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Wang C, Chiu S, Wu S, Pan L, Yen Y, Lai Y, Chen C. Treatment and mortality risk of older adults with non-small cell cancer in Taiwan: A population-based cohort study. Thorac Cancer 2023; 14:2687-2695. [PMID: 37551918 PMCID: PMC10493478 DOI: 10.1111/1759-7714.15055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Older patients tend to have decreased physical functions and more comorbidities than younger patients. At present, the best management for very elderly patients with lung cancer is not known. In this study, we aimed to investigate treatment and mortality risk of older adults with non-small cell cancer (NSCLC) in Taiwan. METHODS This study analyzed data from the Taiwan Cancer Registry database. Patients aged ≥80 years with newly diagnosed NSCLC between 2010 and 2017 were included. Treatment options were categorized as curative, palliative, and no treatment. Patients were followed up until death or December 31, 2020. Univariable and multivariable Cox proportional hazards models were used to estimate mortality risk, and Kaplan-Meier survival curves were drawn. RESULTS A total of 11 941 patients, aged ≥80 years, with newly diagnosed NSCLC between 2010 and 2017 were identified from the Taiwan Cancer Registry and followed up until 2020. The mean age was 84.4 ± 3.7 years old, and 7468 (62.54%) were men. The Kaplan-Meier survival curves showed significant differences across the three treatment options (log-rank p < 0.001). Results from multivariate Cox regression demonstrated that patients on palliative treatment (adjusted HR: 0.52, 95% CI: 0.48-0.56, p < 0.001) and curative treatment (adjusted HR: 0.45, 95% CI: 0.42-0.48, p < 0.001) had a significantly lower mortality risk than those with no treatment. The subgroup analyses stratified by cancer stages also showed consistent findings. CONCLUSION Elderly patients with NSCLC had significantly decreased mortality risk when receiving curative or palliative treatment compared with those without treatment. In the future, further studies are warranted to investigate complications and quality of life of elderly patients with NSCLC during palliative or curative treatment.
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Affiliation(s)
- Chun‐Chieh Wang
- Division of Chest Medicine, Department of Internal MedicinePuli Branch of Taichung Veterans General HospitalNantouTaiwan
- Department of EldercareCentral Taiwan University of Science and TechnologyTaichungTaiwan
| | - Shao‐Wen Chiu
- Healthcare Technology Business Division, Healthcare DepartmentInternational Integrated SystemsTaipeiTaiwan
| | - Shang‐Jung Wu
- Department of NursingPuli Branch of Taichung Veterans General HospitalNantouTaiwan
| | - Lung‐Kwang Pan
- Department of Medical Imaging and Radiological ScienceCentral Taiwan University of Science and TechnologyTaichungTaiwan
| | - Yung‐Feng Yen
- Section of Infectious Diseases, Taipei City Hospital, Taipei City GovernmentTaipeiTaiwan
- Institute of Hospital and Health Care AdministrationNational Yang‐Ming UniversityTaipeiTaiwan
- Department of Health Care ManagementNational Taipei University of Nursing and Health SciencesTaipeiTaiwan
| | - Yun‐Ju Lai
- Department of Health Care ManagementNational Taipei University of Nursing and Health SciencesTaipeiTaiwan
- School of MedicineNational Yang‐Ming UniversityTaipeiTaiwan
- Department of Exercise Health ScienceNational Taiwan University of SportTaichungTaiwan
- Division of Endocrinology and Metabolism, Department of Internal MedicinePuli Branch of Taichung Veterans General HospitalNantouTaiwan
| | - Chu‐Chieh Chen
- Department of Health Care ManagementNational Taipei University of Nursing and Health SciencesTaipeiTaiwan
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Liu W, Ma S, Shi P, Zhang Y, Li M. Postoperative chemotherapy significantly improves survival of elderly patients with stage IB-II non-small cell lung cancer: A population-based study. Cancer Med 2023. [PMID: 37031456 DOI: 10.1002/cam4.5834] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 02/23/2023] [Accepted: 03/12/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND There is scant evidence-based information about survival benefits of postoperative chemotherapy in elderly patients with early-stage non-small cell lung cancer (NSCLC). The purpose of this study is to compare the overall survival (OS) and cancer-specific survival (CSS) rates of surgery alone versus postoperative chemotherapy in patients aged ≥70 years with stage I-II NSCLC. METHODS Elderly patients aged ≥70 years diagnosed with stage I-II NSCLC were selected from the Surveillance, Epidemiology, and End Results (SEER) database from January 1, 2010 to December 31, 2015. OS and CSS were compared between the two groups utilizing overlap weighting analysis, inverse probability of treatment weight (IPTW), and propensity score matching (PSM). RESULTS Of the 7193 included patients with stage I-II NSCLC who are more than 70 years old, 681 patients (9.5%) received postoperative chemotherapy and 6512 patients (90.5%) received surgery-alone. Median OS was 77 months in postoperative chemotherapy group versus 79 months in surgery-alone group (p = 0.89). The result of IPTW analysis showed the similar results. The probability of patients choosing chemotherapy increased with the AJCC stage and Grade increasing (p < 0.001) and decreased with the growth of age (p < 0.001). The results of subgroup analysis showed that the survival rate of stage IA patients decreased significantly after postoperative chemotherapy (p < 0.01) while the survival rate of stage IB-II patients increased significantly (p < 0.01). At the same time, we found that patients in the postoperative chemotherapy group tended to have better OS than those in the surgery-alone group with the grade and tumor size increasing. CONCLUSION The results of this study indicated that postoperative chemotherapy could significantly improve the survival of stage IB-II NSCLC patients aged ≥70 years, and decrease the survival of stage IA patients.
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Affiliation(s)
- Wujianhong Liu
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Shangshang Ma
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Pingfan Shi
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Yanfei Zhang
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Ming Li
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
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3
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Rong F, Shi R, Hu L, Chen R, Wang D, Lv X, Zhao Y, Huang W, Yang Y, Zhou H, Hong K. Low-dose computed tomography for lung cancer screening in Anhui, China: A randomized controlled trial. Front Oncol 2022; 12:1059999. [PMID: 36591449 PMCID: PMC9795014 DOI: 10.3389/fonc.2022.1059999] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022] Open
Abstract
Background Lung cancer is the leading cause of cancer-related death worldwide, with risk factors such as age and smoking. Low-dose computed tomography screening can reduce lung cancer mortality. However, its effectiveness in Asian populations remains unclear. Most Asian women with lung cancer are non-smokers who have not been screened. We conducted a randomized controlled trial to evaluate the performance of low-dose computed tomography screening in a Chinese population, including high-risk smokers and non-smokers exposed to passive smoking. The baseline data are reported in this study. Methods Between May and December 2019, eligible participants were randomized in a ratio of 1:1:1 to a screening (two arms) or control cohort. Non-calcified nodules/masses with a diameter >4 mm on low-dose computed tomography were considered positive findings. Results In total, 600 patients (mean age, 59.1 ± 6.9 years) underwent low-dose computed tomography. Women accounted for 31.5% (189/600) of patients; 89.9% (170/189) were non-smokers/passive smokers. At baseline, the incidence of lung cancer was 1.8% (11/600). The incidence of lung cancer was significantly lower in smokers than in female non-smokers/passive smokers (1.0% [4/415] vs. 4.1% [7/170], respectively; P=0.017). Stage 0-I lung cancer accounted for 90.9% (10/11) of cases. Conclusions We demonstrate the importance of including active smokers and female non-smokers/passive smokers in lung cancer screening programs. Further studies are needed to explore the risk factors, and long-term cost-benefit of screening Asian non-smoking women. Clinical trial registration http://chictr.org.cn/showproj.aspx?proj=39003, identifier ChiCTR1900023197.
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4
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Yang H, Zeng X, Zhang Y, Tong W, Yao G, Lan C, Liu J, Liu Z, Zhong N. Influence of ABO blood group on susceptibility to different pathological types of lung cancer: a retrospective study. World J Surg Oncol 2022; 20:379. [DOI: 10.1186/s12957-022-02845-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 11/20/2022] [Indexed: 12/05/2022] Open
Abstract
Abstract
Purpose
Current research has shown a link between ABO blood group and many diseases. The purpose of this study aimed to investigate the influence of the ABO blood group on the risk of developing different pathological types of lung cancer.
Materials and methods
This retrospective study was composed of 7681 patients with lung cancer and 12, 671 non-lung cancer patients who were admitted to the First Affiliated Hospital of Nanchang University from January 2016 to January 2021. The subjects with lung cancer were grouped into small cell lung cancer group (n = 725), lung adenocarcinoma group (n = 4520), and lung squamous cell carcinoma group (n = 2286) according to pathological types. The ABO blood group distribution of each lung cancer type group was compared with that of the control group. Statistical analysis was determined with chi-square and logistic regression.
Results
Univariate analysis showed that the ABO blood group distribution of lung adenocarcinoma, lung squamous cell carcinoma, and small cell lung cancer was different from that of the control group (P < 0.01). After adjusting for age, sex, smoking history, and drinking history, logistic regression analysis showed that the risk of lung adenocarcinoma in blood type O was higher than that in blood type A (P < 0.01). There was no significant difference in ABO blood group composition between small cell lung cancer group, lung squamous cell carcinoma group, and control group (P > 0.05). In addition, gender and age have an influence on all three types of lung cancer (P < 0.01). Smoking was a risk factor in lung squamous cell carcinoma and small cell carcinoma (P < 0.01). Alcohol consumption was a risk factor in lung adenocarcinoma (P < 0.01).
Conclusion
ABO blood group may be correlated with the occurrence of lung adenocarcinoma in Jiangxi province, but not with lung squamous cell carcinoma and small cell carcinoma.
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5
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Chen C, Kolbe J, Christmas T. Surgical treatment of non-small-cell lung cancer in octogenarians: a single-centre retrospective study. Intern Med J 2021; 51:596-599. [PMID: 33890378 DOI: 10.1111/imj.15268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 10/01/2020] [Accepted: 10/01/2020] [Indexed: 11/30/2022]
Abstract
Lung resection in patients aged ≥80 years is considered high risk and contributes to the low rates of resection in this population. This review of 79 octogenarians who underwent curative surgery for non-small-cell lung cancer demonstrated no intraoperative mortality, 30-day mortality of 1.3% and 12-month mortality of 10%. In this selected cohort of octogenarians, surgery resulted in acceptable short- to medium-term outcomes.
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Affiliation(s)
- Charlotte Chen
- Respiratory Services, Auckland District Health Board, Auckland, New Zealand
| | - John Kolbe
- Respiratory Services, Auckland District Health Board, Auckland, New Zealand.,Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Tim Christmas
- Respiratory Services, Auckland District Health Board, Auckland, New Zealand
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Artificial Intelligence Tools for Refining Lung Cancer Screening. J Clin Med 2020; 9:jcm9123860. [PMID: 33261057 PMCID: PMC7760157 DOI: 10.3390/jcm9123860] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/19/2020] [Accepted: 11/25/2020] [Indexed: 12/19/2022] Open
Abstract
Nearly one-quarter of all cancer deaths worldwide are due to lung cancer, making this disease the leading cause of cancer death among both men and women. The most important determinant of survival in lung cancer is the disease stage at diagnosis, thus developing an effective screening method for early diagnosis has been a long-term goal in lung cancer care. In the last decade, and based on the results of large clinical trials, lung cancer screening programs using low-dose computer tomography (LDCT) in high-risk individuals have been implemented in some clinical settings, however, this method has various limitations, especially a high false-positive rate which eventually results in a number of unnecessary diagnostic and therapeutic interventions among the screened subjects. By using complex algorithms and software, artificial intelligence (AI) is capable to emulate human cognition in the analysis, interpretation, and comprehension of complicated data and currently, it is being successfully applied in various healthcare settings. Taking advantage of the ability of AI to quantify information from images, and its superior capability in recognizing complex patterns in images compared to humans, AI has the potential to aid clinicians in the interpretation of LDCT images obtained in the setting of lung cancer screening. In the last decade, several AI models aimed to improve lung cancer detection have been reported. Some algorithms performed equal or even outperformed experienced radiologists in distinguishing benign from malign lung nodules and some of those models improved diagnostic accuracy and decreased the false-positive rate. Here, we discuss recent publications in which AI algorithms are utilized to assess chest computer tomography (CT) scans imaging obtaining in the setting of lung cancer screening.
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Ni X, Zhang B, Xu N, Zeng X, Wang Q. Trends and Regional Distribution Pattern of Female Lung Cancer - China, 1992-2016. China CDC Wkly 2020; 2:614-618. [PMID: 34594721 PMCID: PMC8422195 DOI: 10.46234/ccdcw2020.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 08/01/2020] [Indexed: 12/24/2022] Open
Abstract
What is already known about this topic? The incidence of female lung cancer in China has been rising, whereas the incidence ratio among men and women is declining. The rising trend of female lung cancer is a prominent public health concern for China. What is added by this report? The joint secular trends distribution of the incidence, mortality, and years of life lost (YLLs) due to premature death of lung cancer in Chinese women demonstrated a certain regionality, which implied the risk factors for female lung cancer in China might be different by region. Common determinant risk factors may exist in regions sharing the same joint secular trends. What are the implications for public health practice? The secular trends and the regional pattern of the trends of female lung cancer in China suggested that the prevention and control of female lung cancer should be implemented with targeted regional interventions.
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Affiliation(s)
- Xue Ni
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Bei Zhang
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ning Xu
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xinying Zeng
- The National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qiang Wang
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
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8
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Chen E, Senders ZJ, Hardacre J, Kim J, Ammori J. Perioperative outcomes and survival of octogenarians undergoing curative resection for esophagogastric adenocarcinoma. J Surg Oncol 2020; 121:1015-1021. [PMID: 32090338 DOI: 10.1002/jso.25866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 02/07/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Current data are conflicting as to whether the outcomes of octogenarians undergoing resection for esophagogastric adenocarcinoma are comparable to younger patients. This study aims to compare perioperative outcomes and survival of patients ≥80 years old with younger patients undergoing curative resection for esophagogastric adenocarcinoma. METHODS Retrospective data were collected on 190 patients who underwent resection with curative intent for adenocarcinomas found in the stomach and esophagogastric junction from 2004 to 2015 at a single institution. RESULTS Of the 190 patients, 34 (18%) were ≥80 years old. Octogenarians were more likely to have chronic kidney disease (CKD) and were less likely to have received neoadjuvant chemotherapy. Pathologic features were similar between groups. Octogenarians' tumors were more likely to be located in the gastric body as compared to the esophagogastric junction in younger patients. Although the length of stay was comparable, octogenarians were significantly less likely to be discharged home (P < .01). Both groups had a single death during the index admission. Incidence and severity of 90 days postoperative complications were not significantly different between groups. There was no difference in 30-day, 90-day, 1-year, or median survival. CONCLUSIONS Perioperative outcomes and survival of octogenarians undergoing curative resection for esophagogastric cancer are comparable to younger patients at our institution.
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Affiliation(s)
- Eric Chen
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Zachary J Senders
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Jeffrey Hardacre
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Julian Kim
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - John Ammori
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
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"Age matters"-German claims data indicate disparities in lung cancer care between elderly and young patients. PLoS One 2019; 14:e0217434. [PMID: 31188861 PMCID: PMC6561547 DOI: 10.1371/journal.pone.0217434] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/28/2019] [Indexed: 12/25/2022] Open
Abstract
Background Although lung cancer is most commonly diagnosed in elderly patients, evidence about tumor-directed therapy in elderly patients is sparse, and it is unclear to what extent this affects treatment and care. Our study aimed to discover potential disparities in care between elderly patients and those under 65 years of age. Methods We studied claims from 13 283 German patients diagnosed with lung cancer in 2009 who survived for at least 90 days after diagnosis. We classified patients as “non-elderly” (≤ 65), “young-old” (65–74), “middle-old” (75–84), and “old-old” (≥ 85). We compared receipt of tumor-directed therapy (6 months after diagnosis), palliative care, opioids, antidepressants, and pathologic diagnosis confirmation via logistic regression. We used generalized linear regression (gamma distribution) to compare group-specific costs of care for 3 months after diagnosis. We adjusted all models by age, nursing home residency, nursing care need, comorbidity burden, and area of residence (urban, rural). The age group “non-elderly” served as reference group. Results Compared with the reference group “non-elderly”, the likelihood of receiving any tumor-directed treatment was significantly lower in all age groups with a decreasing gradient with advancing age. Elderly lung cancer patients received significantly fewer resections and radiotherapy than non-elderly patients. In particular, treatment with antineoplastic therapy declined with increasing age (“young-old” (OR = 0.76, CI = [0.70,0.83]), “middle-old” (OR = 0.45, CI = [0.36,0.50]), and “old-old” (OR = 0.13, CI = [0.10,0.17])). Patients in all age groups were less likely to receive structured palliative care than “non-elderly” (“young-old” (OR = 0.84, CI = [0.76,0.92]), “middle-old” (OR = 0.71, CI = [0.63,0.79]), and “old-old” (OR = 0.57, CI = [0.44,0.73])). Moreover, increased age was significantly associated with reduced quotas for outpatient treatment with opioids and antidepressants. Costs of care decreased significantly with increasing age. Conclusion This study suggests the existence of age-dependent care disparities in lung cancer patients, where elderly patients are at risk of potential undertreatment. To support equal access to care, adjustments to public health policies seem to be urgently required.
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Sarkaria IS, Gorrepati ML, Mehendale S, Oh DS. Lobectomy in octogenarians: real world outcomes for robotic-assisted, video-assisted thoracoscopic, and open approaches. J Thorac Dis 2019; 11:2420-2430. [PMID: 31372279 DOI: 10.21037/jtd.2019.05.52] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background The proportion of the elderly (≥80 years old) patient population in the United States is increasing. Consequently, surgeons are more involved in the care of these patients than they had been in the past. Therefore, surgeons must re-evaluate their prior assumptions about their surgical management of octogenarian patients. Although open thoracotomy is a popular approach for pulmonary lobectomy, minimally invasive techniques are associated with improved outcomes in this frail patient population. Our goal was to evaluate perioperative outcomes of standard open lobectomy to both video-assisted thoracoscopic and robotic-assisted lobectomy in patients ≥80 years old. Methods Octogenarian patients, who underwent elective pulmonary lobectomy from January 1, 2011 through September 30, 2015, were identified from the National Premier Healthcare Database. One-to-one propensity score matching (PSM) was performed between robotic-assisted and open lobectomy populations and between video-assisted thoracoscopic and open lobectomy populations. Rates of perioperative outcomes from each comparison were analyzed. Results Of the 1,849 octogenarian patients who satisfied the inclusion criteria, propensity-score matched (1:1) comparative analyses of robotic-assisted lobectomy (n=232) and open lobectomy (n=232) patients as well as video-assisted thoracoscopic lobectomy (n=562) and open lobectomy (n=562) patients were made. Both robotic-assisted and video-assisted thoracoscopic lobectomy cohorts were associated with shorter lengths of stay (both P<0.001) and higher rates of discharge to home compared to open lobectomy (P=0.0435 and P=0.0037, respectively). Robotic-assisted lobectomy was associated with fewer postoperative complications compared to open lobectomy (P=0.0249). Conclusions Minimally invasive lobectomy is a viable surgical option in octogenarians and provides improved outcomes compared to open thoracotomy in a retrospective cohort. Carefully selected patients can achieve excellent outcomes.
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Affiliation(s)
- Inderpal S Sarkaria
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | | | - Daniel S Oh
- Clinical Affairs, Intuitive Surgical, Inc., Sunnyvale, CA, USA.,Division of Thoracic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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11
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Mery B, Rancoule C, Assouline A, Aissou L, Falk AT, Auberdiac P, Vallard A, Chargari C, Magné N. Efficacy and tolerance of thoracic radiotherapy in the oldest old patients: A case series. Indian J Cancer 2019; 56:163-166. [PMID: 31062737 DOI: 10.4103/ijc.ijc_346_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND There are only scarce data on the management of nonagenarians with lung cancer, and more particularly on the place of radiation therapy. The aim of the present study was to retrospectively evaluate the efficacy and tolerance of radiotherapy (RT) in nonagenarians with thoracic cancer. PATIENTS AND METHODS Records from RT departments from four institutions were reviewed to identify patients 90 years old of age and older undergoing RT over the past decade for thoracic cancer and more particularly lung cancer. Tumors' characteristics as well as treatment specificities and its intent were examined. RESULTS Thirteen patients receiving RT courses were identified, mean age 91.9 years. Treatment was given with curative and palliative intent in 15.4% and 84.6%, respectively. The median total prescribed dose was 30 Gy (4-70). The median number of fractions was equal to 10 (1-35). The median dose received for each fraction was 3 Gy (1.7-7). RT could not be completed in 2 patients (15.4%). At last follow-up, 11 patients (76.9%) were deceased, cancer being the cause of death for 90% of them. Most toxicities were grade 1 or 2. Two patients (15.4% of cases) have developed grade 2 toxicity during treatment. One patient (7.7% of cases) experienced an acute grade 3 toxicity. CONCLUSION The study shows that RT for thoracic cancer is feasible in nonagenarians. Although the definitive benefit of RT could not be addressed here, hypofractionated therapy allowed a certain measure of control with acceptable side effects.
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Affiliation(s)
- Benoite Mery
- Department of Medical Oncology and Radiotherapy, Institut de Cancérologie Lucien Neuwirth, 42271 Saint Priest en Jarez, France
| | - Chloe Rancoule
- Department of Medical Oncology and Radiotherapy, Institut de Cancérologie Lucien Neuwirth, 42271 Saint Priest en Jarez, France
| | - Avi Assouline
- Department of Radiotherapy, Centre Clinique de la Porte de Saint Cloud, Boulogne-Billancourt, France
| | - Lounis Aissou
- Department of Medical Oncology and Radiotherapy, Institut de Cancérologie Lucien Neuwirth, 42271 Saint Priest en Jarez, France
| | - Alexander T Falk
- Department of Radiotherapy, Centre Antoine Lacassagne, Nice, France
| | - Pierre Auberdiac
- Department of Radiotherapy, Clinique Claude Bernard, Albi, France
| | - Alexis Vallard
- Department of Medical Oncology and Radiotherapy, Institut de Cancérologie Lucien Neuwirth, 42271 Saint Priest en Jarez, France
| | - Cyrus Chargari
- Department of Radiation Oncology, Gustave Roussy Cancer Center, 94800, Villejuif, France
| | - Nicolas Magné
- Department of Medical Oncology and Radiotherapy, Institut de Cancérologie Lucien Neuwirth, 42271 Saint Priest en Jarez, France
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12
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Competing Risk Analysis in Lung Cancer Patients Over 80 Years Old Undergoing Surgery. World J Surg 2019; 43:1857-1866. [DOI: 10.1007/s00268-019-04982-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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13
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Tufman A, Kahnert K, Duell T, Kauffmann-Guerrero D, Milger K, Schneider C, Stump J, Syunyaeva Z, Huber RM, Reu S. Frequency and clinical relevance of EGFR mutations and EML4-ALK translocations in octogenarians with non-small cell lung cancer. Onco Targets Ther 2017; 10:5179-5186. [PMID: 29123416 PMCID: PMC5661834 DOI: 10.2147/ott.s140472] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background Tyrosine kinase inhibitors (TKIs) have improved response rates in some patients with non-small cell lung cancer (NSCLC), and testing for EGFR mutation and ALK translocation is recommended for all patients with advanced lung adenocarcinoma. The frequency of driver mutations in elderly and very elderly patients has not been described. Patients and methods We reviewed EGFR and ALK in patients over the age of 70 years diagnosed and treated at our center in 2015 (subgroups: 70-74, 75-79 and >80 years). We then assessed a second cohort, including all patients with lung cancer over the age of 80 years diagnosed in 2014. We also analyzed smoking history, treatment and response. Results In the 2015 cohort of 179 patients, 16 were 80 years or older at diagnosis. Six of eight (75%) octogenarians with non-squamous NSCLC were EGFR or ALK positive. The 2014 cohort confirmed the high rate of driver alterations in octogenarians. Of 334 patients, 32 were 80 years or older and, of these, 10 had non-squamous histology and were tested for driver alterations (four of 10 [40%] EGFR or ALK positive). Rates of genetic drivers were somewhat lower in patients with non-squamous NSCLC aged 70-74 years (27.0%) and 75-79 years (26.7%). When treated with a TKI, octogenarians had high response rates and progression-free survival. Most octogenarians with lung adenocarcinoma were never smokers, with an inverse correlation of pack-years smoked to age at diagnosis. Conclusion Very elderly patients with non-squamous NSCLC show high rates of driver alterations in EGFR and ALK. This, often frail and comorbid, population may not be fit for treatment with cytotoxic chemotherapy and may benefit from targeted treatments. Testing for EGFR and ALK alterations should not be restricted to younger patients. The biology of lung cancer in the very elderly may differ from that of moderately elderly patients, as longevity may select for individuals more resistant to, or with little exposure to, environmental carcinogens.
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Affiliation(s)
- Amanda Tufman
- Division of Respiratory Medicine and Thoracic Oncology, Department of Internal Medicine V, Thoracic Oncology Centre Munich, Ludwig-Maximilians University.,German Center for Lung Research, Comprehensive Pneumology Center (DZL CPC-M)
| | - Kathrin Kahnert
- Division of Respiratory Medicine and Thoracic Oncology, Department of Internal Medicine V, Thoracic Oncology Centre Munich, Ludwig-Maximilians University.,German Center for Lung Research, Comprehensive Pneumology Center (DZL CPC-M)
| | - Thomas Duell
- German Center for Lung Research, Comprehensive Pneumology Center (DZL CPC-M).,Asklepios Pulmonary Hospital in Munich-Gauting
| | - Diego Kauffmann-Guerrero
- Division of Respiratory Medicine and Thoracic Oncology, Department of Internal Medicine V, Thoracic Oncology Centre Munich, Ludwig-Maximilians University.,German Center for Lung Research, Comprehensive Pneumology Center (DZL CPC-M)
| | - Katrin Milger
- Division of Respiratory Medicine and Thoracic Oncology, Department of Internal Medicine V, Thoracic Oncology Centre Munich, Ludwig-Maximilians University.,German Center for Lung Research, Comprehensive Pneumology Center (DZL CPC-M)
| | - Christian Schneider
- German Center for Lung Research, Comprehensive Pneumology Center (DZL CPC-M).,Department of Thoracic Surgery
| | - Julia Stump
- Division of Respiratory Medicine and Thoracic Oncology, Department of Internal Medicine V, Thoracic Oncology Centre Munich, Ludwig-Maximilians University.,German Center for Lung Research, Comprehensive Pneumology Center (DZL CPC-M)
| | - Zulfiya Syunyaeva
- Division of Respiratory Medicine and Thoracic Oncology, Department of Internal Medicine V, Thoracic Oncology Centre Munich, Ludwig-Maximilians University.,German Center for Lung Research, Comprehensive Pneumology Center (DZL CPC-M)
| | - Rudolf Maria Huber
- Division of Respiratory Medicine and Thoracic Oncology, Department of Internal Medicine V, Thoracic Oncology Centre Munich, Ludwig-Maximilians University.,German Center for Lung Research, Comprehensive Pneumology Center (DZL CPC-M)
| | - Simone Reu
- German Center for Lung Research, Comprehensive Pneumology Center (DZL CPC-M).,Pathology Institute, Ludwig-Maximilians University, Munich, Germany
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Significance of Body Mass Index for Postoperative Outcomes after Lung Cancer Surgery in Elderly Patients. World J Surg 2017; 42:153-160. [DOI: 10.1007/s00268-017-4142-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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15
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[Non-small cell lung cancer irradiation in elderly]. Cancer Radiother 2016; 20:322-9. [PMID: 27342942 DOI: 10.1016/j.canrad.2016.01.013] [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: 12/09/2015] [Revised: 01/13/2016] [Accepted: 01/15/2016] [Indexed: 12/18/2022]
Abstract
People over the age of 65 are often excluded from participation in oncological clinical trials. However, more than half of patients diagnosed with non-small-cell lung cancer are older than 65 years. Any therapeutic strategy must be discussed in multidisciplinary meetings after adapted geriatric assessment. Patients who benefit from the comprehensive geriatric assessment (CGA) of Balducci and Extermann are those whose G8 screening tool score is less than or equal to 14. Age itself does not contraindicate a curative therapeutic approach. Stereotactic radiotherapy is an alternative to surgery for early stages in elderly patients who are medically inoperable or who refuse surgery, because it significantly increases overall survival. Mostly sequential (rarely concomitant) chemoradiotherapy can be proposed to elderly patients with locally advanced stages in good general state of health. For the others, an exclusive palliative radiotherapy, a single or dual agent of chemotherapy, a targeted drug or best supportive care only may be discussed.
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Vavalà T, Follador A, Tiseo M, Galetta D, Morabito A, Di Maio M, Martelli O, Caffo O, Piovano PL, Cortinovis D, Zilembo N, Casartelli C, Banna GL, Ardizzoia A, Barzelloni ML, Bearz A, Genestreti G, Mucciarini C, Filipazzi V, Menis J, Rizzo E, Barbieri F, Rijavec E, Cecere F, Bria E, Spitaleri G, Rossi A, Novello S. BE-POSITIVE: Beyond progression after tyrosine kinase inhibitor in EGFR- positive non small cell lung cancer patients: Results from a multicenter Italian observational study. Lung Cancer 2016; 95:73-81. [PMID: 27040855 DOI: 10.1016/j.lungcan.2016.02.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 02/22/2016] [Accepted: 02/24/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Non-small-cell-lung-cancer (NSCLC) patients harbouring epidermal growth factor receptor (EGFR) mutations develop drug resistance after 9-12 months of EGFR tyrosine kinase inhibitors (TKIs) therapy pointing out the issue of the second-line treatment choice. MATERIALS AND METHODS From June 2009 until May 2013 patients affected by advanced NSCLC harbouring EGFR mutations receiving first-line TKI were collected mainly retrospectively in 24 Italian Centers. Primary objective was to describe the percentage of EGFR mutated patients receiving second-line therapy after progression to first-line EGFR-TKIs assessing the type, the activity in terms of objective response rate (ORR), efficacy in terms of progression free survival (PFS) and overall survival (OS), and safety of second-line treatment. Secondary objective was to describe the efficacy of first-line EGFR-TKIs. RESULTS 312 patients were included. Most of them were females (203, 65.1%), never smokers (200, 64.1%), with adenocarcinoma histology (290, 92.9%). The most common mutations were EGFR exon 19 deletion and L858R, detected in 186 and 97 cases (59.6% and 31.1%), respectively. At data cut-off, 274 patients (95.1%) received any second-line treatment (including best supportive care or local treatments only). A total of 163 patients received second-line systemic therapy with an ORR of 20.9% (95% CI:14.62-27.10), a median PFS and OS of 4.7 (95% CI:3.81-5.26) and 24.5 (95% CI:21.65-27.37) months, respectively. Grade 3-4 hematological and non-hematological toxicities were reported in 9% and 6.3% of 144 patients treated with chemotherapy while non-hematological toxicity was reported in 4 cases of the 17 patients receiving second-line target agents. CONCLUSIONS BE-Positive is the first multicenter observational study reporting outcomes of therapies in a "real-life Caucasian EGFR-mutated population", highlighting the need of further researches about new treatment strategies in this setting.
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Affiliation(s)
- Tiziana Vavalà
- Department of Oncology, University of Torino AOU San Luigi, Regione Gonzole 10, 10043 Orbassano (TO), Italy
| | - Alessandro Follador
- Department of Oncology, University Hospital of Udine, Piazzale S. Maria della Misericordia 15, 33100 Udine, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, via Gramsci, 14, 43126 Parma, Italy
| | - Domenico Galetta
- Medical Oncology Unit, Clinical Cancer Center Giovanni Paolo II, viale Orazio Flacco, 65, 70124 Bari, Italy
| | - Alessandro Morabito
- Thoracic Medical Oncology, National Cancer Institute, Fondazione "G.Pascale", via Mariano Semmola 80131, Napoli, Italy
| | - Massimo Di Maio
- Clinical Trials Unit, National Cancer Institute, Fondazione "G.Pascale", via Mariano Semmola, 80131 Napoli, Italy
| | - Olga Martelli
- Medical Oncology, S.Giovanni-Addolorata Hospital, via di S. Stefano Rotondo 5a, 00184 Roma, Italy
| | - Orazio Caffo
- Medical Oncology Unit, Santa Chiara Hospital, Largo Medaglie D'oro 9, 38122 Trento, Italy
| | - Pier Luigi Piovano
- Medical Oncology Unit, AO SS. Antonio Biagio e Cesare Arrigo, via S. Pio V 5, Alessandria, Italy
| | - Diego Cortinovis
- Medical Oncology Unit, AOU San Gerardo, via Giambattista Pergolesi 33, 20900 Monza, Italy
| | - Nicoletta Zilembo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, via Giacomo Venezian 1, Milano, Italy
| | - Clelia Casartelli
- Medical Oncology Unit, Valduce Hospital, via Dante Alighieri 11, 22100 Como, Italy
| | - Giuseppe Luigi Banna
- Division of Medical Oncology, AO Cannizzaro Hospital, via Messina 829, 95126 Catania, Italy
| | - Antonio Ardizzoia
- Medical Oncology Unit, A.Manzoni Hospital via dell'Eremo 9/11, 23900 Lecco, Italy
| | - Maria Luisa Barzelloni
- AOU San Giovanni di Dio e Ruggi d' Aragona c/o P.O. G. da Procida, largo Città di Ippocrate, 84131 Salerno, Italy
| | - Alessandra Bearz
- Department of Medical Oncology, National Institute for Cancer Research, via Franco Gallini 2, Aviano (PN), Italy
| | - Giovenzio Genestreti
- Department of Medical Oncology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), via Piero Maroncelli 40, 47014 Meldola, Italy
| | - Claudia Mucciarini
- Department of Oncological Medicine, Ramazzini Hospital, via Guido Molinari 2, 41012 Carpi (MO), Italy
| | - Virginio Filipazzi
- UOC Medical Oncology, AO Luigi Sacco, via Giovanni Battista Grassi 74, 20157 Milano,Italy
| | - Jessica Menis
- Department of Oncology, University Hospital of Udine, Piazzale S. Maria della Misericordia 15, 33100 Udine, Italy
| | - Elisa Rizzo
- EORTC Headquarters, Avenue E. Mounier 83, 1200 Bruxelles, Belgium
| | - Fausto Barbieri
- Department of Oncology and Hemathology, AOU of Modena, viale del pozzo 71, Modena, Italy
| | - Erika Rijavec
- Lung Cancer Unit, IRCCS AOU San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Largo R. Benzi 10, 16132 Genova, Italy
| | - Fabiana Cecere
- Medical Oncology Unit, University Hospital Careggi, Largo Brambilla 3, 50134 Firenze, Italy
| | - Emilio Bria
- Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, P.zza L. A. Scuro 10, 37134 Verona, Italy
| | - Gianluca Spitaleri
- Division of Thoracic Oncology, European Institute of Oncology, via Ripamonti 435, 20141 Milano, Italy
| | - Antonio Rossi
- Division of Medical Oncology, S.G. Moscati Hospital, Contrada Amoretta Avellino, Italy
| | - Silvia Novello
- Department of Oncology, University of Torino AOU San Luigi, Regione Gonzole 10, 10043 Orbassano (TO), Italy.
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Risk factor for respiratory death after lung cancer surgery in octogenarians. Asian Cardiovasc Thorac Ann 2015; 23:1044-9. [DOI: 10.1177/0218492315605725] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background As society ages, the frequency of elderly patients undergoing surgery for lung cancer is increasing. However, the indications for surgery in octogenarians are still controversial. We examined the outcomes of elderly patients undergoing thoracic surgery for lung cancer, focusing especially on non-cancer-related death. Methods Between January 2004 and March 2011, 1673 patients with lung cancer underwent surgical resection at our institution. Of these, we retrospectively examined 174 patients aged 80 years or older. Results Perioperative morbidity and mortality were 24.3% and 1.15%, respectively. Of 163 patients who were followed up completely, 78 (47.9%) died. The overall postoperative survival rate at 3 and 5 years was 63.6% and 48.3%, respectively. Almost half of the deaths were due to causes other than lung cancer recurrence, with respiratory disease accounting for the majority. We found that a low body mass index was a significant risk factor for death due to respiratory disease after lung cancer surgery in this patient cohort. Conclusion The overall survival rate of octogenarians undergoing lung cancer surgery is acceptable. However, because octogenarians with a low body mass index have a significantly higher risk of death due to respiratory disease, surgeons and pulmonologists should take this into account when performing postoperative follow-up in these patients.
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19
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Leduc C, Quoix E. Systemic treatment of elderly patients. Lung Cancer 2015. [DOI: 10.1183/2312508x.10010614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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20
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Dabó H, Gomes R, Hespanhol V, Queiroga H. Non-small cell lung cancer in octogenarian patients--the experience in a tertiary university hospital. REVISTA PORTUGUESA DE PNEUMOLOGIA 2015; 21:281-2. [PMID: 26188425 DOI: 10.1016/j.rppnen.2015.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 06/03/2015] [Indexed: 11/12/2022] Open
Affiliation(s)
- H Dabó
- Pulmonology Department of Centro Hospitalar de São João, Oporto, Portugal.
| | - R Gomes
- Pulmonology Department of Hospital Sousa Martins, Unidade Local de Saúde - Guarda, Portugal
| | - V Hespanhol
- Pulmonology Department of Centro Hospitalar de São João, Oporto, Portugal; School of Medicine, University of Oporto, Oporto, Portugal
| | - H Queiroga
- Pulmonology Department of Centro Hospitalar de São João, Oporto, Portugal; School of Medicine, University of Oporto, Oporto, Portugal
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Hino H, Murakawa T, Ichinose J, Nagayama K, Nitadori J, Anraku M, Nakajima J. Results of Lung Cancer Surgery for Octogenarians. Ann Thorac Cardiovasc Surg 2015; 21:209-16. [PMID: 25740447 DOI: 10.5761/atcs.oa.14-00160] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Growing number of elderly lung cancer patients reflecting a lengthening life span has become a serious problem. Purpose of this study was to elucidate the short and long-term outcome of the surgery for octogenarians, and to evaluate the role of lung cancer surgery for this high age group. METHODS The patients with lung cancer aged 80 years or more who underwent the surgery at our institute from January 1998 through December 2012 were retrospectively analyzed by chart review, and the operative mortality, morbidity and the long-term survival were assessed. RESULTS Out of a total of 1107 patients with primary lung cancer who received surgery during the study period, 94 were octogenarians (8.5%). Sixty-nine patients (73.4%) had preoperative co-morbidity including hypertension in 50 (53.2%), coincidence of other malignancy in 35 (37.2%), anti-coagulant therapy in 29 (30.9%). Twenty-six patients (27.7%) had major or minor postoperative morbidity, and one (1.1%) died due to bronchopleural fistula. Overall-5-year survival rate was 57.5%. Univariative and multivariative analysis using Cox proportional hazard model revealed that male gender and non-adenocarcinoma histology were significant risk factors for poor prognosis. CONCLUSION Gender and histology should be taken into account in preoperative evaluation of indication for lung cancer in octogenarians.
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Affiliation(s)
- Haruaki Hino
- Department of Thoracic Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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Cannon NA, Iyengar P, Choy H, Timmerman R, Meyer J. Stereotactic ablative body radiation therapy for tumors in the lung in octogenarians: a retrospective single institution study. BMC Cancer 2014; 14:971. [PMID: 25518879 PMCID: PMC4301933 DOI: 10.1186/1471-2407-14-971] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 12/11/2014] [Indexed: 11/11/2022] Open
Abstract
Background Treatment of cancer in the lung in octogenarians is limited by their health and functional status. Stereotactic ablative radiotherapy is an established noninvasive treatment option for medically inoperable patients, with a toxicity profile that may be more tolerable in elderly patients. Methods Patients more than 80 years old treated with stereotactic ablative radiotherapy for malignant tumors in the lung between January 2007 and August 2012 at a single institution were identified and retrospectively analyzed for toxicity and survival. Results Thirty patients were identified with a total of 32 lesions treated. Patients ranged in age from 80.8 to 90.7 years old (median 84.9) at the time of treatment. Twenty patients had ECOG performance status 0–1, and 10 had performance status 2–3. Stage distribution at treatment was: stage I (20 patients), stage III (1), stage IV (1), and 8 recurrent tumors. Patients were treated to a median total dose of 54 Gy in 3 fractions (range 20–60 Gy in 1 to 5 fractions). Median follow up was 13 months (range 2–60 months). Fifteen patients were still living at last review. There was one failure in field and one failure in the same lobe that was treated. One patient died with progressive regional disease, and four died of progressive metastatic disease. Three patients had late grade 3 pulmonary dyspnea with no grade 4 or 5 toxicities. One patient had late grade 2 pneumonitis, and 3 patients had late grade 1 pneumonitis. Three patients had grade 1 chest wall pain. Conclusions Octogenarians tolerated ablative treatment with minimal toxicity. Stereotactic ablative body radiotherapy is an option to consider in treatment of elderly patients.
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Affiliation(s)
| | | | | | | | - Jeffrey Meyer
- Department of Radiation Oncology, University of Texas Southwestern, 5801 Forest Park Rd, Dallas 75390, Texas, USA.
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Sim SH, Kim YJ, Kim SH, Keam B, Kim TM, Lee SH, Kim DW, Heo DS, Lee JS. Current status of chemotherapy use and clinical outcome in octogenarians with advanced non-small cell lung cancer. J Cancer Res Clin Oncol 2014; 141:1073-81. [PMID: 25410789 DOI: 10.1007/s00432-014-1875-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 11/07/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although about one-fourth of patients dying of lung cancer are aged 80 years or older in Korea, the current treatment status and outcome in octogenarians are largely unknown. We aimed to evaluate the proportion of octogenarians with advanced non-small cell lung cancer (NSCLC) who receive systemic chemotherapy and analyze the clinical outcome in these patients. METHODS The medical records of 281 octogenarians who were diagnosed with stage IIIB/IV or recurrent NSCLC were retrospectively reviewed. RESULTS In total, 127 out of 281 patients (45 %) received chemotherapy. Among the patients with ECOG PS 0-2, 119 patients (57 %) received chemotherapy. The first-line treatments were platinum doublets in 61 patients (48 %), single-agent chemotherapy in 34 (27 %), and epidermal growth factor receptor tyrosine kinase inhibitors in 32 (25 %). In patients with ECOG PS 0-2, patients who received chemotherapy lived longer compared with patients who only received best supportive care (16.1 vs. 4.0 months, P < 0.001). Among the 127 patients who received chemotherapy, patients who received EGFR TKIs showed longer survival than patients who only received cytotoxic agents (21.4 vs. 9.8 months, P < 0.001). In a multivariate analysis, ECOG PS 3-4 and smoking history were unfavorable prognostic factors, while recurrent disease and systemic chemotherapy were favorable prognostic factors. CONCLUSION Nearly half of octogenarians with advanced NSCLC received systemic chemotherapy. The patients showed prolonged survival compared with the best supportive care group. Further studies are warranted to provide an optimal tailored treatment for octogenarians.
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Affiliation(s)
- Sung Hoon Sim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Lee MC, Buitrago DH, Kadota K, Ujiie H, Woo K, Sima CS, Travis WD, Jones DR, Adusumilli PS. The tumor immune microenvironment in octogenarians with stage I non-small cell lung cancer. Oncoimmunology 2014; 3:e967142. [PMID: 25941595 PMCID: PMC4368147 DOI: 10.4161/21624011.2014.967142] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 09/13/2014] [Indexed: 12/14/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related mortality and has increasingly become a disease of elderly patients. Elderly patients are underrepresented in clinical trials that evaluate treatments for NSCLC. It has been suggested that patients >65 years of age have less robust immune responses to infections, immunizations, and tumors compared with younger patients. With increasing focus and number of immunotherapy clinical trials for NSCLC, we investigated the relationship between patient age and the tumor immune microenvironment in NSCLC. Using tissue microarrays from 1,278 patients with surgically resected Stage I NSCLC (≤65 years [33%], 66-79 years [55%], and ≥80 years [12%]), we determined whether quantitative and qualitative immune cell infiltration in the tumor differed between younger and older patients. Furthermore, we investigated the prognostic value of immune cell infiltration with respect to recurrence in octogenarians. We found that there were no statistically significant differences between older and younger patients in tumoral immune infiltration or effector regulatory immune response ratios (FoxP3/CD3, FoxP3/CD4, and FoxP3/CD8 ratios). In octogenarians, presence of low tumoral CD68+ immune cells was an independent predictor of recurrence. In the uniform cohort of surgically selected and resected Stage I NSCLC patients, tumor immune cell infiltration among the older age group resembled other age groups. Our study provides information that supports inclusion of older age patients selected for surgical resection in neoadjuvant or adjuvant immunotherapy clinical trials for lung cancer.
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Affiliation(s)
- Ming-Ching Lee
- Thoracic Service; Department of Surgery; Memorial Sloan Kettering Cancer Center; New York, NY
- Institute of Clinical Medicine; National Yang-Ming University; Taipei, Taiwan
| | - Daniel H. Buitrago
- Thoracic Service; Department of Surgery; Memorial Sloan Kettering Cancer Center; New York, NY
| | - Kyuichi Kadota
- Thoracic Service; Department of Surgery; Memorial Sloan Kettering Cancer Center; New York, NY
- Department of Pathology; Memorial Sloan Kettering Cancer Center; New York, NY
| | - Hideki Ujiie
- Thoracic Service; Department of Surgery; Memorial Sloan Kettering Cancer Center; New York, NY
| | - Kaitlin Woo
- Department of Epidemiology & Biostatistics; Memorial Sloan Kettering Cancer Center; New York, NY
| | - Camelia S. Sima
- Department of Epidemiology & Biostatistics; Memorial Sloan Kettering Cancer Center; New York, NY
| | - William D. Travis
- Department of Pathology; Memorial Sloan Kettering Cancer Center; New York, NY
| | - David R. Jones
- Thoracic Service; Department of Surgery; Memorial Sloan Kettering Cancer Center; New York, NY
| | - Prasad S. Adusumilli
- Thoracic Service; Department of Surgery; Memorial Sloan Kettering Cancer Center; New York, NY
- Center for Cell Engineering; Memorial Sloan Kettering Cancer Center; New York, NY
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Pallis AG, Gridelli C, Wedding U, Faivre-Finn C, Veronesi G, Jaklitsch M, Luciani A, O'Brien M. Management of elderly patients with NSCLC; updated expert's opinion paper: EORTC Elderly Task Force, Lung Cancer Group and International Society for Geriatric Oncology. Ann Oncol 2014; 25:1270-1283. [PMID: 24638905 DOI: 10.1093/annonc/mdu022] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
Non-small-cell lung cancer (NSCLC) is a very common disease in the elderly population and its incidence in this particular population is expected to increase further, because of the ageing of the Western population. Despite this, limited data are available for the treatment of these patients and, therefore, the development of evidence-based treatment recommendations is challenging. In 2010, European Organization for Research and Treatment of Cancer (EORTC) took an initiative in collaboration with International Society of Geriatric Oncology (SIOG) and created an experts panel that provided an experts' opinion consensus paper for the management of elderly NSCLC patients. Since this publication, important new data are available and EORTC and SIOG recommended to update the 2010 recommendations. Besides recommendations for surgery, adjuvant chemotherapy and radiotherapy, treatment of locally advanced and metastatic disease, recommendations were expanded, to include data on patient preferences and geriatric assessment.
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Affiliation(s)
- A G Pallis
- Medical Department, European Organization for Research and Treatment of Cancer, Brussels, Belgium.
| | - C Gridelli
- Division of Medical Oncology, 'S.G. Moscati' Hospital-Avellino, Avellino, Italy
| | - U Wedding
- Department of Internal Medicine II, Jena University Hospital, Jena, Germany
| | | | - G Veronesi
- Lung Cancer Early Detection Unit, Division of Thoracic Surgery, European Institute of Oncology, Milano, Italy
| | - M Jaklitsch
- Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - A Luciani
- Department of Medical Oncology, S. Paolo Hospital, Milan, Italy
| | - M O'Brien
- The Royal Marsden NHS Foundation, Surrey, UK
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Early lung cancer in the elderly: sublobar resection provides equivalent long-term survival in comparison with lobectomy. Contemp Oncol (Pozn) 2014; 18:111-5. [PMID: 24966794 PMCID: PMC4068813 DOI: 10.5114/wo.2014.42726] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 07/30/2013] [Accepted: 09/05/2013] [Indexed: 12/15/2022] Open
Abstract
Aim of the study The worldwide population shift towards older ages will inevitably lead to more elderly patients being diagnosed with non-small cell lung cancer (NSCLC). It still remains controversial whether sublobar resection is effective in such cases at an early stage. To answer this question, we need to understand the clinical characteristics of these tumors. Material and methods From 2004 to 2010, a total of 167 patients with stage I non-small cell lung cancer (NSCLC) of age ≥ 70 years underwent complete resection in our institution. The clinical data were retrospectively analyzed as regards gender, stage of disease, histology, smoking status, smoking amount, drinking status, surgical approaches and overall survival. Survival was analyzed by the Kaplan-Meier method and log-rank test. Results The overall 5-year survival rate was 62.4%. There were 122 (73.1%) patients who underwent standard lobectomy resection and 45 (26.9%) patients underwent sublobar resection. Patients with different surgical approaches (lobectomy and sublobar resection) had nearly the same 5-year survival rate (60.9% vs. 63.4%, p = 0.558). Gender (p = 0.023), smoking status (p = 0.045) and smoking amount (p = 0.007) significantly influenced the prognosis. Conclusions In elderly stage I NSCLC patients, sublobar resection is considered to be an appropriate treatment in comparison with lobectomy, as this procedure provides equivalent long-term survival.
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Zauderer MG, Sima CS, Korc-Grodzicki B, Kris MG, Krug LM. Toxicity of initial chemotherapy in older patients with lung cancers. J Geriatr Oncol 2014; 4:64-70. [PMID: 23525607 DOI: 10.1016/j.jgo.2012.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Despite the growing number of elderly patientswith lung cancers,we lack adequate information about how best to treat them. A phase III trial demonstrated a survival benefit of doublet chemotherapy in elderly patients with lung cancers compared to single agents at the cost of increased toxicity. We undertook this study to identify and describe chemotherapyassociated toxicity patterns among elderly patients treated for lung cancers. MATERIALS AND METHODS We reviewed records of patients age 70 or older with metastatic lung cancers who received initial chemotherapy at the Memorial Sloan-Kettering Cancer Center during 2008 and 2009. RESULTS We identified 70 patients: 28 (40%) completed at least 4 cycles of chemotherapy without dose reduction but 31 (44%) required hospitalization for toxicity. Baseline albumin <3.5 g/dL and anemiawere associatedwith grade 3–5 chemotherapy-associated toxicity. Also, an increase in platelets from cycle 1 to cycle 2 was associated with chemotherapy-associated toxicity. No other statistically significant associations between chemotherapy-associated toxicity and putative biologic and functional risk factors, including age and performance status, were identified. CONCLUSION Patients deemed eligible for chemotherapy by their physicianswere just as likely to have severe chemotherapy-associated toxicity requiring hospitalization as to finish an initial course of therapy without any serious problems. An increase in platelet count from cycle 1 to cycle 2 was associated with increased toxicity. Additional research, such as exploration of inflammatory cytokines (PDGF, IL6, and IGF-1) to identify the mechanisms of chemotherapy tolerance and prospective evaluation and validation of existing metrics, is needed so that all patients can be appropriately risk stratified.
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Yasuda M, Nagashima A, Haro A, Saitoh G. Treatment of the postoperative recurrence of lung cancer in octogenarians. Surg Today 2013; 44:1626-32. [PMID: 24026198 DOI: 10.1007/s00595-013-0719-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 07/24/2013] [Indexed: 12/26/2022]
Abstract
PURPOSE Guidelines for the treatment of postoperative recurrent lung cancer in octogenarians do not exist. In this study, we investigated the prognosis of patients with recurrence after the resection of lung cancer and discuss the management of recurrent tumors in octogenarians. METHODS This study clinicopathologically evaluated 135 octogenarians who underwent resections for lung cancer at a single institution between 1992 and 2010. We retrospectively reviewed the clinical records of 37 patients with confirmed recurrence. The overall survival of the patients and the treatments used for postoperative recurrence were evaluated. RESULTS Among 37 patients, six underwent intensive treatment, 14 underwent palliative treatment and 17 received supportive care only. The overall survival rates of the patients in the antitumor treatment groups tended to be associated with a better prognoses than those of the patients in the supportive care only group, but they did not exhibit significantly better prognoses at 1 year (p = 0.202). However, among the patients with a good performance status, the intensive treatment group tended to exhibit prolonged survival. Of the 37 patients with recurrent tumors, five (14%) died of other diseases. CONCLUSIONS Antitumor treatment of postoperative recurrent lung cancer in octogenarians may not always improve the survival rate. However, carefully selecting patients for intensive therapy, such as those with a good performance status, may lead to longer survival rates after postoperative recurrence in octogenarians.
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Affiliation(s)
- Manabu Yasuda
- Department of Chest Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-ku, Kitakyushu, 802-0077, Japan,
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Lung surgery in the elderly today. Lung Cancer 2013; 80:115-9. [DOI: 10.1016/j.lungcan.2013.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 11/08/2012] [Accepted: 01/04/2013] [Indexed: 12/20/2022]
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Guerra M, Neves P, Miranda J. Surgical treatment of non-small-cell lung cancer in octogenarians. Interact Cardiovasc Thorac Surg 2013; 16:673-80. [PMID: 23396622 DOI: 10.1093/icvts/ivt020] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Reluctance to recommend lung cancer surgery for octogenarians is partly based on the expectation that the rate of complications and mortality is higher in this group of patients, and on the impression that the life expectancy of an octogenarian with lung cancer is limited by death from natural causes. Moreover, the belief that radiation therapy and observation yield similar results to surgery in early-stage disease have influenced low resection rates in this population. Nevertheless, advances in surgical techniques, anaesthesia and postoperative care have made surgical lung resection a safer procedure than it was in the past. Judging from the more recent findings, surgery should not be withheld because of postoperative mortality, but suboptimal or palliative treatment may be necessary in patients with poor physical or mental function. To enable informed decision-making, both patients and clinicians need information on the risks of surgical treatment. In this review, available information from the literature was collected in an effort to understand the real benefit of surgical treatment in octogenarians with non-small-cell lung cancer, and to determine what should be done or avoided during the selection course.
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Affiliation(s)
- Miguel Guerra
- Department of Cardiothoracic Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nove de Gaia, Portugal.
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Srisomboon C, Koizumi K, Haraguchi S, Mikami I, Iijima Y, Shimizu K. Thoracoscopic surgery for non-small-cell lung cancer: elderly vs. octogenarians. Asian Cardiovasc Thorac Ann 2013; 21:56-60. [DOI: 10.1177/0218492312455528] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Octogenarians are rarely referred for surgical treatment of lung cancer owing to the morbidity and mortality of pulmonary resection, their frailty, and limited lifespan. We reviewed the results of thoracoscopic surgery, performed completely under the monitor, for treatment of primary non-small-cell lung cancer in octogenarians, and compared them with those in elderly patients. Patients and methods: Between September 25, 2002 and August 25, 2011, a retrospective database of 24 octogenarians and 70 elderly patients (age range, 75–79 years) who underwent thoracoscopic surgery for treatment of primary non-small-cell lung cancer were reviewed. Demographic, histopathologic, preoperative, perioperative, postoperative, outcome variables, and survival were assessed. Results: In the octogenarian group, 29% had postoperative respiratory complications, 4% had postoperative cardiac complications, operative mortality was 4%, the recurrence rate was 8%, and the postsurgical 5-year survival rate was 74%. In the elderly group, 25% had postoperative respiratory complications, 6% had postoperative cardiac complications, operative mortality was 3%, the recurrence rate was 6%, and the postsurgical 5-year survival rate was 80%. Conclusions: Thoracoscopic surgery for treatment of primary non-small-cell lung cancer can be performed with similar postoperative complication rates, operative mortality, and survival in octogenarians when compared to elderly patients.
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Affiliation(s)
- Chaisit Srisomboon
- Division of Thoracic Surgery, Department of Surgery, Nippon Medical School, Tokyo, Japan
- Department of Biological Regulation and Regenerative Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
- Department of Surgery, Faculty of Medicine, Thammasat University Rangsit Center, Pathum Thani, Thailand
| | - Kiyoshi Koizumi
- Division of Thoracic Surgery, Department of Surgery, Nippon Medical School, Tokyo, Japan
- Department of Biological Regulation and Regenerative Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Shuji Haraguchi
- Division of Thoracic Surgery, Department of Surgery, Nippon Medical School, Tokyo, Japan
- Department of Biological Regulation and Regenerative Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Iwao Mikami
- Division of Thoracic Surgery, Department of Surgery, Nippon Medical School, Tokyo, Japan
- Department of Biological Regulation and Regenerative Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yoshihito Iijima
- Division of Thoracic Surgery, Department of Surgery, Nippon Medical School, Tokyo, Japan
- Department of Biological Regulation and Regenerative Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kazuo Shimizu
- Department of Biological Regulation and Regenerative Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
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Survival After Segmentectomy and Wedge Resection in Stage I Non–Small-Cell Lung Cancer. J Thorac Oncol 2013; 8:73-8. [DOI: 10.1097/jto.0b013e31827451c4] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Abstract
The greatest risk by far for developing lung cancer is cigarette smoking, but age, radon exposure, environmental pollution, occupational exposures, gender, race, and pre-existing lung disease also are important contributors. However, not all people with these risk factors develop lung cancer, and some without any known risk factor do, indicating the importance of genetic influences. Future advances in understanding and treating lung cancer will be based on genetic analysis. The most effective preventive measure is to never start or to stop cigarette smoking.
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Affiliation(s)
- Patricia de Groot
- Division of Diagnostic Imaging, Department of Diagnostic Radiology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030, USA.
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Risk analysis of pulmonary resection for elderly patients with lung cancer. Surg Today 2012; 43:514-20. [DOI: 10.1007/s00595-012-0401-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 02/19/2012] [Indexed: 10/27/2022]
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Cheng YD, Duan CJ, Dong S, Zhang H, Zhang SK, Wang SQ, Zhang CF. Clinical controlled comparison between lobectomy and segmental resection for patients over 70 years of age with clinical stage I non-small cell lung cancer. Eur J Surg Oncol 2012; 38:1149-55. [PMID: 22901959 DOI: 10.1016/j.ejso.2012.08.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 07/19/2012] [Accepted: 08/02/2012] [Indexed: 11/15/2022] Open
Abstract
AIMS The standard surgical procedure for elderly (≥ 70 years) patients with clinical stage I non-small cell lung cancer (NSCLC) was investigated. METHODS A non-randomized prospective controlled study was conducted to compare lobectomy with segmental resection for the treatment of elderly clinical stage I lung cancer patients under different pulmonary function. Perioperative indicators including time and volume of thoracic drainage, incidence of postoperative complications, locoregional recurrence rates, and 1, 3, and 5-year survival rates were analyzed. RESULTS A total of 184 patients were included in the study. Patients were classified into two groups according to pulmonary function: group 1 included 64 patients who had poor pulmonary function, with a forced expiratory volume in 1 s (FEV(1)) of less than 1.5 L, whereas group 2 consisted of 120 patients with an FEV(1) ≥ 1.5 L. The patients in group 1 had a longer postoperative mechanical ventilation time and a higher incidence rate of respiratory associated complications than those in group 2 (21.9 vs. 8.35%, p = 0.009). The local recurrence and long-term survival rates were not significantly different between lobectomy and segmental resection. Among the patients who underwent segmental resection, those who had regional lymph node dissection showed a higher 3-year and 5-year survival rate than those undergoing selected lymph node resection (77.8 vs. 51.7%, p = 0.042; 55.6 vs. 27.6%, p = 0.034), but this was not significant in lobectomy. CONCLUSIONS Segmental resection combined with regional lymph node resection could be the best choice for elderly clinical stage I NSCLC patients with FEV(1) < 1.5 L.
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Affiliation(s)
- Y D Cheng
- Department of Cardio-thoracic Surgery of Xiangya Hospital Central South University, Xiangya Road 87th, Changsha 410008, Hunan, PR China
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The elderly patient with surgically resected non-small cell lung cancer — A distinct situation? Exp Gerontol 2012; 47:237-42. [DOI: 10.1016/j.exger.2011.12.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 12/05/2011] [Accepted: 12/18/2011] [Indexed: 11/30/2022]
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Britt GJ, Gaughan EM, Nguyen KSH, Warner JL, Goldstein MA, Huberman MS, Costa DB. Case series of treatment approaches in fit nonagenarians with stage IV non-small-cell lung cancer. J Thorac Dis 2012; 3:141-3. [PMID: 22263078 DOI: 10.3978/j.issn.2072-1439.2011.03.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2011] [Indexed: 11/14/2022]
Abstract
An increasing number of nonagenarians are treated for non-small-cell lung cancer (NSCLC); however guidelines and case series describing the care of very elderly patients with advanced NSCLC are not available. Medical records of patients treated at Beth Israel Deaconess Medical Center between 2007 and 2009 who had NSCLC were reviewed, and those with stage IV NSCLC and age 90 or older were included in this case series. Three successive fit nonagenarians were identified out of the one hundred and one cases with stage IV NSCLC, and their clinical course was summarized. The first case depicts a conservative approach (best supportive care), while the later cases describe the use of platinum-based (carboplatin-pemetrexed) and anti-epidermal growth factor targeted therapies. This series illustrates the diversity of approaches now available and the evolving treatment paradigm as it applies to fit elderly with NSCLC, including nonagenarians. It also emphasizes the importance of considering performance status rather than biologic age when making treatment decisions.
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Affiliation(s)
- Gregory J Britt
- Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Cheng Y, Zhang C. [Advances of treatment about elderly clinical stage I non-small cell lung cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2011; 14:949-53. [PMID: 22152696 PMCID: PMC6000196 DOI: 10.3779/j.issn.1009-3419.2011.12.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
随着人口的老龄化, 高龄肺癌患者的比例在增大。近十几年来肺叶切除加纵隔淋巴结清扫一直是Ⅰ期非小细胞肺癌(non small cell lung cancer, NSCLC)患者的标准术式。近年研究发现Ⅰ期高龄NSCLC亚肺叶切除术可以取得和肺叶切除术相当的远期疗效而且可以保留更多的正常肺组织, 有关Ⅰ期NSCLC的标准术式再次引起争议。Ⅰ期高龄NSCLC患者是一个特殊的群体, 常因机体功能减退或合并有基础疾病而无法耐受开胸手术, 胸腔镜的问世以及立体定向放射治疗技术的发展使患者有了更多的选择。Ⅰ期高龄NSCLC的治疗在朝着个体化和多样化方向发展。
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Affiliation(s)
- Yuanda Cheng
- Department of Cardiothoracic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
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Dela Cruz CS, Tanoue LT, Matthay RA. Lung cancer: epidemiology, etiology, and prevention. Clin Chest Med 2011. [PMID: 22054876 DOI: 10.1016/j.ccm.2011.09.001.lung] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Lung cancer is the leading cause of cancer death in the United States and around the world. A vast majority of lung cancer deaths are attributable to cigarette smoking, and curbing the rates of cigarette smoking is imperative. Understanding the epidemiology and causal factors of lung cancer can provide additional foundation for disease prevention. This article focuses on modifiable risk factors, including tobacco smoking, occupational carcinogens, diet, and ionizing radiation. It also discusses briefly the molecular and genetic aspects of lung carcinogenesis.
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Affiliation(s)
- Charles S Dela Cruz
- Pulmonary and Critical Care Medicine Section, Department of Internal Medicine, Yale University School of Medicine, 300 Cedar Street, TAC S441-C, New Haven, CT 06519, USA.
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Abstract
Lung cancer is the leading cause of cancer death in the United States and around the world. A vast majority of lung cancer deaths are attributable to cigarette smoking, and curbing the rates of cigarette smoking is imperative. Understanding the epidemiology and causal factors of lung cancer can provide additional foundation for disease prevention. This article focuses on modifiable risk factors, including tobacco smoking, occupational carcinogens, diet, and ionizing radiation. It also discusses briefly the molecular and genetic aspects of lung carcinogenesis.
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Affiliation(s)
- Charles S Dela Cruz
- Pulmonary and Critical Care Medicine Section, Department of Internal Medicine, Yale University School of Medicine, 300 Cedar Street, TAC S441-C, New Haven, CT 06519, USA.
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VanderWalde A, Pal SK, Reckamp KL. Management of non-small-cell lung cancer in the older adult. Maturitas 2011; 68:311-21. [DOI: 10.1016/j.maturitas.2011.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 01/07/2011] [Indexed: 11/30/2022]
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Franceschi C, Pauletto P, Incalzi RA, Fabbri LM. Invecchiamento, infiammazione sistemica e malattie croniche complesse. ITALIAN JOURNAL OF MEDICINE 2011. [DOI: 10.1016/j.itjm.2011.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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