Surgical tactics for benign bronchial and lung tumors

Purpose: Treatment of central lung tumors with stereotactic ablative radiotherapy (SABR) has been associated with higher rates of toxicities than patients with peripheral tumors. Here we report our institution's experience in treating central lung tumor patients with SABR, compared to patients treated for peripheral lung tumors. Methods: We retrospectively reviewed outcomes in 82 patients with a total of 96 primary or metastatic lung tumors treated by SABR. The cohort included 47 central and 49 peripheral tumors and all were treated with 50 Gy in 4-5 fractions. Outcomes and radiation-associated toxicities were compared between the two groups, not including patients in whom central and peripheral tumors were concurrently treated (8 such patients). Dosimetric analysis was performed on patients with central tumors to determine max point dose (MPD) and volumetric max dose (Vmax) to central structures. Results: Median follow-up time was 15 months (range 1 to 59 months). Median overall survival was 34 and 40 months (p=0.75) for patients with central and peripheral tumors, respectively. We observed no hemoptysis and no grade 5 toxicities. Rates of symptomatic toxicity were higher in patients with central tumors (grade 2+, 38% vs. 11%, p=0.0056) but were equivalent for severe toxicity (grade 3+, 5.4% vs. 5.4%, p=0.93). The vast majority of toxicities were due to radiation pneumonitis, incidence of which was significantly greater in patients with central tumors (grade 2+, 30% vs. 2.7%, p=0.0021; grade 3+, 5.4% vs. 0%, p=0.15). Dosimetric analysis of 36 central tumor treatment plans revealed that 23 (64%) exceeded at least one of the dose constraints used in RTOG 0813, most commonly for central airway. Rates of grade 2+ pneumonitis were not significantly different between patients exceeding RTOG 0813 central airway dosing constraints vs. those meeting them (24% vs. 20%, p=0.69), but trended towards significance for grade 3+ radiation pneumonitis, with patients exceeding RTOG 0813 central airway dosing constraints experiencing higher rates (0% vs. 13%, p=0.095). Conclusions: Central lung tumor patients treated with SABR appear to have greater risk for symptomatic radiation pneumonitis than patients with peripheral tumors. Exceeding RTOG 0813 dosimetric constraints for central airway may predispose to higher risk for severe radiation pneumonitis. Citation Format: Aadel A. Chaudhuri, Chad Tang, Nicholas Trakul, Jacob Wynne, Billy Loo, Maximilian Diehn. Increased rates of radiation pneumonitis in patients receiving stereotactic ablative radiotherapy for central versus peripheral lung tumors. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 864. doi:10.1158/1538-7445.AM2014-864

The objective of this study was to compare the clinical outcomes of stereotactic body radiation therapy (SBRT) in elderly patients aged 65 or older with clinical stage I-II non-small-cell lung cancer (NSCLC), specifically examining the differences between centrally located lung tumors and peripherally located lung tumors. From April 2009 to January 2020, a total of 136 patients with 136 tumors (65 central, 71 peripheral; NSCLC) at an early stage (T1-3N0M0) were treated with SBRT at a single institution. Central/peripheral location was assessed retrospectively on planning CT scans. A propensity score matching analysis was utilized to compare the two groups. In addition, the prognosis and related toxicity were compared between the two study arms. A total of 33 central tumors and 33 peripheral tumors were matched and analyzed. The results showed no significant differences in overall survival (OS) and progression-free survival (PFS) between the two groups. The 2-year OS was 71.88% (95% CI, 57.87%-89.27%) in the central lung cancer group, while it was 93.94% (95% CI, 86.14%-100.00%) in the peripheral lung cancer group (P=0.462). The 2-year PFS was 43.75% in the central lung cancer group, while it was 78.79% in the peripheral lung cancer group (P=0.279). Further subgroup analysis indicated that the location of peripheral tumor have a positive impact on OS in patients with adenocarcinoma. The occurrence of local failure, regional failure, or distant failure was comparable between central and peripheral tumors. There was no statistically significant difference in toxicity between the central and the peripheral tumor groups. The outcomes of SBRT for central tumors versus peripheral lung tumors in elderly patients with early-stage NSCLC were similar. SBRT demonstrated a similar level of safety in terms of toxicity for both central and peripheral lung tumors.

Simple Clinical Factors Associated With Radiation-Induced Lung Toxicity After Stereotactic Body Radiation Therapy in Lung Cancer: A Pooled Analysis of 70 Studies

Location as an important predictor of lymph node involvement for pulmonary adenocarcinoma

Objective To compare the serum anti-survivin antibody levels between benign and malignant lung tumor,thus to provide evidence for using anti-survivin antibody as an indicator in non-small cell lung cancer.Methods ELISA was used to measure the level of anti-survivin antibody in healthy population(control group,n=60),benign lung tumor patients(benign lung tumor group,n=60) and non-small cell lung cancer patients(non-small cell lung cancer group,n=60). Results The anti-surviving antibody did not express 11.7%(7/60) in the control group and almost no expression 20.0%(12/60) in the benign lung tumor group,with no significant difference between the two groups(P＞0.05).In the non-small cell lung cancer group,the anti-survivin antibody expressed in 41 patients,which was significantly higher than those in the benign lung tumor group(x2=38.352,P＜0.01).Conclusion Anti-survivin antibody does not express in the healthy population and the benign lung tumor patients,whereas shows high expression in non-small cell lung cancer.This finding indicates that anti-survivin antibody can provide important evidence for non-small cell lung cancer diagnosis,and can be used as an indicator for non-small lung cancer screening. Key words: Anti-survivin antibody; non-small lung cancer; Survivin; Squamous carcinoma; Adenocarcinoma; Lung benign pathological change

3:09 PM Abstract No. 265 Comparative evaluation of outcomes following microwave ablation of central versus peripheral renal tumors

Background:The differential diagnosis of lung cancer (LC) and benign lung tumors is challenging in clinic.Spiral computed tomography (CT) and X-ray are commonly utilized imaging techniques.Accordingly, the practical significance of CT and X-ray imaging in the differential identification of benign versus malignant pulmonary neoplasms was explored.Materials and Methods: A retrospective analysis was performed on data from 105 patients who had undergone both CT and X-ray examinations to evaluate variations in peripheral blood tumor markers.The imaging features of benign and malignant lung tumors were compared, and the diagnostic efficacy of CT and X-ray was assessed.Results: CT examination of patients with unilateral lung tumors or lung insufficiency demonstrated a greatly higher detection rate of speculated lesions compared to X-ray.Additionally, tumor markers showed a positive correlation with tumor size.The positive rate for differential diagnosis using CT was notably superior to that of X-ray (P<0.05).The sensitivity (Sen), specificity (Spe), accuracy (Acc), positive predictive value, and negative predictive value of CT and X-ray in differential diagnosis were 86.4%, 68.3%, 94.9%, 74.4%, 89.5%, 70.5%, 96.6%, 81.8%, 80.4%, and 58.0%, respectively.CT was considerably more valuable for differential diagnosis (P<0.05).Conclusion: X-ray and CT scans serve as pivotal diagnostic tools for distinguishing between benign and malignant pulmonary neoplasms.CT has a better effect in the differential diagnosis of lung tumors, and its imaging performance is more comprehensive, which is worthy of clinical application.

Peripheral (extraosseous) odontogenic tumors are rare, and reports in the literature have mainly been single case reports or a small series of cases. The aim of this study was to determine the relative frequency of peripheral (extraosseous) odontogenic tumors relative to one another and relative to their central (intraosseous) counterparts in an oral pathology biopsy service and to compare these data with information available in the literature. The files of the Pacific Oral and Maxillofacial Pathology Laboratory of the University of the Pacific, San Francisco, CA, USA, served as the source of material for this study. Files were systematically searched for all cases of peripheral odontogenic tumors (POTs) during a 20-year-period. There were 91,178 cases accessed in which central and POTs were identified in 1,133 (1.24%), central tumors in 1,088 (1.2%), and peripheral tumors in 45 (0.05%). Peripheral tumors accounted for 4% of all 1133 central and POTs. Peripheral odontogenic fibroma (PODF) was the most common of the 45 POTs accounting for 51.1% (23 cases) followed by peripheral ameloblastoma (PA) 28.9% (13 cases) and peripheral calcifying cystic odontogenic tumor (PCCOT) 13.3% (six cases). Peripheral calcifying epithelial odontogenic tumor, peripheral ameloblastic fibroma, and peripheral ameloblastic carcinoma were also identified--each comprised 2.2% (one case each). PODF was more common than its central counterpart by a 1.4:1 ratio. This was the only peripheral tumor that was more common than its central counterpart. PA accounted for 9.3% of all ameloblastomas and PCCOT for 26% of all calcifying cystic odontogenic tumors. There is only scarce information in the literature on the relative frequency of POTs. Additional studies should be conducted to determine the true relative frequency. To ensure accuracy, pathologists with experience in the field of odontogenic tumors should conduct these studies. Intraosseous tumors that perforate through the bone to the gingival tissue, clinically presenting as 'peripheral tumors' should be excluded.

Should We Change Conformality Index Recommendations Based on Tumor Centricity for Lung SBRT?

Simple SummaryPatients with early-stage non-small cell lung cancer (NSCLC) treated with stereotactic body radiation therapy (SBRT) often receive different treatment regimens based on the location of the tumor to minimize the risk of severe side effects. The aim of our study was to examine survival outcomes of patients treated with single-fraction SBRT for peripheral tumors and five-fraction SBRT for central tumors. In a cohort of 265 patients with NSCLC, we found no differences in patients treated for peripheral versus central tumors in progression-free survival, overall survival, local failure, nodal failure, or distant failure. These findings were confirmed upon propensity score matching. Our study demonstrated survival outcomes of patients treated with SBRT for early-stage NSCLC were equivalent for central and peripheral tumors.Background: The treatment of early-stage non-small cell lung cancer (NSCLC) with stereotactic body radiation therapy (SBRT) frequently involves different fractionation schemes for peripheral and central tumors due to concerns with toxicity. We performed an observational cohort study to determine survival outcomes for patients with peripheral and central NSCLC treated with SBRT. Methods: A single-institutional database of patients with early-stage NSCLC treated with SBRT from September 2008 to December 2018 was evaluated. Outcomes were progression-free survival (PFS), overall survival (OS), local failure (LF), nodal failure (NF), and distant failure (DF). Cox multivariable analysis (MVA), Kaplan–Meier plotting, Fine–Gray competing risk MVA, and propensity score matching were performed. Results: A total of 265 patients were included with a median follow-up of 44.2 months. There were 191 (72%) and 74 (28%) patients with peripheral and central tumors treated with single-fraction SBRT to a dose of 27 Gy and five-fraction SBRT to a dose of 50 Gy, respectively. On Cox MVA, there was no difference in OS (adjusted hazards ratio (aHR) of 1.04, 95% CI of 0.74–1.46) or PFS (aHR of 1.05, 95% CI of 0.76–1.45). On Fine–Gray competing risk MVA, there were no differences in LF, NF, or DF. Propensity matching confirmed these findings. Conclusion: The survival outcomes of patients treated with SBRT for early-stage NSCLC were equivalent for central and peripheral tumors.

Indications for invasive mediastinal staging in patients with early non-small cell lung cancer staged with PET-CT

Radiofrequency Ablation of Lung Malignancies

Deep learning has shown considerable promise in the differential diagnosis of lung lesions. However, the majority of previous studies have focused primarily on X-ray, computed tomography (CT), and magnetic resonance imaging (MRI), with relatively few investigations exploring the predictive value of ultrasound imaging. This study aims to develop a deep learning model based on ultrasound imaging to differentiate between benign and malignant peripheral lung tumors. A retrospective analysis was conducted on a cohort of 371 patients who underwent ultrasound-guided percutaneous lung tumor procedures across two centers. The dataset was divided into a training set (n = 296) and a test set (n = 75) in an 8:2 ratio for further analysis and model evaluation. Five distinct deep learning models were developed using ResNet152, ResNet101, ResNet50, ResNet34, and ResNet18 algorithms. Receiver Operating Characteristic (ROC) curves were generated, and the Area Under the Curve (AUC) was calculated to assess the diagnostic performance of each model. DeLong's test was employed to compare the differences between the groups. Among the five models, the one based on the ResNet18 algorithm demonstrated the highest performance. It exhibited statistically significant advantages in predictive accuracy (p < 0.05) compared to the models based on ResNet152, ResNet101, ResNet50, and ResNet34 algorithms. Specifically, the ResNet18 model showed superior discriminatory power. Quantitative evaluation through Net Reclassification Improvement (NRI) analysis revealed that the NRI values for the ResNet18 model, when compared with ResNet152, ResNet101, ResNet50, and ResNet34, were 0.180, 0.240, 0.186, and 0.221, respectively. All corresponding p-values were less than 0.05 (p < 0.05 for each comparison), further confirming that the ResNet18 model significantly outperformed the other four models in reclassification ability. Moreover, its predictive outcomes led to marked improvements in risk stratification and classification accuracy. The ResNet18-based deep learning model demonstrated superior accuracy in distinguishing between benign and malignant peripheral lung tumors, providing an effective and non-invasive tool for the early detection of lung cancer.

The Changing Radiographic Presentation of Bronchogenic Carcinoma With Reference to Cell Types

Purpose: This study assesses the effect of physiological abdominal compression from prone positioning by comparing respiratory-induced tumor movements in supine and prone positions. Methods: 19 lung cancer patients underwent repeated supine and prone free-breathing 4DCT scans. The effect of patient position on motion magnitude was investigated for tumors, lymph nodes (9 cases), and subgroups of central (11 cases), peripheral (8 cases) and small peripheral tumors (5 cases), by evaluating the population average excursions, absolute and relative to a carina-point. Results: Absolute motion analysis: In prone, motion increased by ~20% for tumors and ~25% for lymph nodes. Central tumors moved more compared to peripheral tumors in both supine and prone (~22%, and ~4% respectively). Central tumors movement increased by ~12% in prone. For peripheral tumors the increase in prone position was ~25% (~40% and 29% changes on along RL and AP directions). Motion relative to carina-point analysis: Overall, tumor excursions relative to carina-point increased by ~17% in prone. Lymph node relative magnitudes were lower by ~4%. Likewise, the central tumors moved ~7% less in prone. The subgroup of peripheral tumors exhibited increased amplitudes by ~44%; the small peripheral tumors had even larger relative displacements in prone (~46%). Conclusion: Tumor and lymphmore » node movement in the patient population from this study averaged to be higher in prone than in supine position. Results from carina analysis also suggest that peripheral tissues have more physiologic freedom of motility when placed in the prone position, regardless of size. From these observations we should continue to avoid prone positioning for all types of primary lung tumor, suggesting that patients should receive radiotherapy for primary lung cancer in supine position to minimize target tissue mobility during normal respiratory effort. Further investigation will include more patients with peripheral tumors to validate our observations.« less