Peripheral Non-small Cell Lung Cancer Research Articles

Lobectomy and limited resection in small-sized peripheral non-small cell lung cancer.

Although lobectomy is the standard surgical procedure for non-small cell lung cancer (NSCLC), recent studies show favorable outcomes after limited resection in patients with small-sized peripheral tumors. We conducted a randomized controlled trial of such patients to estimate postoperative outcomes and pulmonary function following these surgical techniques. Between 2005 and 2008, eligible patients with tumors of 2 cm or less were randomly assigned 1:1 to undergo lobectomy or limited resection; 32 and 33 NSCLC patients in each group, respectively, were analyzed. The primary end points were 5-year overall survival (OS) and disease-free survival (DFS), while the secondary end points were postoperative pulmonary function including forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1). The 5-year OS rates were 93.8% and 90.9% in the lobectomy and limited resection groups, respectively (P=0.921). The 5-year DFS rates were 93.8% and 90.9% in the lobectomy and limited resection groups, respectively (P=0.714). These rates did not differ significantly between the two resection groups. The median postoperative/preoperative FVC ratios were 84.1% and 90.0% in the lobectomy and limited resection groups, respectively, while the median postoperative/preoperative FEV1 ratios were 81.9% and 89.1%, respectively. Both ratios were significantly higher in the limited resection group (P=0.032 and P=0.005 for FVC and FEV1 ratios, respectively). A similar outcome, with more preserved postoperative pulmonary function, was observed in patients who underwent limited resection compared to those who underwent lobectomy. Ongoing large-scale multi-institutional prospective randomized trials of lobar versus sublobar resection in patients with small peripheral NSCLCs will hopefully provide definitive information about intentional limited resection of small peripheral tumors.

A Phase 2 Randomized Study of 2 Stereotactic Body Radiation Therapy (SBRT) Regimens for Medically Inoperable Patients With Node-Negative, Peripheral Non-Small Cell Lung Cancer

A Phase 2 Randomized Study of 2 Stereotactic Body Radiation Therapy (SBRT) Regimens for Medically Inoperable Patients With Node-Negative, Peripheral Non-Small Cell Lung Cancer

The clinical analysis of stereotactic ablative radiotherapy for stage I peripheral non-small cell lung cancers

Objective To investigate the efficacy and toxicity of stereotactic ablative radiotherapy for stage I peripheral non-small cell lung cancers. Methods Thirty six patients of stage I peripheral non-small cell lung cancers were treated with stereotactic ablative radiotherapy. The prescription dose was 12 Gy per fraction×4 fraction in one to two weeks. The 100% planning target volume (PTV) was covered by the isodose curve of 95% prescription dose. Organs at risk and their respective tolerance doses used during treatment planning were developed from the research scheme of the Radiation Therapy Oncology Group 0236. Before the radiation delivery, all patients were scanned by the fan beam CT or the cone beam CT for image guidance and registration. The follow-up for the patients was given to observe the toxicity and efficacy of stereotactic ablative radiotherapy (SABR). Results The median follow-up time was 18.7 months (range of 4 to 36 months). After treatment, the overall response rate was 88.9%, with complete response (CR) 17 cases(47.2%), partial response (PR) 15 cases(41.7%), and stable disease (SD) 4 cases(11.1%). The estimated overall survival rate at 1 and 3 years was 92.3% (95% confidence interval [CI], 86.3%~97.1%) and 85.3% (95% CI, 80.5%~90.6%). The estimated local control rate at 3 years was 90.2% (95% CI, 85.7%~94.8%). There was no grade Ⅲ or above toxicity related to treatment. Conclusions The stereotactic ablative radiotherapy attains good local control and survival efficacy for the stage I peripheral non-small lung cancer patients. It is well tolerated owing to low toxicity. Key words: Carcinoma, non-small-cell lung/RT; Catheter ablation/MT; Radiosurgery/MT

Radiobiological modeling of two stereotactic body radiotherapy schedules in patients with stage I peripheral non-small cell lung cancer.

This study aims to compare the radiobiological response of two stereotactic body radiotherapy (SBRT) schedules for patients with stage I peripheral non-small cell lung cancer (NSCLC) using radiobiological modeling methods. Volumetric modulated arc therapy (VMAT)-based SBRT plans were designed using two dose schedules of 1 × 34 Gy (34 Gy in 1 fraction) and 4 × 12 Gy (48 Gy in 4 fractions) for 19 patients diagnosed with primary stage I NSCLC. Dose to the gross target volume (GTV), planning target volume (PTV), lung and chest wall (CW) were converted to biologically equivalent dose in 2 Gy fraction (EQD2) for comparison. Five different radiobiological models were employed to predict the tumor control probability (TCP) value. Three additional models were utilized to estimate the normal tissue complication probability (NTCP) value for the lung and the modified equivalent uniform dose (mEUD) value to the CW. Our result indicates that the 1 × 34 Gy dose schedule provided a higher EQD2 dose to the tumor, lung and CW. Radiobiological modeling revealed that the TCP value for the tumor, NTCP value for the lung and mEUD value for the CW were 7.4% (in absolute value), 7.2% (in absolute value) and 71.8% (in relative value) higher on average, respectively, using the 1 × 34 Gy dose schedule.

Association of maximum standardized uptake value with occult mediastinal lymph node metastases in cN0 non-small cell lung cancer.

The management of non-small cell lung cancer (NSCLC) relies on the tumour-node-metastasis (TNM) stage, and the treatment regimen differs based on the N status. Positron emission tomography-computed tomography (PET-CT) has emerged as a powerful imaging tool for the detection of various cancers with a relatively low false-negative rate. We explored predictors to identify false-negative N2 disease in PET-CT. A total of 284 consecutive cN0 patients with peripheral NSCLC who underwent PET-CT scans followed by curative intent resections were enrolled as a training set to identify predictors of occult N2 metastases by multivariable analysis. The accuracy and cut-off values for the predictors were calculated using a receiver operating characteristic curve. Clinical and pathological data were analysed retrospectively. An additional 151 patients were collected as a test set to validate the results, including the occult N2 rate and accuracy. In total, 8.5% (24/284) PET-CT-diagnosed N0 NSCLC cases had pathologically diagnosed N2 metastases. The SUVmax of the primary tumour was a unique independent risk factor for occult N2 NSCLC [P = 0.003, 95% confidence interval = 0.81-0.96, odds ratio (OR) = 0.88]. Occult N2 metastases occurred more frequently in the subcarinal (16/24) and right lower paratracheal lymph nodes (12/24). Accordingly, we divided the patients into two groups by SUVmax: the occult N2 rates in the SUVmax of <2.6 and SUVmax of ≥2.6 groups were 1.0% (1/100) and 12.5% (23/184), respectively (P = 0.001). In the test set, the occult N2 incidence rate was 9.3% (14/151), with the highest rates occurring in the subcarinal (9/14) and right lower paratracheal lymph nodes (6/14). In the two groups defined by SUVmax, the occult N2 rates were 4% (2/50) and 11.9% (12/101), respectively. The SUVmax of the primary tumour was an independent risk factor for occult N2 metastases in NSCLC patients diagnosed as clinical N0 by PET-CT. SUVmax of ≥2.6 of the primary tumour may indicate the risk of N2 metastases, and invasive mediastinal staging techniques or comprehensive therapy should not be ignored in these patients.

A pilot study of chemical ablation of peripheral non-small-cell lung cancer: a novel, effective, safe, and inexpensive method

Chemical ablation with acetic acid or ethanol is effective against hepatocellular carcinoma and therefore its application in peripheral non-small-cell lung cancer (NSCLC) may be beneficial. The aim of the study was to assess the efficacy and safety of percutaneous chemical ablation using acetic acid or ethanol in peripheral NSCLC cases. This was a prospective randomized control study conducted at the Chest and Clinical Oncology Departments, Mansoura, Egypt, from 2011 to 2014. Thirty-three patients were included with a mean age of 60 years, and were randomly divided into three groups: group A (acetic acid plus chemotherapy group) consisted of nine patients; group B (ethanol plus chemotherapy group) consisted of nine patients; and the control group C (chemotherapy alone group) consisted of 15 patients. Patients who were operable, who had tumors infiltrating the main stem bronchi or mediastinum, and those who refused to complete the study were excluded. Clinical and radiological data were evaluated before treatment and 3 and 6 months after treatment. There was a significant reduction in both cough score and chest pain in group A after 6 months of treatment, in the hemoptysis score in group A and group B after 6 months of treatment, and in dyspnea score in groups A and B after 3 and 6 months of treatment. There was a statistically significant difference in the tumor response results in both groups after 3 and 6 months of treatment when compared with the control group. There were one or more immediate complications but all were controllable with no mortality. Survival was better in groups A and B than in the control group. The cost of acetic acid and ethanol palliation for each patient was 10 $US. Chemical ablation is an effective and inexpensive adjuvant palliative treatment for patients with inoperable peripheral NSCLC.

Surgical treatment in patients with Stage I peripheral non-small cell lung cancer: Results, prognosis, prospects

Surgical treatment in patients with Stage I peripheral non-small cell lung cancer: Results, prognosis, prospects

Multivariate Analysis of Pleural Invasion of Peripheral Non-Small Cell Lung Cancer-Based Computed Tomography Features.

The aim of this study was to comprehensively analyze computed tomography features to improve the diagnostic accuracy of visceral pleural invasion of peripheral non-small cell lung cancer. The computed tomography features of 205 non-small cell lung cancer patients were retrospectively studied. The lesion's relation to the pleura was classified into 5 grades. A multivariate logistic regression analysis was conducted to identify independent factors predicting pleural invasion. The multivariate logistic regression analysis showed that sex (odds ratio [OR], 1.822; P = 0.080), pleural indentation (OR, 4.111; P < 0.001), tumor density (OR, 2.735; P = 0.008), and distance between the lesion and pleura (OR, 1.981; P = 0.048) were independent predictors of pleural invasion. A patient with a score of 10.6 had an 80% risk of pleural invasion, whereas a score lower than 2 was associated with a lower (20%) risk of pleural invasion. Comprehensive consideration of these factors of pleural indentation, sex, tumor density, and distance between the lesion and pleura might improve the diagnosis of pleural invasion.

Monitor unit optimization in stereotactic body radiotherapy for small peripheral non-small cell lung cancer patients.

The increasingly attractive stereotactic body radiotherapy (SBRT) treatment for stage I lung cancer is concomitant with a large amount of monitor units (MU), leading to excessive out-of-field dose and prolonged beam-on time. The study aims to reduce the MU number and shorten the beam-on time by optimizing the planning parameters. Clinically acceptable treatment plans from fourteen patients suffered from peripheral stage I non-small cell lung cancer (NSCLC) were created in the study. Priority for the upper objective of the target (PUOT), strength and Max MU setting in the MU objective function (MUOF) were adjusted respectively to investigate their effect on MU number, organs at risk (OARs) sparing and beam-on time. We found that the planning parameters influenced the MU number in a PUOT, strength and Max MU dependent manner. Combined with high priority for the UOT (HPUOT) and MUOF, the MU number was reduced from 443 ± 25 to 228 ± 22 MU/Gy without compromising the target coverage and OARs sparing. We also found beam-on time was proportional to MU number and it could be shortened from 7.9 ± 0.5 to 4.1 ± 0.4 minutes.

Radiobiological modeling analysis of the optimal fraction scheme in patients with peripheral non-small cell lung cancer undergoing stereotactic body radiotherapy.

This study aimed to determine the optimal fraction scheme (FS) in patients with small peripheral non-small cell lung cancer (NSCLC) undergoing stereotactic body radiotherapy (SBRT) with the 4 × 12 Gy scheme as the reference. CT simulation data for sixteen patients diagnosed with primary NSCLC or metastatic tumor with a single peripheral lesion ≤3 cm were used in this study. Volumetric modulated arc therapy (VMAT) plans were designed based on ten different FS of 1 × 25 Gy, 1 × 30 Gy, 1 × 34 Gy, 3 × 15 Gy, 3 × 18 Gy, 3 × 20 Gy, 4 × 12 Gy, 5 × 12 Gy, 6 × 10 Gy and 10 × 7 Gy. Five different radiobiological models were employed to predict the tumor control probability (TCP) value. Three other models were utilized to estimate the normal tissue complication probability (NTCP) value to the lung and the modified equivalent uniform dose (mEUD) value to the chest wall (CW). The 1 × 30 Gy regimen is recommended to achieve 4.2% higher TCP and slightly higher NTCP and mEUD values to the lung and CW compared with the 4 × 12 Gy schedule, respectively. This regimen also greatly shortens the treatment duration. However, the 3 × 15 Gy schedule is suggested in patients where the lung-to-tumor volume ratio is small or where the tumor is adjacent to the CW.

Prediction of occult lymph node metastasis using volume-based PET parameters in small-sized peripheral non-small cell lung cancer.

BackgroundPatients with small-sized peripheral non-small cell lung cancer (NSCLC), but without lymph node metastasis, may be optimal candidates for sublobar resection. We aim to identify the predictors of occult lymph node metastasis (OLNM) using F-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) in clinically node-negative, small-sized NSCLC.MethodsOne hundred thirty nine patients with small-sized NSCLC (of less than 3 cm in diameter) who underwent surgical resection with mediastinal lymph node dissection were evaluated. The maximum standardized uptake value (SUVmax), metabolic total volume (MTV) and total lesion glycolysis (TLG) of the primary tumor were measured on pretreatment PET/CT. These metabolic parameters and pathological variables were analyzed for OLNM.ResultsThe mean tumor size was 2.11 ± 0.63 cm, and the mean number of dissected lymph nodes was 19.74 ± 12.86. Adenocarcinoma occurred in 106 patients (76.3 %). Twenty-four patients (17.2 %) had lymph node metastasis. The mean SUVmax, MTV and TLG were 4.61 ± 3.99 (0.5 ~ 17.8), 4.18 ± 6.39 (0 ~ 34.6) and 16.13 ± 28.86 (0 ~ 164.2), respectively. On receiver operating characteristic (ROC) curve analysis, the areas under the curve (AUC) for SUVmax, MTV and TLG for node metastasis were 0.753, 0.783 and 0.775, respectively. On multivariate analysis, SUVmax (Odds ratio [OR] = 1.120, p = 0.044) and MTV (OR = 1.117, p = 0.007) were found to be risk factors for OLNM. The concordance index of MTV was 0.763, which was slightly higher than that of SUVmax.ConclusionSUVmax and volume-based parameters are significant risk factors for OLNM in small peripheral NSCLC. MTV showed a better predictive performance than that of the other PET parameters; therefore, MTV may be a possible indicator for sublobar resection in clinically node-negative small-sized NSCLC.

Single-Fraction Carbon-Ion Radiation Therapy for Patients 80 Years of Age and Older With Stage I Non-Small Cell Lung Cancer

In an aging society, many senior citizens want less invasive treatment because of potential medical complications. The National Institute of Radiological Sciences has started to treat stage I lung cancer with single-fraction carbon-ion radiation therapy (CIRT) as a dose escalation prospective phase 1/2 trial. We evaluated the efficacy and safety of CIRT for patients 80 years of age and older, undergoing single-fraction CIRT. Peripheral non-small cell lung cancer patients who were treated with single-fraction CIRT were prospectively followed. We analyzed the data from among these patients 80 years of age and older. There were 70 patients. Median age was 83 years (range: 80-89) and median follow-up period was 42.7 months (range: 12-128 months). Three-year local control, cause-specific survival, and overall survival rates were 88.0%, 81.6%, and 72.4%, respectively. Five-year local control, cause-specific survival, and overall survival rates were 85.8%, 64.9%, and 39.7%, respectively. There were no adverse effects higher than grade 2 either in the acute or late phase in terms of skin and lung. Analgesic agents were necessary for only 5 patients (7.1%), to relieve muscular or rib fracture pain caused by irradiation. Single-fraction CIRT was low-risk and effective, even for the elderly.

Dosimetric Comparison of Monte Carlo (MC) Versus Non MC RTOG 0915 Algorithms for the Calculation of Stereotactic Body Radiation Therapy (SBRT) Doses in the Treatment of Peripheral Non-Small Cell Lung Cancer (NSCLC) Lesions

Dosimetric Comparison of Monte Carlo (MC) Versus Non MC RTOG 0915 Algorithms for the Calculation of Stereotactic Body Radiation Therapy (SBRT) Doses in the Treatment of Peripheral Non-Small Cell Lung Cancer (NSCLC) Lesions

A Randomized Phase 2 Study Comparing 2 Stereotactic Body Radiation Therapy Schedules for Medically Inoperable Patients With Stage I Peripheral Non-Small Cell Lung Cancer: NRG Oncology RTOG 0915 (NCCTG N0927)

To compare 2 stereotactic body radiation therapy (SBRT) schedules for medically inoperable early-stage lung cancer to determine which produces the lowest rate of grade ≥3 protocol-specified adverse events (psAEs) at 1 year. Patients with biopsy-proven peripheral (≥2 cm from the central bronchial tree) T1 or T2, N0 (clinically node negative by positron emission tomography), M0 tumors were eligible. Patients were randomized to receive either 34 Gy in 1 fraction (arm 1) or 48 Gy in 4 consecutive daily fractions (arm 2). Rigorous central accreditation and quality assurance confirmed treatment per protocol guidelines. This study was designed to detect a psAEs rate >17% at a 10% significance level (1-sided) and 90% power. Secondary endpoints included rates of primary tumor control (PC), overall survival (OS), and disease-free survival (DFS) at 1 year. Designating the better of the 2 regimens was based on prespecified rules of psAEs and PC for each arm. Ninety-four patients were accrued between September 2009 and March 2011. The median follow-up time was 30.2 months. Of 84 analyzable patients, 39 were in arm 1 and 45 in arm 2. Patient and tumor characteristics were balanced between arms. Four (10.3%) patients on arm 1 (95% confidence interval [CI] 2.9%-24.2%) and 6 (13.3%) patients on arm 2 (95% CI 5.1%-26.8%) experienced psAEs. The 2-year OS rate was 61.3% (95% CI 44.2%-74.6%) for arm 1 patients and 77.7% (95% CI 62.5%-87.3%) for arm 2. The 2-year DFS was 56.4% (95% CI 39.6%-70.2%) for arm 1 and 71.1% (95% CI 55.5%-82.1%) for arm 2. The 1-year PC rate was 97.0% (95% CI 84.2%-99.9%) for arm 1 and 92.7% (95% CI 80.1%-98.5%) for arm 2. 34 Gy in 1 fraction met the prespecified criteria and, of the 2 schedules, warrants further clinical research.

Combined endobronchial and esophageal endosonography for the diagnosis and staging of lung cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline, in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS).

This is an official guideline of the European Society of Gastrointestinal Endoscopy (ESGE), produced in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS). It addresses the benefit and burden associated with combined endobronchial and esophageal mediastinal nodal staging of lung cancer. The Scottish Intercollegiate Guidelines Network (SIGN) approach was adopted to define the strength of recommendations and the quality of evidence.The article has been co-published with permission in the European Journal of Cardio-Thoracic Surgery and the European Respiratory Journal. Recommendations 1 For mediastinal nodal staging in patients with suspected or proven non-small-cell lung cancer (NSCLC) with abnormal mediastinal and/or hilar nodes at computed tomography (CT) and/or positron emission tomography (PET), endosonography is recommended over surgical staging as the initial procedure (Recommendation grade A). The combination of endobronchial ultrasound with real-time guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic (esophageal) ultrasound with fine needle aspiration, with use of a gastrointestinal (EUS-FNA) or EBUS (EUS-B-FNA) scope, is preferred over either test alone (Recommendation grade C). If the combination of EBUS and EUS-(B) is not available, we suggest that EBUS alone is acceptable (Recommendation grade C).Subsequent surgical staging is recommended, when endosonography does not show malignant nodal involvement (Recommendation grade B). 2 For mediastinal nodal staging in patients with suspected or proven non-small-cell peripheral lung cancer without mediastinal involvement at CT or CT-PET, we suggest that EBUS-TBNA and/or EUS-(B)-FNA should be performed before therapy, provided that one or more of the following conditions is present: (i) enlarged or fluorodeoxyglucose (FDG)-PET-avid ipsilateral hilar nodes; (ii) primary tumor without FDG uptake; (iii) tumor size ≥ 3 cm (Fig. 3a - c) (Recommendation grade C). If endosonography does not show malignant nodal involvement, we suggest that mediastinoscopy is considered, especially in suspected N1 disease (Recommendation grade C).If PET is not available and CT does not reveal enlarged hilar or mediastinal lymph nodes, we suggest performance of EBUS-TBNA and/or EUS-(B)-FNA and/or surgical staging (Recommendation grade C). 3 In patients with suspected or proven < 3 cm peripheral NSCLC with normal mediastinal and hilar nodes at CT and/or PET, we suggest initiation of therapy without further mediastinal staging (Recommendation grade C). 4 For mediastinal staging in patients with centrally located suspected or proven NSCLC without mediastinal or hilar involvement at CT and/or CT-PET, we suggest performance of EBUS-TBNA, with or without EUS-(B)-FNA, in preference to surgical staging (Fig. 4) (Recommendation grade D). If endosonography does not show malignant nodal involvement, mediastinoscopy may be considered (Recommendation grade D). 5 For mediastinal nodal restaging following neoadjuvant therapy, EBUS-TBNA and/or EUS-(B)-FNA is suggested for detection of persistent nodal disease, but, if this is negative, subsequent surgical staging is indicated (Recommendation grade C). 6 A complete assessment of mediastinal and hilar nodal stations, and sampling of at least three different mediastinal nodal stations (4 R, 4 L, 7) (Fig. 1, Fig. 5) is suggested in patients with NSCLC and an abnormal mediastinum by CT or CT-PET (Recommendation grade D). 7 For diagnostic purposes, in patients with a centrally located lung tumor that is not visible at conventional bronchoscopy, endosonography is suggested, provided the tumor is located immediately adjacent to the larger airways (EBUS) or esophagus (EUS-(B)) (Recommendation grade D). 8 In patients with a left adrenal gland suspected for distant metastasis we suggest performance of endoscopic ultrasound fine needle aspiration (EUS-FNA) (Recommendation grade C), while the use of EUS-B with a transgastric approach is at present experimental (Recommendation grade D). 9 For optimal endosonographic staging of lung cancer, we suggest that individual endoscopists should be trained in both EBUS and EUS-B in order to perform complete endoscopic staging in one session (Recommendation grade D). 10 We suggest that new trainees in endosonography should follow a structured training curriculum consisting of simulation-based training followed by supervised practice on patients (Recommendation grade D). 11 We suggest that competency in EBUS-TBNA and EUS-(B)-FNA for staging lung cancer be assessed using available validated assessment tools (Recommendation Grade D).

Computed Tomography–Guided Interstitial High-Dose-Rate Brachytherapy in Combination With Regional Positive Lymph Node Intensity-Modulated Radiation Therapy in Locally Advanced Peripheral Non–Small Cell Lung Cancer: A Phase 1 Clinical Trial

To assess the technical safety, adverse events, and efficacy of computed tomography (CT)-guided interstitial high-dose-rate (HDR) brachytherapy in combination with regional positive lymph node intensity modulated radiation therapy in patients with locally advanced peripheral non-small cell lung cancer (NSCLC). Twenty-six patients with histologically confirmed NSCLC were enrolled in a prospective, officially approved phase 1 trial. Primary tumors were treated with HDR brachytherapy. A single 30-Gy dose was delivered to the 90% isodose line of the gross lung tumor volume. A total dose of at least 70Gy was administered to the 95% isodose line of the planning target volume of malignant lymph nodes using 6-MV X-rays. The patients received concurrent or sequential chemotherapy. We assessed treatment efficacy, adverse events, and radiation toxicity. The median follow-up time was 28months (range, 7-44months). There were 3 cases of mild pneumothorax but no cases of hemothorax, dyspnea, or pyothorax after the procedure. Grade 3 or 4 acute hematologic toxicity was observed in 5 patients. During follow-up, mild fibrosis around the puncture point was observed on the CT scans of 2 patients, but both patients were asymptomatic. The overall response rates (complete and partial) for the primary mass and positive lymph nodes were 100% and 92.3%, respectively. The 1-year and 2-year overall survival (OS) rates were 90.9% and 67%, respectively, with a median OS of 22.5months. Our findings suggest that HDR brachytherapy is safe and feasible for peripheral locally advanced NSCLC, justifying a phase 2 clinical trial.

Diagnostic imaging techniques in staging of peripheral non-small cell lung cancer spreading

Aim. To develop a personalized approach for using radiologic and nuclear examination methods diagnostics to improve early diagnosis of bone and brain metastases in patients with peripheral non-small cell lung cancer.Methods. The first group included 1473 patients with peripheral non-small cell lung cancer, who underwent chest X-ray, abdominal and pelvic ultrasonography, bone scintigraphy, and chest, abdominal and pelvic X-ray computed tomography with intravenous contrast from 2006 to 2010 for diagnosing remote metastases. The second group included 55 patients with peripheral non-small cell lung cancer, who underwent comprehensive examination of the full skeleton using X-ray computed tomography and magnetic resonance imaging, single-photon emission computed tomography, positron-emission tomography. The results of brain magnetic resonance imaging in 40 patients (group 3) with peripheral small cell lung cancer with brain metastases were also analyzed.Results.In peripheral non-small cell lung cancer, bone (23.9%) and brain (14%) metastases were the most frequent. The risk for bone metastases was significantly higher in patients with adenocarcinoma (pConclusion. For timely diagnosis of bone metastases, it is reasonable to administer positron-emission tomography with Fludeoxyglucose (18F) to all potentially resectable patients with peripheral small cell lung cancer, which in addition reveals metastases in other body regions. Brain magnetic resonance imaging should be administered if the primary tumor was detected.

Computed tomography-guided percutaneous microwave ablation of patients 75 years of age and older with early-stage nonsmall cell lung cancer.

We aimed to assess the clinical outcome of computed tomography (CT)-guided percutaneous microwave ablation (MWA) in patients 75 years of age and older with early stage peripheral nonsmall cell lung cancer (NSCLC). Twenty-eight patients, aged ≥ 75 years, with Stage I and lymph node-negative IIa peripheral NSCLC underwent CT-guided percutaneous MWA in our hospital between July 2007 and March 2015. The overall 1-, 2-, 3-, and 4-year survival rates were estimated using Kaplan-Meier analysis. Adverse events were recorded. The median follow-up time was 22.5 months. The overall median survival time (MST) was 35 months (95% confidence interval [CI] 22.3-47.7 months), and the cancer-specific MST was 41.9 months (95% CI 38.8-49.9 months). The 1-, 2-, 3-, and 4-year overall survival rates were 91.7%, 76.5%, 47.9%, and 47.9%, while the cancer-specific survival rates were 94.7%, 73.9%, 64.7%, and 64.7%, respectively. Median time to local progression was 28.0 months (95% CI 17.7-38.3 months). Major complications were included pneumothorax (21.4%, requiring drainage), pleural effusions (3.6%, requiring drainage), and pulmonary infection (3.6%). CT-guided percutaneous MWA is safe and effective for the treatment of patients 75 years of age and older with medically inoperable early stage peripheral NSCLC.

Advantages of CyberKnife for inoperable stage I peripheral non-small-cell lung cancer compared to three-dimensional conformal radiotherapy.

This study was conducted to compare the clinical curative effect and acute radiation lung reactions between CyberKnife (CK) and three-dimensional conformal radiotherapy (3DCRT) treatment for inoperable stage I peripheral non-small-cell lung cancer (NSCLC). We retrospectively analyzed 68 patients with inoperable stage I peripheral NSCLC between 2012 and 2013 in our institution. The CK patients were treated with 42-60 Gy in three fractions, while the 3DCRT patients were treated with a total of 60 Gy, at 2 Gy per fraction. The patients were followed up and the clinical outcome was evaluated according to the Response Evaluation Criteria in Solid Tumours. We assessed the presence of acute radiation pneumonitis and pulmonary function status by thoracic scan and pulmonary function tests following CK and 3DCRT treatment. The binary univariate logistic regression analysis demonstrated that treatment method and forced expiratory volume in 1 sec/forced vital capacity (FEV1/FVC) prior to treatment (pre-FEV1/FVC) were the main factors affecting the risk of radiation pneumonitis. The analysis of these factors through multivariate logistic regression method demonstrated that treatment method for grade 1 and 2 [odds ratio (OR)= 7.866 and 11.334, respectively) and pre-FEV1/FVC for grade 1, 2 and 3 (OR = 5.062, 11.498 and 15.042, respectively) were significant factors affecting the risk of radiation pneumonitis (P<0.05). The 68 patients were divided into two subgroups using the threshold of pre-FEV1/FVC selected by the receiver operating characteristic curve. There were significant differences between the 3DCRT and CK treatment in both the pre-FEV1/FVC <68% and ≥68% subgroups for radiation pneumonitis (P=0.023 and 0.002, respectively). There was no statistically significant change in FVC, FEV1 and carbon monoxide diffusion capacity (DCLO) in the CK group, whereas there was a decrease in DCLO in the 3DCRT group. The complete remission rate was 40 vs. 34.2% at 1 year in the CK and 3DCRT groups, respectively. In conclusion, in this cohort of patients with inoperable stage I peripheral NSCLC, CK appears to be a safe and superior alternative to conventionally fractionated radiotherapy.

Phase 1 Study of CT-Guided Interstitial 3-Dimensional (3D) Brachytherapy for Peripheral Non-Small Cell Lung Cancer: Locally Advanced Non-Small Cell Lung Cancer

Phase 1 Study of CT-Guided Interstitial 3-Dimensional (3D) Brachytherapy for Peripheral Non-Small Cell Lung Cancer: Locally Advanced Non-Small Cell Lung Cancer