Evidence-Based Medicine in the Treatment of Non–small-Cell Lung Cancer

Reif, Michael S.; Socinski, Mark A.; Rivera, M. Patricia

doi:10.1016/s0272-5231(05)70011-3

Cited by 55 publications

(35 citation statements)

References 68 publications

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“…Although no large, prospective, randomised trials have been conducted comparing surgery and radiotherapy in early-stage NSCLC, surgical treatment has traditionally been considered the treatment of choice [8]. Historically, the first successful pneumonectomy in one stage for a lung cancer was performed in 1933 by GRAHAM and SINGER [9] in the USA.…”

Section: Sublobar (Limited) Resection For Lung Cancermentioning

confidence: 99%

Surgical implications of the new IASLC/ATS/ERS adenocarcinoma classification

Asamura²,

et al. 2011

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A new adenocarcinoma classification was recently introduced by a joint working group of the International Association for the Study of Lung Cancer (IASLC), American Thoracic Society (ATS) and European Respiratory Society (ERS). A distinction is made between pre-invasive lesions, and minimally invasive and invasive adenocarcinoma. The confusing term ''bronchioloalveolar carcinoma'' is not used any more and new subcategories include adenocarcinoma in situ and minimally invasive adenocarcinoma.Due to a renewed interest in screen-detected nodules and early-stage lung cancers of ,2 cm, this classification also has profound implications for thoracic surgeons.In this article, surgical topics are discussed: the role of a minimally invasive approach, especially video-assisted thoracic surgery, limited resection for early-stage lung cancer, the extent of lymph node dissection, the accuracy of intraoperative frozen section analysis, management of multiple lung nodules and prognostic factors in operated patients. Specific key issues are presented based on the current evidence and areas of surgical uncertainty are defined providing a basis for further studies.Thoracic surgeons will play a major role in the application and global introduction of this new adenocarcinoma classification. The remaining controversies regarding the precise diagnosis and management of early-stage lesions will have to be resolved by multidisciplinary and international collaboration.

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Section: Sublobar (Limited) Resection For Lung Cancermentioning

confidence: 99%

Surgical implications of the new IASLC/ATS/ERS adenocarcinoma classification

Asamura²,

et al. 2011

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“…Hiromitsu Takizawa 1) , Kazuya Kondo 1) , Hisashi Matsuoka 1) , Koh Uyama 1) , Hiroaki Toba 1) , Koichiro Kenzaki 1) , Shoji Sakiyama 1) , Akira Tangoku 1) , Kazumasa Miura 2) , Kiyoshi Yoshizawa 2) , and Junji Morita NSCLC (3). For the removal of mediastinal lymph nodes, many investigators insist on the importance of systematic nodal dissection (SND) for accurate staging (4)(5)(6)(7)(8)(9)(10).…”

Section: Effect Of Mediastinal Lymph Nodes Sampling In Patients With mentioning

confidence: 99%

“…Despite advances in variety of therapies, surgery is still the best treatment option for patients with localized non-small cell lung cancer (NSCLC) (1). For the removal of the primary tumor, a surgical procedure such as lobectomy, bilobectomy, and pneumonectomy should be selected for the purpose of complete resection.…”

Section: Introductionmentioning

confidence: 99%

Effect of mediastinal lymph nodes sampling in patients with clinical stage I non-small cell lung cancer

et al. 2008

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:Objective : Systematic nodal dissection has been recommended for patients with resectable non-small cell lung cancer because of its staging accuracy. However, in patients with clinical stage I non-small cell lung cancer whether systematic nodal dissection provides more benefits than mediastinal lymph node sampling or not is controversial. In this retrospective study, we evaluated the effect of mediastinal lymph node sampling in patients with clinical stage I NSCLC. Methods : One hundred and nineteen consecutive patients with clinical stage I NSCLC, who underwent curative operation between January 1994 and December 2000, were retrospectively reviewed (dissection group = 58 : sampling group= 61). Systematic nodal dissection was defined as complete removal of mediastinal lymph node, and mediastinal lymph node sampling was defined as removal of lymph node levels 3, 4, and 7 for right-sided tumors and levels 5, 6, and 7 for left-sided tumors. Results : The total number of removed mediastinal lymph nodes in patients who underwent systematic nodal dissection was 22.1 9.7, which was significantly higher than that in patients who underwent mediastinal lymph node sampling of 11.4 7.0 (p 0.001). Postoperatively N2 disease was detected in 8 patients (13.8% %) in the dissection group and 7 (11.5% %) in the sampling group. After the median follow up of 79 months, the cancer specific survival rate at 5 year was 78.0% % in the dissection group and 76.2% % in the sampling group (p = 0.60). Conclusions : Mediastinal lymph node sampling showed the similar effect to systematic nodal dissection in patients with clinical stage I non-small cell lung cancer. J. Med. Invest. 55 : 37-43, February, 2008

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“…KEYWORDS: Lung carcinoma, lung function, lung function tests, surgical resection S urgical resection remains the treatment of choice for anatomically resectable nonsmall cell lung cancer [1,2], offering the best prospect of long-term survival. However, many patients have coexisting chronic airflow limitation [3], which is associated with an increased risk from surgery.…”

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confidence: 99%

Relationship between pulmonary function and lung cancer surgical outcome

Win

Jackson²,

Sharples³

et al. 2005

Eur Respir J

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The British Thoracic Society and American College of Chest Physician guidelines outline criteria for investigating patients for lung cancer surgery. However, the guidelines are based on relatively old studies. Therefore, the relationship between pulmonary function test results and surgical outcome were studied prospectively in a large cohort of lung cancer patients.From January 2001 to December 2003, 110 patients underwent surgery for lung cancer. All underwent full lung function testing in order to predict post-operative lung function.The hospital mortality rate was 3% and major complication rate 22%. There was poor overall outcome in 13%. Mean pre-operative lung function values were: forced expiratory volume in one second (FEV1) 2.0 L (79.4% of the predicted value), and carbon monoxide diffusing capacity of the lung (DL,CO) 73.6% pred. The mean post-operative lung function values were: FEV1 1.4 L (55.6% pred), and DL,CO 51.3% pred. All lung function values were better predictors of poor surgical outcome when expressed as a percentage of the predicted value. Using a threshold of preoperative FEV1 of 47% pred resulted in the most useful positive and negative predictive probabilities, 0.90 and 0.67, respectively.Lung function values expressed as a percentage of the predicted value are more useful predictors of post-operative outcome than absolute values. The threshold of predicted forced expiratory volume in one second for surgical intervention could be lower (45-50% pred) than is currently accepted without increased mortality.KEYWORDS: Lung carcinoma, lung function, lung function tests, surgical resection S urgical resection remains the treatment of choice for anatomically resectable nonsmall cell lung cancer [1,2], offering the best prospect of long-term survival. However, many patients have coexisting chronic airflow limitation [3], which is associated with an increased risk from surgery. Loss of lung tissue may grossly impair post-operative ventilatory function in such patients, predisposing to cardiopulmonary complications, including death. The British Thoracic Society (BTS) and American College of Chest Physician guidelines [4,5] outline criteria for investigating patients with borderline lung function. However, many of the studies on which the guidelines are based are relatively old, and often based on predominantly male patients who were significantly younger than patients currently being considered for surgery.The latest BTS guidelines suggest that further investigation is unnecessary if a patient has a forced expiratory volume in one second (FEV1) of .2.0 L for pneumonectomy or .1.5 L for lobectomy. This is because studies have shown a mortality rate of ,5% using these criteria. However, these figures are based mainly on studies involving males, and it is likely that lower values would be more appropriate for females. It is possible that a figure based on a value expressed as a percentage of the predicted value would be better still, since this would also take into account the patient's age, s...

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Evidence-Based Medicine in the Treatment of Non–small-Cell Lung Cancer

Cited by 55 publications

References 68 publications

Surgical implications of the new IASLC/ATS/ERS adenocarcinoma classification

Surgical implications of the new IASLC/ATS/ERS adenocarcinoma classification

Effect of mediastinal lymph nodes sampling in patients with clinical stage I non-small cell lung cancer

Relationship between pulmonary function and lung cancer surgical outcome

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