Rengan
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Jeffrey Bradley
- Department of Radiation Oncology, Washington University, St. Louis, MO, USA
| | - Charles B. Simone
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
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17
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Do the surgical results in the National Lung Screening Trial reflect modern thoracic surgical practice? J Thorac Cardiovasc Surg 2018; 157:2038-2046.e1. [PMID: 31288364 DOI: 10.1016/j.jtcvs.2018.11.139] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 11/15/2018] [Accepted: 11/25/2018] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Surgical data from the National Lung Screening Trial (NLST) has yet to be closely examined. We sought to analyze surgical procedures and complications from the NLST to determine their relevance to modern surgical practice. METHODS The NLST database was queried for patients who underwent surgical resection for confirmed lung cancer, specifically evaluating postoperative complications. Numerical variables were compared using the Mann-Whitney U test. Categorical variables were compared using the χ2 test. Logistic regression uni- and multivariable analysis of independent risk factors of postoperative complications was performed. RESULTS At operation, 80% of patients (n = 821) had lobectomy, 4.1% (n = 42) had pneumonectomy, and 16.1% (n = 166) had sublobar resection, among whom 69% (n = 114) had wedge resection. Only 29.6% (n = 305) of the cohort had a thoracoscopic resection. Although the overall rate of surgical patients with any complication was 31% (n = 318), only 15.5% of patients (n = 160) had major complications, most commonly prolonged air leaks (n = 67, 6.5%). Respiratory failure (n = 28, 2.7%), prolonged ventilation (n = 9, 0.9%), myocardial infarction or cardiac arrest (n = 7, 0.7%), and stroke (n = 2, 0.2%) were rare events. Overall 30-day mortality in patients undergoing resection was 1.7% (n = 18). On multivariable analysis, greater smoking pack history (odds ratio [OR], 1.01; 95% confidence interval [CI], 1.001-1.01) and pulmonary comorbidities (OR, 1.34; 95% CI, 0.98-1.82) were significant or approached significance for an association with complications/death, whereas sublobar resection (OR, 0.59; 95% CI, 0.38-0.94) and video-assisted thoracoscopic surgery approach (OR, 0.76; 95% CI, 0.56-1.04) were significant or approached significance for an association with decreased rates of complications/death. CONCLUSIONS Operative mortality and postoperative morbidity were very low in patients undergoing resection for screen-detected lung cancer. Increased use of sublobar resection and minimally invasive surgical approaches may be associated with fewer complications.
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Bracht JWP, Mayo-de-Las-Casas C, Berenguer J, Karachaliou N, Rosell R. The Present and Future of Liquid Biopsies in Non-Small Cell Lung Cancer: Combining Four Biosources for Diagnosis, Prognosis, Prediction, and Disease Monitoring. Curr Oncol Rep 2018; 20:70. [PMID: 30030656 DOI: 10.1007/s11912-018-0720-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Liquid biopsies have potential as tools for diagnosis, prognosis, and prediction of response to therapy. Herein, we will extensively review four liquid biosources, tumor-educated platelets (TEPs), cell-free DNA (cfDNA), circulating tumor cells (CTCs), and extracellular vesicles (EVs) and we will clarify their optimal application in non-small cell lung cancer (NSCLC) diagnosis and therapy. RECENT FINDINGS Liquid biopsies are a minimally invasive alternative to tissue biopsies-especially important in NSCLC patients-since tumor tissue is often unavailable or insufficient for complete genetic analysis. The main advantages of liquid biopsies include the possibility for repeated sampling, the lower cost, and the fact that they can reflect the complete molecular status of the patient better than a single-site biopsy. This is specifically important for lung adenocarcinoma patients since the detection of specific genetic alterations can predict response to targeted therapies. Molecular analysis is currently cardinal for therapy decision-making and disease monitoring in lung cancer patients. Liquid biopsies can make easier our daily clinical practice and if prospectively tested and validated may serve as a means for lung cancer early detection.
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Affiliation(s)
| | - Clara Mayo-de-Las-Casas
- Pangaea Oncology, Laboratory of Molecular Biology, Quirón-Dexeus University Institute, Sabino Arana 5-19, 08028, Barcelona, Spain
| | - Jordi Berenguer
- Pangaea Oncology, Laboratory of Molecular Biology, Quirón-Dexeus University Institute, Sabino Arana 5-19, 08028, Barcelona, Spain
| | - Niki Karachaliou
- Pangaea Oncology, Laboratory of Molecular Biology, Quirón-Dexeus University Institute, Sabino Arana 5-19, 08028, Barcelona, Spain. .,Instituto Oncológico Dr Rosell (IOR), University Hospital Sagrat Cor, QuironSalud Group, Viladomat 288, 08029, Barcelona, Spain.
| | - Rafael Rosell
- Pangaea Oncology, Laboratory of Molecular Biology, Quirón-Dexeus University Institute, Sabino Arana 5-19, 08028, Barcelona, Spain. .,Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Carretera de Canyet, s/n, 08916, Badalona, Barcelona, Spain. .,Institut d'Investigació en Ciències Germans Trias i Pujol, Camí de les Escoles, s/n, 08916, Badalona, Barcelona, Spain. .,Instituto Oncológico Dr Rosell (IOR), Quirón-Dexeus University Institute, Sabino Arana 5-19, 08028, Barcelona, Spain.
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19
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Kron T, Chesson B, Hardcastle N, Crain M, Clements N, Burns M, Ball D. Credentialing of radiotherapy centres in Australasia for TROG 09.02 (Chisel), a Phase III clinical trial on stereotactic ablative body radiotherapy of early stage lung cancer. Br J Radiol 2018; 91:20170737. [PMID: 29446317 DOI: 10.1259/bjr.20170737] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE A randomised clinical trial comparing stereotactic ablative body radiotherapy (SABR) with conventional radiotherapy for early stage lung cancer has been conducted in Australia and New Zealand under the auspices of the TransTasman Radiation Oncology Group (NCT01014130). We report on the technical credentialing program as prerequisite for centres joining the trial. METHODS Participating centres were asked to develop treatment plans for two test cases to assess their ability to create plans according to protocol. Dose delivery in the presence of inhomogeneity and motion was assessed during a site visit using a phantom with moving inserts. RESULTS Site visits for the trial were conducted in 16 Australian and 3 New Zealand radiotherapy facilities. The tests with low density inhomogeneities confirmed shortcomings of the AAA algorithm for dose calculation. Dose was assessed for a typical treatment delivery including at least one non-coplanar beam in a stationary and moving phantom. This end-to-end test confirmed that all participating centres were able to deliver stereotactic ablative body radiotherapy with the required accuracy while the planning study demonstrated that they were able to produce acceptable plans for both test cases. CONCLUSION The credentialing process documented that participating centres were able to deliver dose as required in the trial protocol. It also gave an opportunity to provide education about the trial and discuss technical issues such as four-dimensional CT, small field dosimetry and patient immobilisation with staff in participating centres. Advances in knowledge: Credentialing is an important quality assurance tool for radiotherapy trials using advanced technology. In addition to confirming technical competence, it provides an opportunity for education and discussion about the trial.
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Affiliation(s)
- Tomas Kron
- 1 Department of Physical Sciences, Peter MacCallum Cancer Centre , Melbourne, VIC , Australia.,2 Sir Peter MacCallum Department of Oncology, University of Melbourne , Parkville, VIC , Australia
| | - Brent Chesson
- 3 Department of Radiation Therapy Services, Peter MacCallum Cancer Centre , Melbourne, VIC , Australia
| | - Nicholas Hardcastle
- 1 Department of Physical Sciences, Peter MacCallum Cancer Centre , Melbourne, VIC , Australia
| | - Melissa Crain
- 4 Trans Tasman Radiation Oncology Group (TROG) , Newcastle, NSW , Australia
| | | | - Mark Burns
- 3 Department of Radiation Therapy Services, Peter MacCallum Cancer Centre , Melbourne, VIC , Australia
| | - David Ball
- 2 Sir Peter MacCallum Department of Oncology, University of Melbourne , Parkville, VIC , Australia.,6 Department of Radiation Oncology, Peter MacCallum Cancer Centre , Melbourne, VIC , Australia
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20
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Pedersen JH, Sørensen JB, Saghir Z, Fløtten Ø, Brustugun OT, Ashraf H, Strand TE, Friesland S, Koyi H, Ek L, Nyrén S, Bergman P, Jekunen A, Nieminen EM, Gudbjartsson T. Implementation of lung cancer CT screening in the Nordic countries. Acta Oncol 2017; 56:1249-1257. [PMID: 28571524 DOI: 10.1080/0284186x.2017.1329592] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION We review the current knowledge of CT screening for lung cancer and present an expert-based, joint protocol for the proper implementation of screening in the Nordic countries. MATERIALS AND METHODS Experts representing all the Nordic countries performed literature review and concensus for a joint protocol for lung cancer screening. RESULTS AND DISCUSSION Areas of concern and caution are presented and discussed. We suggest to perform CT screening pilot studies in the Nordic countries in order to gain experience and develop specific and safe protocols for the implementation of such a program.
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Affiliation(s)
- Jesper Holst Pedersen
- Department of Cardiothoracic Surgery RT Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jens Benn Sørensen
- Department of Oncology, Finsen Centre/Rigshospitalet Copenhagen, Copenhagen, Denmark
| | - Zaigham Saghir
- Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark
| | - Øystein Fløtten
- Department of Pulmonary Medicine, Haukeland universitetssjukehus, Bergen, Norway
| | - Odd Terje Brustugun
- Section of Oncology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Haseem Ashraf
- Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark
- Department of Radiology, Akershus University Hospital, Loerenskog, Norway
| | | | - Signe Friesland
- Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Hirsh Koyi
- Department of Respiratory Medicine, Gävle Hospital, Gävle, Sweden
| | - Lars Ek
- Department of Heart and Lung Diseases, Skåne University Hospital, Sweden
| | - Sven Nyrén
- Department of Thoraxradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Per Bergman
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Antti Jekunen
- Vaasa Oncology Clinic, Turku University, Turku, Finland
| | - Eeva-Maija Nieminen
- Helsinki University, Helsinki University Hospital, Heart and Lung Centre, Helsinki, Finland
| | - Tomas Gudbjartsson
- Department of Cardiothoracic Surgery, Faculty of Medicine, Landspitli University Hospital, University of Iceland, Reykjavik, Iceland
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21
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Yu XJ, Dai WR, Xu Y. Survival Outcome after Stereotactic Body Radiation Therapy and Surgery for Early Stage Non-Small Cell Lung Cancer: A Meta-Analysis. J INVEST SURG 2017; 31:1-8. [PMID: 28829659 DOI: 10.1080/08941939.2017.1341573] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 09/07/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Treatment modalities in medically compromised patients with early-stage non-small cell lung cancer (NSCLC) are controversial. Stereotactic body radiotherapy (SBRT) or stereotactic ablative radiotherapy has been increasingly recognized as a favorable alternative to surgical resection for early-stage NSCLC. Many retrospective analyses compared the efficacy of stereotactic body radiotherapy (SBRT) with surgery for early-stage non-small cell lung cancer (NSCLC). However, the efficacy between SBRT and surgery regimens for patients with early-stage NSCLC remains unclear. This study aimed to investigate the efficacy between SBRT and surgery. METHODS Publications on comparison SBRT with Surgery in treatment of early stage non-small cell lung cancer (NSCLC) from 2011 to 2017 were collected. Retrospective trials analyzed the summary hazard ratios (HRs) of overall survival (OS), disease-free survival (DFS), local control survival (LC), regional control survival (RC), loco-regional control survival (LRC), and distant control survival (DC) between SBRT and Surgery. The major outcomes measures were hazard ratios (HRs). Meta-analysis Revman 5.3 software was used to analyze the combined Pooled HRs using fixed- or random-effects models according to the heterogeneity. RESULT A systematic literature search was conducted including14 studies. In this meta-analysis, patients with SBRT achieved inferior OS, DFS, LC, RC, LRC and DC, compared with surgery. CONCLUSION In this study we found more favorable outcomes with stage I NSCLC treated with SBRT. The surgery had no obvious advantages in this meta-analysis. Although surgery has become the recommended treatment at present, SBRT has potential to be an alternative treatment as a novel non-invasive radiation therapy modality in patients with stage I-II NSCLC.
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Affiliation(s)
- Xiao-Jun Yu
- a Department of Cardiothoracic Surgery , The First People's Hospital of Fuyang , Hangzhou , China
| | - Wan-Rong Dai
- b Department of Pharmacy , The First Affiliated Hospital of Zhejiang University , Hangzhou , China
| | - Yong Xu
- c Department of Thoracic Surgery, Sir Run Run Shaw Hospital, School of Medicine , Zhejiang University , Hangzhou , China
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22
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Cornwell LD, Echeverria AE, Samuelian J, Mayor J, Casal RF, Bakaeen FG, Omer S, Preventza O, Mai W, Chen G, Simpson KH, Moghanaki D, Zhu AW. Video-assisted thoracoscopic lobectomy is associated with greater recurrence-free survival than stereotactic body radiotherapy for clinical stage I lung cancer. J Thorac Cardiovasc Surg 2017; 155:395-402. [PMID: 28888379 DOI: 10.1016/j.jtcvs.2017.07.065] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 07/05/2017] [Accepted: 07/17/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Stereotactic body radiotherapy is the standard treatment for medically inoperable early-stage non-small cell lung cancer. Recent data suggest that in operable patients, stereotactic body radiotherapy produces outcomes comparable to those of surgical resection. In veterans with early non-small cell lung cancer, we compared the outcomes of stereotactic body radiotherapy and video-assisted thoracoscopic lobectomy. METHODS We retrospectively reviewed data from 183 patients (94.0% male) with clinical stage I non-small cell lung cancer who underwent stereotactic body radiotherapy (n = 56) or video-assisted thoracoscopic lobectomy (n = 127) from 2009 to 2014. Propensity matching was used to produce more comparable groups. Primary end points were tumor control and overall, recurrence-free, and lung-cancer-specific survival, as estimated by Kaplan-Meier actuarial analysis. Multivariable analysis was used to identify independent predictors. RESULTS In the overall cohort, the patients who received stereotactic body radiotherapy were older than the patients who received video-assisted thoracoscopic lobectomy (median age, 79.5 vs 64 years) and had more comorbidities. In the 37 propensity-matched pairs, the 3-year actuarial tumor control rate was 54.3% after stereotactic body radiotherapy and 90.6% after video-assisted thoracoscopic lobectomy (P = .0038). Actuarial lung cancer-specific 3-year survival was 78.1% (stereotactic body radiotherapy) versus 93.6% (video-assisted thoracoscopic lobectomy) (P = .055). One-year overall, 3-year overall, and 3-year recurrence-free survivals were 89.2%, 52.9%, and 38.5% after stereotactic body radiotherapy and 94.6%, 85.7%, and 82.8% after video-assisted thoracoscopic lobectomy (P < .005 for all), respectively. In multivariable analysis, stereotactic body radiotherapy independently predicted recurrence and poorer survival. CONCLUSIONS In veteran patients with early-stage non-small cell lung cancer, video-assisted thoracoscopic lobectomy resulted in better disease control and survival than stereotactic body radiotherapy. Although prior reports suggest that stereotactic body radiotherapy is a suitable alternative to surgery in early-stage lung cancer, a prospective randomized trial is needed. Nevertheless, stereotactic body radiotherapy remains a suitable option for medically inoperable patients.
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Affiliation(s)
- Lorraine D Cornwell
- Michael E. DeBakey VA Medical Center, Houston, Tex; Baylor College of Medicine, Houston, Tex.
| | - Alfredo E Echeverria
- Michael E. DeBakey VA Medical Center, Houston, Tex; Baylor College of Medicine, Houston, Tex
| | | | - Jessica Mayor
- Michael E. DeBakey VA Medical Center, Houston, Tex; Baylor College of Medicine, Houston, Tex
| | - Roberto F Casal
- Michael E. DeBakey VA Medical Center, Houston, Tex; Baylor College of Medicine, Houston, Tex
| | - Faisal G Bakaeen
- Cleveland Clinic, Cleveland, Ohio; Texas Heart Institute, Houston, Tex
| | - Shuab Omer
- Michael E. DeBakey VA Medical Center, Houston, Tex; Baylor College of Medicine, Houston, Tex
| | - Ourania Preventza
- Baylor College of Medicine, Houston, Tex; Texas Heart Institute, Houston, Tex
| | - Weiyuan Mai
- Michael E. DeBakey VA Medical Center, Houston, Tex; Baylor College of Medicine, Houston, Tex
| | - George Chen
- Michael E. DeBakey VA Medical Center, Houston, Tex; Baylor College of Medicine, Houston, Tex
| | | | - Drew Moghanaki
- The Hunter Holmes McGuire VA Medical Center, Richmond, Va
| | - Angela W Zhu
- Michael E. DeBakey VA Medical Center, Houston, Tex; Baylor College of Medicine, Houston, Tex
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23
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Hamaji M, Chen-Yoshikawa TF, Matsuo Y, Motoyama H, Hijiya K, Menju T, Aoyama A, Sato T, Sonobe M, Date H. Salvage video-assisted thoracoscopic lobectomy for isolated local relapse after stereotactic body radiotherapy for early stage non-small cell lung cancer: technical aspects and perioperative management. J Vis Surg 2017; 3:86. [PMID: 29302412 DOI: 10.21037/jovs.2017.04.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 04/06/2017] [Indexed: 11/06/2022]
Abstract
Limited data is available on salvage surgery for local relapse (LR) after stereotactic body radiotherapy (SBRT) for non-small cell lung cancer (NSCLC). We aimed to characterize treatment options and clarify long-term outcomes of isolated LR after SBRT for patients with clinical stage I NSCLC. Herein, we discuss technical aspects, perioperative management, and postoperative follow-up of two patients of the 12 patients undergoing salvage surgery for LR after SBRT at Kyoto University between 1999 and 2013. A 76-year-old male, 15 months after SBRT, underwent a salvage right upper lobectomy combined with adjacent right lower lobe wedge resection via video-assisted thoracoscopic surgery (VATS) for a 5.0-cm mass. Local recurrence was found 5 years after salvage surgery and treated with repeat SBRT, however he died from multiple distant metastases. An 85-year-old male, 14 months after SBRT, underwent a salvage left upper lobectomy via VATS for a 3.5-cm mass. Moderate intrapleural adhesion was noted and required careful dissection on the mediastinum. He is alive with no recurrence at 2 years from salvage surgery. Salvage VATS lobectomy was feasible after SBRT in two patients. Long-term follow-up and continued discussions at multidisciplinary conferences are required.
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Affiliation(s)
- Masatsugu Hamaji
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Yukinori Matsuo
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hideki Motoyama
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kyoko Hijiya
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshi Menju
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akihiro Aoyama
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshihiko Sato
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Makoto Sonobe
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Heineman DJ, Ten Berge MG, Daniels JM, Versteegh MI, Marang-van de Mheen PJ, Wouters MW, Schreurs WH. Clinical Staging of Stage I Non-Small Cell Lung Cancer in the Netherlands-Need for Improvement in an Era With Expanding Nonsurgical Treatment Options: Data From the Dutch Lung Surgery Audit. Ann Thorac Surg 2016; 102:1615-1621. [PMID: 27665481 DOI: 10.1016/j.athoracsur.2016.07.054] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 07/16/2016] [Accepted: 07/20/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND The clinical stage of non-small cell lung cancer (NSCLC) determines the initial treatment, whereas the pathologic stage best determines prognosis and the need for adjuvant treatment. In an era in which stereotactic ablative radiotherapy (SABR) has become an alternative modality to surgical intervention, clinical staging is even more important, because pathologic staging is omitted in the case of SABR. The objective of this study was to determine the concordance between clinical and pathologic stage in routine clinical practice for patients with early-stage NSCLC. METHODS Prospective data were derived from the Dutch Lung Surgery Audit (DLSA) in 2013 and 2014. Patients with clinical stage I NSCLC who underwent surgical resection and had a positron emission tomography-computed tomography (PET-CT) scan in their clinical workup were selected. Clinical and pathologic TNM (cTNM and pTNM) stages were compared. RESULTS From a total of 1,790 patients with clinical stage I, 1,555 (87%) patients were included in this analysis. Concordance between cTNM and pTNM was 59.9%. Of the patients with clinical stage I, 22.6% were upstaged to pathologic stage II or higher. In total, 14.9% of all patients with clinical stage I had nodal metastases, and 5.5% of all patients had unforeseen N2 disease. In patients with clinical stage T2a tumors, 21.3% had nodal metastases, 14.5% being N1 and 6.7% being N2 disease. CONCLUSIONS Concordance between clinical and pathologic stage is 59.9%. In patients with clinical stage I NSCLC, 22.6% were upstaged to pathologic stage II or higher, which is an indication for adjuvant chemotherapy. Improvement in accuracy of staging is thus needed, particularly for these patients.
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Affiliation(s)
| | | | | | | | | | - Michael Wilhelmus Wouters
- Department of Surgical Oncology, Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, the Netherlands; Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, the Netherlands
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Veronesi G, Novellis P, Voulaz E, Alloisio M. Early detection and early treatment of lung cancer: risks and benefits. J Thorac Dis 2016; 8:E1060-E1062. [PMID: 27747063 DOI: 10.21037/jtd.2016.08.76] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Giulia Veronesi
- Thoracic Surgery Division, Humanitas Cancer Center, Rozzano, Italy
| | | | - Emanuele Voulaz
- Thoracic Surgery Division, Humanitas Cancer Center, Rozzano, Italy
| | - Marco Alloisio
- Thoracic Surgery Division, Humanitas Cancer Center, Rozzano, Italy
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Rocco G, Morabito A, Leone A, Muto P, Fiore F, Budillon A. Management of non-small cell lung cancer in the era of personalized medicine. Int J Biochem Cell Biol 2016; 78:173-179. [DOI: 10.1016/j.biocel.2016.07.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 07/11/2016] [Accepted: 07/13/2016] [Indexed: 01/20/2023]
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Harris C, Meek D, Gilligan D, Williams L, Solli P, Rintoul RC. Assessment and Optimisation of Lung Cancer Patients for Treatment with Curative Intent. Clin Oncol (R Coll Radiol) 2016; 28:682-694. [PMID: 27546624 DOI: 10.1016/j.clon.2016.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 07/13/2016] [Accepted: 07/18/2016] [Indexed: 12/25/2022]
Abstract
Over the past decade the field of lung cancer management has seen many developments. Coupled with an ageing population and increasing rates of comorbid illness, the work-up for treatments with curative intent has become more complex and detailed. As well as improvements in imaging and staging techniques, developments in both surgery and radiotherapy may now allow patients who would previously have been considered unfit or not appropriate for treatment with curative intent to undergo radical therapies. This overview will highlight published studies relating to investigation and staging techniques, together with assessments of fitness, with the aim of helping clinicians to determine the most appropriate treatments for each patient. We also highlight areas where further research may be required.
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Affiliation(s)
- C Harris
- Department of Thoracic Oncology, Papworth Hospital, Cambridge, UK
| | - D Meek
- Department of Thoracic Oncology, Papworth Hospital, Cambridge, UK
| | - D Gilligan
- Department of Thoracic Oncology, Papworth Hospital, Cambridge, UK
| | - L Williams
- Department of Cardiology, Papworth Hospital, Cambridge, UK
| | - P Solli
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK
| | - R C Rintoul
- Department of Thoracic Oncology, Papworth Hospital, Cambridge, UK.
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Lagendijk JJW, van Vulpen M, Raaymakers BW. The development of the MRI linac system for online MRI-guided radiotherapy: a clinical update. J Intern Med 2016; 280:203-8. [PMID: 27197553 DOI: 10.1111/joim.12516] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- J J W Lagendijk
- Department of Radiotherapy, Centre for Image Sciences, UMC Utrecht, Utrecht, the Netherlands
| | - M van Vulpen
- Department of Radiotherapy, Centre for Image Sciences, UMC Utrecht, Utrecht, the Netherlands
| | - B W Raaymakers
- Department of Radiotherapy, Centre for Image Sciences, UMC Utrecht, Utrecht, the Netherlands
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29
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Bablekos GD, Analitis A, Michaelides SA, Charalabopoulos KA, Tzonou A. Management and postoperative outcome in primary lung cancer and heart disease co-morbidity: a systematic review and meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:213. [PMID: 27386487 DOI: 10.21037/atm.2016.06.02] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Co-morbidity of primary lung cancer (LC) and heart disease (HD), both requiring surgical therapy, characterizes a high risk group of patients necessitating prompt diagnosis and treatment. The aim of this study is the review of available evidence guiding the management of these patients. METHODS Postoperative outcome of patients operated for primary LC (first meta-analysis) and for both primary LC and HD co-morbidity (second meta-analysis), were studied. Parameters examined in both meta-analyses were thirty-day postoperative mortality, postoperative complications, three- and five-year survival probabilities. The last 36 years were reviewed by using the PubMed data base. Thirty-seven studies were qualified for both meta-analyses. RESULTS The pooled 30-day mortality percentages (%) were 4.16% [95% confidence interval (CI): 2.68-5.95] (first meta-analysis) and 5.26% (95% CI: 3.47-7.62) (second meta-analysis). Higher percentages of squamous histology and lobectomy, were significantly associated with increased (P=0.001) and decreased (P<0.001) thirty-day postoperative mortality, respectively (first meta-analysis). The pooled percentages for postoperative complications were 34.32% (95% CI: 24.59-44.75) (first meta-analysis) and 45.59% (95% CI: 35.62-55.74) (second meta-analysis). Higher percentages of squamous histology (P=0.001), lobectomy (P=0.002) and p-T1 or p-T2 (P=0.034) were associated with higher proportions of postoperative complications (second meta-analysis). The pooled three- and five- year survival probabilities were 68.25% (95% CI: 45.93-86.86) and 52.03% (95% CI: 34.71-69.11), respectively. Higher mean age (P=0.046) and percentage lobectomy (P=0.009) significantly reduced the five-year survival probability. CONCLUSIONS Lobectomy and age were both accompanied by reduced five-year survival rate. Also, combined aorto-coronary bypass grafting (CABG) with lobectomy for squamous pT1 or pT2 LC displayed a higher risk of postoperative complications. Moreover, medical decision between combined or staged surgery is suggested to be individualized based on adequacy of coronary arterial perfusion, age, patient's preoperative performance status (taking into account possible co-morbidities per patient), tumor's staging and extent of lung resection.
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Affiliation(s)
- George D Bablekos
- 1 Technological Educational Institute of Athens, Faculty of Health and Caring Professions, Agiou Spyridonos, 12243, Egaleo, Athens, Greece ; 2 Department of Physiology, Medical School, Democritus University of Thrace, Dragana 68100, Alexandroupolis, Greece ; 3 Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527, Goudi, Athens, Greece ; 4 Department of Occupational Lung Diseases and Tuberculosis, "Sismanogleio" General Hospital, 15126, Maroussi, Athens, Greece
| | - Antonis Analitis
- 1 Technological Educational Institute of Athens, Faculty of Health and Caring Professions, Agiou Spyridonos, 12243, Egaleo, Athens, Greece ; 2 Department of Physiology, Medical School, Democritus University of Thrace, Dragana 68100, Alexandroupolis, Greece ; 3 Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527, Goudi, Athens, Greece ; 4 Department of Occupational Lung Diseases and Tuberculosis, "Sismanogleio" General Hospital, 15126, Maroussi, Athens, Greece
| | - Stylianos A Michaelides
- 1 Technological Educational Institute of Athens, Faculty of Health and Caring Professions, Agiou Spyridonos, 12243, Egaleo, Athens, Greece ; 2 Department of Physiology, Medical School, Democritus University of Thrace, Dragana 68100, Alexandroupolis, Greece ; 3 Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527, Goudi, Athens, Greece ; 4 Department of Occupational Lung Diseases and Tuberculosis, "Sismanogleio" General Hospital, 15126, Maroussi, Athens, Greece
| | - Konstantinos A Charalabopoulos
- 1 Technological Educational Institute of Athens, Faculty of Health and Caring Professions, Agiou Spyridonos, 12243, Egaleo, Athens, Greece ; 2 Department of Physiology, Medical School, Democritus University of Thrace, Dragana 68100, Alexandroupolis, Greece ; 3 Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527, Goudi, Athens, Greece ; 4 Department of Occupational Lung Diseases and Tuberculosis, "Sismanogleio" General Hospital, 15126, Maroussi, Athens, Greece
| | - Anastasia Tzonou
- 1 Technological Educational Institute of Athens, Faculty of Health and Caring Professions, Agiou Spyridonos, 12243, Egaleo, Athens, Greece ; 2 Department of Physiology, Medical School, Democritus University of Thrace, Dragana 68100, Alexandroupolis, Greece ; 3 Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527, Goudi, Athens, Greece ; 4 Department of Occupational Lung Diseases and Tuberculosis, "Sismanogleio" General Hospital, 15126, Maroussi, Athens, Greece
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Mattonen SA, Ward AD, Palma DA. Pulmonary imaging after stereotactic radiotherapy-does RECIST still apply? Br J Radiol 2016; 89:20160113. [PMID: 27245137 DOI: 10.1259/bjr.20160113] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The use of stereotactic ablative radiotherapy (SABR) for the treatment of primary lung cancer and metastatic disease is rapidly increasing. However, the presence of benign fibrotic changes on CT imaging makes response assessment following SABR a challenge, as these changes develop with an appearance similar to tumour recurrence. Misclassification of benign fibrosis as local recurrence has resulted in unnecessary interventions, including biopsy and surgical resection. Response evaluation criteria in solid tumours (RECIST) are widely used as a universal set of guidelines to assess tumour response following treatment. However, in the context of non-spherical and irregular post-SABR fibrotic changes, the RECIST criteria can have several limitations. Positron emission tomography can also play a role in response assessment following SABR; however, false-positive results in regions of inflammatory lung post-SABR can be a major clinical issue and optimal standardized uptake values to distinguish fibrosis and recurrence have not been determined. Although validated CT high-risk features show a high sensitivity and specificity for predicting recurrence, most recurrences are not detected until more than 1-year post-treatment. Advanced quantitative radiomic analysis on CT imaging has demonstrated promise in distinguishing benign fibrotic changes from local recurrence at earlier time points, and more accurately, than physician assessment. Overall, the use of RECIST alone may prove inferior to novel metrics of assessing response.
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Affiliation(s)
- Sarah A Mattonen
- 1 Department of Medical Biophysics, The University of Western Ontario, London, ON, Canada
| | - Aaron D Ward
- 1 Department of Medical Biophysics, The University of Western Ontario, London, ON, Canada.,2 Department of Oncology, The University of Western Ontario, London, ON, Canada
| | - David A Palma
- 2 Department of Oncology, The University of Western Ontario, London, ON, Canada.,3 Division of Radiation Oncology, London Health Sciences Centre, London, ON, Canada
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31
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van Vulpen M, Wang L, Orton CG. Within the next five years, adaptive hypofractionation will become the most common form of radiotherapy. Med Phys 2016; 43:3941. [DOI: 10.1118/1.4951735] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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32
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Rocco G. Narcissus, the Beam, and lung cancer. J Thorac Cardiovasc Surg 2016; 152:338-343.e3. [PMID: 27209014 DOI: 10.1016/j.jtcvs.2016.04.072] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/31/2016] [Accepted: 04/24/2016] [Indexed: 12/16/2022]
Abstract
In the management of lung cancer, the rules of engagement of stereotactic ablative radiotherapy (SABR) are not clearly defined. The potential for SABR to affect to an unprecedented level current protocols and in all disease stages emerges vehemently from the literature. However, in a time when the role of surgery is being reassessed, surgeons need to take a closer look at the evidence for the use of SABR in lung cancer patients and clearly define their indisputable role within the context of multidisciplinary teams. The myth of Narcissus exemplified in the absolute masterpiece by Caravaggio seems to represent an ideal metaphor to explain the ever-evolving interaction between surgery and SABR in lung cancer management.
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Affiliation(s)
- Gaetano Rocco
- Division of Thoracic Surgery, Department of Thoracic Surgical and Medical Oncology, Istituto Nazionale Tumori, Fondazione Pascale, IRCSS, Naples, Italy.
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33
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Follow-up of patients after stereotactic radiation for lung cancer: a primer for the nonradiation oncologist. J Thorac Oncol 2016; 10:412-9. [PMID: 25695219 DOI: 10.1097/jto.0000000000000435] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The use of stereotactic ablative radiotherapy (SABR) as primary treatment for early stage non-small-cell lung cancer, or for ablation of metastases, has increased rapidly in the past decade. With local recurrence rates reported at approximately 10%, and a patient population that is becoming increasingly fit and amenable to salvage treatment, appropriate multidisciplinary follow-up care is critical. Appropriate follow-up will allow for detection and management of radiation-related toxicity, early detection of recurrent disease and differentiation of recurrence from radiation-induced lung injury. METHODS This narrative review summarizes issues surrounding follow-up of patients treated with SABR in the context of a multidisciplinary perspective. We summarize treatment-related toxicities including radiation pneumonitis, chest wall pain, rib fracture, and fatal toxicity, and highlight the challenges of early and accurate detection of local recurrence, while avoiding unnecessary biopsy or treatment of benign radiation-induced fibrotic lung damage. RESULTS Follow-up recommendations based on the current evidence and available guidelines are summarized. Imaging follow-up recommendations include serial computed tomography (CT) imaging at 3-6 months posttreatment for the initial year, then every 6-12 months for an additional 3 years, and annually thereafter. With suspicion of progressive disease, recommendations include a multidisciplinary team discussion, the use of high-risk CT features for accurate detection of local recurrence, and positron emission tomography/CT SUV max cutoffs to prompt further investigation. Biopsy and/or surgical or nonsurgical salvage therapy can be considered if safe and when investigations are nonreassuring. CONCLUSIONS The appropriate follow-up of patients after SABR requires collaborative input from nearly all members of the thoracic multidisciplinary team, and evidence is available to guide treatment decisions. Further research is required to develop better predictors of toxicity and recurrence.
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Rudokas M, Najlah M, Alhnan MA, Elhissi A. Liposome Delivery Systems for Inhalation: A Critical Review Highlighting Formulation Issues and Anticancer Applications. Med Princ Pract 2016; 25 Suppl 2:60-72. [PMID: 26938856 PMCID: PMC5588529 DOI: 10.1159/000445116] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 03/01/2016] [Indexed: 12/18/2022] Open
Abstract
This is a critical review on research conducted in the field of pulmonary delivery of liposomes. Issues relating to the mechanism of nebulisation and liposome composition were appraised and correlated with literature reports of liposome formulations used in clinical trials to understand the role of liposome size and composition on therapeutic outcome. A major highlight was liposome inhalation for the treatment of lung cancers. Many in vivo studies that explored the potential of liposomes as anticancer carrier systems were evaluated, including animal studies and clinical trials. Liposomes can entrap anticancer drugs and localise their action in the lung following pulmonary delivery. The safety of inhaled liposomes incorporating anticancer drugs depends on the anticancer agent used and the amount of drug delivered to the target cancer in the lung. The difficulty of efficient targeting of liposomal anticancer aerosols to the cancerous tissues within the lung may result in low doses reaching the target site. Overall, following the success of liposomes as inhalable carriers in the treatment of lung infections, it is expected that more focus from research and development will be given to designing inhalable liposome carriers for the treatment of other lung diseases, including pulmonary cancers. The successful development of anticancer liposomes for inhalation may depend on the future development of effective aerosolisation devices and better targeted liposomes to maximise the benefit of therapy and reduce the potential for local and systemic adverse effects.
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Affiliation(s)
- Mindaugas Rudokas
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston
| | - Mohammad Najlah
- Faculty of Medical Science, Anglia Ruskin University, Chelmsford, UK
| | - Mohamed Albed Alhnan
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston
| | - Abdelbary Elhissi
- Pharmaceutical Sciences Section, College of Pharmacy, Qatar University, Doha, Qatar
- *Dr. Abdelbary Elhissi, Pharmaceutical Sciences Section, College of Pharmacy, Qatar University, PO Box 2713, Doha (Qatar), E-Mail
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Ricardi U, Badellino S, Filippi AR. Stereotactic body radiotherapy for early stage lung cancer: History and updated role. Lung Cancer 2015; 90:388-96. [DOI: 10.1016/j.lungcan.2015.10.016] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 10/12/2015] [Indexed: 12/21/2022]
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Treatment and Prognosis of Isolated Local Relapse after Stereotactic Body Radiotherapy for Clinical Stage I Non-Small-Cell Lung Cancer. J Thorac Oncol 2015; 10:1616-24. [DOI: 10.1097/jto.0000000000000662] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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37
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Differentially expressed protein-coding genes and long noncoding RNA in early-stage lung cancer. Tumour Biol 2015; 36:9969-78. [DOI: 10.1007/s13277-015-3714-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 06/23/2015] [Indexed: 01/01/2023] Open
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Chen H, Louie AV. Stereotactic ablative radiotherapy and surgery: two gold standards for early-stage non-small cell lung cancer? ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:113. [PMID: 26207241 PMCID: PMC4481359 DOI: 10.3978/j.issn.2305-5839.2015.05.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 05/22/2015] [Indexed: 12/25/2022]
Abstract
There is growing clinical equipoise between surgery and stereotactic ablative radiotherapy (SABR) in the management of early-stage non-small cell lung cancer (ES-NSCLC). Increasing evidence suggest similar outcomes between these modalities. Through the guidance of a multidisciplinary team, a shared decision making approach in this setting in favoured.
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Affiliation(s)
- Hanbo Chen
- Department of Radiation Oncology, London Regional Cancer Program, Western University, London, ON, Canada
| | - Alexander V Louie
- Department of Radiation Oncology, London Regional Cancer Program, Western University, London, ON, Canada
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Hamaji M, Chen F, Matsuo Y, Kawaguchi A, Morita S, Ueki N, Sonobe M, Nagata Y, Hiraoka M, Date H. Video-Assisted Thoracoscopic Lobectomy Versus Stereotactic Radiotherapy for Stage I Lung Cancer. Ann Thorac Surg 2015; 99:1122-9. [DOI: 10.1016/j.athoracsur.2014.11.009] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 10/30/2014] [Accepted: 11/12/2014] [Indexed: 10/24/2022]
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Kamada T, Tsujii H, Blakely EA, Debus J, De Neve W, Durante M, Jäkel O, Mayer R, Orecchia R, Pötter R, Vatnitsky S, Chu WT. Carbon ion radiotherapy in Japan: an assessment of 20 years of clinical experience. Lancet Oncol 2015; 16:e93-e100. [PMID: 25638685 DOI: 10.1016/s1470-2045(14)70412-7] [Citation(s) in RCA: 344] [Impact Index Per Article: 38.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Charged particle therapy is generally regarded as cutting-edge technology in oncology. Many proton therapy centres are active in the USA, Europe, and Asia, but only a few centres use heavy ions, even though these ions are much more effective than x-rays owing to the special radiobiological properties of densely ionising radiation. The National Institute of Radiological Sciences (NIRS) Chiba, Japan, has been treating cancer with high-energy carbon ions since 1994. So far, more than 8000 patients have had this treatment at NIRS, and the centre thus has by far the greatest experience in carbon ion treatment worldwide. A panel of radiation oncologists, radiobiologists, and medical physicists from the USA and Europe recently completed peer review of the carbon ion therapy at NIRS. The review panel had access to the latest developments in treatment planning and beam delivery and to all updated clinical data produced at NIRS. A detailed comparison with the most advanced results obtained with x-rays or protons in Europe and the USA was then possible. In addition to those tumours for which carbon ions are known to produce excellent results, such as bone and soft-tissue sarcoma of the skull base, head and neck, and pelvis, promising data were obtained for other tumours, such as locally recurrent rectal cancer and pancreatic cancer. The most serious impediment to the worldwide spread of heavy ion therapy centres is the high initial capital cost. The 20 years of clinical experience at NIRS can help guide strategic decisions on the design and construction of new heavy ion therapy centres.
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Affiliation(s)
- Tadashi Kamada
- National Institute of Radiological Sciences, Chiba, Japan
| | | | | | - Jürgen Debus
- University of Heidelberg and Heidelberg Ion Therapy Centre, Heidelberg, Germany
| | | | - Marco Durante
- GSI Helmholtz Center for Heavy Ion Research and Darmstadt University of Technology, Darmstadt, Germany.
| | - Oliver Jäkel
- University of Heidelberg and Heidelberg Ion Therapy Centre, Heidelberg, Germany
| | | | - Roberto Orecchia
- CNAO Foundation, Pavia, and European Institute of Oncology, Milan, Italy
| | | | | | - William T Chu
- Lawrence Berkeley National Laboratory, Berkeley, CA, USA
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Cascales A, Martinetti F, Belemsagha D, Le Pechoux C. Challenges in the treatment of early non-small cell lung cancer: what is the standard, what are the challenges and what is the future for radiotherapy? Transl Lung Cancer Res 2015; 3:195-204. [PMID: 25806301 DOI: 10.3978/j.issn.2218-6751.2014.08.03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 07/23/2014] [Indexed: 12/25/2022]
Abstract
In the last 15 years, the use of Stereotactic Ablative Radiation Therapy (SABRT) in the management of small peripheral lung tumours has developed considerably, so that it currently represents a standard of care for inoperable stage I non-small cell lung cancer (NSCLC), offering a survival advantage over traditional radiotherapy, local control rates at 3 years around 90%, with a low risk of toxicity. Indications have extended to larger tumours up to 5 cm and centrally located tumours. In this review we will explore the role of SABRT in early stage NSCLC, the state of the art, the challenges and the future for this technique. There are ongoing studies to optimize such approaches within a multicentric setting. Trials comparing surgery to SABRT in operable or marginally operable have failed because of poor accrual. Several questions remain that need to be addressed in prospective studies.
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Affiliation(s)
- Almudena Cascales
- 1 Department of Radiation Oncology, 2 Medical Physics Unit, Gustave Roussy, Université Paris Sud, Villejuif, France
| | - Florent Martinetti
- 1 Department of Radiation Oncology, 2 Medical Physics Unit, Gustave Roussy, Université Paris Sud, Villejuif, France
| | - Deborah Belemsagha
- 1 Department of Radiation Oncology, 2 Medical Physics Unit, Gustave Roussy, Université Paris Sud, Villejuif, France
| | - Cecile Le Pechoux
- 1 Department of Radiation Oncology, 2 Medical Physics Unit, Gustave Roussy, Université Paris Sud, Villejuif, France
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Bertolaccini L, Terzi A, Ricchetti F, Alongi F. Surgery or stereotactic ablative radiation therapy: how will be treated operable patients with early stage not small cell lung cancer in the next future? ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:25. [PMID: 25738145 DOI: 10.3978/j.issn.2305-5839.2015.01.06] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 12/04/2014] [Indexed: 11/14/2022]
Abstract
Lung neoplasm is the most influent cause of death for cancer. With the increasing of life expectancy in elderly patients and with the intensification of lung cancer screening by low-dose computed tomography, a further rise of the number of new non-small cell lung cancer (NSCLC) cases has been shown. Standard of care of early stage NSCLC patients is lobectomy but approximately 20% of them are not fit for surgery for comorbidities. Due to the high local control rates and the little adverse effects, stereotactic body radiation therapy (SBRT) also called stereotactic ablative radiation therapy (SABR), has rapidly replaced the conventional radiotherapy in not operable patients with stage I NSCLC. We review the evidence for use of SABR in medically inoperable patients with stage I NSCLC, and its possible extension of use to operable patients, from the perspectives of radiation oncologists and thoracic surgeons. Until the results of large randomized trials will be available, the multidisciplinary management, balancing during discussion the advantages/disadvantages of each treatment modality, could be the coming soon best approach for medically operable early-stage NSCLC. As a result, the minimally invasive thoracic surgery advantages and the SABR innovations will be translated into real clinical benefits.
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Affiliation(s)
- Luca Bertolaccini
- 1 Thoracic Surgery Unit, 2 Radiation Oncology Department, Sacro Cuore-Don Calabria Hospital, 37024 Negrar Verona, Italy
| | - Alberto Terzi
- 1 Thoracic Surgery Unit, 2 Radiation Oncology Department, Sacro Cuore-Don Calabria Hospital, 37024 Negrar Verona, Italy
| | - Francesco Ricchetti
- 1 Thoracic Surgery Unit, 2 Radiation Oncology Department, Sacro Cuore-Don Calabria Hospital, 37024 Negrar Verona, Italy
| | - Filippo Alongi
- 1 Thoracic Surgery Unit, 2 Radiation Oncology Department, Sacro Cuore-Don Calabria Hospital, 37024 Negrar Verona, Italy
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Abstract
European studies have contributed significantly to the understanding of lung cancer screening. Smoking within screening, quality of life, nodule management, minimally invasive treatments, cancer prevention programs, and risk models have been extensively investigated by European groups. Mortality data from European screening studies have not been encouraging so far, but long-term results of the NELSON study are eagerly awaited. Investigations on molecular markers of lung cancer are ongoing in Europe; preliminary results suggest they may become an important screening tool in the future.
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Affiliation(s)
- Giulia Veronesi
- Lung Cancer Early Detection Unit, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
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Louie AV, Palma DA, Dahele M, Rodrigues GB, Senan S. Management of early-stage non-small cell lung cancer using stereotactic ablative radiotherapy: Controversies, insights, and changing horizons. Radiother Oncol 2015; 114:138-47. [DOI: 10.1016/j.radonc.2014.11.036] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 11/18/2014] [Accepted: 11/20/2014] [Indexed: 12/17/2022]
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Pinsky PF, Gierada DS, Hocking W, Patz EF, Kramer BS. National Lung Screening Trial findings by age: Medicare-eligible versus under-65 population. Ann Intern Med 2014; 161:627-33. [PMID: 25199624 PMCID: PMC4505793 DOI: 10.7326/m14-1484] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The NLST (National Lung Screening Trial) showed reduced lung cancer mortality in high-risk participants (smoking history of ≥30 pack-years) aged 55 to 74 years who were randomly assigned to screening with low-dose computed tomography (LDCT) versus those assigned to chest radiography. An advisory panel recently expressed reservations about Medicare coverage of LDCT screening because of concerns about performance in the Medicare-aged population, which accounted for only 25% of the NLST participants. OBJECTIVE To examine the results of the NLST LDCT group by age (Medicare-eligible vs. <65 years). DESIGN Secondary analysis of a group from a randomized trial (NCT00047385). SETTING 33 U.S. screening centers. PATIENTS 19 612 participants aged 55 to 64 years (under-65 cohort) and 7110 participants aged 65 to 74 years (65+ cohort) at randomization. INTERVENTION 3 annual rounds of LDCT screening. MEASUREMENTS Demographics, smoking and medical history, screening examination adherence and results, diagnostic follow-up procedures and complications, lung cancer diagnoses, treatment, survival, and mortality. RESULTS The aggregate false-positive rate was higher in the 65+ cohort than in the under-65 cohort (27.7% vs. 22.0%; P < 0.001). Invasive diagnostic procedures after false-positive screening results were modestly more frequent in the older cohort (3.3% vs. 2.7%; P = 0.039). Complications from invasive procedures were low in both groups (9.8% in the under-65 cohort vs. 8.5% in the 65+ cohort). Prevalence and positive predictive value (PPV) were higher in the 65+ cohort (PPV, 4.9% vs. 3.0%). Resection rates for screen-detected cancer were similar (75.6% in the under-65 cohort vs. 73.2% in the 65+ cohort). Five-year all-cause survival was lower in the 65+ cohort (55.1% vs. 64.1%; P = 0.018). LIMITATION The oldest screened patient was aged 76 years. CONCLUSION NLST participants aged 65 years or older had a higher rate of false-positive screening results than those younger than 65 years but a higher cancer prevalence and PPV. Screen-detected cancer was treated similarly in the groups. PRIMARY FUNDING SOURCE National Institutes of Health.
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46
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Stereotactic Ablative Radiation Therapy for Subcentimeter Lung Tumors: Clinical, Dosimetric, and Image Guidance Considerations. Int J Radiat Oncol Biol Phys 2014; 90:843-9. [DOI: 10.1016/j.ijrobp.2014.06.064] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 06/20/2014] [Accepted: 06/23/2014] [Indexed: 12/21/2022]
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47
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Louie AV, Senan S, Patel P, Ferket BS, Lagerwaard FJ, Rodrigues GB, Salama JK, Kelsey C, Palma DA, Hunink MG. When Is a Biopsy-Proven Diagnosis Necessary Before Stereotactic Ablative Radiotherapy for Lung Cancer? Chest 2014; 146:1021-1028. [DOI: 10.1378/chest.13-2924] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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48
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Matsuo Y, Chen F, Hamaji M, Kawaguchi A, Ueki N, Nagata Y, Sonobe M, Morita S, Date H, Hiraoka M. Comparison of long-term survival outcomes between stereotactic body radiotherapy and sublobar resection for stage I non-small-cell lung cancer in patients at high risk for lobectomy: A propensity score matching analysis. Eur J Cancer 2014; 50:2932-8. [PMID: 25281527 DOI: 10.1016/j.ejca.2014.09.006] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 08/13/2014] [Accepted: 09/02/2014] [Indexed: 12/24/2022]
Abstract
BACKGROUND The aim of this study was to perform a survival comparison between stereotactic body radiotherapy (SBRT) and sublobar resection (SLR) in patients with stage I non-small-cell lung cancer (NSCLC) at high risk for lobectomy. METHODS All patients who underwent SBRT or SLR because of medical comorbidities for clinical stage I NSCLC were reviewed retrospectively. Propensity score matching (PSM) was performed to reduce selection bias between SLR and SBRT patients based on age, gender, performance status, tumour diameter, forced expiratory volume in 1 second (FEV1) and Charlson comorbidity index (CCI). RESULTS One hundred and fifteen patients who underwent SBRT and 65 SLR were enrolled. The median potential follow-up periods for SBRT and SLR were 6.7 and 5.3 years, respectively. No treatment-related deaths were observed. Before PSM, the 5-year overall survival (OS) was 40.3% and 60.5% for SBRT and SLR, respectively (P=0.008). PSM identified 53 patients from each treatment group with similar characteristics: a median age of 76 years, a performance status of 0-1, a median tumour diameter of ∼20 mm, a median FEV1 of ∼1.8L and a median CCI of 1. The difference in OS became insignificant between the matched pairs (40.4% and 55.6% at 5 years with SBRT and SLR; P=0.124). The cumulative incidence of cause-specific death was comparable between groups (35.3% and 30.3% at 5 years, P=0.427). CONCLUSION SBRT can be an alternative treatment option to SLR for patients who cannot tolerate lobectomy because of medical comorbidities.
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Affiliation(s)
- Yukinori Matsuo
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Japan.
| | - Fengshi Chen
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Japan
| | - Masatsugu Hamaji
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Japan
| | - Atsushi Kawaguchi
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Japan
| | - Nami Ueki
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Japan
| | - Yasushi Nagata
- Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Makoto Sonobe
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Japan
| | - Masahiro Hiraoka
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Japan
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49
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Maingon P, Lisbona A. [Irradiation in stereotactic conditions: prerequisites]. Cancer Radiother 2014; 18:383-6. [PMID: 25179251 DOI: 10.1016/j.canrad.2014.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 06/20/2014] [Indexed: 12/31/2022]
Abstract
Indications of treatment by stereotactic body radiotherapy are dramatically increasing due to new potential indications. The conditions associated with the treatment delivery are multiple. The first step of the process is crucial. It is related to the validation of the indication proposed during the multidisciplinary meeting as regard the evidence-based proof of the concept. These emerging techniques mainly extracranial stereotactic body irradiation do not benefit from long-term evaluation in terms of efficiency as well as normal tissue late toxicities. Priority should be given to prospective independent clinical trials, validated by an independent scientific committee, performed under a relevant and well dedicated multicentric quality assurance program aiming to improve knowledge and selection of indications. The SFRO is still working with others professionals on the definition of the conditions for the implementation of such treatments and actively collaborates with the authorities to define the appropriate conditions to preserve the quality of the treatment delivery under these specific conditions.
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Affiliation(s)
- P Maingon
- Département de radiothérapie, centre Georges-François-Leclerc, 1, rue Professeur-Marion, 21034 Dijon cedex, France.
| | - A Lisbona
- Service de physique médicale, institut de cancérologie de l'Ouest René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain, France
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50
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Louie AV, Rodrigues GB, Palma DA, Senan S. Measuring the population impact of introducing stereotactic ablative radiotherapy for stage I non-small cell lung cancer in Canada. Oncologist 2014; 19:880-5. [PMID: 24951606 PMCID: PMC4122471 DOI: 10.1634/theoncologist.2013-0469] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 05/20/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The Cancer Risk Management Model (CRMM) was used to estimate the health and economic impact of introducing stereotactic ablative radiotherapy (SABR) for stage I non-small cell lung cancer (NSCLC) in Canada. METHODS The CRMM uses Monte Carlo microsimulation representative of all Canadians. Lung cancer outputs were previously validated internally (Statistics Canada) and externally (Canadian Cancer Registry). We updated costs using the Ontario schedule of fees and benefits or the consumer price index to calculate 2013 Canadian dollars, discounted at a 3% rate. The reference model assumed that for stage I NSCLC, 75% of patients undergo surgery (lobectomy, sublobar resection, or pneumonectomy), 12.5% undergo radiotherapy (RT), and 12.5% undergo best supportive care (BSC). SABR was introduced in 2008 as an alternative to sublobar resection, RT, and BSC at rates reflective of the literature. Incremental cost effectiveness ratios (ICERs) were calculated; a willingness-to-pay threshold of $100,000 (all amounts are in Canadian dollars) per quality-adjusted life-year (QALY) was used from the health care payer perspective. RESULTS The total cost for 25,085 new cases of lung cancer in 2013 was calculated to be $608,002,599. Mean upfront costs for the 4,318 stage I cases were $7,646.98 for RT, $8,815.55 for SABR, $12,161.17 for sublobar resection, $16,266.12 for lobectomy, $22,940.59 for pneumonectomy, and $14,582.87 for BSC. SABR dominated (higher QALY, lower cost) RT, sublobar resection, and BSC. RT had lower initial costs than SABR that were offset by subsequent costs associated with recurrence. Lobectomy was cost effective when compared with SABR, with an ICER of $55,909.06. CONCLUSION The use of SABR for NSCLC in Canada is projected to result in significant cost savings and survival gains.
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Affiliation(s)
- Alexander V Louie
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands; Department of Radiation Oncology, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; Department of Epidemiology, Harvard School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - George B Rodrigues
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands; Department of Radiation Oncology, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; Department of Epidemiology, Harvard School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - David A Palma
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands; Department of Radiation Oncology, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; Department of Epidemiology, Harvard School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Suresh Senan
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands; Department of Radiation Oncology, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada; Department of Epidemiology, Harvard School of Public Health, Harvard University, Boston, Massachusetts, USA
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