Non-small Cell Bronchogenic Carcinoma Research Articles

PET/CT implication on bronchogenic carcinoma TNM staging and follow-up using RECIST/PERCIST criteria: a comparative study with CT

BackgroundTo evaluate the role of PET/CT on bronchogenic carcinoma staging as well as treatment response evaluation on follow-up compared to CT study alone.MethodsA prospective study of 60 patients confirmed histopathologically to have non-small cell bronchogenic carcinoma, 30 of them came for staging (group T) while the rest 30 came for follow-up (group F) to assess therapy response. All patients underwent PET/CT with data analysis done using the eighth edition tumor, nodal, metastatic staging (TNM) staging for group T and RECIST/PERCIST criteria for group F. The CT data alone transferred to a blind radiologist for analysis using the same parameters. The results were collected and compared.ResultsRegarding group T, 12 patients showed different TNM staging between PET/CT and CT alone, 5 cases with different T stagings, 4 cases with different N stagings, and 5 cases with different M stagings. Also, 8 cases showed different surgical stagings. Regarding group F, 9 cases showed a difference between RECIST obtained by CT and PERCIST obtained by PET/CT with most of the cases (6 cases) showed change from partial or stable response to progressive response.ConclusionPET/CT has a significant role in TNM staging of bronchogenic carcinoma more at T2 staging due to its ability to differentiate the tumoral mass from the nearby pulmonary reaction. Also, PET/CT makes a difference in tumoral follow-up by its ability to detect the functional changes even before structural changes. Finally, PET/CT is a very important tool in management strategy.

Resected Non-Small Cell Bronchogenic Carcinoma Stage pIIIA-N2. Which Patients Will Benefit Most From Adjuvant Therapy?

BackgroundControversy persists as regards the indications and results of surgery in the treatment of patients with stage pIIIA-N2 non-small cell lung cancer (NSCLC). The objective of this study was to analyze the overall survival of a multicenter series of these patients and the role of adjuvant treatment, looking for factors that may define subgroups of patients with an increased benefit from this treatment. MethodsA retrospective study was conducted on 287 patients, with stage pIIIA-N2 NSCLC subjected to complete resection, taken from a multi-institutional database of 2994 prospectively collected consecutive patients who underwent surgery for lung cancer. Adjuvant treatment was administered in 238 cases (82.9%). Analyses were made of the age, gender, histological type, administration of induction and adjuvant chemotherapy and/or radiation therapy treatments. ResultsThe 5-year survival was 24%, with a median survival of 22 months. Survival was 26.5% among patients receiving with adjuvant treatment, versus 10.7% for those without it (P=.069). Age modified the effect of adjuvant treatment on survival (interaction P=.049). In patients under 70 years of age with squamous cell carcinoma, adjuvant treatment reduced the mortality rate by 37% (hazard ratio: 0.63; 95% CI; 0.42–0.95; P=.036). ConclusionsCompletely resected patients with stage pIIIA-N2 NSCLC receiving adjuvant treatment reached higher survival rates than those who did not. Maximum benefit was achieved by the subgroup of patients under 70 years of age with squamous cell carcinoma.

Importance of histological verification of mediastinal lymphadenopathy in exact staging of non-small cell bronchogenic carcinoma.

Diagnostics and treatment of bronchogenic non-small cell lung carcinoma is a severe clinical problem. Radical surgery is the major treatment modality with the highest chance for a long-time survival. The aim of the study was to map metastasizing of bronchogenic non-small cell lung carcinoma into homolateral mediastinal lymph nodes and to assess the importance of histological verification of mediastinal lymphadenectomy for exact staging and treatment. Study of 29 patients with non-small cell lung carcinoma in stage IIIa, IIIb and IV (TNM classification) diagnosed from September 2006 to March 2007, with mediastinal lymph nodes invasion according to CT, and with subsequent mediastinal lymph node dissection during autopsy. 50% of the right upper lobe tumors metastasized into group 1 nodes (N1-N4) and 50% into group 3 (N7). 66% of the right lower lobe tumors metastasized into group 3 nodes (N7) and 33.3% into group 1 (N1-4). 20.0% of the left upper lobe tumors metastasized into group 1 nodes (N1-4), 33.0% into group 2 (N5-6), 25.0% into group 3 (N7) and 16.7% into group 4 (N8-9). 23.5% of the left lower lobe tumors metastasized into group 1 nodes (N1-4), 23.5% into group 2 (N5-6), 23.5 % into group 4 (N8-9) and 29.5% into group 3 (N7). 27.6% of examined patients had false positivity of lymph node metastasis according to CT. Histological verification of suspect mediastinal lymph nodes via Endobronchial Ultrasound Biopsy (EBUS) or mediastinoscopy or thoracoscopy is crucial for determining the stage of the disease according to the TNM classification. False positivity of imaging methods in diagnostics of non-small cell brochogenic carcinoma can contraindicate up to quarter of potentially operable patients (Tab. 3, Ref. 11).

Role of imaging techniques in the TNM classification of non-small cell bronchogenic carcinoma

The Seventh Edition of the TNM classification for non-small cell bronchogenic carcinomas includes a series of changes in the T and M descriptor, in particular a re-classification of malignant pleural and pericardial effusions and of separated tumor nodes, new tumour size cut-off values and sub-divisions of the T1–T2 and M1 categories. We review these corrections that led to the changes in the staging system that affects stages II–III. Furthermore, we describe and illustrate the role of the different imaging techniques in tumour staging (CT, PET, PET–CT and MRI), highlighting their respective indications, advantages and disadvantages, as well their complementary function.

Papel de las técnicas de imagen en la nueva clasificación TNM del carcinoma broncogénico no microcítico

The Seventh Edition of the TNM Classification for non-small cell bronchogenic carcinomas include a series of changes in the T and M descriptor, in particular a re-classification of malignant pleural and pericardial effusions and of separated tumour nodes, new tumour size cut-off values and sub-divisions of the T1-T2 and M1 categories. We review these corrections that led to the changes in the staging system that affects stages II-III. Furthermore, we describe and illustrate the role of the different imaging techniques in tumour staging (CT, PET, PET-CT and MRI), highlighting their respective indications, advantages and disadvantages, as well their complementary function.

Twenty-year Progress in Surgical Treatment for Non-small Cell Bronchogenic Carcinoma

Twenty-year Progress in Surgical Treatment for Non-small Cell Bronchogenic Carcinoma

The IASLC Lung Cancer Staging Project: Data Elements for the Prospective Project

The International Association for the Study of Lung Cancer Retrospective Staging Project culminated in a series of recommendations to the International Union Against Cancer and to the American Joint Committee on Cancer regarding the seventh edition of the tumor, node, metastasis (TNM) classification for lung cancer. The International Staging Committee of the International Association for the Study of Lung Cancer now issues this call for participation in the Prospective Project designed to assess the validity of each component of T, N, and M, and other factors relevant to lung cancer staging and prognosis. In the Retrospective Project, the original data acquisition was typically motivated by interests other than staging. In contrast, the Prospective Project offers online data entry. Alternatively, participants may transfer existing data, provided core objectives are addressed. Cancer Research and Biostatistics will coordinate data management and analysis. The study population is newly diagnosed lung cancer patients. Data elements include patient characteristics, baseline laboratory values, first-line treatment, TNM plus supporting evidence, and survival. Pretreatment TNM will be collected for all cases; postsurgical TNM, if resection is attempted. T descriptors include size and degree of tumor extension, with further description of extent of visceral pleural invasion, venous invasion, carcinomatous lymphangitis, and pleural lavage cytology. M descriptors characterize the newly proposed M1a category and sites of distant metastases. Nodal station involvement is described by means of a newly proposed nodal map, facilitating international participation, and allowing further investigation of nodal zones. Successful collection and analysis of these data can be expected to yield unprecedented improvements in the utility and validity of lung cancer staging.

Surgical Treatment of Solitary Metastasis in the Male Breast from Non-Small Cell Lung Cancer

Detection of metastases in the breast from extramammary neoplasms is rare. We present a case of metastases in breast tissue from surgically treated non-small cell bronchogenic carcinoma. A histologic and immunohistologic study was essential for choosing the appropriate treatment for the patient. The patient is alive and disease-free 18 months after the breast surgery.

Incorporation of photodynamic therapy as an induction modality in non-small cell lung cancer

Incorporation of photodynamic therapy (PDT) into the induction therapy regimen utilized for treatment of locally advanced primary non-small cell bronchogenic carcinoma (NSCLC) is explored. We present a retrospective review of 41 patients diagnosed with non-metastatic NSCLC who underwent induction PDT with chemotherapy and/or radiation. Fifty percent of patients initially deemed unresectable, were able to undergo definitive surgical resection after trimodality induction therapy. Twenty-seven percent of patients considered to require pneumonectomy were able to have a lobectomy. The pathological stage was less than the preinduction clinical stage in 14 of 22 cases; of which four patients had no residual tumor. There was no 30/90-day postoperative mortality. Mean survival was 35.9 months (lobectomy), 25.5 months (pneumonectomy) and 14.7 months (no surgery). Median survival was 78% (12 months) and 46% (36 months). The main postoperative complication following pneumonectomy was bronchopleural fistula formation. All patients who developed this complication had undergone trimodality induction therapy. Incorporation of PDT into the induction arsenal for patients with loco-regionally advanced NSCLC may be safely performed. PDT may define an alternative induction strategy for patients requiring pneumonectomy; further studies exploring the true efficacy of PDT as an induction modality are encouraged.

Carcinoma broncogénico no microcítico en estadios avanzados: influencia pronóstica de la pérdida de peso e implicaciones clínicas

This study of advanced-stage non-small cell bronchogenic carcinoma aimed 1) to identify prognostic factors collected at the moment of diagnosis, 2) to determine whether weight loss is a useful parameter to screen for subjects who will receive greater benefit from anticancer therapy.Patients and methods. Eighty-one patients were enrolled after diagnosis of stage III-B and IV non-small cell bronchogenic carcinoma and levels of activity < 2 according to Eastern Co-operative Oncology Group classification. The variables studied were age, sex, smoking history, associated disease, clinical data (weight loss, dyspnea, superior vena cava syndrome), laboratory parameters [hemoglobin, serum albumin, total lymphocytes, serum lactate dehydrogenase (LDH), calcium and liver enzymes], tumor-node-metastasis (TNM) staging, histologic type, activity, treatment received and survival in weeks. The results were analyzed in two groups: 1) the general group consisting of results for all patients, and 2) the no-weight-loss group consisting of results for those whose weight had been stable. Student t, chi-squared, Kaplan Meier, log-rank and Cox's regression model were used to analyze data and survival. Mean survival was 29 weeks (21-37). Survival was significantly related to weight loss, total lymphocytes, serum LDH, TNM and activity level in the general group. Only two factors continued to have prognostic value in the multivariate study: weight loss (OR: 1.48 (1.14-1.92), p = 0.002) and TNM (OR: 0.72 (0.54-0.96), p = 0.02). Among the patients with no weight loss, treatment received and TNM were significantly related to survival in univariable analysis and in Cox's regression model. In our experience with advanced lung cancer subjected to anticancer therapy, the presence of weight loss is the variable with the greatest prognostic value, such that it may be useful to consider it routinely, along with activity level, to try to identify patients who will receive the most benefit from cytostatic treatment.

Modelo de riesgo de mortalidad en el carcinoma broncogénico no anaplásico de células pequeñas en estadio I

To develop and validate a mortality risk model for patients with resected stage I non-small cell bronchogenic carcinoma (NSCBC). Tumors from 798 patients with diagnoses of NSCBC were resected and classified in stage I. The Kaplan-Meier method and Cox's proportional hazard model were used to analyze the influence of clinical and pathologic variables on survival. Univariate analysis revealed that age (p = 0.0461), symptoms (p = 0.0383), histology (p = 0.0489) and tumor size (p = 0.0002) and invasion (p = 0.0010) affected survival. Size (p = 0.0000) and age (p = 0.0269) were entered into multivariate analysis. Each patient's risk was estimated by applying the regression equation derived from multivariate analysis; the mean was 1.47 +/- 0.31 (range 0.68 to 2.92). The series was divided into three groups by degree of risk (low, intermediate and high), establishing the cutoff points at 1.16 and 1.78 (standard deviation of the mean). Five-year survival rates were 85%, 62% and 46%, respectively (p = 0.0000). To validate the model's predictive capacity, the series was divided randomly into two groups: the study group with 403 patients and the validation group with 395. Age (p = 0.0295), symptoms (p = 0.0396), tumor size (p = 0.0010) and invasion (p = 0.0010) affected survival in the univariate analysis. Size (p = 0.0000) and age (p = 0.0358) were entered into Cox's model. Mean risk was 1.94 +/- 0.36 (range 0.98 to 3.32). The series was divided into three risk groups, with cut-off points established at 1.58 and 2.30. Five year survival rates were 90%, 62% and 46% for the low, intermediate and high risk groups, respectively (p = 0.0000). The same model proved able to identify risk when applied to the validation group, in which five-year survival rates were 78%, 61% and 48%, respectively (p = 0.0000). Risk models can identify patient subgroups, potentially influenced by co-adjuvant treatment, as well as facilitate comparison of patient series.

Accelerated Hyperfractionation in Patients with Non-Small Cell Bronchogenic Cancers as a Cost-Effective and User- and Patient-Friendly Schedule

We developed an accelerated hyperfractionation schedule with acceptable effect and toxicity in non-small cell bronchogenic carcinomas. An evolutionary institutional pilot was initiated in March 1995 as a modification of Radiation Therapy Oncology Group (RTOG) 9205, thrice-daily fractionation schedule. Twenty-nine patients with bronchogenic and 7 with head and neck cancers had treatment initiated and completed. A dose of 1.2 Gy was delivered to a mediastinal plus tumor field concomitantly with synchronous boost of 0.6Gy to a limited volume of gross tumor (twice daily for 27 treatments days in 4 weeks) with a total dose being 75.60 Gy to the primary gross tumor and 50.4 Gy to the elective volume. The bronchogenic cancers were stages IB (medically unresectable, n = 3), IIB (n = 4), IIIA (n = 4), or IIIB (n = 18). Eleven patients had squamous cell cancers, 13 adenocarcinomas, 1 large cell, and 2 carcinomas not specified. With 12 months median follow-up, tolerance has been excellent without any patient complaining of at least Oncology Nursing Society (ONS) grade 3 esophagitis; treatment interruptions occurred in only one patient after 8 days. Weight loss occurred in 12 patients, averaging 4.8% for these patients and 2% overall. Seven patients had a complete response and 20 a partial response. Median survival was 12 months, 1-year survival 58%, 2-year 21%, and 3-year 18%. Seven patients with bronchogenic cancer are still alive. Seven head and neck cancer patients were treated, in which five had base of tongue tumors stage T2 to 4, NO to N1. Pharyngitis and mucositis were problematic in at least four patients. The outcomes are comparable with other RTOG experience. Hyper-fractionated synchronous concomitant boost of total tumor dose to 75.6 Gy in 4 weeks for bronchogenic patients was well tolerated and acceptable to physicians and patients.

Estrogen‐receptor‐related protein p29 in primary nonsmall cell lung carcinoma

Estrogen-dependent intracellular processes are important in the growth regulation of normal tissue and may play a role in the regulation of malignancies. Utilization of estrogen receptor assays in breast carcinoma is well established, but the role of such evaluation in other cancers largely is unknown. In this study, immunohistochemical expression of estrogen receptor (ER) and the ER-related protein p29 was correlated with survival of patients with nonsmall cell carcinoma of the lung. All patients with a tissue diagnosis of primary nonsmall cell bronchogenic carcinoma diagnosed over a 6-year period at the Medical Center Hospital of Vermont were reviewed. Assays for p29 and ER using a streptavidin-biotin immunoperoxidase method were performed on each tumor. Results were correlated with clinical data, including survival. Of 111 tumors examined, 109 (98%) were positive for p29 whereas none of the tumors reacted with ER (ER1D5). The relation between p29 expression and survival time was different for men and women. A statistically significant negative relation for women was observed; this relation was most pronounced in patients with Stage I and II tumors. A positive but not statistically significant relation was observed for men. The ER-related protein p29 commonly is expressed in nonsmall cell carcinomas of the lung. The relation between p29 and survival time is different for males and females, suggesting the presence of gender specific factors that may influence tumor growth and overall patient survival, especially in patients with early stage lung carcinoma.

Estrogen‐receptor‐related protein p29 in primary nonsmall cell lung carcinoma

BACKGROUND Estrogen-dependent intracellular processes are important in the growth regulation of normal tissue and may play a role in the regulation of malignancies. Utilization of estrogen receptor assays in breast carcinoma is well established, but the role of such evaluation in other cancers largely is unknown. In this study, immunohistochemical expression of estrogen receptor (ER) and the ER-related protein p29 was correlated with survival of patients with nonsmall cell carcinoma of the lung. METHODS All patients with a tissue diagnosis of primary nonsmall cell bronchogenic carcinoma diagnosed over a 6-year period at the Medical Center Hospital of Vermont were reviewed. Assays for p29 and ER using a streptavidin-biotin immunoperoxidase method were performed on each tumor. Results were correlated with clinical data, including survival. RESULTS Of 111 tumors examined, 109 (98%) were positive for p29 whereas none of the tumors reacted with ER (ER1D5). The relation between p29 expression and survival time was different for men and women. A statistically significant negative relation for women was observed; this relation was most pronounced in patients with Stage I and II tumors. A positive but not statistically significant relation was observed for men. CONCLUSIONS The ER-related protein p29 commonly is expressed in nonsmall cell carcinomas of the lung. The relation between p29 and survival time is different for males and females, suggesting the presence of gender specific factors that may influence tumor growth and overall patient survival, especially in patients with early stage lung carcinoma. Cancer 1998;82:1495-500. © 1998 American Cancer Society.

Evolución del carcinoma broncogénico resecado: supervivencia a los 5 años. Nuestra experiencia

To review the causes of non-small cell bronchogenic carcinoma treated surgically with the intention to cure, in order to determine and analyze the course of disease in our patients, particularly regarding survival after five years, and to compare our outcomes with those reported in the literature. Retrospective study of all patients resected in our unit from September 1984 through December 1990. We also analyze sex, age, and course of disease over a period of 60 months, emphasizing surgically related mortality, TNM stage, type of resection and tissue type. We calculated five year actuarial survival globally and for each variable studied, excluding patients who died as a result of surgery and those who were lost to follow-up. We identified 115 cases (13.62% of all patients under-going surgery during this period). Nine patients (7.82%) died after surgery. Six patients were lost to follow-up and for three patients data were incomplete. Fifty-three patients died within five years of surgery. Forty-four lived at least five years. Overall actuarial survival was 56.05%. Analyzing by TNM stages, 54.9% were stage I, 50% were stage II and 32.09% were stage IIIa. Pneumonectomy was performed on 43.59%, single or double lobectomy on 50.29%, and infralobar resection on 33.33% Histology revealed 54.56% to be epidermoid versus 33.01% for all other tissue types. The outcomes for bronchogenic carcinomas resected in our department are comparable to those in the literature, survival after five postoperative years being similar to the rate reported for other series.

Quality of life after surgical therapy of bronchogenic carcinoma.

Quality of life (QL) after the "curative" resection of non-small cell bronchogenic carcinoma was assessed by patients using the EORTC QL questionnaire (QLQ) and by a psychologist using the Spitzer Index. Quality of life was assessed in 52 patients on one occasion 12 months postoperatively and in 20 patients regularly starting with a preoperative assessment. Self- and external evaluation showed a significant correlation (r = 0.41), but QL was assessed as being higher by the external observer. After surgery it was mainly affected by restrictions related to physical activities, job and household tasks, and disease symptoms, whereas limitations in emotional, social, and financial domains were found less frequently and less severely. Of the different medical (surgical procedures, tumor recurrence) and social factors (sex, marital and employment status), only tumor recurrence was determined to have a significant and negative influence on postoperative QL (P < 0.02). When compared to the preoperative assessment, QL had deteriorated on discharge from hospital but was restored within 3-6 months postoperatively in disease-free patients.

MEDIASTINAL LYMPH NODE DISSECTION FOR NON-SMALL CELL LUNG CARCINOMA

The authors analyzed the accuracy of preoperastive detection of mediastinal lymph node metastasis with computed tomography and correlated the levels of mediastinal lymph node metastases with the location of primary tumors, the CT factor, and the results of surgical treatment for non-small cell lung carcinoma. During the past 21 years 228 squamous cell carcinomas and 217 adenocarcinomas were removed by lobectomy or pneumonectomy, and all accessible mediastinal lymph nodes were resected. The preoperative diagnosis of mediastinal lymph node metastases from computed tomography findings was accurate in only 55% of squamous cell carcinomas and 43% of adenocarcinomas. Right upper lobe carcinomas were apt to metastasize to #1-4 lymph nodes and middle or lower lobe carcinomas to #7 nodes. Carcinomas of both left lobe were apt to metastasize to #5 or 6 lymph nodes. Of the pN2 squamous cell carcinomas 7.2% and of the adenocarcinomas 34.5% were cT1. Thus, the cT factor in pN2 adenocar-cinomas was significantly smaller than that in squamous cell carcinomas with mediastinal lymph node metastases. The survival rates of patients with pNO or pN1 cancers were significantly better than those with pN2 or pN3 cancers. However, the 5-year cumulative survival rate of patients with pN2 cancers treated with relative curative resection was over 20%, being significantly better than that of patients who were treated with non-curative resection. We conclude that mediastinal lymph node dissection which aims at curative surgery should be performed for all resectable non-small cell bronchogenic carcinomas regardless of the preoperative diagnosis of mediastinal lymph node metastasis, the location of the primary tumor, or the histological type, since the preoperative diagnosis of mediastinal lymph node metastasis is not very reliable and many small cancers, especially adenocarcinomas, have mediastinal metastases.

CT and MR Imaging in Staging Non-Small Cell Bronchogenic Carcinoma

CT and MR Imaging in Staging Non-Small Cell Bronchogenic Carcinoma

Papel de la tomografía computarizada (TC) de tórax en la definición de la extensión anatómica en el carcinoma broncogénico (CB)

A series of 129 carriers of non-small cell bronchogenic carcinoma (BC), in whom computed tomography (CT) of the thorax was performed as part of the preoperative study, are presented. The results of CT were compared with those of thoracotomy in terms of sensitivity (SEN), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV). Thoracic wall (prevalence 0.18): SEN, SP, PPV and NPV were 0.65, 0.92, 0.63 and 0.92, respectively. In peripheral tumors these values were 0.85, 0.90, 0.69 and 0.96, respectively. CT demonstrating invasion of the thoracic wall thus requires confirmation for the purpose of surgical staging. If CT reveals an intact wall, however, surgery may take place immediately. Malignant mediastinal lymph nodes: (prevalence 0.36): SEN, SP, PPV, and NPV were 0.70, 0.89, 0.78 and 0.84, respectively. For peripheral tumors these values were 0.78, 0.93, 0.82 and 0.91, respectively. CT demonstrating malignant mediastinal lymph nodes should be confirmed by mediastinoscopy. If mediastinal malignancy is not observed by CT, thoracotomy may be performed in peripherally located tumors; in centrally located tumors, however, the absence of adenopathy should be confirmed by mediastinoscopy.

Carboplatin, vinblastine and mitomycin-C in the treatment of non-small cell bronchogenic carcinoma : Athanassiades P, Athanassiades H, Psychogiou E, Kokolakis N, Giannioti E. Dept. of Clinical Therapeutics, University of Athens, 80 Vas. Sofias - K. Lourou Str., 11528 Athens. J Chemother 1992;4:196–199

Carboplatin, vinblastine and mitomycin-C in the treatment of non-small cell bronchogenic carcinoma : Athanassiades P, Athanassiades H, Psychogiou E, Kokolakis N, Giannioti E. Dept. of Clinical Therapeutics, University of Athens, 80 Vas. Sofias - K. Lourou Str., 11528 Athens. J Chemother 1992;4:196–199