The Extent of Lung Parenchyma Resection Significantly Impacts Long-Term Quality of Life in Patients With Non-Small Cell Lung Cancer

Schulte, Tobias L.; Schniewind, Bodo; Dohrmann, P.; Küchler, Thomas; Kurdow, Roland

doi:10.1378/chest.08-1114

Cited by 105 publications

(85 citation statements)

References 17 publications

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“…Our previous analysis of quality of life after SRT revealed little deterioration, in marked contrast to the reported negative impact of quality of life postsurgery. 28,29 In our study, cytohistologic confirmation of malignancy was available only in 39% of patients, and this low percentage is not uncommon in trials that evaluate the management of suspected early NSCLC. 30 Similar findings were observed by Sawada et al in 1039 patients who underwent surgical resection for a diagnosis of lung cancer or suspected lung cancer and in whom routine investigations confirmed a histologic diagnosis of lung cancer in only 523 patients.…”

Section: Discussionmentioning

confidence: 81%

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: 81%

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

Haasbeek

Lagerwaard

Antonisse

et al. 2009

Cancer

165

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“…16) On the other hand, a pneumonectomy, especially a right one, includes a higher occurrence of postoperative complications compared to the lobectomy: poorer quality of life, cardiopulmonary dysfunction, and long-term complications. [17][18][19][20][21] So we think that, lobectomy could be the surgery of choice when interlobar lymph node is involved (including the involvement of more distal lymph nodes). Maximum efforts should be spent to avoid pneumonectomy.…”

Section: Discussionmentioning

confidence: 99%

Extent of Lung Resection in Non-small Lung Cancer with Interlobar Lymph Node Involvement

Günlüoğlu

Demir

Turna

et al. 2011

ATCS

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Background: Optimal resection type for non-small cell lung cancer (NSCLC) with interlobar lymph node involvement (ILNI) has seldom been reported. To completely resect a NSCLC with ILNI, some surgeons believe that a pneumonectomy is needed. Methods: We retrospectively studied 151 patients (147 men, 4 women; mean age 58 ± 8 years, range 34-79) with non-small lung cancer without mediastinal or hilar lymph node metastasis who underwent an anatomic lung resection with systematic lymph node dissection between January 1995 and November 2006. All patients had involvement of the surgical-pathologic interlobar (#11) lymph node: 8 patients had a T1 tumor; 95, T2; 39, T3; and 9, T4. We evaluated the effect of resection type (pneumonectomy in 90 patients versus lobectomy in 61) on their prognosis by univariate and multivariate analyses. Results: The 5-year survival rate of patients was 61% for the lobectomy and 35% for the pneumonectomy ( p = 0.04). We did not find statistically significant differences in sex, median age, distributions of tumor site, histology and differentiation, complete resection rate, N1 involvement status, morbidity and mortality. Patients who underwent the pneumonectomy had larger tumors and more T3 tumors. The T status, multiple levels N1 involvement and histology did not affect survival in the univariate analysis. Multivariate analysis revealed resection type as a significant prognostic factor. Conclusions: Pneumonectomy was not necessary in patients with NSCLC and interlobar lymph node involvement that we had discovered intraoperatively.

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“…Moreover, quality of life and functional wellbeing indicators may still show a detrimental impact of major lung resection up to 2 years post-operatively in a significant proportion of patients [95][96][97][98][99]. In one study, 24% and 11% of long-term cancer survivors still experienced moderate and severe limitations, respectively, in their daily activities due to residual dyspnoea [100].…”

Section: Estimating Risks and Benefitsmentioning

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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The Extent of Lung Parenchyma Resection Significantly Impacts Long-Term Quality of Life in Patients With Non-Small Cell Lung Cancer

Cited by 105 publications

References 17 publications

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

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

Extent of Lung Resection in Non-small Lung Cancer with Interlobar Lymph Node Involvement

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

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