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Di Pressa F, Perrone F, Benini A, Lohr F, Tiseo M, Bruni A. Management of oligometastatic and oligoprogressive epidermal growth factor receptor mutated non-small cell lung cancer patients: state of the art of a combined approach. EXPLORATION OF TARGETED ANTI-TUMOR THERAPY 2024; 5:449-464. [PMID: 38966183 PMCID: PMC11220311 DOI: 10.37349/etat.2024.00228] [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: 10/06/2023] [Accepted: 02/04/2024] [Indexed: 07/06/2024] Open
Abstract
Recently, the development of targeted therapy approaches such as those based on tyrosine kinase inhibitor (TKI) greatly improved the clinical outcomes of patients affected by oncogene addicted advanced non-small cell lung cancer (NSCLC). Similarly, the improvement of radiation therapy techniques has permitted to deliver high radiation doses to a limited number of metastatic target lesions (oligopersistent or oligoprogressive), with limited high-dose normal tissue exposure that leads to low severe toxicity rates. The aim of this narrative review was to provide an overview of the currently established definition of oligometastatic and oligoprogressive disease, to define first line and subsequent lines targeted therapies and the role of consolidative non-invasive local ablative treatments (LATs) in these settings. The potential benefit of local treatment (LT) such as radiotherapy (RT) or surgery might be represented by an overall reduction of switching to subsequent systemic treatments lowering the risk of further systemic dissemination. Further randomized clinical trials will clarify the role of LT and their correct timing in relation to systemic targeted therapies.
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Affiliation(s)
- Francesca Di Pressa
- Radiation Therapy Unit, Department of Oncology and Hematology, University Hospital of Modena, 41124 Modena, Italy
| | - Fabiana Perrone
- Medical Oncology Unit, University Hospital of Parma, 43126 Parma, Italy
| | - Anna Benini
- Radiation Therapy Unit, Department of Oncology and Hematology, University Hospital of Modena, 41124 Modena, Italy
| | - Frank Lohr
- Proton Therapy Unit, APSS Trento and CISMed, University of Trento, 38100 Trento, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, 43126 Parma, Italy
- Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy
| | - Alessio Bruni
- Radiation Therapy Unit, Department of Oncology and Hematology, University Hospital of Modena, 41124 Modena, Italy
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Dumitriu Carcoana AO, Labib KM, Fiedler CR, Marek JC, Ladehoff LC, West WJ, Malavet JA, Doyle WN, Moodie CC, Garrett JR, Tew JR, Baldonado JJAR, Fontaine JP, Toloza E. A High Preoperative Blood Urea Nitrogen to Serum Albumin Ratio Does Not Predict Worse Outcomes Following the Robotic-Assisted Pulmonary Lobectomy for Lung Cancer. Cureus 2023; 15:e50468. [PMID: 38222193 PMCID: PMC10786433 DOI: 10.7759/cureus.50468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND The blood urea nitrogen to serum albumin ratio (BAR) is an emerging prognostic parameter of interest. The utility of BAR as a prognostic factor has not been analyzed in lung cancer patients undergoing pulmonary lobectomy. We evaluated the ability of High BAR to predict worse outcomes after robotic-assisted pulmonary lobectomy (RAPL) for lung cancer. METHODS We retrospectively analyzed 400 patients who underwent RAPL from September 2010 to March 2022 by one surgeon. Patients were stratified by Low BAR (<6.25 mg/g) and High BAR (≥6.25 mg/g). Patients' demographics, tumor characteristics, comorbidities, surgical complications, outcomes, and survival were collected and compared by High and Low BAR groups. The primary outcome of interest was 30-day mortality. RESULTS Receiver operator curves (ROC) confirmed that 6.25 was an optimal threshold for estimating mortality based on Low and High BAR. There were no differences in surgical complications or outcomes between the Low and High BAR groups. The ability of BAR to predict 30-day mortality was evaluated with the area under the curve (AUC) analysis, which showed that higher BAR could not predict mortality (AUC=0.655; 95% CI, 0.435-0.875; p=0.166). Similarly, survival analysis revealed no difference in five-year overall survival between the Low and High BAR groups (p=0.079). CONCLUSION High BAR did not predict worse outcomes after RAPL for lung cancer in our study. Further studies are needed to better determine the prognostic ability of BAR in lower-risk populations.
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Affiliation(s)
| | - Kristie M Labib
- Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, USA
| | - Cole R Fiedler
- Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, USA
| | - Jenna C Marek
- Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, USA
| | - Lauren C Ladehoff
- Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, USA
| | - William J West
- Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, USA
| | - Jose A Malavet
- Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, USA
| | - William N Doyle
- Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, USA
| | | | | | - Jenna R Tew
- Thoracic Oncology, Moffitt Cancer Center, Tampa, USA
| | - Jobelle Joyce Anne R Baldonado
- Thoracic Oncology, Moffitt Cancer Center, Tampa, USA
- Surgery and Oncologic Sciences, University of South Florida Health Morsani College of Medicine, Tampa, USA
| | - Jacques P Fontaine
- Thoracic Oncology, Moffitt Cancer Center, Tampa, USA
- Surgery and Oncologic Sciences, University of South Florida Health Morsani College of Medicine, Tampa, USA
| | - Eric Toloza
- Thoracic Oncology, Moffitt Cancer Center, Tampa, USA
- Surgery and Oncologic Sciences, University of South Florida Health Morsani College of Medicine, Tampa, USA
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Nistor CE, Ciuche A, Cucu AP, Nitipir C, Slavu C, Serban B, Cursaru A, Cretu B, Cirstoiu C. Management of Lung Cancer Presenting with Solitary Bone Metastasis. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58101463. [PMID: 36295624 PMCID: PMC9612355 DOI: 10.3390/medicina58101463] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/09/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022]
Abstract
Lung neoplasm is the main cause of cancer-related mortality, and bone metastasis is among the most common secondary tumors. The vast majority of patients also present with multiple bone metastases, which makes systemic and adjuvant pain therapy preferable to surgery. The optimal approach for a resectable non-small-cell lung tumor that also presents a unique, resectable bone metastasis is not fully established. The number of papers addressing this subject is small, and most are case reports; nevertheless, survival rates seem to increase with radical surgery. The sequencing of local versus systemic treatment should always be discussed within the multidisciplinary team that will choose the best approach for each patient. As targeted systemic therapies become more accessible, radical surgery, together with existing reconstructive methods, will lead to an increase in life expectancy and a better quality of life.
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Affiliation(s)
- Claudiu-Eduard Nistor
- Department Thoracic Surgery, Dr. Carol Davila Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Adrian Ciuche
- Department Thoracic Surgery, Dr. Carol Davila Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Anca Pati Cucu
- Department Thoracic Surgery, Dr. Carol Davila Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Cornelia Nitipir
- Department of Medical Oncology, Carol Davila University Medicine & Pharmacy, Elias University Emergency Hospital, 011468 Bucharest, Romania
| | - Cristina Slavu
- Department of Medical Oncology, Carol Davila University Medicine & Pharmacy, Elias University Emergency Hospital, 011468 Bucharest, Romania
| | - Bogdan Serban
- Department Orthopedic & Traumatology, Carol Davila University Medicine & Pharmacy, University Emergency Hospital, 050098 Bucharest, Romania
| | - Adrian Cursaru
- Department Orthopedic & Traumatology, Carol Davila University Medicine & Pharmacy, University Emergency Hospital, 050098 Bucharest, Romania
| | - Bogdan Cretu
- Department Orthopedic & Traumatology, Carol Davila University Medicine & Pharmacy, University Emergency Hospital, 050098 Bucharest, Romania
- Correspondence:
| | - Catalin Cirstoiu
- Department Orthopedic & Traumatology, Carol Davila University Medicine & Pharmacy, University Emergency Hospital, 050098 Bucharest, Romania
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