T1N0 Non-small Cell Lung Cancer Research Articles

A critical appraisal of the adjuvant chemotherapy guidelines for patients with completely resected T3N0 non-small-cell lung cancer

Background. A Joint Expert Panel recently published guidelines for adjuvant cisplatin-based chemotherapy, recommending routine use in patients with completely resected stage II (T1-2N1 and T3N0) non-small-cell lung cancer (NSCLC). However, these two tumor subgroups should be considered as different entities. While the efficacy of adjuvant chemotherapy has been established in patients with T1-2N1 NSCLC, its benefit in patients with T3N0 tumor remains questionable. Material and methods. We performed an extensive review of the literature using the Joint Expert Panel guidelines as a start point. Altogether, we identified 76 potentially relevant articles. Basing on inclusion and exclusion criteria, 23 of the 76 articles were eventually included in this review. Results. After careful evaluation of the selected articles, we found no information on the effect of adjuvant chemotherapy in patients with T3N0 NSCLC. Discussion. In the absence of evidence-based data, we recommend that the lack of information on the efficacy of adjuvant chemotherapy for T3N0 tumors be discussed with patients and propose chemotherapy as an individual option. While the efficacy of adjuvant chemotherapy will be difficult to assess prospectively through a large randomized clinical trial, a pooled-analysis of the existing data would quickly and with a limited effort provide a preliminary answer.

Phase I Study of Accelerated Conformal Radiotherapy for Stage I Non–Small-Cell Lung Cancer in Patients With Pulmonary Dysfunction: CALGB 39904

The optimal treatment for medically inoperable stage I non-small-cell lung cancer (NSCLC) has not been defined. Cancer and Leukemia Group B trial 39904 prospectively assessed accelerated, once-daily, three-dimensional radiotherapy for early-stage NSCLC. The primary objectives were to define the maximally accelerated course of conformal radiotherapy and to describe the short-term and long-term toxicity of therapy. Entry was limited to patients with clinical stage T1N0 or T2N0 NSCLC (< 4 cm) and pulmonary dysfunction. The nominal total radiotherapy dose remained at 70 Gy, while the number of daily fractions in each successive cohort was reduced. Thirty-nine eligible patients were accrued (eight patients each on cohorts 1 to 4 and seven patients on cohort 5) between January 2001 and July 2005. One grade 3 nonhematologic toxicity was observed in both cohort 3 (dyspnea) and cohort 4 (pain). The major response rate was 77%. After a median follow-up time of 53 months, the actuarial median survival time of all eligible patients was 38.5 months. Local relapse was observed in three patients. Accelerated conformal radiotherapy was well tolerated in a high-risk population with clinical stage I NSCLC. Outcomes are comparable to prospective reports of alternative therapies, including stereotactic body radiation therapy and limited resection, with less apparent severe toxicity. Further investigation of this approach is warranted.

Relationship Between Functional Preservation after Segmentectomy and Volume-Reduction Effects after Lobectomy in Stage I Non-small Cell Lung Cancer Patients with Emphysema

To evaluate whether functional preservation after segmentectomy has a greater advantage of pulmonary functions than volume-reduction effects after lobectomy in patients with emphysema with clinical T1N0 non-small cell lung cancer (NSCLC). Between January 2000 and December 2006, 47 cases of lobectomy and 71 cases of segmentectomy were performed in patients with stage I NSCLC using intraoperative sentinel node identification. The postoperative change of the forced expiratory volume in 1 second (deltaFEV(1)) 6 months after segmentectomy was compared with that of 6 months after lobectomy. The difference in the deltaFEV(1) between after segmentectomy and after lobectomy was evaluated according to the ratio of the estimated postoperative FEV(1) to the predicted normal value of FEV(1) (%ppoFEV(1)). In 50 patients with the preoperative FEV(1)% less than 70%, there was no difference in the deltaFEV(1) between the segmentectomy group (n = 30) and the lobectomy group (n = 20). In 36 patients with emphysema diagnosed by high-resolution chest computed tomography, a negative linear correlation between the %ppoFEV(1) and the deltaFEV(1) was found in the lobectomy subgroup (n = 16, r = 0.508, p = 0.0012), but not in the segmentectomy subgroup (n = 20). When patients with emphysema had the %ppoFEV(1) more than or equal to 70%, the deltaFEV(1) had a tendency to be smaller in the segmentectomy subgroups than in the lobectomy subgroups. Segmentectomy should be considered in patients with cT1N0 NSCLC with a normal (>80%) predicted postoperative FEV(1). In patients with a %ppoFEV(1) under 70%, segmentectomy offers no functional advantages over lobectomy.

Outcomes after stereotactic lung radiotherapy or wedge resection for stage I non-small cell lung cancer (NSCLC)

7516 Background: To compare clinical outcomes between lung stereotactic radiotherapy (SBRT) and wedge resection for stage I NSCLC. Methods: 112 cases of T1–2N0 NSCLC were treated with wedge resection (n=69) or image-guided lung SBRT (n=43) from 2/2003–8/2008. SBRT patients were treated on a phase II trial. All patients were ineligible for anatomic lobectomy; 93% undergoing SBRT were medically inoperable; 7% refused surgery. Mean FEV1 and DLCO were 1.58L and 13.9ml/min/mmHg for wedge cases vs 1.29L and 10.1ml for SBRT (p&lt;0.01, p&lt;0.01). Mean Charlson Co-morbidity Index and median age were 3 and 74y for wedge vs 4 and 77y for SBRT (p&lt;0.01, p=0.04). Patients were staged using CT, 18FDG PET-CT, pulmonary function testing, and chemistries. SBRT patients had bone scan and brain MRI. Mediastinoscopies were performed for 28% of wedge cases vs.16% for SBRT (p=NS). SBRT was prescribed as 48 (T1) or 60 (T2) Gy in 4–5 fractions to the edge of the target volume. Adjuvant chemotherapy was given to 22% of SBRT vs12% of wedge patients (p=NS). Results: Median potential follow-up=2.3y. No significant differences were identified in local (LR), regional (RR), or locoregional recurrence (LRR), distant metastasis (DM), freedom from any failure (FFF), overall survival, or cause-specific survival between the two groups (Table); however, trends toward reduced LR and improved FFF were found with SBRT. Results excluding cases of synchronous primary tumors or pathologicalT4 (satellite lesion at wedge) are also shown, with FFF significantly better for SBRT. Multivariate analysis showed tumor grade to predict LR; LR to predict DM; LR and angiolymphatic invasion to predict RR and RR, (+)margin, FEV1, and pathologic diameter OS (p=0.06, p=0.08, p=0.01, p=0.04) in wedge cases. Conclusions: Both lung SBRT and wedge resection are reasonable treatment options for Stage I NSCLC patients ineligible for anatomic lobectomy. SBRT showed trends toward reduced LR and failure. Additional follow-up will be needed to verify durability of these findings. [Table: see text] No significant financial relationships to disclose.

Adjuvant Paclitaxel Plus Carboplatin Compared With Observation in Stage IB Non–Small-Cell Lung Cancer: CALGB 9633 With the Cancer and Leukemia Group B, Radiation Therapy Oncology Group, and North Central Cancer Treatment Group Study Groups

Adjuvant chemotherapy for resected non-small-cell lung cancer (NSCLC) is now accepted on the basis of several randomized clinical trials (RCTs) that demonstrated improved survival. Although there is strong evidence that adjuvant chemotherapy is effective in stages II and IIIA NSCLC, its utility in stage IB disease is unclear. This report provides a mature analysis of Cancer and Leukemia Group B (CALGB) 9633, the only RCT designed specifically for stage IB NSCLC. Within 4 to 8 weeks of resection, patients were randomly assigned to adjuvant chemotherapy or observation. Eligible patients had pathologically confirmed T2N0 NSCLC and had undergone lobectomy or pneumonectomy. Chemotherapy consisted of paclitaxel 200 mg/m(2) intravenously over 3 hours and carboplatin at an area under the curve dose of 6 mg/mL per minute intravenously over 45 to 60 minutes every 3 weeks for four cycles. The primary end point was overall survival. Three hundred-forty-four patients were randomly assigned. Median follow-up was 74 months. Groups were well-balanced with regard to demographics, histology, and extent of surgery. Grades 3 to 4 neutropenia were the predominant toxicity; there were no treatment-related deaths. Survival was not significantly different (hazard ratio [HR], 0.83; CI, 0.64 to 1.08; P = .12). However, exploratory analysis demonstrated a significant survival difference in favor of adjuvant chemotherapy for patients who had tumors > or = 4 cm in diameter (HR, 0.69; CI, 0.48 to 0.99; P = .043). Because a significant survival advantage was not observed across the entire cohort, adjuvant chemotherapy should not be considered standard care in stage IB NSCLC. Given the magnitude of observed survival differences, CALGB 9633 was underpowered to detect small but clinically meaningful improvements. A statistically significant survival advantage for patients who had tumors > or = 4 cm supports consideration of adjuvant paclitaxel/carboplatin for stage IB patients who have large tumors.

Accelerated conformal radiotherapy for stage I non-small cell lung cancer (NSCLC) in patients with pulmonary dysfunction: A CALGB phase I study

7556 Background: The optimal treatment for medically inoperable stage I NSCLC has not been defined. Methods: CALGB 39904 is a prospective phase I study assessing accelerated once-daily radiotherapy for early stage NSCLC. The primary objectives were to define the maximally accelerated course of conformal radiotherapy; and to describe the short-term and long-term toxicity of therapy. Entry was limited to patients with clinical stage T1N0 and T2N0 NSCLC (&lt; 4 cm) with pulmonary dysfunction (FEV1 &lt;40% predicted, DLCO 45mmHg, V02 max &lt;15m1/kg/min, O2 requirement). The nominal total radiotherapy dose was held constant at 70 Gy, while the number of daily fractions in each successive cohort was reduced (table). Results: The study was activated on 12/15/2000, and closed on 7/29/2005. Forty patients were accrued with 8 on each cohort. One patient on cohort 5 declined protocol treatment leaving 39 eligible patients. Patients were generally female (53%), white (83%), and ECOG performance status = 1 (67%). The median age was 74 (range 48 to 87), and the majority of the patients (73%) had T1N0M0 disease. Treatment was well tolerated without grade 4+ toxicity. There was one hematologic toxicity (lymphopenia) in cohort 2, and one non-hematologic toxicity each in cohort 3 (dyspnea) and cohort 4 (pain).The major repsonse rate was 74% (31% complete response, 43 % partial response), and 26% of patients had stable disease. After a median follow-up of 38.1 months, 21 patients remain alive. The actuarial median survival of all eligible patients is 38.5 months (95% confidence interval= 19.45 to NE). Conclusion: Accelerated conformal radiotherapy was well tolerated in a high-risk population with clinical stage I NSCLC. Outcomes are comparable to prospective reports of alternative therapies, including stereotactic body radiosurgery and limited resection,with less apparent severe toxicity. Further investigation of this approach is warranted. No significant financial relationships to disclose. [Table: see text]

Aberrant DNA Methylation of OLIG1, a Novel Prognostic Factor in Non-Small Cell Lung Cancer

BackgroundLung cancer is the leading cause of cancer-related death worldwide. Currently, tumor, node, metastasis (TNM) staging provides the most accurate prognostic parameter for patients with non-small cell lung cancer (NSCLC). However, the overall survival of patients with resectable tumors varies significantly, indicating the need for additional prognostic factors to better predict the outcome of the disease, particularly within a given TNM subset.Methods and FindingsIn this study, we investigated whether adenocarcinomas and squamous cell carcinomas could be differentiated based on their global aberrant DNA methylation patterns. We performed restriction landmark genomic scanning on 40 patient samples and identified 47 DNA methylation targets that together could distinguish the two lung cancer subgroups. The protein expression of one of those targets, oligodendrocyte transcription factor 1 (OLIG1), significantly correlated with survival in NSCLC patients, as shown by univariate and multivariate analyses. Furthermore, the hazard ratio for patients negative for OLIG1 protein was significantly higher than the one for those patients expressing the protein, even at low levels.ConclusionsMultivariate analyses of our data confirmed that OLIG1 protein expression significantly correlates with overall survival in NSCLC patients, with a relative risk of 0.84 (95% confidence interval 0.77–0.91, p < 0.001) along with T and N stages, as indicated by a Cox proportional hazard model. Taken together, our results suggests that OLIG1 protein expression could be utilized as a novel prognostic factor, which could aid in deciding which NSCLC patients might benefit from more aggressive therapy. This is potentially of great significance, as the addition of postoperative adjuvant chemotherapy in T2N0 NSCLC patients is still controversial.

Clinical Significance of p53 Gene Mutation in T1-2N0 Non-Small Cell Lung Cancer

In the early stage, long-term survival with non-small cell lung carcinoma has never been ideal. The aim of this study was to compare pathologically proven N0 lymph nodes obtained during mediastinoscopy with p53 gene mutation, and to correlate these with postoperative recurrence. Thirty patients undergoing mediastinoscopy for staging of non-small cell lung carcinoma were studied prospectively. Standard cervical mediastinoscopy was performed in all cases, and the specimens were divided into two pieces for histopathological and genetic investigations. All but one of the patients were male, and the mean age was 61.2 years (range, 42-74 years). Although the histopathology was negative in all cases, p53 gene mutation was observed in 6 (20%) patients. Recurrence was detected in 3 patients who had negative histopathology but were positive for p53 mutation, and in one who had negative histopathology and no p53 mutation. Patients with pathologically N0 disease and p53 gene mutation must be carefully monitored for local recurrence or distant metastasis. Neoadjuvant and/or adjuvant therapies may be considered in this group of patients.

Absence of toxicity with hypofractionated 3-dimensional radiation therapy for inoperable, early stage non-small cell lung cancer

PurposeHypofractionated radiotherapy may overcome repopulation in rapidly proliferating tumors such as lung cancer. It is more convenient for the patients and reduces health care costs. This study reports our results on patients with medically inoperable, early stage, non-small cell lung cancer (NSCLC) treated with hypofractionation.Materials and methodsStage T1-2N0 NSCLC patients were treated with hypofractionation alone, 52.5 Gy/15 fractions, in 3 weeks, with 3-dimensional conformal planning. T1-2N1 patients with the hilar lymphnode close to the primary tumor were also eligible for this treatment. We did not use any approach to reduce respiratory motion, but it was monitored in all patients. Elective nodal radiotherapy was not performed. Routine follow up included assessment for acute and late toxicity and radiological tumor response. Median follow up time was 29 months for the surviving patients.ResultsThirty-two patients with a median age of 76 years, T1 = 15 and T2 = 17, were treated. Median planning target volume (PTV) volume was 150cc and median V16 of both lungs was 13%. The most important finding of this study is that toxicity was minimal. Two patients had grade ≤ 2 acute pneumonitis and 3 had mild (grade 1) acute esophagitis. There was no late toxicity. Actuarial 1 and 2-year overall survival rates are 78% and 56%, cancer specific survival rates (CSS) are 90% and 74%, and local relapse free survival rates are 93% and 76% respectively.Conclusion3-D planning, involved field hypofractionation at a dose of 52.5 Gy in 15 daily fractions is safe, well tolerated and easy radiation treatment for medically inoperable lung cancer patients. It shortens by half the traditional treatment. Results compare favorably with previously published studies. Further studies are needed to compare similar technique with other treatments such as surgery and stereotactic radiotherapy.

Results of a Phase I Dose-Escalation Study Using Single-Fraction Stereotactic Radiotherapy for Lung Tumors

The purpose of this study was to report initial results of a phase I study using single-fraction stereotactic radiotherapy (RT) in patients with inoperable lung tumors. Eligible patients included those with inoperable T1-2N0 non-small cell lung cancer (NSCLC) or solitary lung metastases. Treatments were delivered by means of the CyberKnife. All patients underwent computed tomography-guided metallic fiducial placement in the tumor for image-guided targeting. Nine to 20 patients were treated per dose cohort starting at 15 Gy/fraction followed by dose escalation of 5 to 10 Gy to a maximal dose of 30 Gy/fraction. A minimal 3-month period was required between each dose level to monitor toxicity. Thirty-two patients (21 NSCLC and 11 metastatic tumors) were enrolled. At 25 Gy, pulmonary toxicity was noted in patients with prior pulmonary RT and treatment volumes greater than 50 cc; therefore, dose escalation to 30 Gy was applied only to unirradiated patients and treatment volume less than 50 cc. Ten patients received doses less than 20 Gy, 20 received 25 Gy, and two received 30 Gy. RT-related complications were noted for doses greater than 25 Gy and included four cases of grade 2 to 3 pneumonitis, one pleural effusion, and three possible treatment-related deaths. The 1-year freedom from local progression was 91% for dose greater than 20 Gy and 54% for dose less than 20 Gy in NSCLC (p = 0.03). NSCLC patients had significantly better freedom from relapse (p = 0.003) and borderline higher survival than those with metastatic tumors (p = 0.07). Single-fraction stereotactic RT is feasible for selected patients with lung tumors. For those with prior thoracic RT, 25 Gy may be too toxic. Higher dose was associated with improved local control. Longer follow-up is necessary to determine the treatment efficacy and toxicity.

Stage IB Nonsmall Cell Lung Cancers: Are They All the Same?

There is renewed interest in adjuvant chemotherapy after complete resection of nonsmall cell lung cancer, including stage IB (T2N0) cancers. Given the heterogeneity of the T2 classification, we hypothesize that there are survival differences in patients with stage IB NSCLC based on specific histopathologic tumor characteristics. A retrospective evaluation of 119 consecutive patients from 1999 to 2004 with a pathologic diagnosis of T2N0 nonsmall cell lung cancer was performed. Patient follow-up was 97%. Overall survival and disease-free survival rates were calculated by the Kaplan-Meier method. Univariate analysis was performed using the log rank test and multivariate analysis by Cox's proportional hazard model. Data were significant if p < 0.05. The 4-year overall survival and disease-free survival rates were 62% and 60%, respectively. The local and distant recurrence rates were 5% and 18%, respectively. Tumor size (p = 0.001), histologic grade (p = 0.002), the Eastern Cooperative Oncology Group performance status (p = 0.002), angioinvasion (p = 0.03), and visceral pleural involvement (p = 0.02) were predictors of overall survival by univariate analysis. Multivariate analysis demonstrated increasing tumor size (1.26 [95% confidence intervals 1.12, 1.64]) and histologic grade (4.05 [95% confidence intervals 1.38, 11.90]) to be significant independent predictors of a worse overall survival. The 4-year survival of patients without any of these variables was 89% compared with 56% if one or more of these factors were present (p = 0.03). There is significant heterogeneity in the T2N0 class of nonsmall cell lung cancer. Risk stratification using specific histopathologic variables may help determine which patients will benefit most from adjuvant therapy.

O-033 Docetaxel (DOC), cisplatin (CIS) and gemcitabine (GEM) asneoadjuvant treatment in stage IIIAN2 and T4N0-1 non-small cell lung cancer (NSCLC) patients (P). final results of SLCG phase II trial 9901

O-033 Docetaxel (DOC), cisplatin (CIS) and gemcitabine (GEM) asneoadjuvant treatment in stage IIIAN2 and T4N0-1 non-small cell lung cancer (NSCLC) patients (P). final results of SLCG phase II trial 9901

P-699 Surgery with or without postoperative radiation therapy in patients with chest wall invading T3N0 non-small cell lung cancer

P-699 Surgery with or without postoperative radiation therapy in patients with chest wall invading T3N0 non-small cell lung cancer

Long term results of induction carboplatin (CBDCA) and docetaxel (DOC) with concurrent radiation in early-stage non-small cell lung cancer (NSCLC)

7237 Background: Despite surgical resection, patients with clinical T2N0, T1–2N1 and T3N0 NSCLC have poor 5-year survivals (30% to 50%). Since a significant proportion of patients with early-stage NSCLC experience distant as well as loco-regional recurrences, multimodality therapy has recently been encouraged in an attempt to prolong survival. We conducted a phase II study to determine the feasibility and efficacy of induction CBDCA and DOC with concurrent radiation in early-stage NSCLC. Methods: Eligible were patients with previously untreated stage IB, and II histologically proven NSCLC. Clinical nodal stage was assessed by mediastinoscopy, mediastinotomy and CT imaging. A negative biopsy result of all enlarged mediastinal lymph nodes (shortest diameter ≥1.0 cm on CT scan) was required. CBDCA (AUC=5) and DOC (60 mg/m2) were administered once every 3 weeks for 2 cycles concurrent with 40 Gy (2Gy/fx/day) radiation. In patients with no evidence of disease progression thoracotomy was performed 3–5 weeks later. Results: Forty patients were entered into the study between 02/99 and 07/01. Patient characteristics included M/F: 27/13; median age (range): 59 (39–73); clinical stage T2N0/T1N1/T2N1/T3N0: 21/2/13/4; adeno/squamous/large cell: 26/12/2. Despite a high rate of grade 3/4 neutropenia (88%), no serious infectious events were observed. All the patients completed induction chemoradiotherapy and major responses were observed in 29 (73%). Of these, thirty-nine patients underwent thoracotomy and were resected completely. The type of operation was pneumonectomy in 2 and lobectomy in 37. A pathologic response (T or N downstaging) was identified in 30 (77%) and 10 (26%) had no residual disease. One patient had a bronchopleural fistula after left pneumonectomy. Median follow up was 57 months. Actuarial 3-year and estimated 5-year survivals were 82.5% and 69.9%, respectively. Three-year and 5-year disease free survivals were 76.9% and 71.0%, respectively. Conclusions: Induction concurrent chemotherapy (CBDCA + DOC) with thoracic radiotherapy is feasible, tolerable and deserves further evaluation in a randomized phase III study. No significant financial relationships to disclose.

827 poster Surgery with or without postoperative radiation therapy in patients with chest wall invading T3N0 non-small cell lung cancer

827 poster Surgery with or without postoperative radiation therapy in patients with chest wall invading T3N0 non-small cell lung cancer

Pneumonectomy for stage i (T1N0 and T2N0) nonsmall cell lung cancer has potent, adverse impact on survival

Background Surgically treated, stage I (T1N0 and T2N0) nonsmall cell lung cancer has a relatively favorable prognosis. Our aim was to determine whether performing a pneumonectomy in this group of patients has an impact on survival. Methods Four hundred eighty-five patients with stage I nonsmall cell lung cancer undergoing lung resection between 1991 and 2000 were studied. Three hundred seventy-four patients underwent a smaller resection than a pneumonectomy and 111 had a pneumonectomy. Results Patients undergoing less extensive resections were older (mean age, 65 vs 63 years) ( p = 0.01); these patients were also more likely to have a history of chronic obstructive airway disease (9% vs 2%) ( p = 0.01) or asthma (10% vs 3%) ( p = 0.04), nonsquamous cell type (56% vs 27%) ( p < 0.0001), and T1 tumor stage (66% vs 17%) ( p = 0.002) than patients having a pneumonectomy. Operative mortality was 2.4% versus 8% ( p = 0.01). Overall 1-, 3-, and 5-year Kaplan-Meier survival rates (95% confidence interval [CI]) after less extensive resections were 85% (CI, 82% to 90%), 63% (CI, 56% to 69%), and 50% (CI, 42% to 57%), respectively, and after pneumonectomy the survival rates were 66% (CI, 53% to 73%), 47% (CI, 35% to 57%), and 44% (CI, 32% to 55%), respectively ( p = 0.0006). When the Cox proportional hazards model was applied to all study patients (n = 485), pneumonectomy ( p = 0.001), T2 stage ( p = 0.006), older age ( p = 0.03), and male gender ( p = 0.03) were independent adverse predictors of survival. When the analysis was limited to the patients having T1N0 disease (n = 145), pneumonectomy ( p = 0.0008), older age ( p = 0.05), and nonsquamous cell type ( p = 0.02) were independent adverse determinants of survival. When only the patients with T2N0 disease were analyzed (n = 340), male gender ( p = 0.0005) and pneumonectomy ( p = 0.01) were independent negative predictors of survival. Conclusions In this study, the patients who underwent pneumonectomy for stage T1N0 or T2N0 nonsmall cell lung cancer had a significantly poorer survival than those patients who underwent smaller lung resections.

P-203 SLCG 9901: phase II trial with cisplatin (cis), gemcitabine (gem) and docetaxel (doc) as neoadjuvant treatment in stage IIIA N2 and T4N0-1 non-small cell lung cancer (NSCLC) patients

P-203 SLCG 9901: phase II trial with cisplatin (cis), gemcitabine (gem) and docetaxel (doc) as neoadjuvant treatment in stage IIIA N2 and T4N0-1 non-small cell lung cancer (NSCLC) patients

P-605 Postoperative radiation therapy for chest wall invading T3N0 non-small cell lung cancer: Elective hilar and mediastinal irradiation is not necessary

P-605 Postoperative radiation therapy for chest wall invading T3N0 non-small cell lung cancer: Elective hilar and mediastinal irradiation is not necessary

Thorascopic wedge resection and radiotherapy for T1N0 non-small cell lung cancer (NSCLC) in high risk patients: Preliminary analysis of a cancer and leukemia group B and Eastern Cooperative Oncology Group phase II trial

Thorascopic wedge resection and radiotherapy for T1N0 non-small cell lung cancer (NSCLC) in high risk patients: Preliminary analysis of a cancer and leukemia group B and Eastern Cooperative Oncology Group phase II trial

Ongoing clinical trials in lung cancer

II. Lung Cancer Study Group. Ginsberg R J, Rubenstein LV. Randomized trial of lobectomy versus limited resection for T1N0 non-small cell lung cancer. Ann Thorac StoLe. 1995; 60: 615-23. 12. Ginsberg RJ, Rubinstein L. Lung Cancer Study Group. A randomized comparative trial of lobectomy vs limited resection for patients with T 1 NO non-small cell lung cancer. Lung Cancer 1991: 7: (Suppl): 83. 13. Fernando HC, Goldstraw P. The accuracy ofclinical evaluative intrathoracic staging in lung cancer as assessed by postsurgical patholpgic staging. Cancer 1990; 65: 2503-6.