Located Lung Cancer Research Articles

Single-center clinical experience of extended sleeve lobectomy (ESL) versus standard sleeve lobectomy (SL).

Sleeve lobectomy (SL) and extended SL (ESL), which aim to preserve pulmonary function and enhance the quality of life of patients while ensuring oncological outcomes, are valuable surgical options for the treatment of centrally located non-small cell lung cancer (NSCLC). This study aimed to compare perioperative adverse events and long-term survival between SL and ESL in NSCLC patients, providing a comprehensive review of surgical outcomes, complications, and survival to assess the roles of SL and ESL in thoracic oncology. This single-center retrospective study assessed the outcomes of NSCLC patients who underwent SL or ESL from June 2014 to January 2022. The patients were selected based on specific inclusion criteria, and statistical analyses were conducted to examine the postoperative outcomes, overall survival (OS), and disease-free survival (DFS) of the patients. A total of 218 patients met the inclusion criteria. Among 218 patients, 33 underwent ESL and 185 underwent SL. Compared to SL, ESL was associated with longer operative times and higher R0 resection rates (93.9% vs. 78.8%, P=0.047). Despite the higher complexity of ESL compared to SL, there were no significant differences in the perioperative complications or mortality rates between the groups. Survival analysis was conducted on the propensity score matching (PSM) data, the results demonstrated superior OS and DFS in the ESL group compared to the SL group. Advanced age, more advanced nodal (N) status, and non-R0 resection were significant predictors of poorer prognosis. ESL is a feasible and effective alternative for treating centrally located NSCLC, with better R0 resection rates and comparable survival outcomes to SL, without increasing the risk of grade III-IV complications. Further studies with larger cohorts need to be conducted to validate these findings and refine the surgical techniques.

The comparison of perioperative outcomes and disease-free survival between pneumonectomy after immunochemotherapy and after isolated chemotherapy: one single center experience

ObjectiveThis study aims to compare the perioperative outcomes and disease-free survival (DFS) between pneumonectomy after immunochemotherapy and chemotherapy.MethodsWe retrospectively identified patients who received neoadjuvant immunotherapy (n = 15) or chemotherapy alone (n = 12) in our single center between 2021 and 2023.The primary end point was 30-day major complications. The secondary end point was major pathologic response.ResultsThere was no significant difference in operation time, blood loss and postoperative stay time between ICI (Received immune checkpoint inhibitor treatment including PD-1 and PD-L1 inhibitors) and Chemo cohort. There were also no difference in postoperative complications including complications > grade III, 90-day death and bronchial fistula. The pCR rate was 40.0% (6/15) in the ICI cohort versus 0.0% (0/12) in the chemo cohort (p = 0.020). The MPR or pCR rate was 60.0% (9/15) in the ICI cohort versus 8.3% (1/12) in the chemo cohort (p = 0.014). ICI cohort was associated with an improved overall 1, 2, and 3-year disease-free survival(DFS)compared with chemo cohort. At the same time, both patients received ICI and Chemo were grouped according to whether pCR occurred or not, and it was found that DFS in the pCR group was better than DFS in the non-pCR group.ConclusionsBased on our results, we argue that compared with pneumonectomy after isolated chemotherapy, pneumonectomy after immunochemotherapy not added 90-day mortality, postoperative, morbidity, but improved DFS; thus, it should be the induction therapy choice for anatomically eligible centrally located lung cancers.

A Multicenter Retrospective Case-Control Study on Simple vs Extended Sleeve Lobectomies

BackgroundSleeve resection is currently the gold standard procedure for centrally located non-small cell lung cancer (NSCLC). Extended sleeve lobectomy (ESL) consists of an atypical bronchoplasty with resection of >1 lobe and carries several technical difficulties compared with simple sleeve lobectomy (SSL). Our study compared the outcomes of ESL and SSL for NSCLC. MethodsThis multicenter, retrospective, cohort study included 1314 patients who underwent ESL (155 patients) or SSL (1159 patients) between 2000 and 2018. The primary end points were 30-day and 90-day mortality, overall survival (OS), disease-free survival (DFS), and complications. ResultsNo differences were found between the 2 groups in general characteristics and surgical and survival outcomes. In particular, there were no differences in early and late complication frequency, 30- and 90-day mortality, R status, recurrence, OS (54.26 ± 33.72 months vs 56.42 ± 32.85 months, P = .444), and DFS (46.05 ± 36.14 months vs 47.20 ± 35.78 months, P = .710). Mean tumor size was larger in the ESL group (4.72 ± 2.30 cm vs 3.81 ± 1.78 cm, P < .001). Stage IIIA was the most prevalent stage in ESL group (34.8%), whereas stage IIB was the most prevalent in SSL group (34.3%; P < .001). The multivariate analyses found nodal status was the only independent predictive factor for OS. ConclusionsESL gives comparable short- and long-term outcomes to SSL. Appropriate preoperative staging and exclusion of metastases to mediastinal lymph nodes, as well as complete (R0) resection, are essential for good long-term outcomes.

Sublobar Resection in Early Non-Small Cell Lung Cancer With Epidermal Growth Factor Receptor Mutant

BackgroundLobectomy is a standard surgical procedure for peripherally located early-stage non-small cell lung cancers (NSCLCs) measuring 2 to 4 cm. However, it is unclear whether sublobar resections, such as wedge resection and segmentectomy, are effective in treating tumors with driver mutations in the epidermal growth factor receptor (EGFR). MethodsWe analyzed the clinicopathologic findings and surgical outcomes of 1395 patients with radiologically solid-dominant NSCLC measuring 2 to 4 cm, without clinical lymph node involvement, who underwent complete resection between 2010 and 2020. The patients, who underwent sublobar resections (n = 231) or lobectomy (n = 1164), were categorized by their EGFR mutation status and the surgical procedures performed. The follow-up was conducted for a median of 45.3 months. ResultsThe 5-year overall survival (OS) rates after sublobar resections (n = 39) were comparable to those after lobectomy (n = 359) in patients with EGFR mutation-positive tumors (80.5% [95% CI, 51.3%-93.2%] vs 88.8% [95% CI, 84.1%-92.1%], respectively; P = .16). Multivariable Cox regression analysis of OS revealed that the surgical procedure was an independent prognostic predictor in the entire cohort (hazard ratio, 0.6; 95% CI, 0.4-1.0; P = .028), but it was not an independent prognostic predictor in patients with EGFR-mutated tumors (hazard ratio, 0.6; 95% CI, 0.2-1.7; P = .32). ConclusionsSublobar resection with a secure surgical margin could be a viable option for appropriately selected patients with peripheral early-stage NSCLC tumors measuring 2 to 4 cm and harboring EGFR mutations, because it provides comparable OS to that of lobectomy.

Utility of needle biopsy in centrally located lung cancer for genome analysis: a retrospective cohort study

BackgroundIt is essential to collect a sufficient amount of tumor tissue for successful next-generation sequencing (NGS) analysis. In this study, we investigated the clinical risk factors for avoiding re-biopsy for NGS analysis (re-genome biopsy) in cases where a sufficient amount of tumor tissue could not be collected by bronchoscopy.MethodsWe investigated the association between clinical factors and the risk of re-genome biopsy in patients who underwent transbronchial biopsy (TBB) or endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and required re-genome biopsy in cases enrolled in LC-SCRUM Asia, a prospective nationwide genome screening project in Japan. We also examined whether the frequency of re-genome biopsy decreased between the first and second halves of the enrolment period.ResultsOf the 572 eligible patients, 236 underwent TBB, and 134 underwent EBUS-TBNA. Twenty-four TBBs required re-genome biopsy, and multivariate analysis showed that the risk of re-genome biopsy was significantly increased in lesions where the tumor lesion was centrally located. In these cases, EBUS-TBNA should be utilized even if the lesion is a pulmonary lesion. However, it should be noted that even with EBUS-TBNA, lung field lesions are at a higher risk of re-canalization than mediastinal lymph node lesions. It was also found that even when tumor cells were detected in rapid on-site evaluation, a sufficient amount of tumor tissue was not always collected.ConclusionsFor centrally located pulmonary mass lesions, EBUS-TBNA, rather than TBB, can be used to obtain tumor tissues that can be analyzed by NGS.

Interim Analysis of DD3: A Phase IB/II Trial of Dose-Deescalated 3-Fraction SBRT for Centrally Located Lung Cancer

Prior studies suggested excessive toxicity for central lung tumors treated with 3-fraction stereotactic body radiation therapy (SBRT). This may be related to the high biologically equivalent dose assuming alpha/beta of 10 (BED) of 54 Gy in 3 fractions (BED = 151.2), as 50-60 Gy in 5 fractions (BED = 100.0-132.0) was well-tolerated in RTOG 0813. We initiated a prospective phase IB/II trial to test the hypothesis that a dose-deescalated regimen of 45 Gy in 3 fractions (BED 112.5) would be safe and efficacious in central lung tumors. We enrolled patients with primary or secondary lung tumors ≤5cm in a central but not ultra-central tumor location defined as within 2 cm of (but not abutting) tracheobronchial tree, esophagus, or heart. Patients were either medically inoperable or refused surgical intervention. Co-primary endpoints were safety and efficacy, defined as local control (LC). Secondary endpoints included lobar control, regional control (LRC), distant control (DC), progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS). Organ-at-risk dose constraints were consistent with those of RTOG 0236. The Bayesian predictive probability approach was utilized for continuous monitoring after 10 patients were treated and have mature assessment of toxicity, after which interim analysis was planned. We recommended terminating the trial for safety if there was sufficient evidence that the rate of grade ≥3 was greater than 0.25 (predictive probability >0.80). As of the data cut-off date of 1/26/23, the trial was open for 34 months (including a nearly-immediate suspension due to the COVID-19 pandemic). A total of 17 patients have been treated on protocol with a median follow-up of 12 months. No grade ≥3 adverse events attributable to SBRT have occurred to date, though one patient died of unrelated cardiac arrhythmias 1 month after SBRT completion (Table 1). Maximum CTCAE grade 2 adverse events attributable to SBRT occurred in 17.6% of patients. The predictive probability of concluding unacceptably high toxicity rate by the end of the trial based on toxicity data in the current stage is 0.62%. To date, there have been 0 local recurrences, 1 regional recurrence without local recurrence (8 months after SBRT completion, successfully salvaged with definitive chemoradiotherapy without additional toxicities), and 1 distant recurrence without local recurrence (6 months after SBRT in a patient with lung metastasis from colon adenocarcinoma). Interim analysis of the DD3 trial suggests that for patients with central but not ultra-central lung tumors, an SBRT regimen of 45 Gy in 3 fractions warrants continued trial accrual and follow-up given no grade ≥3 toxicities or local recurrences in the early follow-up period among the first 17 patients enrolled.

An optimal dose-fractionation for stereotactic body radiotherapy in peripherally, centrally and ultracentrally located early-stage non-small lung cancer.

Stereotactic body radiotherapy (SBRT), also known as stereotactic ablative radiotherapy (SABR), is commonly used in inoperable patients with early-stage non-small lung cancer (NSCLC). This treatment has good outcomes and low toxicity in peripherally located tumors. However, in lesions which are located close to structures such as the bronchial tree or mediastinum the risk of severe toxicity increases. This review summarizes the evidence of dose-fractionation in SBRT of NSCLC patients in various locations.

Reduction of Blood Loss by Means of the Cavitron Ultrasonic Surgical Aspirator for Thoracoscopic Salvage Anatomic Lung Resections.

In centrally located lung tumors, salvage pulmonary resections pose challenges due to adhesions between the pulmonary parenchyma, chest wall, and hilum. This study aimed to investigate the surgical outcomes associated with Cavitron Ultrasonic Surgical Aspirator (CUSA) usage in thoracoscopic salvage pulmonary resections. Patients with centrally located advanced-stage lung tumors who underwent salvage anatomic resections following systemic or radiotherapy were included. They were categorized into CUSA and non-CUSA groups, and perioperative parameters and surgical outcomes were analyzed. Results: The study included 7 patients in the CUSA group and 15 in the non-CUSA group. Despite a longer median surgical time in the CUSA group (3.8 h vs. 6.0 h, p = 0.021), there was a significant reduction in blood loss (100 mL vs. 250 mL, p = 0.014). Multivariate analyses revealed that the use of CUSA and radiotherapy had opposing effects on blood loss (β: -296.7, 95% CI: -24.8 to -568.6, p = 0.034 and β: 282.9, 95% CI: 19.7 to 546.3, p = 0.037, respectively). In conclusion, while using CUSA in the salvage anatomic resection of centrally located lung cancer may result in a longer surgical time, it is crucial in minimizing blood loss during the procedure.

Anatomical segmentectomy versus wedge resection for small (≤2 cm) peripheral non-small cell lung cancer in 80 or more aged elderly patients: a randomized phase III study (JCOG2109, AWESOME)

Abstract The standard treatment for small-sized and peripherally located early-stage non-small cell lung cancer is segmentectomy with secured margins. However, in 80 or more aged elderly patients, whether wedge resection will provide a better prognosis than segmentectomy is controversial. The aim of this trial is to confirm the non-inferiority of wedge resection to anatomical segmentectomy in terms of overall survival in these patients, who can tolerate lobectomy, with small-sized (≤2 cm), radiological solid dominant (consolidation-to-tumour ratio &amp;gt;0.5) and peripherally located early-stage non-small cell lung cancer in a randomized phase III trial. The primary endpoint is overall survival. If the non-inferiority of overall survival and the minimal invasiveness of wedge resection are proven, it can be a new standard treatment for such patients. A planned total of 400 patients will be enrolled from 53 institutions in 5 years. This trial has been registered in the Japan Registry of Clinical Trials with code jRCT1030220482 (https://jrct.niph.go.jp/latest-detail/jRCT1030220482).

Pulmonary artery reconstruction using a pulmonary vein conduit in case having an imbalanced dissection length during double-sleeve lobectomy

BackgroundAmong the types of lung resection procedures, pneumonectomy carries the highest risk for mortality. In recent years, bronchovascular double-sleeve lobectomy has been performed for centrally located non-small cell lung cancer involving both the bronchus and the pulmonary artery (PA) in order to avoid pneumonectomy. The use of an autologous pulmonary vein (PV) conduit for PA reconstruction during lung-sparing resections had first been reported in 2009. Such situations may occur in cases requiring the resection of a long segment of the PA without associated bronchial sleeve resection.Case presentationWe experienced two cases who underwent PA reconstruction using a PV conduit after double-sleeve resection. In both cases, the tumor was located in the left upper lobe and invaded the long segment of the PA; however, it had not significantly invaded the bronchus. Our strategy for bronchovascular reconstruction involved the use of a PV conduit to avoid high tension on direct anastomosis given the imbalance in the excision length between the PA and the bronchus. The intraoperative and postoperative courses were uneventful, with both cases not receiving anticoagulant agents during the postoperative period. The reconstructed bronchus and PA functioned well during postoperative follow-up visits.ConclusionsFollowing sleeve resection, an autologous PV conduit may be indicated for PA reconstruction when an excessive distance exists between the two vascular stumps.

Elevation of the Neutrophil-to-Lymphocyte Ratio Is a Significant Postoperative Poor Prognostic Factor in Patients With Clinical T3-4 Centrally Located Primary Lung Cancer.

In centrally located non-small cell lung cancer (CLNSCLC) surgery, large tumors and extension to neighboring structures prevent the attainment of adequate surgical fields and make operations more difficult, and some patients have extremely poor outcomes. This study aimed to identify novel postoperative prognostic factors in patients with advanced CLNSCLC. CLNSCLC was defined as a tumor requiring pneumonectomy or sleeve lobectomy for complete removal. We retrospectively investigated the clinical courses of 35 patients with cT3-4 CLNSCLC. This study included 21 patients with cT3 and 14 with cT4 lung cancer. Nine patients underwent pneumonectomy and 26 underwent sleeve lobectomy. Univariate analysis revealed that a high neutrophil-to-lymphocyte ratio (NLR, p=0.005) and carcinoembryonic antigen (CEA) positivity (p=0.028) were significant poor prognostic factors. Only high NLR (p=0.020) was a significant independent predictor in multivariate analysis. Nine of 16 patients with high NLR (56%) experienced disease recurrence, whereas 6 of 19 patients without high NLR (32%) had recurrent disease. High NLR and CEA positivity were significant poor prognostic factors in patients with cT3-4 CLNSCLC, and only high NLR was an independent predictor. Our findings may be helpful in selecting optimal treatments for advanced CLNSCLC.

Minimally invasive sleeve lobectomy for centrally located lung cancer: A real-world study with propensity-score matching.

The safety, feasibility, and prognosis of sleeve lobectomy by minimally invasive surgery (MIS) remain to be validated. The purpose of this study was to investigate outcomes in real-world patients receiving minimally invasive sleeve lobectomy in a balanced large cohort. Between January 2013 and December 2018, 578 consecutive patients undergoing sleeve resection at a high-volume center were retrospectively analyzed. Surgical and oncologic outcomes were compared between MIS and thoracotomy patients after propensity-score matching (PSM). MIS sleeve lobectomy was increasingly used as a time-trend in real-world. Before PSM, the MIS group had smaller tumor size, more T2-stage cases, and more right upper lobe sleeve lobectomies compared to the Open group. After 1:4 PSM by patient demographics and tumoral characteristics, 100 cases of MIS and 338 cases of Open sleeve lobectomy were further analyzed. Although median operation time was longer in the MIS group than in the Open group (170.5 minutes vs.149.5 minutes, P < 0.001), patients in MIS group had significantly less estimated intraoperative blood loss (100 ml vs. 200 ml, P = 0.003), shorter drainage duration (5 days vs. 6 days, P = 0.027) and less amount of drainage (1280 ml vs. 1640 ml, P < 0.001) after surgery. Complete resection rate, combined angioplasty, number of dissected lymph nodes, post-operative length of stay, postoperative morbidity and mortality rate, and application of adjuvant therapy were similar between the two matched groups. Conversion to open thoracotomy was necessary in 13.6% patients, but with similar perioperative outcomes compared to Open cases except for longer operation time. More lower lobe sleeve lobectomies were accomplished via robot-assisted thoracoscopic surgery than via video-assisted thoracoscopic surgery (40.0% vs. 12.0%, P = 0.017) in MIS patients. Five-year overall survivals (MIS vs. Open: 72.7% vs. 64.4%, P = 0.156) and five-year progression-free survivals (MIS vs. Open: 49.2% vs. 50.5%, P = 0.605) were similar between the two matched groups. MIS sleeve lobectomy is associated with similar or even better perioperative results and oncologic outcomes to open thoracotomy. Conversion to thoracotomy does not compromise perioperative outcomes. Robot surgery may be preferable for more complex sleeve resections.

Potential benefit of dose-escalated stereotactic body radiation therapy using CyberKnife for early-stage primary lung cancer.

The study aimed to evaluate the efficacy and safety of dose-escalated stereotactic body radiotherapy (SBRT) for primary lung cancer. Patients with peripherally located T1-2N0M0 primary lung cancer who underwent SBRT from April 2013 to December 2019 were included. Group A received 60Gy in five fractions with CyberKnife prescribed at 99% gross tumor volume. Group B received 48Gy in four fractions by a gantry-mounted linear accelerator, with isocenter prescription. Cumulative incidence of local failure (LF), progression free survival (PFS), overall survival (OS), and toxicity were retrospectively compared. Groups A and B comprised 39 and 36 patients, respectively. Group A had more patients without histological confirmation (p<.001) and showed lower V20 of bilateral lungs (p=.025). The median follow-up duration of Group A and B was 22.0 and 21.5 months, respectively, and the 2-year cumulative incidence of LF, PFS, and OS were .0%versus 11.6% (p=.065), 66.2%versus 62.7% (p=.694), 84.1%versus 81.1% (p=.827), respectively. There was no difference in Grade ≥ 2 toxicity rate between Groups A and B (7.7%vs. 11.1%; p=.704). Dose-escalated SBRT using CyberKnife showed reduced lung dose and potential benefits for improved local control with comparable toxicity.

Novel light delivery method for performing transbronchial photodynamic therapy ablation to treat peripheral lung cancer: A pilot study

BackgroundPhotodynamic therapy involves using a photosensitizer with l illumination and is recommended for treating early, centrally located lung cancers, but it is not a standard treatment for peripheral lung tumor.. We previously proposed a novel light delivery method, in which lipiodol is perfused into the bronchial tree to increase the scope of illumination via the fiber effect. Herein, we attempted this novel technique under electromagnetic bronchoscope guidance in a hybrid operation room where lipiodol facilitated light diffusion, and evaluated the effectiveness and feasibility of this technique for peripheral lung cancers. MethodsThis phase 0 pilot study included three patients with peripheral lung cancers (primary tumors ≤20-mm diameter). The photodynamic therapy was administered using Porfimer sodium as the photosensitizer, and an electromagnetic navigation bronchoscope in a hybrid operating room to guide the catheter to the tumor. This facilitated lipiodol infusion to encase the tumor and permit the transbronchial photodynamic therapy ablation. ResultsAdministering 630 nm 200 J/cm (400mW/500sec) energy through a 3-cm cylindrical diffusing laser fiber was safe; no significant acute complications were observed. Although the treatment outcome was unsatisfactory due to the low light dose, tumor pathology in one case revealed tumor necrosis, with no significant damage to the surrounding lung tissue. ConclusionsNovel light delivery transbronchial photodynamic therapy ablation for peripheral lung tumors is feasible and safe. Additional clinical trials may help determine the best illumination plan and light dose through multiple deliveries from multiple angles.

In 18F-positron emission tomography/computed tomography-guided precision radiotherapy for centrally located non-small cell lung cancer, tumor related atelectasis is a prognostic factor of survival.

PurposeTumor related atelectasis(TRA) is an essential factor affecting survival that can cause chest pain, cough, hemoptysis, chest tightness, dyspnea, and even death. In the current study, we explored the possible impact of TRA on survival in cancer patients and the guiding significance of 18F-positron emission tomography/computed(PET/CT) in radiotherapy for patients with atelectasis tumors.MethodsIn this retrospective study, we analyzed the treatment model and survival of patients with centrally located non-small cell lung cancer(NSCLC) treated with radiotherapy at two medical centers between May 2005 and August 2019. We identified 152 eligible patients and used propensity score matching (1:1) to process the data to reduce confounding factors, data bias, and mal-distribution.ResultsWe used propensity scores created well-matched groups of 57 patients overall with or without TRA. The one-year survival rate of all patients was 71.9%, and the two-year survival rate was 33.3%. Compared to the atelectasis group, the overall survival (OS) of patients in the non-atelectasis group was significantly prolonged (25 months vs. 17 months, p = 0.004), as well as in the atelectasis recovery group (28 months vs. 14 months, p = 0.008). In multivariate analysis, non-atelectasis was closely correlated with favorable OS (HR, 1.804 (−2.840); 95% CI, 1.145–2.840; p = 0.011).ConclusionPET/CT can accurately stage NSCLC and better guide the treatment of NSCLC complicated with atelectasis. Tumor-associated atelectasis in patients with centrally located NSCLC can lead to is a poor prognostic marker.

MO11-5 Dosimetry comparison between IMRT and 3DCRT/ VMAT for centrally located non-small cell lung cancer

The aim of the study is to investigate the overall plan quality and radiation dose to heart, lung and esophagus, to using IMRT or 3DCRT/ VMAT (3DVMAT) technique for centrally located non-small cell lung cancer treatment.

T Stage and Pretreatment Standardized Uptake Values Predict Tumor Recurrence With 5-Fraction SABR in Early-Stage Non-Small Cell Lung Cancer

PurposeFive-fraction stereotactic ablative radiotherapy (SABR) regimens are frequently used to treat centrally located early-stage non-small cell lung cancer or disease in the proximity of the chest wall as a means of optimizing tumor control and reducing treatment toxicity. However, increasing these SABR regimens to 5 fractions may reduce tumor control outcomes. We sought to identify the clinical parameters predictive of treatment failures with these 5-fraction courses. MethodsNinety patients with T1-2 non-small cell lung cancer were treated with 50 or 60 Gy in 5 fractions. Failure over time was modeled using cumulative incidences of local, regional, or distant failure, with death as a competing risk. Cox proportional hazards analysis for incidences of failure was performed to control for patient variables. ResultsOf 90 patients, 24 of 53 patients with T1 tumors and 19 of 37 patients with T2 tumors received 50 Gy SABR, and the other 47 patients received 60 Gy. Two-year overall survival and progression-free survival for the whole cohort were 75.8% and 59.3%, respectively. Total SABR dose (50 vs 60 Gy) did not influence survival nor failure rates at 2 and 5 years. Within 2 years of treatment, 7.8% of all patients developed local failure. For all patient and tumor characteristics evaluated, only T stage and pretreatment positron emission tomography standardized uptake values served as predictors of local, regional, and distant failure at 2 and 5 years posttreatment on univariate and multivariable analysis. ConclusionsFive-fraction SABR provides excellent in-field control. T2 and high fluorodeoxyglucose uptake tumors have increased failure rates, suggesting the potential need for adjuvant therapies, which are being assessed in randomized phase 3 trials.

The long-term oncologic outcomes of robot-assisted bronchial single sleeve lobectomy for 104 consecutive patients with centrally located non-small cell lung cancer

BackgroundUp to now, no study has described the long-term survival and its prognostic factors of robot-assisted sleeve lobectomy. Here, the present cohort study reported the long-term oncologic outcomes of robot-assisted sleeve lobectomy to evaluate the oncological feasibility of sleeve lobectomy via a robotic surgical system in patients with centrally located non-small cell lung cancer (NSCLC).MethodsA total of 104 consecutive patients with centrally located NSCLC who underwent robot-assisted bronchial single sleeve lobectomy between October 2014 and May 2021 were retrospectively reviewed. Bronchial single sleeve lobectomy only refers to the resection and end-to-end anastomosis reconstruction of the bronchus, without the resection of the pulmonary vessels or carina. The recurrence status during follow-up, 5-year overall survival (OS) and disease-free survival (DFS) were assessed.ResultsIn the total cohort, 47 (45.2%) patients had pathological stage I disease, 28 (26.9%) patients had pathological stage II disease, and 29 (27.9%) patients had pathological stage III disease. Recurrence occurred in 26 (25.0%) patients, including locoregional recurrence in 10 (9.6%) patients and distant recurrence in 16 (15.4%) patients. No endobronchial nor perianastomotic recurrence was detected. The Kaplan-Meier curves indicated that the 5-year DFS and OS rates in the cohort were 67.9% and 73.0%, respectively. In terms of pathological stages, the 5-year DFS and OS rates were 82.9% and 82.2% for stage I patients, 57.8% and 69.7% for stage II patients, and 54.5% and 63.7% for stage III patients, respectively. Multivariable analyses demonstrated that higher pathological stage or N2 stage were independent risk factors for poorer DFS and OS.ConclusionsRobot-assisted bronchial single sleeve lobectomy could be an oncologically adequate procedure for patients with centrally located NSCLC, due to the long-term survival was similar to that reported for video-assisted thoracoscopic surgery (VATS) or open technique. Further studies of comparative studies or high-quality randomized controlled trials are required.

Are Sleeves the New Pneumonectomy?

Outcomes after sleeve resection are increasingly studied for patients with advanced non-small cell lung cancer.1 Sleeve lobectomies avoid pneumonectomy (PN) and preserve lung parenchyma. In this issue of The Annals of Thoracic Surgery, Hattori and colleagues2 evaluated 43 patients who underwent extended sleeve lobectomy (ESL) with complex reconstruction and resection of more than 1 lobe for centrally located non-small cell lung cancer. Of the 43 patients, long-term survival was relatively good. The 3-year overall survival was 62.8% with 3-year recurrence-free survival of 43.5%.

The Ingenuity to Improve the Therapeutic Outcome of PDT for Centrally Located Lung Cancer

The Ingenuity to Improve the Therapeutic Outcome of PDT for Centrally Located Lung Cancer