A pilot study of stereotactic body radiation therapy (SBRT) after surgery for stage III non-small cell lung cancer

Background

Standard therapy for stage III non-small cell lung cancer with chemotherapy and conventional radiation has suboptimal outcomes. We hypothesized that a combination of surgery followed by stereotactic body radiation therapy (SBRT) would be a safe alternative.

Methods

Patients with stage IIIA (multistation N2) or IIIB non-small cell lung cancer were enrolled from March 2013 to December 2015. The protocol included transcervical extended mediastinal lymphadenectomy (TEMLA) followed by surgical resection, 10 Gy SBRT directed to the involved mediastinum/hilar stations and/or positive surgical margins, and adjuvant systemic therapy. Patients not suitable for anatomic lung resection were treated with 30 Gy to the primary tumor. The primary efficacy end-point was the proportion of patients with grade 3 or higher adverse events (AE) or toxicities.

Results

Of 10 patients, 7 patients underwent neoadjuvant chemotherapy. All patients had TEMLA. Nine of 10 patients underwent surgical resection. The remaining patient had an unresectable tumor and received 30 Gy SBRT to the primary lesion. All patients had post-operative SBRT. Median follow-up was 18 months. There were no perioperative mortalities. Six patients had any grade 3 AEs with no grade 4–5 AEs. Of these, 4 were not attributable to radiation. Pulmonary-related grade 3 AEs were experienced by 2 patients. There were no failures within the 10 Gy volume. Overall survival and progression-free survival rates at 2 years were 68% (90% CI 36–86) and 40% (90% CI 16–63), respectively.

Conclusions

In carefully selected patients with locally advanced non-small cell lung cancer, combining surgery with SBRT was well tolerated with no local failure.

Trial registration

ClinicalTrials.gov identifying number NCT01781741. Registered February 1, 2013.

Improving Community Health Workers Knowledge of and Attitude Toward Breast Cancer in Rural Communities in Eastern Nigeria

Background and context: Nigeria presently grapples with a high burden of all forms of cancers with breast cancer being the most common and most lethal with estimated 27,304 new cases and 13,960 deaths annually. Poor knowledge of breast cancer and the wrong perception about its treatment is pervasive among many Nigerian women particularly those in rural communities leading to late presentation and poor treatment outcomes. Community health workers (CHWs) are at the forefront of closing the knowledge gap and improving on attitude toward breast cancer and its treatment in these rural settings through provision of an effective cancer patient care and support. Against this backdrop, the University of Nigeria Teaching Hospital-Breast cancer support group (UNTH-BCSG) was established by a group of health professionals involved in caring for cancer patients in the eastern parts of the country. The consortium provides education and supports to breast cancer patients, training support to community health workers for early detection and prompt referral, carry out community outreach and education in both urban and rural communities, free cancer screening services to communities, as well as creating and supporting systems that effectively links cancer patients from the community level to the treatment centers. Aim: To implement a training program aimed at improving community health workers knowledge of and attitude toward breast cancer in selected rural communities in eastern Nigeria. Strategy/Tactics: A cross-sectional study design was used to select total of 521 health workers drawn across the 7 randomly selected local government areas in Enugu state, southeastern Nigeria. Respondents' level of knowledge and attitude toward breast cancer was assessed before and after the training. Data were collected using self-administered questionnaire, while data analysis was done with Statistical Package for Social Sciences (IBM-SPSS) version 20. Program/Policy process: Advocacy and campaign on breast cancer screening. Outcomes: Out of a total 521 CHWs with a mean age of 37.71 ± 8.789 years, majority of the workers were females (92.9%), married (74.1%) received formal trainings in community health education (67.3%). Prior to training, only 18.4% of respondents had ever screened for breast cancer, while 68.3% practice breast self-examination. T-test analysis showed that the mean knowledge score of breast cancer (6.86 ± 2.48), mean knowledge of risk of breast cancer (5.69 ± 3.15) and the mean attitude toward breast cancer score (5.98 ± 3.04), significantly improved with the training program to 7.56 ± 2.29, 10.62 ± 3.09, and 7.21 ± 2.69 respectively ( P < 0.01). What was learned: Community health worker still need more sustained training as they operate at the grass root of health care system. Every little assistance will be translated to reduced cancer morbidity and a lot of lives being saved through early detection.

Impact of Support Group Intervention on Quality of Life of Patients With Advanced Breast Cancer

Background: Health-related quality of life is an important end point in breast cancer care. Assessing quality of life in breast cancer patients could contribute to improved treatment outcome and could even serve as monitor along with medical parameters. The need for psychosocial support is well established among breast cancer patients with levels of psychological distress and depression, particularly after diagnosis and treatment. Cancer support helps patients to cope with cancer by adjusting their attitudes, knowledge, and expectation about the disease. Aim: To determine the impact of support group intervention on quality of life of patients with advanced breast cancer To create awareness, educate, counsel and support as well as to mediate in the weaknesses of the medical care system in dealing with breast cancer patients. Methods: A prospective cohort study involving breast cancer patients using a system of breast cancer support group that organizes a two month period meeting for all breast patients in University of Nigeria Teaching Hospital Enugu. Educational information on breast cancer, nutritional needs, exercise and the need for regular follow-up in breast cancer care were given to them as well as the means of overcoming the psychosocial burden in cancer. QOL assessment evaluating the four domains (physical, social, psychological and environmental) on selected patients with advanced breast cancer using WHO BREF was administered. Results: A total of 113 breast cancer patients were involved in this study. At the end of the intervention, 14 women (12.4%) were censored due to death, while postassessment was carried out for only 99 women. Postintervention analysis showed that there was a significant positive correlation between availability of social support to respondents (FS score) and the four quality of life domains ( P < 0.05). Further analysis also showed that respondents' quality of life significantly increased across all domains at postintervention ( P < 0.05). Conclusion: Patients receiving support group intervention all had improved quality of life.

Promoting cancer control training in resource limited environments: Lagos, Nigeria

In resource limited nations, cancer control is often a lower priority issue creating challenges for the prevention, early diagnosis, and treatment of cancer. Training and education are vital components of efforts to tackle this problem. A 3-day cancer control workshop was conducted at the Lagos State University Teaching Hospital (LASUTH), Nigeria, in 2013. The curriculum included didactic lectures, panel discussions, and interactive sessions on local cancer statistics, preventive strategies, cancer registries, screening and diagnostic options, and treatment approaches with limited resources (chemotherapy, radiotherapy, surgery, and palliative care) and several site-specific (breast, lung, cervical, prostate, and colon) topics. Pre-workshop and post-workshop questionnaires were completed by participants. Eighty-six percent of the 50 workshop participants completed at least one questionnaire. Participants were mainly nurses and physicians (89% of responders), and 40% reported >25 years of practice experience. The more common local needs identified were professional education (65%) and increasing public cancer awareness (63%). The greatest interest for future programs was on research collaborations (70%). An immediate impact of the workshop was the commencement of monthly tumor board conferences and a review of the current cancer registry data. Capacity building is critical for the execution of effective cancer control strategies. Conducting collaborative workshops represents a cost-effective means of launching programs and energizing the medical community to pursue ongoing education and research addressing the anticipated cancer epidemic on the African continent.

Radioguided detection of lymph node metastasis in non-small cell lung cancer

BACKGROUND

The detection of micrometastases in thoracic lymph nodes may improve the staging of non-small cell lung cancer patients.

METHODS

Ten patients with resectable lung cancers were enrolled in this pilot study. Every patient had preoperative positron emission tomography (PET) imaging and mediastinoscopy. Patients were injected with 10 mCi of F18-fluorodeoxyglucose (FDG) on the day of surgery, within 4 hours of the planned surgical procedure. A handheld device detected increased FDG uptake (gamma emission) within thoracic lymph nodes during pulmonary resection procedures. The lymph nodes that demonstrated increased FDG uptake, but were nonmalignant by conventional hematoxylin and eosin staining, underwent further serial sectioning and immunohistochemical staining.

RESULTS

The handheld probe detected all FDG-avid lesions on PET imaging. In 3 patients (30%), the probe led to the detection of FDG-avid lymph nodes harboring micrometastases missed by conventional pathologic analysis. A fourth patient had aortopulmonary nodes that were FDG-avid on PET and showed metastases by hematoxylin and eosin staining, but the probe detected adjacent nodes in the same station with micrometastases. Three nodes were false-positive by gamma probe.

CONCLUSIONS

It is feasible to detect occult metastases in lymph nodes by using an FDG-sensitive intraoperative gamma probe, resulting in upstaging of patients. A larger study is indicated to evaluate the sensitivity, specificity, and clinical utility of such a device.

Gallstone shrapnel contamination during laparoscopic cholecystectomy

The fate of lost gallstones in the peritoneal cavity following laparoscopic cholecystectomy is unknown. We report a case of microabscesses and granuloma formation in the peritoneal cavity and abdominal wall caused by infected gallstone shrapnel due to rupture of the gallbladder during extraction.