T1N0M0 Non-small Cell Lung Cancer Research Articles

Abstract No. 502 Comparative analysis of overall survival based on hospital type following percutaneous ablation of stage T1N0M0 non–small cell lung cancer

To compare the overall survival (OS) after percutaneous image-guided ablation of stage T1 Non–small cell lung cancer (NSCLC) performed in cancer centers, academic institutions or community-based hospitals. The National Cancer Database was used to identify all patients with T1N0M0 NSCLC as a single primary tumor from 2004-2013. The study cohort included anyone who underwent percutaneous ablation for lung tumor treatment, regardless of method. Patients with surgical excision or stereotactic body radiation therapy were excluded. Patients were classified into three exclusive groups based on facility type where they received treatment; Integrated Network Cancer Program (INCP), Community Cancer Program (CCP/CCCP) or Academic Comprehensive Cancer Program (ACAD). Unadjusted survival stratified by facility type was estimated with the Kaplan-Meier method; Tukey-Kramer adjustments were made for subsequent multiple comparisons associated with the log-rank test. Multivariable Cox regression was used to adjust for patient characteristics for survival differences. The SASv9.4 software package was used for all analyses; p < 0.05 was considered significant. 32,678 patients were identified with clinical stage T1 NSCLC, of which 15,621 lacked another primary tumor. Among those, 440 patients received percutaneous ablation only for their tumor (189 in CCP/CCCP, 197 in ACAD and 64 in INCP). The log-rank test indicated no significant differences in OS for all pairwise comparisons of facility types and in survival after adjusting for patient co-variables. (Table 1). The facility type location where ablation was performed for stage T1 NSCLC was not associated with OS difference after adjusting for patient related factors. The findings may underscore certain uniformity for T1 tumor ablation and allow for wider implementation of lung cancer treatment among all facilities. A multicenter prospective study may confirm these results.Table 1Direct Head-to-Head Comparison of Overall Survival Among Different Facility TypesComparisonX2P Value (Raw/Turkey Kramer)CCP/CCCP vs. ACAD0.760.40/0.66CCP/CCCP vs. INCP1.900.16/0.35ACAD vs. INCP0.040.84/0.98 Open table in a new tab

Centrally located lung cancer and risk ofoccult nodal disease: an objective evaluation of multiple definitions of tumour centrality with dedicated imaging software.

Current guidelines recommend invasive mediastinal staging in patients with centrally located radiographic stage T1N0M0 nonsmall cell lung cancer (NSCLC). The lack of a specific definition of a central tumour has resulted in discrepancies among guidelines and heterogeneity in practice patterns. Our objective was to study specific definitions of tumour centrality and their association with occult nodal disease. Pre-operative chest computed tomography scans from patients with clinical (c) T1N0M0 NSCLC were processed with a dedicated software system that divides the lungs in thirds following vertical and concentric lines. This software accurately assigns tumours to a specific third based both on the location of the centre of the tumour and its most medial aspect, creating eight possible definitions of central tumours. 607 patients were included in our study. Surgery was performed for 596 tumours (98%). The overall pathological (p) N disease was: 504 (83%) N0, 56 (9%) N1, 47 (8%) N2 and no N3. The prevalence of N2 disease remained relatively low regardless of tumour location. Central tumours were associated with upstaging from cN0 to any N (pN1/pN2). Two definitions were associated with upstaging to any N: concentric lines, inner one-third, centre of the tumour (OR 3.91, 95% CI 1.85-8.26; p<0.001) and concentric lines, inner two-thirds, most medial aspect of the tumour (OR 1.91, 95% CI 1.23-2.97; p=0.004). We objectively identified two specific definitions of central tumours. While the rate of occult mediastinal disease was relatively low regardless of tumour location, central tumours were associated with upstaging from cN0 to any N.

Adjuvant chemotherapy following stereotactic body radiotherapy for early stage non-small-cell lung cancer is associated with lower overall: A National Cancer Database Analysis

ObjectivesAdjuvant chemotherapy is routinely offered post-surgical resection for early stage non-small-cell lung cancer (NSCLC) ≥4 cm; however, its role following definitive stereotactic body radiotherapy (SBRT) has not been well defined. We investigated the association between receipt of adjuvant chemotherapy post-SBRT and overall survival (OS) for patients with T1-T3N0M0 NSCLC in the National Cancer Database (NCDB). Materials and MethodsThe NCDB was queried for patients with T1-T3N0M0 NSCLC treated with definitive SBRT from 2004 to 2014. The association between non-randomized receipt of adjuvant chemotherapy and OS was analyzed for all patients (n = 24,011) and a propensity-matched cohort (n = 608) using Kaplan-Meier methods and Cox proportional hazard models. A subset analysis was performed for patients with tumors ≥4 cm (n = 2,323). ResultsThere were 24,011 patients in the cohort with a median follow-up of 32.5 months. Of these, 322 (1.3%) received adjuvant chemotherapy. Three-year OS was 41.3% with adjuvant chemotherapy compared to 50.6% without adjuvant chemotherapy (p = 0.001). On multivariate analysis, adjuvant chemotherapy was independently associated with higher overall mortality (hazard ratio:1.22, 95% confidence interval:1.06–1.40, p = 0.005). For tumors ≥4 cm, 3-year OS was 38.2% with adjuvant chemotherapy (n = 80) compared to 33.0% without adjuvant chemotherapy (p = 0.81). After propensity-score matching, there was a persistent association between lower OS and adjuvant chemotherapy with those receiving adjuvant chemotherapy (n = 322) having 3-year OS of 41.3% compared to 60.9% without adjuvant chemotherapy (p < 0.0001). ConclusionAdjuvant chemotherapy following definitive SBRT for T1-3N0M0 NSCLC is associated with lower OS and is not associated with a survival benefit for patients with tumors ≥4 cm.

Addition of chemotherapy improves overall survival in patients with T2N0M0 non-small cell lung cancer undergoing definitive radiation therapy: An analysis of the SEER database

ObjectivesDespite recommendations by clinical guidelines, an advantage of adding systemic chemotherapy to definitive radiation in patients with early stage non-small cell lung cancer (NSCLC) has never been demonstrated by randomized or large-scale studies. This study evaluates the role of chemotherapy in T2N0M0 NSCLC patients who did not undergo surgical resection. Materials and methodsUsing the Surveillance, Epidemiology, and End Results (SEER) database, we screened for patients with T2N0M0 NSCLC who received radiation therapy without surgical resection from 2004 to 2015. T-staging was defined according to the American Joint Committee on Cancer (AJCC) 6th (Year 2004+) and 7th (Year 2010+) versions. Overall survival based on chemotherapy status was assessed by univariate and multivariate analyses. ResultsA total of 6075 and 3138 patients were identified for AJCC 6th (T2; 3–7cm) and 7th (T2a; 3–5 cm, T2b; 5–7 cm) version, respectively. Administration of chemotherapy was associated with younger age, male sex, non-adenocarcinoma, and high pathologic grade. Kaplan–Meier’s estimates demonstrated that the chemotherapy group had a statistically significant longer five-year overall survival than the non-chemotherapy group in patients with AJCC 6th T2 (19.9% vs 15.8%, p = 0.0023) and AJCC 7th T2b (5–7 cm, 20.9% vs 13.6%, p = 0.0046) but not those with AJCC 7th T2a (3–5 cm, 24.3% vs 21.1%, p = 0.4369). Multivariate analyses also revealed that the use of chemotherapy was an independent prognostic factor in AJCC 6th T2 and AJCC 7th T2b. ConclusionsThis study strongly suggests that chemotherapy may benefit non-adenocarcinoma patients with primary tumor larger than 5 cm (AJCC 8th T3) undergoing chest radiation.

Long-Term Prognosis After Segmentectomy for cT1 N0 M0 Non-Small Cell Lung Cancer

Prognosis beyond 5 years after segmentectomy for non-small cell lung cancer (NSCLC) has not been well studied. This study is a retrospective analysis of a previous prospective cohort study of patients with peripheral cT1 N0 M0 NSCLC who underwent segmentectomy between 2005 and 2009. Exclusion criteria were right middle lobe tumors, multiple tumors in same lobe, patients having considerable risk for segmentectomy, and patients requesting lobectomy rather than segmentectomy. The median follow-up period was 108 months. Study outcomes included overall survival, recurrence-free probability, and local recurrence. Of 179 patients with cT1 N0 M0 who were treated by segmentectomy, clinical T stages were Tis in 57 patients, T1mi or T1a in 34, T1b in 57, and T1c in 31. All tumors were pathologic N0 tumors. The 10-year recurrence-free probability rates in each clinical stage were 100% in Tis,97% in T1mi or T1a, 90% in T1b, and 69% in T1c, which were significantly lower in advanced T stages (p < 0.001). Fourteen patients (8%) experienced recurrences after segmentectomy; these were local in 8 patients (five recurrences at the surgical margin and three in the preserved lobe) and nonlocal in 6patients. Six of the eight local recurrences developed morethan 5 years after segmentectomy. All eight local recurrences were treated by local therapy, resulting in 6 patients surviving without disease at 55 months of median follow-up after the additional treatments. Although segmentectomy may be a viable curative option for treating T1 N0 M0 NSCLC, monitoring for local recurrence should be continued beyond 5 years after segmentectomy to avoid missing opportunities to effect a cure.

A Phase II Trial of Stereotactic Body Radiation Therapy for Operable T1N0M0 Non-Small Cell Lung Cancer; Japan Clinical Oncology Group (JCOG0403); Long Term Follow-up Results

8512Background: The purpose was to evaluate the safety and efficacy of stereotactic body radiation therapy (SBRT) in patients (pts) with both operable and inoperable T1N0M0 non-small cell lung canc...

Radiotherapy patterns of care for stage I and II non-small cell lung cancer in Sydney, Australia.

Curative radiotherapy is guideline treatment for inoperable patients of good performance status with Stage I & II Non-Small Cell Lung Cancer (NSCLC). The aim of this study was to evaluate radiotherapy patterns of care in these patients, the reasons for palliative treatment and the proportion of patients suitable for curative stereotactic ablative body radiotherapy (SABR). Electronic oncology databases at three institutions were queried to retrieve data on patients with inoperable Stage I & II NSCLC seen in radiation oncology clinics between 1/1/2008 and 31/12/2014. Suitability for SABR was defined as peripheral tumours less than 5cm in size. Factors associated with curative treatment were determined using univariate and multivariate analyses. Three-hundred-and-twelve patients were identified of whom 178 (57%) received curative radiotherapy, 58 (19%) palliative radiotherapy and 76 (24%) no radiotherapy. The main reason for receiving palliative rather than curative treatment was COPD or poor pulmonary function (26%). Method of diagnosis (P=0.031), Simplified Comorbidity Score (P=0.003), ECOG performance status (P=0.016), FEV1% (P=0.040), treating institution (P<0.0001) and time period (P=0.016) were associated with curative radiotherapy on multivariate analysis. In patients with T1-2N0M0 NSCLC, 19 (31%) who did not receive treatment and 7 (21%) who underwent palliative radiotherapy were technically and clinically suitable for SABR. Only 57% of patients with Stage I-II NSCLC were treated with curative radiotherapy. Patient factors were the predominant reason for palliative treatment, however, treating institution also played a role. A considerable proportion of patients who underwent palliative or no radiotherapy were suitable for SABR treatment.

P3.16-19 Clinical Outcomes of Stereotactic Body Radiation Therapy for T2N0M0 Non-Small Cell Lung Cancer

For patients with inoperable stage I non-small cell lung cancer (NSCLC), stereotactic body radiation therapy (SBRT) is considered standard. However, the effectiveness and safety of SBRT specifically for T2N0M0 NSCLC remains controversial. This retrospective study investigated the safety and efficacy of SBRT in T2N0M0 NSCLC. The medical records of 29 patients with T2N0M0 NSCLC treated by SBRT were reviewed. The overall, progression-free, and cause-specific survival rates were determined. The mean follow-up was 20.1 months. At years 1, 2, and 3, the overall survival rates were 93.1, 93.1, and 89.7%, respectively; the corresponding cause-specific survivals were 96.6, 96.6, and 93.1%; the progression-free survivals were 75.9, 65.5, and 62.1%; the local control rates were 100, 96.6, and 96.6%; the regional control was 86.2, 79.3, and 75.9%; and distant control was 89.7, 82.8, and 79.3%. Twenty patients (69.0%) developed symptoms of grade 1 toxicity: dyspnea, chest pain, fatigue, cough, esophagitis, or pneumonia. Among these, 5 patients suffered grade ≥2 therapy-associated pneumonitis, and one patient experienced grade 4 adverse pulmonary effects. SBRT was efficient and safe for patients with inoperable T2N0M0 NSCLC, imposing tolerable toxicities. These results warrant a prospective study to develop the multidisciplinary criteria for SBRT in T2N0M0 NSCLC.

Thoracoscopic lobectomy with mediastinal lymph node dissection as a standard surgery for T1-2N0M0 non-small cell lung cancer (&gt;300 surgeries experience)

BackgroundA lot of clinics worldwide in recent years recommend the use of minimally invasive surgical procedures in the early stages of lung cancer claiming that this technique helps reduce the number of postoperative complications, shortens the period of social rehabilitation of patients, without significantly affecting the long-term results of treatment. In this study we evaluate immediate and long-term results of surgical treatment of patients with early stages of non-small cell lung cancer (NSCLC) after video-assisted thoracoscopic lobectomy (VATS) with mediastinal lymph node dissection.Materials and methodsSince 2008 317 patients with T1-2N0M0 NSCLC over 20 (median age was 65.3 ± 2.5) years underwent VATS with mediastinal lymphadenectomy. Total number of men was 186 (58.7%), women – 131 (41.3%). Histologically verified adenocarcinoma was in 278 (87, 7%), Squamous cell carcinoma in 39 (12.3%). A group of patients who underwent thoracotomy lobectomy (n = 189) was taken to compare immediate and long-term results. Median age in this group was 66.5 ± 1.7. Total number of men was 115, women – 74. Histologically verified adenocarcinoma was in 154 (82.4%), Squamous cell carcinoma in 35 (17.6%).ResultsConversion to thoracotomy during VATS was in 14.3% of surgeries. There was no postoperative mortality in VATS group, whereas in open surgeries this happened in 2.6%. The 3 and 5-year overall survival (OS) rate was 94.0% and 94.0% in the VATS group respectively, 83.0% and 78.0% in the thoracotomy group for clinical stage T1N0M0 NSCLC (p = 0.04554).ConclusionConsidering the results of our research and the literature review we made sure that VATS lobectomy with mediastinal lymph node dissection is an alternative procedure to open approaches: it is much safer, reduce the frequency of post-operative complications and the rehabilitation period. We believe that complete VATS lobectomy with mediastinal lymph node dissection must be taken as a standard in surgical treatment of patients with early stages of non-small cell lung cancer.

Invasive nodal evaluation prior to stereotactic ablative radiation for non-small cell lung cancer

IntroductionInvasive nodal evaluation (INE) is used to improve staging for early stage non-small cell lung cancer (NSCLC), including when stereotactic ablative radiation (SABR) is used. Consensus guidelines from the NCCN recommend performing INE for patients with T2N0 tumors and considering INE for those with T1N0 tumors. We reasoned that if INE results in significant stage migration in the form of substantially fewer patients with occult nodal involvement, then patients treated with SABR who do not undergo INE should have worse overall survival (OS). MethodsPatients diagnosed 2004–2014 with stage T1–2N0M0 NSCLC and treated with SABR were identified from the National Cancer Database. Factors associated with INE were determined using mixed effects logistic regression. We tested for an association between INE and OS for patients diagnosed 2004–2013 using mixed effects proportional hazards regression methods. Results24,603 SABR patients were identified. 6% of the 19,322 patients with T1 tumors and 9% of the 5281 patients with T2 tumors had INE. Median OS was 2.8 years for the no-INE group and 2.7 years for the INE group (log-rank P = 0.69). No significant association was observed between the use of INE and OS in the univariate analysis (HR 1.02, 95% CI 0.94–1.11) or the multivariate analysis (HR 0.94, 95% CI 0.86–1.02). These findings were confirmed using propensity score matched and instrumental variable analysis. On subgroup analysis, INE was associated with a non-significant trend for improved OS in patients with T2 tumors (HR 0.87, 95% CI 0.76–1.00) but not T1 tumors (HR 0.98, 95% CI 0.88–1.09). ConclusionsDespite current NCCN recommendations, the rate of INE was low for patients with stage T1 or T2 tumors. While omitting INE represents a compromise in the completeness of nodal evaluation, we found that it was not associated with a detriment in overall survival.

Late radiological changes after passive scattering proton beam therapy for Stage I lung cancer.

This study aimed to examine late radiological changes after proton beam therapy (PBT) for early-stage non–small cell lung cancer (NSCLC) and to clarify correlations between mass-like radiological changes and patient characteristics. CT scans of patients who underwent passive scattering PBT for T1-2N0M0 NSCLC were analyzed retrospectively. Patients were considered eligible if follow-up CT was performed for at least 2 years, with no definite evidence of local recurrence. The following five periods were defined: (i) 6–12 months, (ii) 12–24 months, (iii) 24–36 months, (iv) 36–48 months and (v) 48–60 months after PBT. Late (≥6 months) radiological changes were scored by consensus of three radiation oncologists according to classifications set forth by Koenig (Radiation injury of the lung after three-dimensional conformal radiation therapy. AJR Am J Roentgenol 2002;178:1383–8.). CT scans of 113 patients (median follow-up, 36 months; range, 24–137 months) were evaluated. Late radiological changes during Periods (i), (ii), (iii), (iv) and (v) included modified conventional pattern (80%, 79%, 72%, 58% and 56%, respectively), mass-like changes (8%, 9%, 14%, 22% and 18%, respectively), scar-like changes (4%, 9%, 11%, 17% and 24%, respectively) and no increased density (8%, 3%, 3%, 2% and 2%, respectively). Mass-like changes were observed in 23 patients (20%). Among patients who developed mass-like changes, the median interval between the initiation of PBT and the onset of mass-like changes was 19 months (range, 6–62 months). In multivariate analysis, a peripheral location was found to be a significant factor (P = 0.035; odds ratio: 4.44; 95% confidence interval: 1.12–21.28). In conclusion, mass-like changes were observed in 20% of patients who underwent PBT. Patients with peripheral tumors showed a higher incidence of mass-like changes.

A phase II trial of stereotactic body radiation therapy for operable T1N0M0 non-small cell lung cancer: Japan Clinical Oncology Group (JCOG0403)—Long term follow-up results.

8512Background: The purpose was to evaluate the safety and efficacy of stereotactic body radiation therapy (SBRT) in patients (pts) with both operable and inoperable T1N0M0 non-small cell lung canc...

SUNSET: Stereotactic Radiation for Ultracentral Non–Small-Cell Lung Cancer—A Safety and Efficacy Trial

BackgroundLung stereotactic body radiotherapy (SBRT) is considered a standard curative treatment for medically inoperable early stage non–small-cell lung cancer (NSCLC). Patients with ultracentral tumors (signifying tumors whose planning target volume touches or overlaps the central bronchial tree, esophagus, or pulmonary artery) may be at higher risk of serious toxicities such as bronchial stricture and collapse, esophageal strictures, tracheal–esophageal fistula, and hemorrhage. The primary objective of the study is to determine the maximum tolerated dose of radiotherapy for ultracentral NSCLC. MethodsThis multicenter phase 1 dose-escalation study will use a time-to-event continual reassessment method (TITE-CRM). Accrual will start at level 1 (60 Gy in 8 fractions delivered daily). The model will use all available information from previously accrued patients to assign the highest dose with a predicted risk of grade 3-5 toxicity of 30% or less. All patients with newly diagnosed stage T1-3 N0M0 NSCLC (International Union Against Cancer, 8th edition) with tumor size ≤ 6 cm and meeting the criteria for ultracentral location (ie, tumors whose planning target volume touches or overlaps the central bronchial tree, esophagus, pulmonary vein, or pulmonary artery) will be eligible for this study. DiscussionIt is important to identify a safe dose-fractionation regimen for treating ultracentral tumors with SBRT. In addition, the data from this study may be informative in guiding future studies on the use of SBRT in treating malignancies within the mediastinum—for example, for salvage treatment of mediastinal lymph nodes for recurrent NSCLC or mediastinal oligometastases.

Uniport versus multiport video-assisted thoracoscopic surgery in the perioperative treatment of patients with T1-3N0M0 non-small cell lung cancer: a systematic review and meta-analysis.

Uniport video-assisted thoracoscopic surgery (VATS) has emerged as a less invasive approach for the treatment of non-small cell lung cancer (NSCLC). However, whether uniport VATS has more potential advantages over multiport VATS remains controversial. This meta-analysis aimed to compare the perioperative efficacy of uniport and multiport VATS for T1-3N0M0 NSCLC. An electronic and manual search of literature published before 1st October 2017 was conducted using PubMed, Embase, Web of Science, and the Wiley Online library. The effective values of dichotomous variables or continuous variables were estimated by odds ratios (OR) or by standardized mean differences (SMD) with 95% confidence intervals (CIs) respectively. Eleven relevant observational studies were included for meta-analysis. Results demonstrated that patients in the uniport group had a significant reduction in the duration of postoperative drainage (uniport: 4.39±2.48 vs. multiport: 4.99±3.24 days; P=0.003), bleeding volume (97.7±60.0 vs. 116.7±99.7 mL; P=0.006), length of hospital stay (6.3±2.4 vs. 7.0±3.6 days; P<0.001), VAS of postoperative pain (2.53±0.73 vs. 4.22±0.71, P=0.02) and in the overall rate of complications (14.5% vs. 17.5%; P=0.008). There were no significant differences between the two treatment groups with regards to mortality, operative time, the number of dissected lymph nodes or the conversion rate. Uniport VATS might have represent a preferable option for the treatment of T1-3N0M0 NSCLC, due to its superior perioperative efficacy.

Radiation Pneumonitis and Change of Pulmonary Function after Stereotactic Body Radiotherapy for T1N0M0 Non-Small Cell Lung Cancer and Their Impact on Survival in a Supplementary Analysis of Japan Clinical Oncology Group (JCOG) Study JCOG0403

The purpose of this study was to investigate the frequency of radiation pneumonitis and change of pulmonary function and their impact on survival after stereotactic body radiotherapy (SBRT) for T1N0M0 non-small cell lung cancer (NSCLC) as a supplementary analysis of Japan Clinical Oncology Group (JCOG) study JCOG0403. Radiation pneumonitis was evaluated using the Common Terminology Criteria for Adverse Events (CTCAE) Version 3.0. The test of pulmonary function included forced expiratory volume in 1.0 second (FEV1.0) and oxygen saturation of peripheral artery (SpO2). These were measured before the start of SBRT and every 6 months after it. In a total of 169 pts (65 medically operable and 104 inoperable; median age,78) enrolled in the phase II study of SBRT with 48Gy in 4 fractions for T1N0M0 pathology-proven NSCLC (JCOG0403), 146 pts and 153 pts whose FEV1.0 and SpO2 were measured before the start of SBRT and at least once after the start of SBRT without events that might affect their pulmonary function, such as local recurrence, regional lymph node metastases, or lung metastases were included in the analysis of FEV1.0 and in the analysis of SpO2, respectively. The worst grade of radiation pneumonitis and the maximum change of pulmonary function were determined based on each record during the first 1 year after the start of SBRT. Hazard ratios (HR) and their 95% confidence intervals (CI) for overall survival (OS) between subgroups were estimated by the Cox proportional hazards model and the landmark analysis was applied to OS counted from 1 year and 30 days after the start of SBRT. Radiation pneumonitis grade 2 or more was observed in 33 (20%) of 169 pts, 14 (22%) of 65 inoperable pts, and 19 (18%) of 104 operable pts. The pts with the factor of older age or tumor located in the middle or lower lobe had grade 2 or more radiation pneumonitis more frequently in the total of 169 pts (Fisher’s exact test p=0.033, p=0.048). FEV1.0 was decreased by 10% or more in 46 (32%) in total, 18 (32%) of inoperable pts, and 28 (32%) of operable pts. Larger tumor size was associated with 10% or more decrease of FEV1.0 in the total pts (p=0.010) and inoperable pts (p=0.016). Absolute % of SpO2 decreased by 5% or more in 5 (3%) of the total of 153 pts, 2 (3%) of 59 inoperable pts, and 3 (3%) of 94 operable pts. Grade 2 or more radiation pneumonitis and 10% or more decrease of FEV1.0 were not associated with OS in any groups, but 5% or more absolute % of SpO2 decrease was a worse factor for OS in the total pts (HR = 3.28: 95%CI, 1.31-8.20, log-rank test p=0.007) and inoperable pts (3.63: 95%CI, 1.10-11.94, p=0.023). The study suggested that more attention should be paid in the pts with the factor of older age, and tumor located in the middle or lower lobe for radiation pneumonitis, and the pts with larger tumor size for deteriorating pulmonary function. Decrease of absolute % of SpO2 5% or more might be a poor prognostic factor.

Potential clinical value of PET/CT in predicting occult nodal metastasis in T1-T2N0M0 lung cancer patients staged by PET/CT.

We assessed the clinical value of 2-fluoro-2-deoxyglucose (18F-FDG) PET/CT imaging for predicting occult nodal metastasis in non-small cell lung cancer (NSCLC) patients. This retrospective study included 54 patients with T1-2N0M0 NSCLC who had undergone 18F-FDG PET/CT before surgery. Occult nodal metastasis was detected in 25.9% (14/54) of the patients. Immunohistochemical analysis revealed that increased glucose transporter 1 expression was associated with occult nodal metastasis, but hexokinase 2 expression was not. Compared to the negative nodal metastasis group, the positive nodal metastasis group was associated with increased maximum standardized uptake value (SUVmax) and tumor size. Multivariate analysis indicated that SUVmax and tumor size were associated with nodal metastasis. Nodal metastasis could be predicted with a sensitivity of 92.9% and a specificity of 55.0% when the SUVmax cutoff was 4.35. When patients were divided into low-risk (tumor size ≤ 2.5 cm and SUVmax ≤ 4.35), moderate-risk (tumor size ≤ 2.5 cm and SUVmax > 4.35 or tumor size > 2.5 cm and SUVmax ≤ 4.35) and high-risk (tumor size > 2.5 cm and SUVmax > 4.35) groups, the lymph node metastasis rates were 4.3%, 22.7%, and 88.9%, respectively. These results indicate that the combination of SUVmax and tumor size has potential clinical value for predicting occult nodal metastasis in NSCLC patients.

Stereotactic body radiotherapy or stereotactic ablative radiotherapy versus surgery for patients with T1-3N0M0 non-small cell lung cancer: a systematic review and meta-analysis.

BackgroundStereotactic body radiotherapy (SBRT) or stereotactic ablative radiotherapy (SABR) has been reported to be a comparable alternative therapy to surgery for patients with T1-3N0M0 non–small cell lung cancer (NSCLC). However, it has not been clarified whether SBRT/SABR is as effective as surgery. We conducted this study to compare the efficacy of SBRT/SABR and surgery in the treatment of T1-3N0M0 NSCLC.Materials and methodsAn electronic and a manual search of the literature was conducted in PubMed, Embase, and the Wiley Online Library in all published data before January 1, 2017. The pooled data included overall survival (OS), recurrence-free survival (RFS), and locoregional/distant recurrence rate. Hazard ratio (HR) of OS (SBRT/SABR vs surgery) was used as the measure of differential effects.ResultsFifteen studies, including 7,810 patients with T1-3N0M0 NSCLC, 2,986 patients in the SBRT/SABR group, and 4,824 patients in the surgery group, were pooled for the meta-analysis. Results showed that patients with SBRT/SABR had a significantly worse 5-year survival rate (HR =1.40; 95% confidence interval [CI]: 1.21, 1.61; P<0.01), and RFS rate (HR =1.84; 95% CI: 1.26, 2.68; P=0.002). Meanwhile, the locoregional recurrence rate (HR =1.17; 95% CI: 0.68, 1.98; P=0.57), and distant recurrence rate (HR =1.36; 95% CI: 0.77, 2.39; P=0.29) were also lower in the surgery group although results were not statistically significant. In subgroup analyses, SBRT/SABR had a significantly lower rate of 5-year survival (HR =1.46; 95% CI: 1.03, 2.06; P=0.03) compared with lobectomy. Similarly, significant differences of OS exist in comparisons of SBRT/SABR versus sublobectomy (HR =1.40; 95% CI: 1.09, 1.80; P=0.008), and wedge resection (HR =1.48; 95% CI: 1.01, 2.16; P=0.04).ConclusionSurgery, both lobectomy and sublobectomy, might be superior to SBRT/SABR with regard to survival of patients with T1-3N0M0 NSCLC. Patients with T1-3N0M0 NSCLC should preferably be treated surgically prior to SBRT/SABR.

Long-term outcome of phase I/II prospective study of dose-escalated proton therapy for early-stage non-small cell lung cancer

PurposeThe aim of this phase I/II study was to assess the long-term clinical benefits and toxicities of proton beam therapy for medically inoperable early-stage non-small cell lung cancer (NSCLC). Patients and methodsFrom June 2006 to September 2011, 35 patients with medically inoperable T1N0M0 (central or superior location, 12 patients) or T2-3N0M0 (any location, 23 patients) NSCLC were treated with 87.5Gy at 2.5Gy/fraction of proton therapy. Toxicities were scored according to the Common Terminology Criteria for Adverse Events, version 4.0. ResultsThe median follow-up time was 83.1months (95% CI: 69.2–97.1months). For all 35 patients, the 1, 3, and 5-year overall survival rates were 85.7%, 42.9%, and 28.1%, respectively. The 5-year local recurrence-free, regional recurrence-free, and distant metastasis-free survival rates were 85.0%, 89.2%, and 54.4%, respectively. Different T stages had no effect on local and regional recurrence (p=0.499, p=1.00). However, with the increase in T stages, the distant metastasis rate increased significantly (p=0.006). The most common adverse effects were dermatitis (grade 2, 51.4%; grade 3, 2.9%) and radiation pneumonitis (grade 2, 11.4%; grade 3, 2.9%). Other grade 2 toxicities included esophagitis (2.9%), rib fracture (2.9%), heart toxicities (5.7%), and chest wall pain (2.9%). ConclusionsAccording to our long-term follow-up data, proton therapy with ablative doses is well tolerated and effective in medically inoperable early-stage NSCLC. Systemic therapy should be considered to reduce the rate of distant metastasis in cases of T2 and T3 lesions.

OA12.03 Percutaneous Cryoablation for Lung Cancer Patients for Whom Surgery or Radiotherapy is Contraindicated Due to Idiopathic Pulmonary Fibrosis

Interstitial lung disease, such as idiopathic pulmonary fibrosis (IPF), have been widely known to be associated with lung cancer. Lung cancer patients concomitant with IPF sometimes develop a life-threatening acute exacerbation after surgery or radiotherapy. Percutaneous cryoablation is evolving as a potentially less invasive local treatment for lung cancer. The purpose of this study is to retrospectively analyze the outcomes of cryoablation for clinical T1N0M0 non-small cell lung cancer (NSCLC) patients for whom surgery or radiotherapy is contraindicated because of IPF. Between December 2003 to March 2016, 210 patients underwent computer tomography guided percutaneous cryoablation for lung tumors at our institution. Of these, 11 histologically proven clinical T1N0M0 NSCLC patients, for whom surgery or radiotherapy was considered contraindicated because of severe IPF, were retrospectively reviewed. Complications, local progression-free survival and clinicopathological factors were evaluated. The cohort was composed of 11 men with a mean age of 74 years (range: 68 to 82). The median follow-up time was 20 months (range: 6 to 55 months). The mean Krebs von den Lungen-6 (KL-6) level was 1608 ±1025 U/mL. The mean tumor size was 24 ± 7mm. The mean percentage of predicted diffusing capacity for carbon monoxide (DLCO) was 37±27%. Thirty and 90-day mortality was 0 and 18%, respectively. Two patients required chest tube drainage because of severe pneumothorax. Acute exacerbation of IPF occurred in two patients (18%). The use of oral steroids and need for chest tube drainage were predictors of higher mortality (p < 0.05) and higher incidence of acute exacerbation of IPF (p < 0.05). However, higher level of KL-6 and low percentage of DLCO were not significant risk factors of mortality or acute exacerbation of IPF. Local progression-free survival at 1, 2 and 3 year was 51, 41 and 31%, respectively. Percutaneous cryoablation for lung cancer patients with IPF provoked acute exacerbation of IPF in 18% of patients. The use of oral steroids and need for chest tube drainage were predictors of higher mortality and higher incidence of acute exacerbation of IPF.

SC08.04 SABR Versus Surgery

SC08.04 SABR Versus Surgery