Surgery for Early-Stage Non-Small Cell Lung Cancer: A Systematic Review of the Video-Assisted Thoracoscopic Surgery Versus Thoracotomy Approaches to Lobectomy

Whitson, Bryan A.; Groth, Shawn S.; Duval, Sue; Swanson, Scott J.; Maddaus, Michael A.

doi:10.1016/j.athoracsur.2008.07.009

Cited by 549 publications

(396 citation statements)

References 52 publications

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“…16 Nearly 70% of elderly patients with NSCLC in the National Cancer Institute's Surveillance, Epidemiology, and End Results database were not treated according to guidelines, 17 and concerns about increased surgical morbidity and mortality were a common reason for deferring from guideline-recommended therapy, although older patients tend to present with earlier stage lung cancer. [18][19][20] Despite this, surgery still is the recommended therapy for the elderly, because realistic nonsurgical treatment options were lacking until the emergence of SRT in recent years.…”

Section: Discussionmentioning

confidence: 99%

“…37,38 A systematic review indicated that even when thoracic surgery is performed using video-assisted thoracoscopic surgery, the mean duration of hospitalization was 8.3 days. 16 Counseling of elderly patients should include information about the likelihood of convalescence at an extended care facility, because approximately 24% of octogenarians are transferred to extended care facilities after undergoing pulmonary resection, and physicians should be aware of the added costs. 2 Steps to standardize the delivery of SRT are essential to ensure the safe use of this technique.…”

Section: Discussionmentioning

confidence: 99%

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Stage I nonsmall cell lung cancer in patients aged ≥75 years

Haasbeek

Lagerwaard

Antonisse

et al. 2009

Cancer

165

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BACKGROUND:The number of patients aged !75 years who present with a stage I nonsmall cell lung cancer (NSCLC) is increasing. Elderly patients often have significant comorbidity and may be unfit for surgery. Furthermore, surgery in the elderly is associated with increased mortality and morbidity. In this study, the authors evaluated the outcomes of stereotactic radiotherapy (SRT) in elderly patients. METHODS: Since 2003, 203 tumors in 193 patients aged !75 years were treated using SRT (118 T1 tumors, 85 T2 tumors). The median patient age was 79 years, 80% of patients were considered medically inoperable, and 20% of patients declined surgery. The median Charlson comorbidity score was 4, and severe chronic obstructive pulmonary disease (Global Initiative for Chronic Obstructive Lung Disease Class III or greater) was present in 25% of patients. Risk-adapted SRT schemes were used with the same total dose of 60 grays in 3 fractions (33%), 5 fractions (50%), or 8 fractions (17% of patients), depending on the patient's risk for toxicity. RESULTS: SRT was well tolerated, and all but 1 patient completed treatment. Survival rates at 1 year and 3 years were 86% and 45%, respectively. Survival was correlated with performance score (P ¼ .001) and pre-SRT lung function (P ¼ .04). The actuarial local control rate at 3 years was 89%. Acute toxicity was uncommon, and late Radiation Therapy Oncology Group grade !3 toxicity was observed in <10% of patients. CONCLUSIONS: SRT achieved high local control rates with minimal toxicity in patients aged !75 years despite their significant medical comorbidities. These results indicated that more active diagnostic and therapeutic approaches are justified in elderly patients and that SRT should be considered and discussed as a curative treatment alternative. Cancer 2010;116:406-14.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Stage I nonsmall cell lung cancer in patients aged ≥75 years

Haasbeek

Lagerwaard

Antonisse

et al. 2009

Cancer

165

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“…1 Surgical resection was considered as the best possible treatment for NSCLC patients; however, only 20%-25% patients were suitable for potentially curative resection. 2 Despite the fact that chemotherapy options had been proven with promising results for the broader population in recent years, the survival status of NSCLC patients remained worrying with an overall 5-year survival less than 20%, raising an urgent need to seek more effective strategies for NSCLC treatment. 3 The past decade witnessed a revolutionary drug development based on "druggable" protein kinases including epidermal Tumor-associated calcium signal transducer 2 regulates neovascularization of non-small-cell lung cancer via activating ERK1/2 signaling pathway growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK).…”

Section: Introductionmentioning

confidence: 99%

Tumor-associated calcium signal transducer 2 regulates neovascularization of non-small-cell lung cancer via activating ERK1/2 signaling pathway

et al. 2017

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Lung cancer, especially the non-small-cell lung cancer, is a highly aggressive vascular cancer with excessively activated signaling pathways. Tumor-associated calcium signal transducer 2, also known as trop2, was identified to be correlated with tumor proliferation and invasion of non-small-cell lung cancer; however, the biological role of trop2 in neovascularization of non-small-cell lung cancer remained elusive. In this study, we first verified that trop2 was overexpressed in non-small-cell lung cancer tissues as well as cell lines and that the increased expression of trop2 promoted non-small-cell lung cancer cell proliferation and invasion. Then, we expanded the biological role of trop2 by in vitro and in vivo angiogenesis assay. The tubular formation analysis revealed that trop2 promoted non-small-cell lung cancer angiogenesis in vitro, and the immunohistochemistry staining of vascular markers (CD31 and CD34) provided evidences that trop2 promoted in vivo neovascularization. The results of polymerase chain reaction array revealed that trop2 promoted the expression level of two well-known angiogenesis factors MMP13 and PECAM1. By screening the trop2-related signaling pathways, we observed that excessive angiogenesis was correlated with activation of ERK1/2 signaling pathway, and ERK1/2 inhibitor (U0126) could suppress the tubular formation ability induced by trop2 expression. These results suggested that trop2 facilitated neovascularization of non-small-cell lung cancer via activating ERK1/2 signaling pathway. Targeting trop2 might provide novel anti-angiogenesis strategy for non-small-cell lung cancer treatment.

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“…VATS is associated with reduced postoperative pain, reduced pulmonary dysfunction and reduced cytokines and acute-phase protein production compared to conventional (open) surgery [64]. It may also reduce duration of drainage and length of hospital stay following lung resection [65,66]. It has been recognised for some time now that VATS lobectomy provides similar long-term results to open lobectomy in patients with stage I disease [67].…”

Section: Surgery For Early Stage Lung Cancer (Stage I and Ii)mentioning

confidence: 89%

“…It has been recognised for some time now that VATS lobectomy provides similar long-term results to open lobectomy in patients with stage I disease [67]. Two recent systematic reviews of the literature concluded that VATS lobectomy was associated with improved survival when compared to thoracotomy and lobectomy [65,67]. This approach is attractive in the older population or in patients with limited pulmonary function [68,69].…”

Section: Surgery For Early Stage Lung Cancer (Stage I and Ii)mentioning

confidence: 99%

Surgery for nonsmall cell lung cancer

Lang-Lazdunski

2013

Eur Respir Rev

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Surgery remains the best curative option in patients with early stage lung cancer (stage I and II). Developments in minimally invasive techniques now allow surgeons to perform lung resections on elderly patients, patients with poor pulmonary function or significant cardiopulmonary comorbidities. New techniques, such as stereotactic radiotherapy and ablative procedures, are being evaluated in early-stage lung cancer and may represent an alternative to surgery in patients unfit for lung resection. Perioperative mortality rates have dropped significantly at most institutions in the past two decades and complications are managed more efficiently. Progress in imaging and staging techniques have helped cut futile thoracotomy rates and offer patients the most adequate treatment options. Large randomised trials have helped clarify the role of neoadjuvant, induction and adjuvant chemotherapy, as well as radiotherapy. Surgery remains an essential step in the multimodality therapy of selected patients with advanced-stage lung cancer (stage III and IV). Interventional and endoscopic techniques have reduced the role of surgery in the diagnosis and staging of nonsmall cell lung cancer, but surgery remains an important tool in the palliation of advanced-stage lung cancer. Large national/international surgical databases have been developed and predictive risk-models for surgical mortality/morbidity published by learned surgical societies. Nonetheless, lung cancer overall survival rates remain deceptively low and it is hoped that early detection/screening, better understanding of tumour biology and development of biomarkers, and development of efficient targeted therapies will help improve the prognosis of lung cancer patients in the next decade. @ERSpublications Despite progress in surgical techniques, radiotherapy techniques and targeted therapy, lung cancer prognosis remains poor

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Surgery for Early-Stage Non-Small Cell Lung Cancer: A Systematic Review of the Video-Assisted Thoracoscopic Surgery Versus Thoracotomy Approaches to Lobectomy

Cited by 549 publications

References 52 publications

Stage I nonsmall cell lung cancer in patients aged ≥75 years

Stage I nonsmall cell lung cancer in patients aged ≥75 years

Tumor-associated calcium signal transducer 2 regulates neovascularization of non-small-cell lung cancer via activating ERK1/2 signaling pathway

Surgery for nonsmall cell lung cancer

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