Impact of Enlarged Nonhypermetabolic Lymph Nodes on Outcomes After Stereotactic Body Radiotherapy for Early-Stage Non–Small-Cell Lung Cancer

Verma, Vivek; Schonewolf, Caitlin; Cushman, Taylor R.; Post, Carl M.; Doms, Alexandra G.; Berman, Abigail T.; DeVries, Matthew; Katz, Sharyn I.; Simone, Charles B.

doi:10.1016/j.cllc.2018.07.005

Cited by 2 publications

(2 citation statements)

References 35 publications

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“…Verma et al suggested that LN mildly increased in size was more likely to harbor disease, but they did not have an adequate concentration of neoplastic cells. 37 Some studies reported that LN granulomatous inflammation was associated with metastasis of breast cancer, renal cell cancer, and lymphomas. 38 Additionally, historical studies have shown an increased risk of cancer in patients previously diagnosed with sarcoidosis, especially lung cancer and lymphoma.…”

Section: Discussionmentioning

confidence: 99%

<p>Enlarged Mediastinal Lymph Nodes in Computed Tomography are a Valuable Prognostic Factor in Non-Small Cell Lung Cancer Patients with Pathologically Negative Lymph Nodes</p>

Zheng¹,

Huang²,

Bi³

et al. 2020

CMAR

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Background Most non-small cell lung cancer patients with enlarged mediastinal lymph nodes (LN) in preoperative computer tomography (CT) images are diagnosed with N0 in the pathological examination after surgery. However, these patients seem to have worse survival than those without enlarged mediastinal LN in our clinical practice. This study aimed to investigate whether the size of mediastinal LN is correlated with the prognosis in pathological N0 patients, which could help us to predict the prognoses further. Methods The retrospective cohort study involved 758 N0 patients with a thin layer CT scan. We have measured the size of mediastinal LN, including long diameter, short diameter, and volume on CT image, and classified patients by X-tile. Next, we explored the risk factors of enlarged LN by univariate and multivariate logistic analysis. Then, we have compared the 5-year cancer-specific survival by Kaplan–Meier and log-rank method. Multivariate Cox analysis was utilized to further survival analysis. Finally, we have constructed the prediction model by nomogram. Results A total of 150 N0 patients (19.8%) had mediastinal LN enlargement in our study. After multivariate logistic analysis, we found the LN enlargement was significantly correlated with age (p=0.001), pathology (p < 0.001) and tumor recurrence (p < 0.001). The patients with LN enlargement had a worse 5-year cancer-specific survival (75.3% vs 92.8%, p < 0.001) after Kaplan–Meier analysis. Patients with a larger volume had increased risk of tumor-associated death when compared with the normal group (p < 0.001) by multivariate Cox analyses. Conclusion N0 patients with larger mediastinal LN had a worse 5-year cancer-specific survival and a higher risk of recurrence. The volume of LN was the most valuable prognostic factor in N0 patients.

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Section: Discussionmentioning

confidence: 99%

<p>Enlarged Mediastinal Lymph Nodes in Computed Tomography are a Valuable Prognostic Factor in Non-Small Cell Lung Cancer Patients with Pathologically Negative Lymph Nodes</p>

Zheng¹,

Huang²,

Bi³

et al. 2020

CMAR

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“…As such, while we recommend that all empiric SBRT patients with lesions >3 cm undergo MRI brain, the requirement could potentially be relaxed for PET-CT and pathologically confirmed node negative patients with tumors >3 cm but ≤5 cm. Whenever feasible, we recommend nodal staging with EBUS for all lesions, acknowledging that it may be acceptable to forego this procedure in patients with no evidence of radiographically enlarged or metabolically active lymph nodes on diagnostic CT chest and PET/CT, respectively, and especially in those with <2 cm lesions and peripherally located lesions (34,45,46). Patients should also undergo pulmonary function testing to better assess their risk of pulmonary complications from treatment and basic laboratory studies to evaluate for an active infection that could be presenting falsely on imaging as a clinical lung cancer.…”

Section: Staging Procedures Recommended For Patients Undergoing Empirmentioning

confidence: 99%

Empiric Radiotherapy for Lung Cancer Collaborative Group multi-institutional evidence-based guidelines for the use of empiric stereotactic body radiation therapy for non-small cell lung cancer without pathologic confirmation

Berman¹,

Jabbour²,

Vachani³

et al. 2018

Transl. Lung Cancer Res

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The standard of care for managing early stage non-small cell lung cancer (NSCLC) is definitive surgical resection. Stereotactic body radiation therapy (SBRT) has become the standard treatment for patient who are medically inoperable, and it is increasingly being considered as an option in operable patients. With the growing use of screening thoracic CT scans for patients with a history of heavy smoking, as well as improved imaging capabilities, the discovery of small lung nodes has become a common dilemma. As a result, clinicians are increasingly faced with managing lung nodules in patients in whom diagnostic biopsy is not safe or feasible. Herein, we describe the scope of the problem, tools available for predicting the probability that a lung nodule is a malignancy, staging procedures, benefits of pathology-proven and empiric SBRT, considerations of safety based on location of the lesion of concern, and overall efficacy of SBRT.

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Impact of Enlarged Nonhypermetabolic Lymph Nodes on Outcomes After Stereotactic Body Radiotherapy for Early-Stage Non–Small-Cell Lung Cancer

Cited by 2 publications

References 35 publications

<p>Enlarged Mediastinal Lymph Nodes in Computed Tomography are a Valuable Prognostic Factor in Non-Small Cell Lung Cancer Patients with Pathologically Negative Lymph Nodes</p>

<p>Enlarged Mediastinal Lymph Nodes in Computed Tomography are a Valuable Prognostic Factor in Non-Small Cell Lung Cancer Patients with Pathologically Negative Lymph Nodes</p>

Empiric Radiotherapy for Lung Cancer Collaborative Group multi-institutional evidence-based guidelines for the use of empiric stereotactic body radiation therapy for non-small cell lung cancer without pathologic confirmation

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