Surgery versus stereotactic body radiation therapy for stage I non–small cell lung cancer: A comprehensive review

Tandberg, Daniel J.; Tong, Betty C.; Ackerson, Bradley G.; Kelsey, Chris R.

doi:10.1002/cncr.31196

Cited by 148 publications

(108 citation statements)

References 71 publications

(202 reference statements)

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“…In addition, lymph node metastasis is rare, like it is in patients with T1 NSCLC. A growing number of T1N0 NSCLC patients are nowadays treated with stereotactic body radiation (SBRT) [60,61]. In these patients surgical lymph node staging, like in EBT for carcinoid, is lacking.…”

Section: Discussionmentioning

confidence: 99%

Endobronchial and surgical treatment of pulmonary carcinoid tumors: A systematic literature review

et al. 2019

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A B S T R A C TThe treatment of pulmonary carcinoid has changed over the last decades. Although surgical resection is still the gold standard, minimally invasive endobronchial procedures have emerged as a parenchyma sparing alternative for tumors located in the central airways. This review was performed to identify the optimal treatment strategy for pulmonary carcinoid, with a particular focus on the feasibility and outcome of parenchyma sparing techniques versus surgical resection. A systematic review of the literature was carried out using MEDLINE, Embase and the Cochrane databases, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Two separate searches of publications in endobronchial and surgical treatment in patients with pulmonary carcinoid, were performed. Outcomes were overall survival, disease free survival, recurrence rate, complications, quality of life, and healthcare costs. Combining the two main searches for endobronchial therapy and surgical therapy yielded 3111 records. Finally, 43 studies concerning surgical treatment and 9 studies related to endobronchial treatment for pulmonary carcinoid were included. Assessment of included studies showed that lymph node involvement, histological grade, tumor location and tumor diameter were identified as poor prognostic factors and seem to be important for patients with pulmonary carcinoid. For patients with a more favorable prognosis, tumor location and tumor diameter are important factors that can help decide on the optimal treatment strategy. Centrally located small intraluminal pulmonary carcinoids, without signs of metastasis can be treated with minimally invasive alternatives such as endobronchial treatment or parenchyma sparing surgical resection. Patients with parenchyma sparing resections should be followed with long term follow up to exclude recurrence of disease. In a multidisciplinary setting, it should be determined whether individual patients are eligible for parenchyma sparing procedures or anatomical resection. Overall evidence is of low quality and future studies should focus on prospective trials in the treatment of pulmonary carcinoid.

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Section: Discussionmentioning

confidence: 99%

Endobronchial and surgical treatment of pulmonary carcinoid tumors: A systematic literature review

et al. 2019

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“…For instance, we could not project the demand for targeted or immunotherapy agents because these are very recent developments. Furthermore, although current guidelines recommend stereotactic body radiotherapy only for patients with medically inoperable early‐stage NSCLC, there is an ongoing debate on its appropriateness in operable patients . Therefore, the proportion of early‐stage cases that require radiotherapy could increase in the future.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, although current guidelines recommend stereotactic body radiotherapy only for patients with medically inoperable early-stage NSCLC, 6 there is an ongoing debate on its appropriateness in operable patients. 30,31 Therefore, the proportion of early-stage cases that require radiotherapy could increase in the future. Two other developments that may possibly alter our estimates are the introduction of risk models to select individuals for screening and the use of nodule management strategies such as Lung-RADS.…”

Section: Limitationsmentioning

confidence: 99%

Treatment capacity required for full‐scale implementation of lung cancer screening in the United States

Blom

Haaf

Arenberg

et al. 2019

Cancer

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Background Full‐scale implementation of lung cancer screening in the United States will increase detection of early stages. This study was aimed at assessing the capacity required for treating those cancers. Methods A well‐established microsimulation model was extended with treatment data from the National Cancer Database. We assessed how treatment demand would change when implementing lung cancer screening in 2018. Three policies were assessed: 1) annual screening of current smokers and former smokers who quit fewer than 15 years ago, aged 55 to 80 years, with a smoking history of at least 30 pack‐years (US Preventive Services Task Force [USPSTF] recommendations); 2) annual screening of current smokers and former smokers who quit fewer than 15 years ago, aged 55 to 77 years, with a smoking history of at least 30 pack‐years (Centers for Medicare and Medicaid Services [CMS] recommendations); and 3) annual screening of current smokers and former smokers who quit fewer than 10 years ago, aged 55 to 75 years, with a smoking history of at least 40 pack‐years (the most cost‐effective policy in Ontario [Ontario]). The base‐case screening adherence was a constant 50%. Sensitivity analyses assessed other adherence levels, including a linear buildup to 50% between 2018 and 2027. Results The USPSTF policy would require 37.0% more lung cancer surgeries in 2015‐2040 than no screening, 2.2% less radiotherapy, and 5.4% less chemotherapy; 5.7% more patients would require any therapy. The increase in surgical demand would be 96.1% in 2018, 46.0% in 2023, 38.3% in 2028, and 24.9% in 2040. Adherence strongly influenced results. By 2018, surgical demand would range from 52,619 (20% adherence) to 96,121 (80%). With a gradual buildup of adherence, the increase in surgical demand would be 9.6% in 2018, 38.3% in 2023, 42.0% in 2028, and 24.4% in 2040. Results for the CMS and Ontario policies were similar, although the changes in comparison with no screening were smaller. Conclusions Full‐scale implementation of lung cancer screening causes a major increase in surgical demand, with a peak within the first 5 years. A gradual buildup of adherence can spread this peak over time. Careful surgical capacity planning is essential for successfully implementing screening.

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“…Stereotactic body radiotherapy (SBRT) is an alternative treatment option to surgery for patients with stage I NSCLC, especially those who have medical comorbidities that preclude surgery. Phase 2 trials of early NSCLC report local control rates from 85% to 92% and OS rates from 43% to 60% at 3 years . Two randomized phase 3 trials of SBRT versus surgery for operable stage I NSCLC are currently recruiting.…”

Section: Non–small Cell Lung Cancermentioning

confidence: 99%

“…Phase 2 trials of early NSCLC report local control rates from 85% to 92% and OS rates from 43% to 60% at 3 years. 75 LRR after surgery for NSCLC primarily occurs in 2 peaks: the first at 6 to 8 months and the second at 22 to 24 months. 77 An analysis of 74 patients who developed a local recurrence after surgery for stage I NSCLC reported that patients who underwent surgical re-resection survived significantly longer than those who received chemotherapy or radiotherapy, although the 5-year postrecurrence survival rate after repeat surgery remained dismal at only 15%.…”

Section: Non-small Cell Lung Cancermentioning

confidence: 99%

Local Cancer Recurrence: The Realities, Challenges, and Opportunities for New Therapies

Mahvi

Liu

Grinstaff

et al. 2018

CA A Cancer J Clinicians

262

167

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Locoregional recurrence negatively impacts both long-term survival and quality of life for a number of malignancies. For appropriate-risk patients with an isolated, resectable local recurrence, surgery represents the only potentially curative therapy. However, oncologic outcomes remain inferior for patients with locally recurrent disease even after macroscopically complete resection. Unfortunately, these operations are often extensive with significant perioperative morbidity and mortality. This review highlights selected malignancies (mesothelioma, sarcoma, lung cancer, breast cancer, rectal cancer, peritoneal surface malignancies) in which surgical resection is a key treatment modality and where local recurrence plays a significant role in overall oncologic outcome with regards to survival and quality of life. For each type of cancer, the current, state-of-the-art treatment strategies and their outcomes are assessed. The need for additional therapeutic options is presented given the limitations of the current standard therapies. New and emerging treatment modalities, including polymer films and nanoparticles, are highlighted as potential future solutions for both prevention and treatment of locally recurrent cancers. Finally, we identify additional clinical and research opportunities, and propose future research strategies based on the varying patterns of local recurrence among the different cancers.

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Surgery versus stereotactic body radiation therapy for stage I non–small cell lung cancer: A comprehensive review

Cited by 148 publications

References 71 publications

Endobronchial and surgical treatment of pulmonary carcinoid tumors: A systematic literature review

Endobronchial and surgical treatment of pulmonary carcinoid tumors: A systematic literature review

Treatment capacity required for full‐scale implementation of lung cancer screening in the United States

Local Cancer Recurrence: The Realities, Challenges, and Opportunities for New Therapies

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