Patterns of recurrence and incidence of second primary tumors after lobectomy by means of video-assisted thoracoscopic surgery (VATS) versus thoracotomy for lung cancer

Flores, Raja M.; Ihekweazu, Ugonna N.; Rizk, Nabil P.; Dycoco, Joseph; Bains, Manjit S.; Downey, Robert J.; Adusumilli, Prasad S.; Finley, David J.; Huang, James; Rusch, Valerie W.; Sarkaria, Inderpal S.; Park, Bernard J.

doi:10.1016/j.jtcvs.2010.08.062

Cited by 58 publications

(43 citation statements)

References 19 publications

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“…This study shows that the numbers of patients who develop second primary tumors are not different between the VATS and open lobectomy approach. This finding is in agreement with the conclusions of a recent single-institution study that showed similar incidence of second primary tumors following lobectomy by VATS versus open technique[10]. …”

Section: Discussionsupporting

confidence: 93%

Patterns of survival and recurrence after surgical treatment of early stage non–small cell lung carcinoma in the ACOSOG Z0030 (ALLIANCE) trial

Scott

Allen

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

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Objective Surgical resection has been the mainstay of curative treatment of early stage lung cancer in selected patients. We evaluated survival and patterns of recurrence after surgical resection for early stage lung cancer from the ACOSOG Z0030/Alliance trial. Methods 1018 patients in the Z0030 trial were analyzed according to clinical T stage. Differences between groups were compared using the two-sample rank test or chi-square test. Logrank test and Cox proportional hazards regression were used to compare survival and recurrence. To compare patients who underwent open versus VATS resections, propensity-score matched analysis was performed. 752 patients (66 VATS and 686 open) were classified into 5 equal-sized propensity score groups. Proportional hazards regression was used to compare these outcomes. Two-sided p-values<0.05 were considered statistically significant. Results There were 578 patients with cT1 tumors and 440 patients with cT2 tumors. Median follow-up was 6.7 years. Median overall survival was 9.1 years (T1) and 6.5 years (T2). Overall survival at 5 years was 72% (T1) and 55% (T2). Local recurrence-free survival at 5 years was 95% (T1) and 91% (T2) (p=0.015). Among T1 patients, 4.2% (23/542) had local recurrences, while 7.3% (30/409) of those with T2 tumors had local failure. There was no difference in the development of new primary tumors between T1 and T2 groups. In the propensity-score matched analysis of VATS versus open lobectomy patients, there was no difference in overall survival, disease-free survival, and freedom from development of a new primary tumor. Conclusions Results of patients with resected early stage NSCLC from a large-scale, multicenter trial serve as benchmarks against which to compare non-surgical therapies for early stage lung cancer. Propensity-score matched analysis shows no difference in survival between the VATS and open lobectomy patients.

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Section: Discussionsupporting

confidence: 93%

Patterns of survival and recurrence after surgical treatment of early stage non–small cell lung carcinoma in the ACOSOG Z0030 (ALLIANCE) trial

Scott

Allen

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

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“…[11, 25] A previous publication from our institution excluding sublobar resections demonstrated similar postoperative recurrence patterns. [24] True local recurrence after lobectomy would likely be limited to a stump recurrence.…”

Section: Discussionmentioning

confidence: 79%

“…[9, 10] In the contemporary era of video assisted techniques (VATS) for anatomic resection, 5 year overall survival has been reported to be 75–80% with a perioperative mortality rate of 1%. [11–13] In small subsets of potentially operable patients from single center studies, SBRT has been associated with good primary tumor control and overall survival. While such findings are encouraging, these data are not sufficient to supplant surgical resection as the standard of care in the operable patient and clinical trials are needed to determine whether outcomes following SBRT are comparable to anatomic surgical resection.…”

Section: Introductionmentioning

confidence: 99%

Analysis of first recurrence and survival in patients with stage I non–small cell lung cancer treated with surgical resection or stereotactic radiation therapy

Crabtree

Puri

Robinson

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

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Objectives Comparative studies of survival between stereotactic body radiation therapy (SBRT) and surgery have been limited by lack of comparisons of recurrence patterns between matched cohorts in non-small cell lung cancer (NSCLC). Methods All patients undergoing treatment with surgery or SBRT for clinical Stage I NSCLC between June 2004-December 2010 were reviewed. Age, tumor characteristics, comorbidity score, pulmonary function, overall (OS) and disease free survival (DFS) and recurrence data were collected and propensity matching performed.. Results The mean age for surgery (N=458) was 65.8 ± 10.5 vs. 74.4 ± 9.4 for SBRT (N=151) (p<0.0001). For the entire surgical cohort 3-year OS and DFS were 78% and 72%, respectively. For the entire SBRT cohort 3-year OS and DFS were 47% and 42%, respectively. The overall local recurrence rate for surgery was 2.6%. The overall local recurrence rate for SBRT was 10.7%. A propensity matched comparison based on age, tumor size, ACE comorbidity score, FEV1%, and tumor location resulted in 56 matched pairs. The 3-year overall survival was 52% vs. 68% for SBRT and surgery, respectively (p=0.05) while disease-free survival was 47% vs. 65% (p=0.01). At 3 years, local recurrence free survival was 90% vs. 92% for SBRT and surgery, respectively (p=0.07) Conclusions While surgical resection seems to result in better overall and disease free survival vs. SBRT, matching these disparate cohorts of patients remains challenging. Participation in clinical trials is essential to define the indications and relative efficacy of surgery and radiation therapy in a high-risk population with Stage I NSCLC.

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“…The benefits of VATS are more evident in patients with advanced age, poor lung function and a higher comorbidity burden [105][106][107][108][109][110][111][112]. In addition, lung cancer recurrence rates with VATS do not seem to be increased, and may even be decreased compared with lobectomy via the standard thoracotomy approach [112][113][114].…”

Section: Surgical Optionsmentioning

confidence: 99%

Slow-growing lung cancer as an emerging entity: from screening to clinical management

et al. 2013

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The current paradigm is that untreated lung cancer is invariably and rapidly fatal, therefore the medical community normally dismisses the idea that a patient could live with such a disease for years without any therapy.Yet evidence from lung cancer screening research and from recent clinical series suggests that, although rarely recognised in routine practice, slow-growing lung cancers do exist and are more common than previously thought.Here, current evidence is reviewed and clinical cases are illustrated to show that slow-growing lung cancer is a real clinical entity, and the reasons why management protocols developed in the screening setting may also be useful in clinical practice are discussed. Features suggesting that a lung cancer may be slow-growing are described and appraised, areas of uncertainty are examined, modern management options for earlystage disease are evaluated and the influence that all this knowledge might have on our clinical decisionmaking is weighed. Further research directed at developing appropriate guidelines for these peculiar but increasingly common patients is warranted. @ERSpublications The increasingly common incidence of slow-growing lung cancer and its influence on clinical decision-making is discussed

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Patterns of recurrence and incidence of second primary tumors after lobectomy by means of video-assisted thoracoscopic surgery (VATS) versus thoracotomy for lung cancer

Abstract: Recurrence rates for video-assisted thoracoscopic surgery appear to be at least equivalent to those for thoracotomy. This study supports lobectomy by means of video-assisted thoracoscopic surgery as an oncologically sound technique.

Cited by 58 publications

References 19 publications

Patterns of survival and recurrence after surgical treatment of early stage non–small cell lung carcinoma in the ACOSOG Z0030 (ALLIANCE) trial

Patterns of survival and recurrence after surgical treatment of early stage non–small cell lung carcinoma in the ACOSOG Z0030 (ALLIANCE) trial

Analysis of first recurrence and survival in patients with stage I non–small cell lung cancer treated with surgical resection or stereotactic radiation therapy

Slow-growing lung cancer as an emerging entity: from screening to clinical management

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