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Guberina N, Pöttgen C, Schuler M, Guberina M, Stamatis G, Plönes T, Metzenmacher M, Theegarten D, Gauler T, Darwiche K, Aigner C, Eberhardt WEE, Stuschke M. Long-term survival of patients with central or > 7 cm T4 N0/1 M0 non-small-cell lung cancer treated with definitive concurrent radiochemotherapy in comparison to trimodality treatment. Radiat Oncol 2022; 17:126. [PMID: 35842712 PMCID: PMC9288731 DOI: 10.1186/s13014-022-02080-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 06/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background To examine long-term-survival of cT4 cN0/1 cM0 non-small-cell lung carcinoma (NSCLC) patients undergoing definitive radiochemotherapy (ccRTx/CTx) in comparison to the trimodality treatment, neoadjuvant radiochemotherapy followed by surgery, at a high volume lung cancer center. Methods All consecutive patients with histopathologically confirmed NSCLC (cT4 cN0/1 cM0) with a curative-intent-to-treat ccRTx/CTx were included between 01.01.2001 and 01.07.2019. Mediastinal involvement was excluded by systematic EBUS-TBNA or mediastinoscopy. Following updated T4-stage-defining-criteria initial staging was reassessed by an expert-radiologist according to UICC-guidelines [8th edition]. Outcomes were compared with previously reported results from patients of the same institution with identical inclusion criteria, who had been treated with neoadjuvant radiochemotherapy and resection. Factors for treatment selection were documented. Endpoints were overall-survival (OS), progression-free-survival (PFS), and cumulative incidences of isolated loco-regional failures, distant metastases, secondary tumors as well as non-cancer deaths within the first year. Results Altogether 46 consecutive patients with histopathologically confirmed NSCLC cT4 cN0/1 cM0 [cN0 in 34 and cN1 in 12 cases] underwent ccRTx/CTx after induction chemotherapy (iCTx). Median follow-up was 133 months. OS-rates at 3-, 5-, and 7-years were 74.9%, 57.4%, and 57.4%, respectively. Absolute OS-rate of ccRTx/CTx at 5 years were within 10% of the trimodality treatment reference group (Log-Rank p = 0.184). The cumulative incidence of loco-regional relapse was higher after iCTx + ccRT/CTx (15.2% vs. 0% at 3 years, p = 0.0012, Gray’s test) while non-cancer deaths in the first year were lower than in the trimodality reference group (0% vs 9.1%, p = 0.0360, Gray’s test). None of the multiple recorded prognostic parameters were significantly associated with survival after iCTx + ccRT/CTx: Propensity score weighting for adjustment of prognostic factors between iCTx + ccRT/CTx and trimodality treatment did not change the results of the comparisons. Conclusions Patients with cT4 N0/1 M0 NSCLC have comparable OS with ccRTx/CTx and trimodality treatment. Loco-regional relapses were higher and non-cancer related deaths lower with ccRTx/CTx. Definitive radiochemotherapy is an adequate alternative for patients with an increased risk of surgery-related morbidity. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-022-02080-9.
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Affiliation(s)
- Nika Guberina
- Department of Radiation Therapy, West German Cancer Center (WTZ), University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany.
| | - Christoph Pöttgen
- Department of Radiation Therapy, West German Cancer Center (WTZ), University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Martin Schuler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany.,Division of Thoracic Oncology, West German Cancer Center, University Medicine Essen - Ruhrlandklinik, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Maja Guberina
- Department of Radiation Therapy, West German Cancer Center (WTZ), University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Georgios Stamatis
- Department of Thoracic Surgery, West German Cancer Center, University Medicine Essen - Ruhrlandklinik, Essen, Germany
| | - Till Plönes
- Department of Thoracic Surgery, West German Cancer Center, University Medicine Essen - Ruhrlandklinik, Essen, Germany
| | - Martin Metzenmacher
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany.,Division of Thoracic Oncology, West German Cancer Center, University Medicine Essen - Ruhrlandklinik, Essen, Germany
| | - Dirk Theegarten
- Institute of Pathology, University Hospital Essen, Essen, Germany
| | - Thomas Gauler
- Department of Radiation Therapy, West German Cancer Center (WTZ), University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Kaid Darwiche
- Department of Pulmonary Medicine, West German Cancer Center, Section of Interventional Pneumology, University Medicine Essen - Ruhrlandklinik, Essen, Germany
| | - Clemens Aigner
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany.,Department of Thoracic Surgery, West German Cancer Center, University Medicine Essen - Ruhrlandklinik, Essen, Germany
| | - Wilfried E E Eberhardt
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany.,Division of Thoracic Oncology, West German Cancer Center, University Medicine Essen - Ruhrlandklinik, Essen, Germany
| | - Martin Stuschke
- Department of Radiation Therapy, West German Cancer Center (WTZ), University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
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Li Q, Zhang P, Wang Y, Liu D, Luo L, Diasio RB, Yang P, Jiang G. T4 extension alone is more predictive of better survival than a tumour size >7 cm for resected T4N0-1M0 non-small-cell lung cancer†. Eur J Cardiothorac Surg 2020; 55:682-690. [PMID: 30508081 DOI: 10.1093/ejcts/ezy360] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/14/2018] [Accepted: 09/03/2018] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES T4N0-1 non-small-cell lung cancer (NSCLC) was historically considered curable but now includes tumours of size >7 cm according to the 8th edition tumour, node and metastasis (TNM) staging. This study was set out to evaluate the role of surgery and predictors of long-term survival after surgery in this renewed group of patients. METHODS Patients, with clinical T4N0-2M0 NSCLC diagnosed in 2010-2013, in the National Cancer Database were queried. A Cox regression analysis was applied to investigate independent predictors of survival in 1588 N0-1 surgical cases. For previous T3 cases, the efficacy of treatment including and not including surgery was compared after propensity score matching by age, gender, race, facility type, comorbidity, laterality, clinical N stage, histology and tumour grade. RESULTS In newly defined T4N0-1 NSCLC patients undergoing surgery, age, gender, comorbidity, nodal status, resection margin, tumour grade, chemotherapy and extension-size group were shown to be independent predictors of survival. In particular, patients with only T4 extension showed better survival than patients with tumour size >7 cm only [hazard ratio (HR) 0.75, 95% confidence interval (CI) 0.62-0.92, P = 0.016]. In the latter group, surgical treatment was associated with better survival than non-surgical treatment after matching (HR 0.45, 95% CI 0.42-0.48, P < 0.001). CONCLUSIONS In the newly defined T4 NSCLC, tumour size >7 cm is a descriptor that is more predictive of worse survival than local extension alone for patients whose treatment included surgery. For T4-extended, N0-1 NSCLC with a tumour size ≤7 cm, surgery might be associated with favourable long-term outcomes and should be further encouraged as a treatment option.
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Affiliation(s)
- Qiuyuan Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Peng Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
| | - Yi Wang
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA
- Department of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Dan Liu
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA
- Division of Pulmonary & Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Luo
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA
- Department of Research and Education, Guizhou Province People's Hospital, Guiyang, China
| | | | - Ping Yang
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA
- Mayo Clinic Cancer Center, Rochester, MN, USA
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
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Lin CT, Raman SP, Fishman EK. An algorithmic approach to CT of pulmonary arterial disorders. Clin Imaging 2016; 40:1226-1236. [DOI: 10.1016/j.clinimag.2016.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 08/05/2016] [Accepted: 08/22/2016] [Indexed: 01/10/2023]
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Jeon JH, Kim MS, Moon DH, Yang HC, Hwangbo B, Kim HY, Lee JM, Lee GK. Prognostic Differences in Subgroups of Patients With Surgically Resected T3 Non-Small Cell Lung Cancer. Ann Thorac Surg 2016; 102:1630-1637. [PMID: 27650104 DOI: 10.1016/j.athoracsur.2016.04.096] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 04/26/2016] [Accepted: 04/28/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study determined the characteristics and prognosis of each descriptor of T3 non-small cell lung cancer (NSCLC). METHODS A total of 3,241 patients underwent an operation for NSCLC between 2001 and 2013, and this study included 461 patients who received complete anatomic resection of T3 NSCLC. The T3 descriptors were coded as follows: tumor invading main bronchus within 2 cm of the carina (T3-cent), tumor invading beyond visceral pleura (T3-inv), tumor larger than 7 cm (T3-size), separate tumor nodules (T3-sep), or tumor with combined T3 descriptors (T3-comb). RESULTS The T3 distribution was as follows: T3-cent, 75 patients (16.3%); T3-inv, 157 patients (34.1%); T3-size, 132 patients (28.6%); T3-sep, 34 patients (7.4%); and T3-comb, 63 patients (13.7%). Subgroup analyses revealed a significant survival benefit in the T3-cent group compared with the other groups (all p < 0.05). The 5-year disease-free survival (DFS) values were 55.4%, 36.7%, 40.9%, 30.3%, and 32.0% in the T3-cent, T3-inv, T3-size, T3-sep, and T3-comb subgroups, respectively. Multivariable analyses revealed that age (p = 0.019), N status (p = 0.001), adjuvant chemotherapy (p < 0.001), and T3 descriptors (T3-cent versus others, p < 0.001) were the most important independent prognostic factors for DFS. Additional analyses were performed to evaluate prognostic factors for DFS in the T3-cent group. Multivariable analysis revealed that bronchoplastic procedures (p = 0.004) was an independent prognostic factor for DFS. CONCLUSIONS Survival for centrally located T3 NSCLC is better than other types of T3 NSCLC. Lung-preserving operations such as bronchoplastic procedures might result in improved survival of these patients.
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Affiliation(s)
- Jae Hyun Jeon
- Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea
| | - Moon Soo Kim
- Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea.
| | - Duk Hwan Moon
- Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea
| | - Hee Chul Yang
- Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea
| | - Bin Hwangbo
- Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea
| | - Hyae Young Kim
- Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea
| | - Jong Mog Lee
- Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea
| | - Geon-Kook Lee
- Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea
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Gao SJ, Corso CD, Blasberg JD, Detterbeck FC, Boffa DJ, Decker RH, Kim AW. Role of Adjuvant Therapy for Node-Negative Lung Cancer Invading the Chest Wall. Clin Lung Cancer 2016; 18:169-177.e4. [PMID: 27890561 DOI: 10.1016/j.cllc.2016.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/19/2016] [Accepted: 08/23/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The present study investigated the effect of adjuvant chemotherapy and radiation on survival among patients undergoing chest wall resection for T3N0 non-small cell lung cancer (NSCLC). MATERIALS AND METHODS Patients with T3N0 NSCLC who underwent chest wall resection were identified in the National Cancer Data Base in 2004 to 2012. The cohort was divided into patients who had received adjuvant chemotherapy, radiation therapy, chemoradiation therapy, or no adjuvant treatment. Kaplan-Meier and log-rank tests were used to compare overall survival, and a bootstrapped Cox proportional hazards model was used to determine the significant contributors to survival. A subset analysis was performed with stratification by margin status and tumor size. RESULTS Of 759 patients identified, 42.0% underwent surgery alone, 23.3% underwent surgery followed by chemotherapy, 22.3% underwent surgery followed by chemoradiation therapy, and 12.3% underwent surgery followed by radiotherapy alone. Tumors > 4 cm benefited from adjuvant chemotherapy and radiation therapy in the multivariable analysis, and those ≤ 4 cm benefited only from adjuvant chemotherapy. The subgroup analysis by margin status identified that margin-positive patients with tumors > 4 cm benefited significantly from either adjuvant chemoradiation therapy or radiation therapy alone. CONCLUSION T3N0 NSCLC with chest wall invasion requires unique management compared with other stage IIB tumors. An important determinant of management is tumor size, with tumors ≤ 4 cm benefiting from adjuvant chemotherapy and tumors > 4 cm benefiting from adjuvant chemotherapy if margin negative and adjuvant chemoradiation therapy or radiotherapy if margin positive.
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Affiliation(s)
- Sarah J Gao
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT
| | - Christopher D Corso
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT
| | - Justin D Blasberg
- Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Frank C Detterbeck
- Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Daniel J Boffa
- Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Roy H Decker
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT
| | - Anthony W Kim
- Department of Surgery, Yale University School of Medicine, New Haven, CT.
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Langer NB, Mercier O, Fabre D, Lawton J, Mussot S, Dartevelle P, Fadel E. Outcomes After Resection of T4 Non-Small Cell Lung Cancer Using Cardiopulmonary Bypass. Ann Thorac Surg 2016; 102:902-910. [PMID: 27209605 DOI: 10.1016/j.athoracsur.2016.03.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 01/26/2016] [Accepted: 03/08/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Complete, en bloc resection offers the greatest chance of long-term survival in T4 non-small cell lung cancer (NSCLC). The use of cardiopulmonary bypass (CPB) to achieve an en bloc resection is controversial because of potentially increased bleeding, lung dysfunction, and tumor dissemination. We reviewed our institutional experience to assess CPB's effect on survival. METHODS All patients who underwent resection for T4 NSCLC at our institution between 1980 and 2013 were retrospectively reviewed and stratified according to whether they did (CPB group, n = 20) or did not (No CPB group, n = 355) undergo CPB. Primary outcomes of interest were overall and disease-free survival and perioperative complications. RESULTS Baseline characteristics and medical therapy were similar between the groups. Median overall survival for all patients was 31 months, with 1-, 3-, 5-, and 10-year survival of 73%, 47%, 40%, and 26%, respectively. Median disease-free survival for all patients was 19 months, with 1-, 3-, 5-, and 10-year disease-free survival of 61%, 40%, 33%, and 21%, respectively. No difference was found in overall or disease-free survival at 1, 3, 5, and 10 years between the No CPB and CPB groups (p = 0.89 and p = 0.88). In addition, no differences were found in the rates of major perioperative complications. CONCLUSIONS The use of CPB allows for complete, en bloc resection in otherwise inoperable patients with T4 NSCLC and offers similar overall and disease-free survival to patients resected without CPB. All thoracic surgeons who manage T4 NSCLC should consider the use of CPB if it is necessary to achieve a complete, en bloc resection.
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Affiliation(s)
- Nathaniel B Langer
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital and University Paris-Sud, Le Plessis Robinson, France
| | - Olaf Mercier
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital and University Paris-Sud, Le Plessis Robinson, France
| | - Dominique Fabre
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital and University Paris-Sud, Le Plessis Robinson, France
| | - James Lawton
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital and University Paris-Sud, Le Plessis Robinson, France
| | - Sacha Mussot
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital and University Paris-Sud, Le Plessis Robinson, France
| | - Philippe Dartevelle
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital and University Paris-Sud, Le Plessis Robinson, France
| | - Elie Fadel
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital and University Paris-Sud, Le Plessis Robinson, France.
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Li Y, Lou J, Qiu S, Guo Y, Pan M. Stereotactic radiotherapy for the treatment of lung cancer with a giant left atrial tumor thrombus: A case report and literature review. Oncol Lett 2016; 11:2229-2232. [PMID: 26998153 DOI: 10.3892/ol.2016.4215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 12/16/2015] [Indexed: 11/06/2022] Open
Abstract
Lung cancer presenting with a giant atrial tumor thrombus is particularly rare. Surgical resection, aided by a cardiopulmonary bypass, is the standard treatment of choice if there is no distant metastasis. However, this form of surgery carries a high risk, with the subsequent patient prognosis being extremely poor. The current study describes the case of a 52-year-old man presenting with left lung squamous cell carcinoma that had extended into the left atrium. The patient was treated with stereotactic radiotherapy, and regarding the atrial disease, a complete response was achieved within 12 months. The present case demonstrates that stereotactic radiotherapy may be a beneficial palliative treatment for patients with stage IV lung cancer invading the left atrium.
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Affiliation(s)
- Yong Li
- Center of Radiation Oncology, Wujing Hospital, Shanghai 201103, P.R. China
| | - Jinrong Lou
- Department of Cardiology, Jiading Central Hospital, Shanghai 201800, P.R. China
| | - Shujun Qiu
- Center of Radiation Oncology, Wujing Hospital, Shanghai 201103, P.R. China
| | - Yutian Guo
- Center of Radiation Oncology, Wujing Hospital, Shanghai 201103, P.R. China
| | - Mianshun Pan
- Center of Radiation Oncology, Wujing Hospital, Shanghai 201103, P.R. China
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Abstract
In this chapter, we discuss the preoperative evaluation that is necessary prior to surgical resection, stage-specific surgical management of lung cancer, and the procedural steps as well as the indications to a variety of surgical approaches to lung resection.
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Affiliation(s)
- Osita I Onugha
- Thoracic surgery, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Jay M Lee
- Thoracic surgery, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
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Ebara K, Takashima S, Jiang B, Numasaki H, Fujino M, Tomita Y, Nakanishi K, Higashiyama M. Pleural invasion by peripheral lung cancer: prediction with three-dimensional CT. Acad Radiol 2015; 22:310-9. [PMID: 25542401 DOI: 10.1016/j.acra.2014.10.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 09/03/2014] [Accepted: 10/08/2014] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the clinical utility of three-dimensional (3D) computed tomography (CT) for predicting pleural invasion by peripheral lung cancer. MATERIALS AND METHODS CT findings (tumor size, vertical diameter, length and area of the interface between tumor and the pleura, ratios of length and area [Rarea] of interface between tumor and the pleura to tumor size, angle between the tumor and adjacent pleura, presence or absence of pleural thickening, and originally developed 3D pleural patterns) in 201 consecutive patients with lung cancer of ≤3 cm in contact with pleural surface were correlated with pathologic findings. Logistic modeling was used for determining the significant factors for prediction of pleural invasion, and receiver operating characteristic (ROC) curves were used for investigating diagnostic capability of significant factors, resulting in a recommendation to the optimal criteria for predicting pleural invasion and to the optimal threshold for differentiating parietal from visceral invasion. RESULTS Sixty-one (30%) of the 201 patients had pathologically verified pleural invasion. Logistic modeling revealed that the 3D pleural pattern was the only significant factor (P < .001; relative risk of 7.34). Among every combination of the 3D patterns, skirt-like pattern showed the highest accuracy of 77% for predicting pleural invasion. In differentiating parietal from visceral pleural invasion, ROC analysis revealed that Rarea was optimal for differentiating parietal from visceral pleural invasion, and the highest accuracy of 77% was obtained with a cut-off value of 13.4 for this criterion. CONCLUSIONS Computer-aided 3D CT analysis of the pleura was useful for predicting pleural invasion.
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Gallamini A, Zwarthoed C, Borra A. Positron Emission Tomography (PET) in Oncology. Cancers (Basel) 2014; 6:1821-89. [PMID: 25268160 PMCID: PMC4276948 DOI: 10.3390/cancers6041821] [Citation(s) in RCA: 201] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 07/25/2014] [Accepted: 08/07/2014] [Indexed: 02/07/2023] Open
Abstract
Since its introduction in the early nineties as a promising functional imaging technique in the management of neoplastic disorders, FDG-PET, and subsequently FDG-PET/CT, has become a cornerstone in several oncologic procedures such as tumor staging and restaging, treatment efficacy assessment during or after treatment end and radiotherapy planning. Moreover, the continuous technological progress of image generation and the introduction of sophisticated software to use PET scan as a biomarker paved the way to calculate new prognostic markers such as the metabolic tumor volume (MTV) and the total amount of tumor glycolysis (TLG). FDG-PET/CT proved more sensitive than contrast-enhanced CT scan in staging of several type of lymphoma or in detecting widespread tumor dissemination in several solid cancers, such as breast, lung, colon, ovary and head and neck carcinoma. As a consequence the stage of patients was upgraded, with a change of treatment in 10%-15% of them. One of the most evident advantages of FDG-PET was its ability to detect, very early during treatment, significant changes in glucose metabolism or even complete shutoff of the neoplastic cell metabolism as a surrogate of tumor chemosensitivity assessment. This could enable clinicians to detect much earlier the effectiveness of a given antineoplastic treatment, as compared to the traditional radiological detection of tumor shrinkage, which usually takes time and occurs much later.
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Affiliation(s)
- Andrea Gallamini
- Department of Research and Medical Innovation, Antoine Lacassagne Cancer Center, Nice University, Nice Cedex 2-06189 Nice, France.
| | - Colette Zwarthoed
- Department of Nuclear Medicine, Antoine Lacassagne Cancer Center, Nice University, Nice Cedex 2-06189 Nice, France.
| | - Anna Borra
- Hematology Department S. Croce Hospital, Via M. Coppino 26, Cuneo 12100, Italy.
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Hong YJ, Hur J, Lee HJ, Kim YJ, Hong SR, Suh YJ, Choi BW. Respiratory dynamic magnetic resonance imaging for determining aortic invasion of thoracic neoplasms. J Thorac Cardiovasc Surg 2014; 148:644-50. [DOI: 10.1016/j.jtcvs.2013.12.060] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 07/31/2013] [Accepted: 12/12/2013] [Indexed: 11/25/2022]
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12
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Shin S, Park JS, Shim YM, Kim HJ, Kim J. Carinal resection and reconstruction in thoracic malignancies. J Surg Oncol 2014; 110:239-44. [PMID: 24888321 DOI: 10.1002/jso.23643] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 04/10/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES The purpose of this study was to present clinical outcomes of malignant tumors involving the carina after surgery in order to establish the management guidelines. METHODS Between 1996 and 2011, 30 patients underwent carinal resection and reconstruction for malignancy involving carina. We retrospectively analyzed their medical records. There were 22 cases of common type of NSCLC (squamous cell carcinoma/adenocarcinoma/large cell neuroendocrine carcinoma) and eight cases of carcinomas of salivary gland type (adenoid cystic carcinoma/mucoepidermoid carcinoma). RESULTS Seventeen right sleeve pneumonectomies, two left sleeve pneumonectomies, nine carinal sleeve right upper lobectomies, and two airway resections and reconstructions without lung resection were performed. There were no in-hospital mortalities. Eleven postoperative morbidities occurred including three cases of acute respiratory distress syndrome following pneumonectomy. Late complications occurred in eight patients including three cases of anastomotic stenosis. During follow-up, 12 mortalities occurred, including 6 cancer-related mortalities. The 5-year overall survival rate (OS) and disease-free survival rate (DFS) were 66.3% and 52.9%, respectively. CONCLUSIONS Malignant tumors involving the carina can be controlled with carinal surgery with acceptable mortality and morbidity. Patients with thoracic malignancy involving the carina should be considered as surgical candidate based on disease extent and functional status.
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Affiliation(s)
- Sumin Shin
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Arslan D, Bozcuk H, Gunduz S, Tural D, Tattli AM, Uysal M, Goksu SS, Bassorgun CI, Koral L, Coskun HS, Ozdogan M, Savas B. Survival Results and Prognostic Factors in T4 N0-3 Non-small Cell Lung Cancer Patients According to the AJCC 7thEdition Staging System. Asian Pac J Cancer Prev 2014; 15:2465-72. [DOI: 10.7314/apjcp.2014.15.6.2465] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Uramoto H, Shimokawa H, Hanagiri T, Ichiki Y, Tanaka F. Factors predicting the surgical outcome in patients with T3/4 lung cancer. Surg Today 2014; 44:2249-54. [PMID: 24532177 DOI: 10.1007/s00595-014-0861-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 11/13/2013] [Indexed: 12/15/2022]
Abstract
PURPOSE Locally advanced lung cancer, such as T3/4 tumors, is considered to have a significantly worse prognosis than lower-stage disease, and the treatment of these tumors is difficult. Nevertheless, the information regarding the optimal treatment of T3/4 lung cancers after an operation is still limited. This study evaluated the prognostic factors for the postoperative outcome in patients with T3/4 lung cancers. METHODS The results of the surgical treatments were retrospectively analyzed for 212 patients with pathological T3 and 197 patients with T4 disease. RESULTS The global 5-year survival rate was 30.7% in this series. The 5-year overall survival (OS) rate in patients with T3 disease was 36.1%, while that in patients with T4 disease was 24.8%. The prognosis in females, those with N0-1 disease and those who underwent a complete resection was better than that of the other patients in both the T3 and T4 subgroups. The examination of the OS according to a time series showed that the rate was higher in more recent versus less recent years. From the standpoint of pulmonary metastasis (PM), the 5-year OS rates in T4 patients with PM and without PM were 38.6 and 17.4%, respectively. Multivariate analyses demonstrated that female gender, T3 disease, N0-1 disease and postoperative treatment were significant favorable prognostic predictors for OS. CONCLUSIONS These findings suggest that surgical resection remains an important treatment option, especially in cases having the aforementioned factors.
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Affiliation(s)
- Hidetaka Uramoto
- Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan,
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Imai K, Minamiya Y, Saito H, Motoyama S, Sato Y, Ito A, Yoshino K, Kudo S, Takashima S, Kawaharada Y, Kurihara N, Orino K, Ogawa JI. Diagnostic imaging in the preoperative management of lung cancer. Surg Today 2013; 44:1197-206. [PMID: 23838838 DOI: 10.1007/s00595-013-0660-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 05/13/2013] [Indexed: 12/25/2022]
Abstract
Surgical resection is the accepted standard of care for patients with non-small cell lung cancer (NSCLC). Several imaging modalities play central roles in the detection and staging of the disease. The aim of this review is to evaluate the utility of computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET) and PET/CT for NSCLC staging. Radiographic staging refers to the use of CT as a non-invasive diagnostic technique. However, while the vast majority of patients undergo only CT, CT is a notoriously inaccurate means of tumor and nodal staging in many situations. PET/CT clearly improves the staging, particularly nodal staging, compared to CT or PET alone. In addition, as a result of the increased soft-tissue contrast, MRI is superior to CT for distinguishing between tissue characteristics. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), which is a minimally invasive technique, also has pathological diagnostic potential. Extensive research and the resultant improvements in the understanding of genetics, histology, molecular biology and oncology are transforming our understanding of lung cancer, and it is clear that imaging modalities such as CT, MRI, PET and PET/CT will have an important role in its preoperative management. However, thoracic surgeons should also be aware of the limitations of these techniques.
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Affiliation(s)
- Kazuhiro Imai
- Department of Chest (& Endocrinological) Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan,
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16
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Imai K, Minamiya Y, Ishiyama K, Hashimoto M, Saito H, Motoyama S, Sato Y, Ogawa JI. Use of CT to evaluate pleural invasion in non-small cell lung cancer: measurement of the ratio of the interface between tumor and neighboring structures to maximum tumor diameter. Radiology 2013; 267:619-26. [PMID: 23329658 DOI: 10.1148/radiol.12120864] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To develop a simple noninvasive technique for evaluating pleural invasion by using routine preoperative computed tomography (CT). MATERIALS AND METHODS The institutional review board approved this retrospective study, and written informed consent was obtained for performing the initial and follow-up CT studies. Preoperative CT findings (169 patients with possible pleural invasion) and pathologic diagnoses after surgical resection were evaluated. The length of the interface between the primary tumor and neighboring structures (arch distance) and the maximum tumor diameter were measured on CT images, after which arch distance-to-maximum tumor diameter ratios were calculated. Receiver operating characteristic (ROC) curves were used to analyze the ratios. RESULTS Median arch distance-to-maximum tumor diameter ratios for pleural invasion categories (pl1, pl2, pl3) assessed by using the Union Internationale Contre le Cancer TNM staging system were as follows: pl1, 0.206 (25th-75th percentile, 0-0.486); pl2, 0.638 (25th-75th percentile, 0.385-0.830); and pl3, 1.092 (25th-75th percentile, 1.045-1.214) (P < .001 between groups). On the basis of the ROC curves, the cut-off value for invasion was an arch distance-to-maximum tumor diameter ratio of 0.9. When the ratio was greater than 0.9, the sensitivity and specificity for thoracic invasion and area under the ROC curve were 89.7%, 96.0%, and 0.976, respectively, which represents an improvement over values obtained by using conventional criteria (radiologists A and B: 46.7% and 74.2% and 91.3% and 84.8%, respectively). CONCLUSION When diagnosing T3 or T4 lung cancer based on arch distance-to-maximum tumor diameter ratios, a higher performance level was achieved than that with use of conventional criteria. Measurement of the ratios is a simple noninvasive technique for evaluating pleural invasion at CT.
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Affiliation(s)
- Kazuhiro Imai
- Department of Chest, Breast and Endocrinologic Surgery and Department of Integrated Medicine, Division of Radiology and Radiation Medicine, Akita University Graduate School of Medicine, 1-1-1 Hondo Akita City 010-8543, Japan.
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Chen S, Cheng YL, Li ST, Ni YJ, Gu B. Effect analysis of chemoradiotherapy after operation in patients with stage III A non-small cell lung cancer. ASIAN PAC J TROP MED 2012; 5:823-7. [PMID: 23043924 DOI: 10.1016/s1995-7645(12)60151-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Revised: 08/27/2012] [Accepted: 09/28/2012] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To investigate the effect of chemoradiotherapy after surgery on III A stage non-small cell lung cancer (NSCLC). METHODS A total of 156 NSCLC patients undergoing total pneumonectomy or pulmonary lobectomy were included in this study. The chemotherapy group (n=75) received the protocol of cisplatin (DDP) + gemcitabine (GEM) / docetaxel (DOC) / vinorelbine (NVB); the radiotherapy + chemotherapy group (n=81) received sequential chemoradiotherapy. The response rate, local control rate in 1 to 2 years, overall survival (OS), progression-free survival (PFS) and adverse reactions were evaluated. RESULTS The overall response rate was obviously higher in radiotherapy + chemotherapy group (79.4%) than in chemotherapy group (56.8%) (P<0.01). The 1 year local control rates for chemotherapy group and radiotherapy + chemotherapy group were (69.1±7.9)% and (77.8±8.2)% respectively and the difference reached statistical significance (P<0.001). The 2 year local control rates were (42.1±6.1)% and (61.5±6.9)% respectively (P<0.001). The difference in median follow-up time between the two groups did not reach statistical meaning (P>0.05), while the median PFS of two groups were 10.8 months and 16.9 months respectively (P<0.001). 1-year and 3-year survival rates were obviously higher in radiotherapy + chemotherapy group than in chemotherapy group, and the difference reached statistical significance (P<0.05 or P<0.01). The adverse reactions manifested as hematological toxicity and digestive tract reaction in the two groups. In the radiotherapy + chemotherapy group, incidences of radiation-induced esophagus injury and lung injury were 24.7% and 34.6% respectively, all occurring within 2 to 6 weeks after the start of radiation and both below grade 2. CONCLUSIONS Chemoradiotherapy after surgery can improve local control rate and reduce or prevent distant metastasis, but there are still many controversies. In clinical work, we should carefully evaluate each patient's age, lung function, basic physical condition scoring and complications to choose a therapeutic schedule that is suitable for the patient.
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Affiliation(s)
- Sheng Chen
- Department of Thoracic Surgery, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu, China.
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Lococo F, Cesario A, Margaritora S, Dall'Armi V, Nachira D, Cusumano G, Meacci E, Granone P. Induction therapy followed by surgery for T3-T4/N0 non-small cell lung cancer: long-term results. Ann Thorac Surg 2012; 93:1633-40. [PMID: 22480394 DOI: 10.1016/j.athoracsur.2012.01.109] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Revised: 01/24/2012] [Accepted: 01/31/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of this study was to analyze the impact of the induction chemoradiotherapy (IT) on the survival pattern in T3/T4-N0 non-small cell lung cancer (NSCLC) patients. METHODS The data of 71 patients treated from January 1992 to May 2007 were reviewed. Of these, 31 patients received IT prior to surgery (IT group: T3, 20 patients; and T4, 11 patients), and 40 directly underwent surgery (S group: T3, 34 patients; and T4, 6 patients). Survival rates were compared using the Kaplan-Meier analysis and the Cox proportional hazards models. RESULTS Mean ages were 62.5±9.9 years in the IT group and 67.7±7.1 in the S group. All patients but 1 completed the IT treatment and 27 patients (87%) were operated. A radical resection was possible in 21 patients (78%). In the IT group a complete pathologic response was obtained in 6 patients (22%), where 8 patients ended up in pI stage, 7 in pII stage, and 6 in pIII stage. The overall 5-year survival (long-term survival [LTS]) and disease-free 5-year survival (DFS) for the entire cohort were 40% and 34%, respectively. No significant differences were found when LTS in the IT group (44%) and in the S group (37%) were compared. At multivariate analysis, the completeness of resection was the only independent predictive factor (hazard ratio [HR]=5.18; 95% confidence interval [CI]=2.55 to 10.28) while Cox multivariate analysis (on the IT group only) confirmed the critical role of the pathologic downstaging (HR=4.62; 95% CI=1.54 to 13.89). CONCLUSIONS A multimodal strategy with IT treatment followed by surgery is a safe and reasonable treatment in T3/T4-N0 NSCLC patients, but no clear evidence of prognostic improvement may be assumed at the present time. Nevertheless, patients with radical resection and complete pathologic response have a very rewarding survival.
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Affiliation(s)
- Filippo Lococo
- Department of General Thoracic Surgery, Catholic University, Rome, Italy.
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Shien K, Toyooka S, Kiura K, Matsuo K, Soh J, Yamane M, Oto T, Takemoto M, Date H, Miyoshi S. Induction chemoradiotherapy followed by surgical resection for clinical T3 or T4 locally advanced non-small cell lung cancer. Ann Surg Oncol 2012; 19:2685-92. [PMID: 22396006 PMCID: PMC3404289 DOI: 10.1245/s10434-012-2302-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Indexed: 12/25/2022]
Abstract
Purpose To examine the usefulness of trimodality therapy in patients with clinical T3 or T4 (cT3–4) locally advanced non–small cell lung cancer (LA-NSCLC). Methods Between 1997 and 2009, a total of 76 LA-NSCLC patients with cT3–4 underwent surgery. Among them, 36 patients underwent induction chemoradiotherapy with docetaxel and cisplatin plus concurrent radiation followed by surgery (IC group). The other 40 patients initially underwent surgery (IS group). The outcomes of the IC and IS groups were then investigated. To minimize possible biases caused by confounding treatment indications, we performed a retrospective cohort analysis by applying a propensity score (PS). Patients were divided into three groups according to PS tertiles, and comparisons between the IC and IS groups were made by PS tertile-stratified Cox proportional hazard models. Results For the entire cohort, which had a median follow-up duration of 48 months, the 3- and 5-year overall survival rates were 83.8 and 78.9%, respectively, in the IC group, versus 66.8 and 56.5%, respectively, in the IS group (P = 0.0092). After adjustments for potentially confounding variables, the IC group continued to have a significantly longer overall survival than the IS group (P = 0.0045). In addition, when the analysis was limited to 52 patients with cT3–4N0 or N1 disease, the IC group had a significantly longer overall survival than the IS group after adjustments for confounding variables (P = 0.019). Conclusions Our study indicates that trimodality therapy is highly effective in patients with cT3–4 LA-NSCLC. Electronic supplementary material The online version of this article (doi:10.1245/s10434-012-2302-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kazuhiko Shien
- Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan
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Ohguri T, Yahara K, Moon SD, Yamaguchi S, Imada H, Hanagiri T, Tanaka F, Terashima H, Korogi Y. Postoperative radiotherapy for incompletely resected non-small cell lung cancer: clinical outcomes and prognostic value of the histological subtype. JOURNAL OF RADIATION RESEARCH 2012; 53:319-325. [PMID: 22327172 DOI: 10.1269/jrr.11082] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The purpose of this study was to evaluate the efficacy and toxicity of the postoperative radiotherapy in patients with incompletely resected NSCLC, and to investigate whether the histological subtype is a prognostic factor. Forty-one incompletely resected NSCLC patients who underwent postoperative radiotherapy were retrospectively analyzed. The microscopic residual tumor (R1 group) was recognized in 23 patients, and the macroscopic residual tumor (R2 group) in 18. The postoperative pathological stages were I (n = 3), II (n = 8), IIIA (n = 17), and IIIB (n = 13). The histology included squamous cell carcinoma (n = 23), adenocarcinoma (n = 14) or other types (n = 4). The first site of disease progression was distant metastases alone for 3 (13%) of 23 with squamous cell carcinoma, and for 9 (64%) of 14 with adenocarcinoma (p < 0.01). The 5-year overall, local control, disease-free, and distant metastasis-free survival rates were 56%, 63%, 37% and 49%. Univariate analyses showed that squamous cell carcinoma histology, N0-1 stage and the R1 group were significant predictors for better disease-free and distant metastasis-free survival. Multivariate showed that squamous cell carcinoma and N0-1 stage were significant predictors for better distant metastasis-free survival. Toxicity was generally mild; Grade 3 toxicities occurred in 3 patients (neutropenia, radiation pneumonia and esophageal stenosis), and no acute and late toxicities of Grade 4 to 5 were observed. In conclusion, postoperative radiotherapy for incompletely resected NSCLC could achieve a relatively high local control rate without severe toxicity. However, different treatment strategies for non-squamous cell carcinoma should be considered, because of the higher risk for the distant metastases.
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Affiliation(s)
- Takayuki Ohguri
- Department of Radiology, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan.
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Daly BD, Ebright MI, Walkey AJ, Fernando HC, Zaner KS, Morelli DM, Kachnic LA. Impact of neoadjuvant chemoradiotherapy followed by surgical resection on node-negative T3 and T4 non–small cell lung cancer. J Thorac Cardiovasc Surg 2011; 141:1392-7. [DOI: 10.1016/j.jtcvs.2010.12.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 10/15/2010] [Accepted: 12/09/2010] [Indexed: 11/29/2022]
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[Interdisciplinary treatment of non-small cell lung cancer]. Internist (Berl) 2011; 52:158-66. [PMID: 21267533 DOI: 10.1007/s00108-010-2700-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
At the time of diagnosis of non-small cell lung cancer, about two thirds of the patients manifest tumor disease limited to the lungs without distant metastases. In this group localized tumor spread (stages I and II) can be distinguished from locally advanced spread including lymph node metastases (stages IIIA and B). In stages I and II with sufficient cardiopulmonary function, surgical resection is considered the standard treatment approach. If lobe resection is not possible due to comorbidities or limited pulmonary function, parenchyma-sparing resection or definitive radiotherapy is advocated. Postoperative adjuvant chemotherapy is recommended for individual cases in stage IB and as the standard treatment in stage II. In stages IIIA and IIIB interdisciplinary consultation involving pneumologists/oncologists, surgeons, and radiation oncologists is necessary to reach decisions on treatment recommendations. Generally multiple treatment modalities are employed in these stages, such as induction chemotherapy followed by surgery and subsequent irradiation or simultaneous chemoradiotherapy. These treatment combinations with curative intent should be differentiated from the numerous treatment methods with palliative intent.
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Modified Anterolateral Approach Provides Improved Accessibility to the Lung Hilum Vascular Region for Giant Mass Lung Cancer Pneumonectomy. Am Surg 2011. [DOI: 10.1177/000313481107700124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Surgical management of patients with a huge pulmonary mass remains a challenge. The surgical risk is amplified by potential hemorrhage, problematic surgical exposure, difficult handling of the tumor, and poor vascular control. We describe a technique that uses a modified anterolateral thoracotomy to accomplish pneumonectomy. An anterolateral thoracotomy was entered through the 4th or 5th intercostal space. The intercostal muscles of the involved interspace were dissected off long enough but without dividing the overlying chest wall muscles. This crucial maneuver allowed a wide rage of rib spreading. The pulmonary hila and lateral aspect of the mediastinum were thus best exposed. Seven patients with large mass pulmonary cancer were admitted for surgical resection via this approach. Intrapericardial access to pulmonary vessels was obtained for pneumonectomy in all patients, including combined carinoplasty and superior vena cava reconstruction for one case. The perioperative courses were smooth and R0-resection was achieved in all cases. The modified anterolateral approach permits very good exposure and control of the pulmonary vessels at the hilum, enabling the resection maneuver to be effective, quick, and safe.
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Riquet M, Arame A, Le Pimpec Barthes F. Non–Small Cell Lung Cancer Invading the Chest Wall. Thorac Surg Clin 2010; 20:519-27. [DOI: 10.1016/j.thorsurg.2010.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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25
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Suzuki M, Yoshida S, Moriya Y, Hoshino H, Mizobuchi T, Okamoto T, Yoshino I. Surgical outcomes of newly categorized peripheral T3 non-small cell lung cancers: comparisons between chest wall invasion and large tumors (>7 cm). Interact Cardiovasc Thorac Surg 2010; 11:420-4. [PMID: 20675400 DOI: 10.1510/icvts.2010.242743] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The prognosis for non-small cell lung cancer (NSCLC) with chest wall invasion can vary due to the heterogeneous nature of the cell population. Because NSCLC with large tumors (>7 cm) have been reclassified as T3, the applicability of the new designation must be evaluated. We reviewed 140 patients with chest wall T3 and 28 patients with T3 NSCLC with large tumors, but no chest wall invasion who underwent resection at our institution. Among chest wall T3 patients, elderly T3 patients (≥80 years old) who died within 42 months, patients with either lymph node or pulmonary metastasis, or patients with a large tumor (>7 cm) had poorer prognoses than those who had not. The survival rates for cases with chest wall T3 and cases with a large tumor without chest wall invasion were not significantly different. NSCLC patients with chest wall T3 with lymph node, or pulmonary metastasis, or with a large tumor should be considered for further multimodal treatment with or without resection to enhance their survival time. Elderly patients with chest wall invasion may not be good candidates for resection. A large tumor is so aggressive that re-classification of large tumor cases as T3 is suitable.
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Affiliation(s)
- Makoto Suzuki
- Department of Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
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Yin R, Xu L, Ren B, Jiang F, Fan X, Zhang Z, Li M, Hu Z. Clinical experience of lobectomy with pulmonary artery reconstruction for central non-small-cell lung cancer. Clin Lung Cancer 2010; 11:120-5. [PMID: 20199978 DOI: 10.3816/clc.2010.n.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND In patients with central lung cancer, lobectomy can be achieved without pneumonectomy by surgical reconstruction of the pulmonary artery (PA). Herein, we report our clinical experience of 34 patients who had lobectomy with PA reconstruction, including perioperative administration, morbidity, mortality, and long-term survival. PATIENTS AND METHODS The clinical records of 34 patients who received lobectomy with PA reconstruction in our department between August 2003 and September 2005 were reviewed. RESULTS In our series, PA reconstruction with end-to-end anastomosis was performed in 18 patients (52.9%). Seven patients (20.6%) required partial PA reconstruction with autologous pericardium patch. Five patients (14.7%) with a lower lobe tumor required PA reconstruction with artery flap. The perioperative mortality was 2.9%, and 1 patient died on postoperative day 13 because of severe bronchopleural fistula. Another 2 patients had acute respiratory distress syndrome (ARDS) and required reintubation in our Intensive Care Unit. The overall Kaplan-Meier 3-year and 5-year survival rates were 46% and 37%, respectively. As compared with the stage III patients, stage I patients had significantly greater 5-year survival (80% vs. 11%; P = .005). Patients with pN0 disease also had greater 5-year survival than patients with pN2-3 disease (71% vs. 9%; P = .004). CONCLUSION In our department, PA reconstruction has been more frequently and actively performed for patients with central lung cancer, especially for some patients with a lower lobe tumor. Although the morbidity and mortality is acceptable, surgeons should be more attentive to lethal postoperative complications such as ARDS induced by lung ischemia-reperfusion injury.
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Affiliation(s)
- Rong Yin
- Department of Thoracic Surgery, Cancer Hospital of Jiangsu Province, Cancer Institution of Jiangsu Province, Nanjing, China
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Mutyala S, Stewart A, Khan AJ, Cormack RA, O'Farrell D, Sugarbaker D, Devlin PM. Permanent Iodine-125 Interstitial Planar Seed Brachytherapy for Close or Positive Margins for Thoracic Malignancies. Int J Radiat Oncol Biol Phys 2010; 76:1114-20. [DOI: 10.1016/j.ijrobp.2009.02.067] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Revised: 02/25/2009] [Accepted: 02/27/2009] [Indexed: 10/20/2022]
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Liu XY, Liu FY, Wang Z, Chen G. Management and Surgical Resection for Tumors of the Trachea and Carina: Experience with 32 Patients. World J Surg 2009; 33:2593-8. [PMID: 19830481 DOI: 10.1007/s00268-009-0258-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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29
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Surgical Treatment of Lung Cancer Invading the Left Atrium or Base of the Pulmonary Vein. World J Surg 2009; 33:492-6. [DOI: 10.1007/s00268-008-9873-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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30
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Bauman JE, Mulligan MS, Martins RG, Kurland BF, Eaton KD, Wood DE. Salvage Lung Resection After Definitive Radiation (>59 Gy) for Non-Small Cell Lung Cancer: Surgical and Oncologic Outcomes. Ann Thorac Surg 2008; 86:1632-8; discussion 1638-9. [DOI: 10.1016/j.athoracsur.2008.07.042] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Revised: 07/14/2008] [Accepted: 07/16/2008] [Indexed: 11/30/2022]
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Yıldızeli B, Dartevelle PG, Fadel E, Mussot S, Chapelier A. Results of Primary Surgery With T4 Non–Small Cell Lung Cancer During a 25-Year Period in a Single Center: The Benefit is Worth the Risk. Ann Thorac Surg 2008; 86:1065-75; discussion 1074-5. [PMID: 18805134 DOI: 10.1016/j.athoracsur.2008.07.004] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Revised: 07/01/2008] [Accepted: 07/02/2008] [Indexed: 10/21/2022]
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32
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Extended pneumonectomy for non–small cell lung cancer: Morbidity, mortality, and long-term results. J Thorac Cardiovasc Surg 2007; 134:1266-72. [PMID: 17976460 DOI: 10.1016/j.jtcvs.2007.01.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Revised: 12/29/2006] [Accepted: 01/08/2007] [Indexed: 11/21/2022]
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Pompeo E, Tacconi F, Mineo TC. Flexible Videopericardioscopy in cT4 Nonsmall-Cell Lung Cancer With Radiologic Evidence of Proximal Vascular Invasion. Ann Thorac Surg 2007; 83:402-8. [PMID: 17257961 DOI: 10.1016/j.athoracsur.2006.09.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2006] [Revised: 08/29/2006] [Accepted: 09/01/2006] [Indexed: 12/25/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate feasibility and effectiveness of flexible videopericardioscopy (FVP) in assessing resectability of cT4 nonsmall-cell lung cancer (NSCLC) with radiologic evidence of proximal vascular invasion. METHODS Between March 2003 and December 2005, 22 patients with NSCLC deemed unresectable owing to signs of proximal vascular invasion at multislice computed tomography were included in a nonrandomized prospective study entailing FVP performed before curative-intent thoracotomy. Primary outcome measures were technical feasibility (graded from 1 = poor to 3 = excellent) and quality of anatomic visualization (graded as diagnostic or nondiagnostic). Patients with FVP evidence of proximal vascular invasion did not receive thoracotomy and were included in an induction chemoradiotherapy protocol. RESULTS Mean operative time was 31 +/- 6 minutes. Technical feasibility ranged from good to excellent in 21 patients. In 1 patient, FVP was not completed owing to intrapericardial adhesions. In 7 patients, FVP disclosed no tumor spread to intrapericardial pulmonary vessels, and radical resection was carried out. The FVP findings were considered not diagnostic because of poor visualization of the right pulmonary artery in 2 patients with bulky hilar tumors. There was no operative mortality and morbidity. Mean hospital stay was 2.9 +/- 1 days for patients who did not undergo thoracotomy and 6.3 +/- 1 days for patients receiving FVP plus resection. Definitive pathologic staging in patients undergoing resection was pT3N1 (n = 2), pT3N0 (n = 2), pT2N0 (n = 3), and pT2N1 (n = 1). CONCLUSIONS Flexible videopericardioscopy proved safely feasible and allowed a better assessment of centrally located NSCLC, with radiologic evidence of proximal vascular involvement eventually resulting in increased resectability rate.
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Affiliation(s)
- Eugenio Pompeo
- Thoracic Surgery Division, Tor Vergata University School of Medicine, Rome, Italy.
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Spaggiari L, Leo F, Veronesi G, Solli P, Galetta D, Tatani B, Petrella F, Radice D. Superior Vena Cava Resection for Lung and Mediastinal Malignancies: A Single-Center Experience With 70 Cases. Ann Thorac Surg 2007; 83:223-9; discussion 229-30. [PMID: 17184668 DOI: 10.1016/j.athoracsur.2006.07.075] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2006] [Revised: 07/26/2006] [Accepted: 07/27/2006] [Indexed: 11/22/2022]
Abstract
BACKGROUND The oncologic value of superior vena cava (SVC) resection for lung and mediastinal malignancies remains controversial. In this context, we have reviewed our experience in the treatment of locally advanced lung and mediastinal tumor invading the SVC system, analyzing postoperative outcome and long-term oncologic results. METHODS The clinical data of patients who underwent SVC resection were retrospectively analyzed to assess postoperative mortality, and overall and procedure-specific morbidity. Overall survival was calculated for mediastinal and lung tumor groups. RESULTS From 1998 to 2004, 70 consecutive patients (52 with lung cancer and 18 with mediastinal tumors) underwent SVC system resection. There were 25 replacements (36%) of the SVC system by prosthesis, whereas the remaining underwent partial resection. Major postoperative morbidity and mortality rates in lung cancer patients were 23% and 7.7%, respectively (50% and 5.6% in mediastinal tumors). In the lung cancer group, 5-year survival probability was 31%, and it was affected by mediastinal nodal status (5-year survival in N0-N1 patients 52%, 21% in N2 patients, 0 in N3 patients). Median survival for mediastinal tumors was 49 months. CONCLUSIONS In conclusion, SVC resection may achieve permanent cure in patients who would have been defined as inoperable 10 years ago. In the case of mediastinal tumors, the need for SVC resection alone should not be considered a contraindication for surgery when prosthetic replacement is feasible. In the case of lung tumors, infiltration of SVC can achieve satisfactory long-term results after neoadjuvant chemotherapy, only when pathologic N2 disease is excluded by preoperative mediastinoscopy.
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Affiliation(s)
- Lorenzo Spaggiari
- Division of Thoracic Surgery, European Institute of Oncology, University of Milan School of Medicine, Milan, Italy.
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