Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Postmus, Pieter E.; Kerr, Keith M.; Oudkerk, Matthijs; Senan, Suresh; Waller, David; Vansteenkiste, Johan; Escriu, Carles; Peters, Solange

doi:10.1093/annonc/mdx222

Cited by 1,688 publications

(1,405 citation statements)

References 130 publications

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“…Akciğer kanserinde FDG PET/BT görüntüleme tedavi planlaması için günümüzde mutlaka yapılması gereken bir inceleme olarak kabul edilmektedir (2,3,6,7,8,21). Özellikle erken evre hastalıkta tanısal işlemlerin uzaması hasta prognozunu olumsuz yönde etkileyebilir (22).…”

Section: Evrelemede Fdg Pet/btunclassified

“…öngörmek için tümör-lenf nodu-uzak metastaz (TNM) evrelemesinden yararlanılır (2,3,4,5,6,7). Ne yazık ki, tanı anında hastaların yarısından fazlasında uzak metastatik hastalık mevcuttur ve standart tedavilere rağmen akciğer kanserinde genel olarak sağkalım oldukça düşüktür.…”

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“…Hastalık akciğer ile sınırlı olduğunda 5 yıllık sağkalım oranı %45 oranında iken, bütün evreler için ortalama 5 yıllık sağkalım %15 civarındadır (4). Erken evre KHDAK hastalarında tedavi seçenekleri cerrahi rezeksiyon ve/veya radyoterapidir (6,7,8,9). İleri evre KHDAK hastalarında ise öncelikli tedaviler kemoterapi ve kemoradyoterapi uygulamalarıdır (6,7,8,9).…”

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“…Erken evre KHDAK hastalarında tedavi seçenekleri cerrahi rezeksiyon ve/veya radyoterapidir (6,7,8,9). İleri evre KHDAK hastalarında ise öncelikli tedaviler kemoterapi ve kemoradyoterapi uygulamalarıdır (6,7,8,9). Bir glikoz analoğu olan flor-18 (F-18) ile işaretli florodeoksiglikoz (FDG) ile yapılan pozitron emisyon tomografi/ bilgisayarlı tomografi (PET/BT), günümüzde hem akciğer nodüllerinin değerlendirilmesinde hem de akciğer kanserinin evrelemesinde klinikte rutin olarak kullanılan bir incelemedir (2,3,8).…”

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“…Akciğer kanseri FDG PET/BT görüntülemenin klinikte öncelikli olarak kabul gördüğü alanlardan birisi olmuştur. Akciğer kanserinde gösterdiği yüksek tanısal doğruluk sayesinde günümüzde FDG PET/ BT görüntüleme birçok klinik akciğer kanseri yönergesinde rutin bir tanısal yöntem olarak yer almaktadır (6,7,8,10,11). PET görüntülerine uygulanan yeni sayısal analiz yöntemleri, PET detektörlerinin manyetik rezonans (MR) görüntüleme ile eş zamanlı kullanılabildiği hibrid PET/MR sistemleri ve glikoz metabolizması dışındaki farklı patofizyolojik mekanizmaları hedefleyen yeni PET radyofarmasötiklerinin üretilmesi gibi gelişmeler sayesinde akciğer kanserinde PET görüntüleme endikasyonlarının ve kullanım yaygınlığının artması öngörülmektedir.…”

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Role of Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Imaging in Diagnosis and Staging of Lung Cancer

Akdemir¹,

Aydos²

2018

Nts

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GirişAkciğer kanseri, en sık görülen kanser türlerinden biri olup, tedavi olanaklarındaki iyileşmelere rağmen kansere bağlı ölüm nedenleri arasında birinci sırada yer alır (1). Tüm akciğer kanserlerinin yaklaşık %85'ini küçük hücreli dışı akciğer kanseri (KHDAK), kalan kısmını da küçük hücreli akciğer kanseri (KHAK) oluşturur (2).KHAK hastalarının çoğunda tanı anında uzak metastaz bulunması ve bu hastaların cerrahi tedavi olasılıklarının düşük olması; buna karşılık KHDAK hastalarında cerrahi tedavi olasılığının daha yüksek olması nedeniyle bu sınıflama özellikle tedavi yaklaşımı bakımından önem taşır. Akciğer kanseri tanısı alan hastalarda uygun tedavi seçeneğini belirlemek ve hasta prognozunu Flor-18 ile işaretli florodeoksiglikoz (FDG) ile yapılan pozitron emisyon tomografisi/bilgisayarlı tomografi (PET/ BT) akciğerde kuşkulu parankimal nodülü olan veya akciğer kanseri tanısı alan hastaların klinik yönetiminde kullanılan güçlü bir tanı aracıdır. Bu yazıda FDG PET/BT görüntülemenin kuşkulu akciğer nodüllerinin değerlendirilmesinde ve yeni tanı akciğer kanserinde evrelemesindeki yerinden, sayısal PET değişkenlerinin hasta prognozu ile ilişkisinden, hibrid PET/manyetik rezonans sistemi gibi teknik gelişmelerden ve akciğer kanserinin patofizyolojisi ile ilişkili FDG dışındaki diğer PET radyofarmasötiklerinin kullanımından bahsedilmektedir. Anahtar Kelimeler: Akciğer kanseri, küçük hücreli-dışı akciğer kanseri, küçük hücreli akciğer kanseri, FDG, PET/BT görüntüleme Positron emission tomography/computed tomography (PET/ CT) using fluorine-18 labelled fluorodeoxyglucose (FDG) is a powerful tool for managing patients with suspected lung nodules and lung cancer. In this review, we discuss the utility of FDG PET/CT imaging in evaluation of suspected pulmonary nodules and initial staging of patients with newly diagnosed lung cancer, prognostic value of quantitative PET parameters, technical developments in PET imaging such as hybrid PET/ magnetic resonance systems, and the use of other PET radiopharmaceuticals related to lung cancer pathophysiology.

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Section: Evrelemede Fdg Pet/btunclassified

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Role of Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Imaging in Diagnosis and Staging of Lung Cancer

Akdemir¹,

Aydos²

2018

Nts

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The Role of Positron Emission Tomography–Computed Tomography in the Workup of Non–Small Cell Lung Cancer

Walter

2019

JAMA Netw Open

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Non-small cell lung cancer (NSCLC) remains a significant global health burden and is a leading cause of cancer-related death. The correct staging of patients with NSCLC is a key step in selecting an adequate treatment regimen, and combined positron emission tomography-computed tomography (PET-CT) with fluorine 18-labeled fluorodeoxyglucose (FDG) is increasingly used for staging and treatment monitoring of patients with NSCLC. The principal strengths of PET-CT with FDG in staging NSCLC include the assessment of intrathoracic lymph nodes and the detection of unanticipated stage IV disease. However, data on the effects of PET-CT with FDG on cancer-related mortality in NSCLC remain sparse.The article by Vella et al 1 aims to provide such data on cancer-related mortality. The authors examined the association of the use of PET-CT with NSCLC mortality in 64 103 patients treated in the US Department of Veterans Affairs from 2000 to 2013. They found that PET-CT use increased over this 13-year period, while mortality decreased. 1 Vella et al 1 concluded that PET-CT was associated with both a higher level of care and decreased mortality for veterans with NSCLC.To appreciate the contribution of this study in the context of the existing body of literature, it is worthwhile to summarize its main strengths and limitations. Strengths of the study by Vella et al 1 include a highly relevant research question, ie, the association of PET-CT with survival in one of the most frequent cancers today; a large patient number; and the choice of survival as the main clinical end point, which is arguably the most relevant clinical outcome in oncology.As does every study, the study by Vella et al 1 has limitations, which are openly discussed in the article. An association such as that shown in the study does not prove or even indicate a causal Open Access. This is an open access article distributed under the terms of the CC-BY License.

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Association of Survival With Adjuvant Chemotherapy Among Patients With Early-Stage Non–Small Cell Lung Cancer With vs Without High-Risk Clinicopathologic Features

Pathak

Goldberg

Canavan³

et al. 2020

JAMA Oncol

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IMPORTANCETumor size larger than 4 cm is accepted as an indication for adjuvant chemotherapy in patients with node-negative non-small cell lung cancer (NSCLC). Treatment guidelines suggest that high-risk features are also associated with the efficacy of adjuvant chemotherapy among patients with early-stage NSCLC, yet this association is understudied.OBJECTIVE To assess the association between adjuvant chemotherapy and survival in the presence and absence of high-risk pathologic features in patients with node-negative early-stage NSCLC. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study using data from the National Cancer Database included 50 814 treatment-naive patients with a completely resected node-negative NSCLC diagnosed between January 1, 2010, and December 31, 2015. The study was limited to patients who survived at least 6 weeks after surgery (ie, estimated median time to initiate adjuvant chemotherapy after surgery) to mitigate immortal time bias. Statistical analysis was performed from December 1, 2018, to February 29, 2020.EXPOSURES Adjuvant chemotherapy use vs observation, stratified according to the presence or absence of high-risk pathologic features (visceral pleural invasion, lymphovascular invasion, and high-grade histologic findings), sublobar surgery, and tumor size. MAIN OUTCOMES AND MEASURESThe association of high-risk pathologic features with survival after adjuvant chemotherapy vs observation was evaluated using Cox proportional hazards regression models.RESULTS Overall, 50 814 eligible patients with NSCLC (27 365 women [53.9%]; mean [SD] age, 67.4 [9.5] years]) were identified, including 4220 (8.3%) who received adjuvant chemotherapy and 46 594 (91.7%) who did not receive adjuvant chemotherapy. Among patients with tumors 3 cm or smaller, chemotherapy was not associated with improved survival (hazard ratio [HR], 1.10; 95% CI, 0.96-1.26; P = .17). For patients with tumors larger than 3 cm to 4 cm, adjuvant chemotherapy was associated with a survival benefit among patients who underwent sublobar surgery (HR, 0.72; 95% CI, 0.56-0.93; P = .004). For tumors larger than 4 cm to 5 cm, a survival benefit was associated with adjuvant chemotherapy only in patients with at least 1 high-risk pathologic feature (HR, 0.67; 95% CI, 0.56-0.80; P = .02). For tumors larger than 5 cm, adjuvant chemotherapy was associated with a survival benefit irrespective of the presence of high-risk pathologic features (HR, 0.75; 95% CI, 0.61-0.91; P = .004). CONCLUSIONS AND RELEVANCEIn this cohort study, tumor size alone was not associated with improved efficacy of adjuvant chemotherapy in patients with early-stage (node-negative) NSCLC. High-risk clinicopathologic features and tumor size should be considered simultaneously when evaluating patients with early-stage NSCLC for adjuvant chemotherapy.

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Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Cited by 1,688 publications

References 130 publications

Role of Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Imaging in Diagnosis and Staging of Lung Cancer

Role of Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Imaging in Diagnosis and Staging of Lung Cancer

The Role of Positron Emission Tomography–Computed Tomography in the Workup of Non–Small Cell Lung Cancer

Association of Survival With Adjuvant Chemotherapy Among Patients With Early-Stage Non–Small Cell Lung Cancer With vs Without High-Risk Clinicopathologic Features

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