Solitary Non-small Cell Lung Cancer Research Articles

Metastasectomy for Synchronous Solitary Non-Small Cell Lung Cancer Metastases

Surgical treatment of patients with limited metastatic lesions from non-small cell lung cancer (NSCLC) remains controversial; however, reports suggest that a subset of patients may benefit from complete resection including metastasectomy. Between 1997 and 2009, 99 patients underwent complete solitary synchronous NSCLC metastasis resection in a single center. Only patients who met the potentially curative operation criteria (ie, primary NSCLC and metastasis resection of a solitary pulmonary or solitary extrapulmonary metastases) were included for retrospective analyses within this study. The overall 5-year survival rate was 38%. A significantly longer survival was observed in patients without mediastinal (N2 or N3) lymph node involvement (median, 50.0 months) compared with patients who had mediastinal lymph node metastases (median, 19.0 months survival; p=0.015). In patients with a solitary metastasis in the ipsilateral (not ipsilobar) or contralateral lung, we observed a 5-year survival rate of 48.5%, whereas the rate was 23.6% in patients with extrapulmonary metastases (p=0.006). In univariate analysis, a trend for a more favorable long-term survival rate was observed for patients with a histologic grade of G1 or G2 versus G3 primary NSCLC (p=0.058). We conclude that metastasectomy for synchronous oligometastatic disease in NSCLC can be performed in selected patients. It appears reasonable that such patients should be considered as surgical candidates if mediastinal lymph node involvement is excluded.

Prognostic Significance of High SUV-max of the Pretreatment FDG-PET Scan in the Conformal Treatment of Solitary Non-small Cell Lung Cancer

For solitary non-small-cell lung cancers (NSCLC), we have been using 3-dimensional non-coplanar conformal techniques such as stereotactic body radiotherapy (SBRT) or 3-dimensional non-coplanar conformal radiotherapy (3DNCCRT) with middle-sized fractions with a fairly good treatment results. FDG-PET scan has been considered useful in the staging of such cases. Maximum uptake value of FDG has been reported to correlate with the activity of the tumor, and thus with the prognosis of the tumor. We investigated whether the prognosis of our cases were correlated with the SUV-max of FDG-PET scan prior to the conformal radiotherapy. Sixty-nine cases with pretreatment PET scan treated between August 2003 and March 2007 were analyzed. There were 47 male cases and 22 female cases. The age ranged from 50 to 91 with an average of 75. Histologically, there were 46 adenocarcinomas, 11 squamous cell carcinomas, and 12 cases of NSCLC not otherwise specified (NOS). By T-stage, there were 41 T1 cases, 26 T2 cases, 1 T3 and T4 case each. SUV-max ranged from 1 to 22.7 with an average of 7.4. Median follow-up period for alive cases was 25 months. There were 24 SBRT cases, whose treatment schedule was 48 Gy in 4 fractions in 1 week, and 45 3DNCCRT cases whose median total dose was 75 Gy in 5 weeks. In both techniques, no elective nodal irradiation was given. There were 9 local recurrences, 6 distant metastases, 5 regional lymph node metastases, and 1 pleural dissemination. The remaining 48 cases (70%) were controlled. Overall local control rates at 2 and 4 years were 84% and 84%, respectively. Overall survival rates at 2 and 4 years were 84% and 81%, respectively. Overall relapse-free survival rates at 2 and 4 years were 65% and 59%, respectively. By treatment method, 2-year relapse-free survival rates were 74% for SBRT cases, and 60% for 3DNCCRT cases (n.s.). By T-stage, 2-year relapse-free survival rates were 65% for T1 cases, and 67% for T2+ cases (n.s.). By histology, 2-year relapse-free survival rates were 64% for squamous cell carcinoma, 67% for adenocarcinoma, and 62% for NOS (n.s.). By SUV-max, 2-year relapse-free survival rates were 83% for cases whose SUV-max is less than 5, and 53% for cases not less than 5 (p < 0.025). Overall survival was also significantly different: 93% for the former and 77% for the latter at 2 years (p < 0.04). High SUV-max carries worse prognosis for solitary NSCLC treated by SBRT or 3DNCCRT. Care should be taken to avoid the recurrence for such tumors. Further studies with larger number of the cases are necessary.

Is surgical resection indicated for a solitary non–small cell lung cancer recurrence?

Some investigators have reported long-term survival after surgical resection of a solitary non-small cell lung cancer recurrence in various sites. However, the role and indications of the second operation remain unclear. We reviewed 28 patients with a solitary recurrence after successful initial resection of primary non-small cell lung cancer who underwent resection of the recurrent lesion. The clinicopathologic factors associated with outcome were analyzed. There were 17 men and 11 women. Recurrence resection was performed for the following sites: 16 in the lung, 5 in the brain, 2 in the adrenal gland, and 1 each in the chest wall, stomach, skin, pelvic lymph node, and malar bone. The median survival time was 25 months, and the 1-, 2-, and 5-year survival rates after recurrence were 89%, 59%, and 32%, respectively. Advanced p-stage (p-stage II and III, n = 14) of the primary tumor was the significant negative prognostic factor. Patients with p-stage II or III had survival equivalent to that of those who had multiple recurrences or were unfit for further surgical intervention. Resection of a solitary non-small cell lung cancer recurrence might provide long-term survival in highly selected patients. However, surgical resection might be contraindicated if the primary tumor is stage II or III.

Measurement of tumor diameter-dependent mobility of lung tumors by dynamic MRI

Background and purposeTo assess the influence of tumor diameter on tumor mobility and motion of the tumor bearing hemithorax during the whole breathing cycle in patients with stage I non-small-cell lung cancer (NSCLC) using dynamic MRI. Patients and methodsBreathing cycles of thirty-nine patients with solitary NSCLCs were examined using a trueFISP sequence (three images per second). Patients were divided into three groups according to the maximal tumor diameter in the transverse plane (<3, 3–5 and >5cm). Continuous time–distance curves and deep inspiratory and expiratory positions of the chest wall, the diaphragm and the tumor were measured in three planes. Motion of tumor-bearing and corresponding contralateral non-tumor bearing regions was compared. ResultsPatients with a tumor >3cm showed a significantly lower diaphragmatic motion of the tumor bearing compared with the non-tumor bearing hemithorax in the craniocaudal (CC) directions (tumors 3–5cm: 23.4±1.2 vs 21.1±1.5cm (P<0.05); tumors >5cm: 23.4±1.2 vs 20.1±1.6cm (P<0.01). Tumors >5cm in the lower lung region showed a significantly lower mobility compared with tumors <3cm (1.8±1.0 vs 3.8±0.7cm, P<0.01) in the CC directions. ConclusionsDynamic MRI is a simple non-invasive method to differentiate mobility of tumors with different diameters and its influence on the surrounding tissue. Tumor diameter has a significant influence on tumor mobility and this might be taken into account in future radiotherapy planning.