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Abstract
BACKGROUND Screening for lung cancer has used chest radiography (CR), low dose computed tomography (LDCT) and sputum cytology (SC). Estimates of the lead time (LT), i.e., the time interval from detection of lung cancer by screening to the development of symptoms, have been derived from longitudinal studies of populations at risk, tumor doubling time (DT), the ratio between its prevalence at the first round of screening and its annual incidence during follow-up, and by probability modeling derived from the results of screening trials. OBJECTIVE To review and update the estimates of LT of lung cancer. METHODS A non-systematic search of the literature for estimates of LT and screening trials. Search of the reference sections of the retrieved papers for additional relevant studies. Calculation of LTs derived from these studies. RESULTS LT since detection by CR was 0.8-1.1 years if derived from longitudinal studies; 0.6-2.1 years if derived from prevalence / incidence ratios; 0.2 years if derived from the average tumor DT; and 0.2-1.0 if derived from probability modeling. LT since detection by LDCT was 1.1-3.5 if derived from prevalence / incidence ratios; 3.9 if derived from DT; and 0.9 if derived from probability modeling. LT since detection of squamous cell cancer by SC in persons with normal CR was 1.3-1.5 if derived from prevalence/incidence ratios; and 2.1 years if derived from the DT of squamous cell cancer. CONCLUSIONS Most estimates of the LT yield values of 0.2-1.5 years for detection by CR; of 0.9-3.5 years for detection by LDCT; and about 2 years or less for detection of squamous cell cancer by SC in persons with normal CR. The heterogeneity of the screening trials and methods of derivation may account for the variability of LT estimates.
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Affiliation(s)
- Jochanan Benbassat
- Department of Medicine (retired), Hadassah Medical Center, PO Box 3894, 91037, Jerusalem, Israel.
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2
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Andreev VY, Yanev NA, Stanimirov SK, Mircheva TV, Ivanov IN, Popovska S, Hristova PA, Ivanov YY. Diagnosis and Treatment of Three Cases of Bronchial Carcinoma In Situ. Folia Med (Plovdiv) 2018; 60:164-169. [PMID: 29668447 DOI: 10.1515/folmed-2017-0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 05/30/2017] [Indexed: 11/15/2022] Open
Abstract
As part of a retrospective study on bronchoscopies performed at the Clinic of Pneumonology and Phthisiatry of the University Hospital - Pleven by autofluorescence bronchoscopy we found 3 cases diagnosed with carcinoma in situ. They were treated in different ways - endobronchial electrocoagulation, extraction by forceps biopsy and open surgery, but the result was the same - clinical healing. The paper presents the three clinical cases and the analysis of the treatment.
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Affiliation(s)
- Valeri Y Andreev
- Clinic of Pneumonology and Phthisiatry, Dr. G. Stranski University Hospital, Pleven, Bulgaria
| | - Nikolay A Yanev
- Clinic of Pneumonology and Phthisiatry, Dr. G. Stranski University Hospital, Pleven, Bulgaria
| | - Stefan K Stanimirov
- Clinic of Pneumonology and Phthisiatry, Dr. G. Stranski University Hospital, Pleven, Bulgaria
| | - Temenuzhka V Mircheva
- Department of Pathological Anatomy, Dr. G. Stranski University Hospital, Pleven, Bulgaria
| | - Ivan N Ivanov
- Department of Pathological Anatomy, Dr. G. Stranski University Hospital, Pleven, Bulgaria
| | - Savelina Popovska
- Department of Pathological Anatomy, Dr. G. Stranski University Hospital, Pleven, Bulgaria
| | - Petkana A Hristova
- Department of Social and Preventive Medicine, Medical Statistics, Pedagogics and Psychology, Medical University of Pleven, Pleven, Bulgaria
| | - Yavor Y Ivanov
- Clinic of Pneumonology and Phthisiatry, Dr. G. Stranski University Hospital, Pleven, Bulgaria
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3
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Scarlata S, Fuso L, Lucantoni G, Varone F, Magnini D, Antonelli Incalzi R, Galluccio G. The technique of endoscopic airway tumor treatment. J Thorac Dis 2017; 9:2619-2639. [PMID: 28932570 DOI: 10.21037/jtd.2017.07.68] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
More than half of primary lung cancers are not resectable at diagnosis and 40% of deaths may be secondary to loco-regional disease. Many of these patients suffer from symptoms related to airways obstruction. Indications for therapeutic endoscopic treatment are palliation of dyspnea and other obstructive symptoms in advanced cancerous lesions and cure of early lung cancer. Bronchoscopic management is also indicated for all those patients suffering from benign or minimally invasive neoplasm who are not suitable for surgery due to their clinical conditions. Clinicians should select cases, evaluating tumor features (size, location) and patient characteristics (age, lung function impairment) to choose the most appropriate endoscopic technique. Laser therapy, electrocautery, cryotherapy and stenting are well-described techniques for the palliation of symptoms due to airway involvement and local treatment of endobronchial lesions. Newer technologies, with an established role in clinical practice, are endobronchial ultrasound (EBUS), autofluorescence bronchoscopy (AFB), and narrow band imaging (NBI). Other techniques, such as endobronchial intra-tumoral chemotherapy (EITC), EBUS-guided-transbronchial needle injection or bronchoscopy-guided radiofrequency ablation (RFA), are in development for the use within the airways. These endobronchial interventions are important adjuncts in the multimodality management of lung cancer and should become standard considerations in the management of patients with advanced lung cancer, benign or otherwise not approachable central airway lesions. We aimed at revising several endobronchial treatment modalities that can augment standard antitumor therapies for advanced lung cancer, including rigid and flexible bronchoscopy, laser therapy, endobronchial prosthesis, and photodynamic therapy (PDT).
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Affiliation(s)
- Simone Scarlata
- Geriatrics, Unit of Respiratory Pathophysiology and Thoracic Endoscopy, Campus Bio Medico University and Teaching Hospital, Rome, Italy
| | - Lello Fuso
- Bronchoscopy and Pneumology Unit, Catholic University, Rome, Italy
| | | | - Francesco Varone
- Bronchoscopy and Pneumology Unit, Catholic University, Rome, Italy
| | - Daniele Magnini
- Bronchoscopy and Pneumology Unit, Catholic University, Rome, Italy
| | - Raffaele Antonelli Incalzi
- Geriatrics, Unit of Respiratory Pathophysiology and Thoracic Endoscopy, Campus Bio Medico University and Teaching Hospital, Rome, Italy
| | - Gianni Galluccio
- Unit of Thoracic Endoscopy, San Camillo Forlanini Hospital, Rome, Italy
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4
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Mazzone PJ. Preoperative evaluation of the lung cancer resection candidate. Expert Rev Respir Med 2014; 4:97-113. [DOI: 10.1586/ers.09.68] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Oskan F, Kornhuber C, Krause G, Vordermark D. Simultaneous stereotactic body radiation therapy of a primary non-small cell lung cancer and synchronous carcinoma in situ in a medically inoperable patient: case report. Radiat Oncol 2013; 8:213. [PMID: 24028532 PMCID: PMC3851482 DOI: 10.1186/1748-717x-8-213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 09/11/2013] [Indexed: 12/02/2022] Open
Abstract
The co-incidence of synchronous intraepithelial neoplasia and early stage invasive lung cancer is not a rare phenomenon. The need for curative treatment and the invasive potential of squamous cell pulmonary carcinoma in situ have been a topic of controversy. Surgical resection still remains the treatment of choice. Varieties of endoscopic techniques such as brachytherapy were developed as an alternative to surgery in selected patients. External beam radiation therapy has been used traditionally in combination with endobronchial brachytherapy in the treatment of roentgenographically occult lung cancer, and can be offered for all patients, but is handicapped, because these tumors are radiographically invisible. We report the first case of a pulmonary carcinoma in situ that was successfully treated with stereotactic body radiation therapy.
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Affiliation(s)
- Feras Oskan
- Department of Radiation Oncology, Martin-Luther University Hospital, Halle-Wittenberg, Dryanderstraße 4, 06110, Halle (Saale), Germany.
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Endo C, Sakurada A, Kondo T. Early central airways lung cancer. Gen Thorac Cardiovasc Surg 2012; 60:557-60. [PMID: 22810461 DOI: 10.1007/s11748-012-0102-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Indexed: 01/13/2023]
Abstract
Early central airways lung cancer accounts for very small percentage of all lung cancers. Given this fact, it is much difficult to carry out a prospective randomized comparative clinical trial. Even retrospective studies can offer important information. Early central airways lung cancer is usually detected by sputum cytology. If sputum cytology shows atypical epithelial cells implying malignancy, the next thing we have to do is bronchoscopy. Both autofluorescence bronchoscopy and white light bronchoscopy were superior to white light bronchoscopy alone in detecting this type of lung cancer. Natural history of this cancer showed about the two-thirds of the patients die from original disease within 10 years. If the tumor length is 10 mm or less, photodynamic therapy is a first-line modality. After photodynamic therapy, a 5-year overall survival of about 80 % and a 10-year overall survival of 70 % can be expected. If a cancer does not meet the criteria for photodynamic therapy, surgical resection is recommended, and 5-year overall survival of about 80 % can be expected. Segmentectomy should be considered because of pulmonary function preservation if a tumor is located at segmental bronchi or beyond it. The frequency of multicentricity is high. Treatment strategy for subsequent primary lung cancer is an important key for the prognosis of patients with treated early central airways lung cancer. Surgical resection is still the most reliable treatment of subsequent primary lung cancer, except for in situ or microinvasive carcinoma located centrally, which could be cured by photodynamic therapy.
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Affiliation(s)
- Chiaki Endo
- Department of Thoracic Surgery, Tohoku University Hospital, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan.
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Prediction of the postoperative pulmonary function in lung cancer patients with borderline function using ventilation–perfusion scintigraphy. Nucl Med Commun 2012; 33:283-7. [PMID: 22157729 DOI: 10.1097/mnm.0b013e32834eaca1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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[Protocols for lung cancer screening: Limitations, and consequences]. Rev Mal Respir 2010; 27:314-28. [PMID: 20403542 DOI: 10.1016/j.rmr.2009.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2009] [Accepted: 11/04/2009] [Indexed: 11/23/2022]
Abstract
Lung cancer is the leading cause of cancer mortality in the world. Its incidence is still rising, especially in women, and its prognosis is poor with a 5-year survival of 15%. Since 1970, several studies on lung cancer screening have been conducted using different investigations. Screening by chest X-ray and sputum cytology does not lead to improved survival in lung cancer. Screening by CT scan has the same outcome but the detection of lung cancer, especially in its early stages, is better than with chest X-ray and sputum cytology. Fluorescence endoscopy is a valuable examination for the detection of pre-invasive bronchial lesions. Genetic studies and identification of circulating tumour cells are being developed. All these examinations are very stressful for the patients. Only few trials have studied the consequences of lung cancer screening on the quality of life. In this review, we analyze the various screening strategies, their impact on quality of life and health and their adverse effects.
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Endo C, Miyamoto A, Sakurada A, Aikawa H, Sagawa M, Sato M, Saito Y, Kondo T. Results of long-term follow-up of photodynamic therapy for roentgenographically occult bronchogenic squamous cell carcinoma. Chest 2009; 136:369-375. [PMID: 19318660 DOI: 10.1378/chest.08-2237] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Photodynamic therapy (PDT) is considered a useful and minimally invasive modality for treating centrally located early lung cancer. To date, there has been limited information on the long-term outcome of patients treated with PDT, especially those who are medically operable. METHODS Beginning in 1994, patients with roentgenographically occult bronchogenic squamous cell carcinoma (ROSCC) who met our criteria underwent PDT at Tohoku University Hospital and were followed up through 2006. Our criteria were as follows: (1) ROSCC without distant metastasis; (2) medically operable by means of lobectomy or further resection; (3) longitudinal tumor length of <or= 10 mm; and (4) superficial bronchoscopic tumor findings. RESULTS A total of 48 patients with ROSCC underwent PDT. The complete response (CR) rate was 94% (45 of 48 of patients). Nine patients (20%) had local recurrence after CR. A total of 11 deaths was observed, with 6 resulting from multiple primary lung cancer and only 1 from the original ROSCC. The 5-year and 10-year overall survival rates for all 48 patients were 81% and 71%, respectively. The Cox proportional hazard model showed that only metachronous multiple primary lung cancer was an independent poor prognostic factor. CONCLUSIONS PDT is thought to be a first-line modality for patients who have ROSCC with a tumor length of <or= 10 mm, even if the tumor is medically operable. Most local recurrence can be cured by active therapy such as surgery, radiotherapy, or PDT. Multiple primary lung cancer subsequent to PDT is an important issue from the viewpoint of survival.
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Affiliation(s)
- Chiaki Endo
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Hospital, Tohoku University, Sendai, Japan.
| | - Akira Miyamoto
- Department of Thoracic Surgery, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Akira Sakurada
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Hospital, Tohoku University, Sendai, Japan
| | - Hirokazu Aikawa
- Department of Thoracic Surgery, Kanazawa Medical University, Uchinada, Japan
| | - Motoyasu Sagawa
- Department of Thoracic Surgery, Kanazawa Medical University, Uchinada, Japan
| | - Masamai Sato
- Department of Thoracic Surgery, Miyagi Cancer Center, Natori, Japan
| | - Yasuki Saito
- Department of Thoracic Surgery, Sendai Medical Center, Sendai, Japan
| | - Takashi Kondo
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Hospital, Tohoku University, Sendai, Japan
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Abstract
Lung cancer is a disease of older persons. It is the most common cause of cancer death in men and women in the United States. A comprehensive evaluation of medical comorbidities and functional status is important in all patients but perhaps more so in older adults, and it should be included in the assessment of older patients who have lung cancer. Age, per se, should not be a limiting factor to treatment, because a large body of evidence demonstrates that fit older patients who have lung cancer can safely undergo the same treatments as their younger counterparts with equally good results.
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11
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Kennedy TC, McWilliams A, Edell E, Sutedja T, Downie G, Yung R, Gazdar A, Mathur PN. Bronchial Intraepithelial Neoplasia/Early Central Airways Lung Cancer. Chest 2007; 132:221S-233S. [PMID: 17873170 DOI: 10.1378/chest.07-1377] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND An evidence-based approach is necessary for the localization and management of intraepithelial and microinvasive non-small cell lung cancer in the central airways. METHODS Material appropriate to this topic was obtained by literature search of a computerized database. Recommendations were developed by the writing committee and then reviewed by the entire guidelines panel. The final recommendations were made by the Chair and were voted on by the entire committee. RESULTS White light bronchoscopy has diagnostic limitations in the detection of microinvasive lesions. Autofluorescence bronchoscopy (AFB) is a technique that has been shown to be a sensitive method for detecting these lesions. In patients with moderate dysplasia or worse on sputum cytology and normal chest radiographic findings, bronchoscopy should be performed. If moderate/severe dysplasia or carcinoma in situ (CIS) is detected in the central airways, then bronchoscopic surveillance is recommended. The use of AFB is preferred if available. In a patient being considered for curative endobronchial therapy to treat microinvasive lesions, AFB is useful. A number of endobronchial techniques as therapeutic options are available for the management of CIS and can be recommended to patients with inoperable disease. In patients with operable disease, surgery remains the mainstay of treatment, although patients may be counseled about these techniques. CONCLUSIONS AFB is a useful tool for the localization of microinvasive neoplasia. A number of endobronchial techniques available for the curative treatment can be considered first-line therapy in inoperable cases. For operable cases, the techniques may be considered and discussed with the patients.
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Affiliation(s)
- Timothy C Kennedy
- MBBS, 550 W University Blvd, Suite 4903, Indianapolis IN 46202, USA.
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12
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Abstract
The result of a lung cancer screening program should be fewer lung cancer-specific deaths in the screened population. Studies evaluating chest imaging as a screening tool for lung cancer have not shown a reduction in lung cancer-specific mortality to date. The ability of institutions using chest imaging to meet the criteria for successful screening programs has also been debated. Contentious issues include the presence of an overdiagnosis bias, the ability to find preclinical disease at a curable point in time, the amount of pseudodisease identified, and the cost-effectiveness of screening programs. Current guidelines remain vague as randomized trials are being completed and technologic advances are occurring. The ultimate face of a successful lung cancer screening program is yet to be defined.
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Affiliation(s)
- Peter J Mazzone
- Department of Pulmonary, Allergy, and Critical Care Medicine, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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14
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Sutedja TG. Overdiagnosis bias in squamous cell cancer clarifying definitions. Chest 2005; 127:691-2; author reply 692. [PMID: 15706024 DOI: 10.1378/chest.127.2.691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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