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Gregoire J. Guiding Principles in the Management of Synchronous and Metachronous Primary Non-Small Cell Lung Cancer. Thorac Surg Clin 2021; 31:237-254. [PMID: 34304832 DOI: 10.1016/j.thorsurg.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Multiple lung cancers can be found simultaneously, with incidence ranging from 1% to 8%. Documentation of more than 1 pulmonary lesion can be challenging, because these solid, ground-glass, or mixed-density tumors may represent multicentric malignant disease or intrapulmonary metastases. If mediastinal nodal and distant deposits are excluded, surgery should be contemplated. After surgical treatment of lung cancer, patients should be followed closely for an undetermined period of time. Good clinical judgment is of outmost importance in deciding which individuals will benefit from those surgical interventions and which are candidates for alternate therapies. Every case should be discussed in a multidisciplinary meeting.
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Affiliation(s)
- Jocelyn Gregoire
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Sainte-Foy, Quebec, Quebec G1V 4G5, Canada.
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Drug Regimen for Patients after a Pneumonectomy. JOURNAL OF RESPIRATION 2021. [DOI: 10.3390/jor1020013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pneumonectomy is an entire lung removal and is indicated for both malignant and benign diseases. Due to its invasiveness and postoperative complications, pneumonectomy is still associated with high mortality and morbidity. Appropriate postoperative management is crucial in pneumonectomy patients to improve quality of life and overall survival rates. Diverse drug regimens are under development to be used in adjuvant chemotherapy or to improve respiratory health after a pneumonectomy. The most common causes for a pneumonectomy are non-small cell lung cancer, malignant pleural mesothelioma, and tuberculosis; thus, an appropriate drug regimen is necessary. The uncommon incidence of pneumonectomy cases remains the major obstacle in studies of postoperative drug regimens. As the majority of current studies include post-lobectomy and post-segmentectomy patients, it is highly recommended that further research of postoperative drug regimens be focused on post-pneumonectomy patients.
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Kawamoto N, Furukawa M, Okita R, Okada M, Hayashi M, Inokawa H, Okabe K, Kawata K. Contralateral pulmonary resection using selective bronchial blockade in postpneumonectomy patients. Thorac Cancer 2020; 11:3528-3535. [PMID: 33052015 PMCID: PMC7705631 DOI: 10.1111/1759-7714.13696] [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: 09/04/2020] [Revised: 09/23/2020] [Accepted: 09/25/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Pulmonary resection is occasionally performed in postpneumonectomy patients with contralateral lung lesions, such as metachronous or metastatic lung cancer. Careful intraoperative respiratory management is essential in such patients. This study evaluated the respiratory management of postpneumonectomy patients who underwent contralateral pulmonary resection with selective bronchial blockade of the lobe or segment to be resected. METHODS We retrospectively analyzed the surgical findings and safety of surgery in six patients who underwent contralateral pulmonary resection with selective bronchial blockade after pneumonectomy for non-small cell lung cancer (NSCLC). RESULTS The percutaneous oxygen saturation did not decrease in any of the patients during bronchial blockade under high oxygen concentration. The median blockade time was 57.5 minutes. The operative field was tolerable secured under conditions of partial lung collapse, and partial pulmonary resection was performed as planned. Postoperatively, one patient developed acute respiratory distress syndrome due to acute exacerbation of interstitial pneumonia; however, no patients died within one month postoperatively. Two patients underwent pulmonary resection in order to obtain adequate tissue specimens to evaluate the biomarkers of multiple lung metastases. On histopathology, one patient tested positive for anaplastic lymphoma kinase (ALK) and was subsequently administered an ALK inhibitor, which prolonged survival. CONCLUSIONS In all patients, intraoperative respiratory condition under partial lung collapse remained stable, and all partial pulmonary resections were safely performed. However, surgical indications should be carefully reviewed preoperatively in patients with interstitial pneumonia. KEY POINTS SIGNIFICANT FINDINGS OF THE STUDY: Contralateral partial pulmonary resection was performed using selective bronchial blockade in postpneumonectomy patients. Percutaneous oxygen saturation did not decrease during the bronchial blockade under high oxygen concentration, and the operative field was tolerable secured under conditions of partial lung collapse. WHAT THIS STUDY ADDS Oxygen concentration can be set to the minimum level, sufficient to maintain oxygenation, during contralateral partial pulmonary resection with selective bronchial blockade.
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Affiliation(s)
- Nobutaka Kawamoto
- Department of Thoracic Surgery, National Hospital Organization Yamaguchi Ube Medical Center, Yamaguchi, Japan
| | - Masashi Furukawa
- Department of Thoracic Surgery, National Hospital Organization Yamaguchi Ube Medical Center, Yamaguchi, Japan
| | - Riki Okita
- Department of Thoracic Surgery, National Hospital Organization Yamaguchi Ube Medical Center, Yamaguchi, Japan
| | - Masanori Okada
- Department of Thoracic Surgery, National Hospital Organization Yamaguchi Ube Medical Center, Yamaguchi, Japan
| | - Masataro Hayashi
- Department of Thoracic Surgery, National Hospital Organization Yamaguchi Ube Medical Center, Yamaguchi, Japan
| | - Hidetoshi Inokawa
- Department of Thoracic Surgery, National Hospital Organization Yamaguchi Ube Medical Center, Yamaguchi, Japan
| | - Kazunori Okabe
- Department of Thoracic Surgery, National Hospital Organization Yamaguchi Ube Medical Center, Yamaguchi, Japan
| | - Keisuke Kawata
- Department of Anesthesiology, National Hospital Organization Yamaguchi Ube Medical Center, Yamaguchi, Japan
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Arifin AJ, Al-Shafa F, Chen H, Boldt RG, Warner A, Rodrigues GB, Palma DA, Louie AV. Is lung stereotactic ablative radiotherapy safe after pneumonectomy?-a systematic review. Transl Lung Cancer Res 2020; 9:348-353. [PMID: 32420074 PMCID: PMC7225144 DOI: 10.21037/tlcr.2020.01.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Patients treated with surgery for lung cancer are at risk of second primary lung cancers (SPLCs), which when localized, may be amenable to radical treatment. Treatment options, however, are limited due to reduced cardiopulmonary reserve and competing mortality risks. The aim of this study was to perform a systematic review of publications examining treatment planning considerations, clinical outcomes, and toxicity rates of stereotactic ablative radiotherapy (SABR) in patients who have previously undergone pneumonectomy. A systematic review of the literature was conducted in accordance with PRISMA guidelines using PubMed and EMBASE from inception to July 2018. Articles were limited to those published in the English language. Non-review articles with patients who received exclusively lung SABR post-pneumonectomy were included. Two reviewers independently performed abstract and full-text review, with discrepancies settled by a third reviewer. Of the 215 articles identified by the initial search, 6 articles comprising 53 patients who received lung SABR post-pneumonectomy met inclusion criteria. The mean age was 68, and most patients were male (73.7%). The mean time to pneumonectomy was 6.5 years. The mean biologically effective dose was 115 Gy, and the most common dose fractionation schemes were 54 Gy in 3 fractions, 48 Gy in 4 fractions, and 50 Gy in 5 fractions. The mean follow-up was 25.4 months. The mean 1-year overall survival and 2-year local control rates were 80.6% and 89.4%. Grade 3 or higher toxicity was reported in 13.2% of patients. SABR appears to be a safe and feasible option for SPLCs in patients with prior pneumonectomy. Multi-institutional and/or prospective studies would be helpful to determine the true risk and appropriateness of SABR in this high-risk patient population.
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Affiliation(s)
- Andrew J Arifin
- Division of Radiation Oncology, London Regional Cancer Program, London, ON, Canada
| | - Faiez Al-Shafa
- Division of Radiation Oncology, London Regional Cancer Program, London, ON, Canada
| | - Hanbo Chen
- Division of Radiation Oncology, London Regional Cancer Program, London, ON, Canada
| | - R Gabriel Boldt
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Andrew Warner
- Division of Radiation Oncology, London Regional Cancer Program, London, ON, Canada
| | - George B Rodrigues
- Division of Radiation Oncology, London Regional Cancer Program, London, ON, Canada
| | - David A Palma
- Division of Radiation Oncology, London Regional Cancer Program, London, ON, Canada
| | - Alexander V Louie
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Agarwal J, Gupta M, Mummudi N, Mhatre R. Single-lung stereotactic body radiotherapy: A case report and discussion of therapeutic challenges. Lung India 2020; 37:177-179. [PMID: 32108609 PMCID: PMC7065547 DOI: 10.4103/lungindia.lungindia_281_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
PURPOSE OF REVIEW Significant advances have been made in the field of stereotactic ablative radiotherapy (SABR) for the treatment of pulmonary neoplasms in recent years. This review aims to summarize recent salient evidence on SABR for early-stage nonsmall cell lung cancer (ES-NSCLC). RECENT FINDINGS In medically inoperable patients, SABR remains the standard of care. The optimal SABR dosing regimen is being studied. Comparisons with non-SABR radiotherapy regimens with lower doses per fraction revealed benefit of SABR. In operable patients, no prospective clinical trial comparing SABR and surgery has been completed, although multiple trials are currently underway to address this question. SABR is generally cost-effective and safe in most patients, with preserved patient-reported quality of life. However, increased toxicity with SABR is noted in patients with disease close to, or invading the proximal tracheobronchial tree. Significant SABR-related toxicity and mortality is also reported in patients with coexisting interstitial lung disease. Considerations on pathologic confirmation, surveillance and multiple primaries are also addressed. SUMMARY SABR is an effective and safe treatment for inoperable ES-NSCLC. Ongoing trials and comparative effectiveness research will help to clarify SABR's role in various lung cancer indications going forward.
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Febbo JA, Gaddikeri RS, Shah PN. Stereotactic Body Radiation Therapy for Early-Stage Non–Small Cell Lung Cancer: A Primer for Radiologists. Radiographics 2018; 38:1312-1336. [DOI: 10.1148/rg.2018170155] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Jennifer A. Febbo
- From the Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, 1653 W Congress Pkwy, Jelke 181, Chicago, IL 60612
| | - Ramya S. Gaddikeri
- From the Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, 1653 W Congress Pkwy, Jelke 181, Chicago, IL 60612
| | - Palmi N. Shah
- From the Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, 1653 W Congress Pkwy, Jelke 181, Chicago, IL 60612
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Ayub A, Rehmani S, Al-Ayoubi AM, Lewis E, Santana-Rodríguez N, Clavo B, Raad W, Bhora FY. Radiation therapy improves survival for unresectable postpneumonectomy lung tumors. J Surg Res 2018; 227:60-66. [DOI: 10.1016/j.jss.2018.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 01/09/2018] [Accepted: 02/13/2018] [Indexed: 11/25/2022]
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Zampieri D, Marulli G, Comacchio GM, Schiavon M, Zuin A, Rea F. Thoracoscopic wedge resection in single-lung patients. J Thorac Dis 2018; 10:861-866. [PMID: 29607158 DOI: 10.21037/jtd.2018.01.54] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The thoracoscopic approach has become a standard procedure in the field of lung resections. However, its advantage in single-lung patients has not yet been well studied. We describe a series of successful thoracoscopic wedge resections in patients presenting with lung cancer after contralateral pneumonectomy. Methods Eight patients, with a previous pneumonectomy (5 right and 3 left) for lung cancer, underwent resection for a suspicious neoplasm on the remaining lung. All lesions were detected in the asymptomatic phase during regular follow-up after pneumonectomy based on repeated computer tomography (CT). Only single peripheral lesions less than 2 cm were eligible for wedge resection were eligible for surgery. Video-assisted thoracoscopic, margin-free tumor wedge resections, were performed during apnea windows with the lung in a deflated position. Results All patients were treated by a wedge resections smaller than a single segment. Only one patient needed a mini-thoracotomy conversion to accomplish a safe margin-free resection. Median total surgical operative time was 37 minutes. There were no postoperative deaths, while morbidity was 12.5%. Conclusions Thoracoscopic surgery represents a feasible surgical option in selected patients after contralateral pneumonectomy, with careful preoperative assessment and using short apnea windows in good collaboration with anesthesiologists. Histological definition, made possible by the surgical-procedure, gives patients the possibility to eventually undergo further targeted therapies. Randomized prospective trials are necessary to assess the best management of peripheral small lung nodules in single-lung patients, in particular to define which patients can benefit from a surgical approach.
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Affiliation(s)
- Davide Zampieri
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Giuseppe Marulli
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Giovanni Maria Comacchio
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Marco Schiavon
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Andrea Zuin
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
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Pulmonary Resection for Second Lung Cancer After Pneumonectomy: A Population-Based Study. Ann Thorac Surg 2017; 104:1131-1137. [DOI: 10.1016/j.athoracsur.2017.04.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 04/13/2017] [Accepted: 04/17/2017] [Indexed: 11/24/2022]
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Chen HX, Xiang H, Xu WH, Li M, Yuan J, Liu J, Sun WJ, Zhang R, Li J, Ren ZQ, Zhang XM, Du B, Wan J, Wu BY, Zeng Q, He KL, Yang C. Manganese Superoxide Dismutase Gene–Modified Mesenchymal Stem Cells Attenuate Acute Radiation-Induced Lung Injury. Hum Gene Ther 2017; 28:523-532. [PMID: 27806643 DOI: 10.1089/hum.2016.106] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Hai-Xu Chen
- Core Laboratory of Translational Medicine, Institute of Geriatrics, Health Management Institute, Gastrointestinal Department of Southern Building, Laboratory of Basic Research and Translational Medicine for Chronic Heart Failure, General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Hang Xiang
- Core Laboratory of Translational Medicine, Institute of Geriatrics, Health Management Institute, Gastrointestinal Department of Southern Building, Laboratory of Basic Research and Translational Medicine for Chronic Heart Failure, General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Wen-Huan Xu
- Core Laboratory of Translational Medicine, Institute of Geriatrics, Health Management Institute, Gastrointestinal Department of Southern Building, Laboratory of Basic Research and Translational Medicine for Chronic Heart Failure, General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Ming Li
- School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, China
| | - Jie Yuan
- Departments of Hematology and Blood Transfusion, General Hospital of the PLA Rocket Force, Beijing, China
| | - Juan Liu
- Departments of Hematology and Blood Transfusion, General Hospital of the PLA Rocket Force, Beijing, China
| | - Wan-Jun Sun
- Departments of Hematology and Blood Transfusion, General Hospital of the PLA Rocket Force, Beijing, China
| | - Rong Zhang
- Departments of Hematology and Blood Transfusion, General Hospital of the PLA Rocket Force, Beijing, China
| | - Jun Li
- Departments of Hematology and Blood Transfusion, General Hospital of the PLA Rocket Force, Beijing, China
| | - Zhao-Qi Ren
- Departments of Hematology and Blood Transfusion, General Hospital of the PLA Rocket Force, Beijing, China
| | - Xiao-Mei Zhang
- Core Laboratory of Translational Medicine, Institute of Geriatrics, Health Management Institute, Gastrointestinal Department of Southern Building, Laboratory of Basic Research and Translational Medicine for Chronic Heart Failure, General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Bin Du
- Departments of Hematology and Blood Transfusion, General Hospital of the PLA Rocket Force, Beijing, China
| | - Jun Wan
- Core Laboratory of Translational Medicine, Institute of Geriatrics, Health Management Institute, Gastrointestinal Department of Southern Building, Laboratory of Basic Research and Translational Medicine for Chronic Heart Failure, General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Ben-Yan Wu
- Core Laboratory of Translational Medicine, Institute of Geriatrics, Health Management Institute, Gastrointestinal Department of Southern Building, Laboratory of Basic Research and Translational Medicine for Chronic Heart Failure, General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Qiang Zeng
- Core Laboratory of Translational Medicine, Institute of Geriatrics, Health Management Institute, Gastrointestinal Department of Southern Building, Laboratory of Basic Research and Translational Medicine for Chronic Heart Failure, General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Kun-Lun He
- Core Laboratory of Translational Medicine, Institute of Geriatrics, Health Management Institute, Gastrointestinal Department of Southern Building, Laboratory of Basic Research and Translational Medicine for Chronic Heart Failure, General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Chao Yang
- Core Laboratory of Translational Medicine, Institute of Geriatrics, Health Management Institute, Gastrointestinal Department of Southern Building, Laboratory of Basic Research and Translational Medicine for Chronic Heart Failure, General Hospital of the Chinese People's Liberation Army, Beijing, China
- Departments of Hematology and Blood Transfusion, General Hospital of the PLA Rocket Force, Beijing, China
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Petrella F, Spaggiari L. Therapeutic options following pneumonectomy in non-small cell lung cancer. Expert Rev Respir Med 2016; 10:919-25. [PMID: 27176616 DOI: 10.1080/17476348.2016.1188694] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Pneumonectomy can be considered the most appropriate treatment for lung cancer that cannot be removed by lesser resection on. AREAS COVERED Therapeutic options following pneumonectomy may be required at least in 3 different scenarios: 1) an early approach due to acute surgical complications 2) a late approach due to chronic surgical complications 3) an integrated radio-chemotherapeutic adjuvant approach for advanced stages. In this review we focused on these three settings with particular emphasis to surgical approach as well as to alternative options. Expert commentary: Pneumonectomy itself does not preclude postoperative additional treatments, if needed, to maximize oncological results and to manage potential short or long term complications. However, as pneumonectomy puts a significant physiological stress on the respiratory and circulatory systems, the benefits and risks of pneumonectomy should be compared with those of alternative, non-resectional treatment modalities.
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Affiliation(s)
| | - Lorenzo Spaggiari
- a Department of Thoracic Surgery , University of Milan , Milan , Italy.,b Department of Oncology and Hematology/Oncology - DIPO , University of Milan , Milan , Italy
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