Incidence of Radiation Therapy Among Patients Enrolled in a Multidisciplinary Pulmonary Nodule and Lung Cancer Screening Clinic

Milligan, Michael; Lennes, Inga T.; Hawari, Saif; Khandekar, Melin J.; Colson, Yolonda L.; Shepard, Jo-Anne O.; Frank, Angela; Sequist, Lecia V.; Willers, Henning; Keane, Florence K.

doi:10.1001/jamanetworkopen.2022.4840

Cited by 5 publications

(2 citation statements)

References 17 publications

(30 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Nevertheless, other screening centers also have found that patient characteristics differ between the NLST and real-world programs 13 and an increasing proportion of all patients with stage I lung cancer are being treated with SBRT. 14 , 15 This suggests that our experience may be occurring on a much larger scale. With widespread implementation of LCS, evaluating outcomes for diverse patients who undergo different treatments will be critical for optimizing the balance of benefits and risks.…”

Section: Discussionmentioning

confidence: 89%

Treatment of Stage I Lung Cancer Detected by Computed Tomography Screening

Gierada

Bai

Spraker

et al. 2022

JTO Clinical and Research Reports

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 89%

Treatment of Stage I Lung Cancer Detected by Computed Tomography Screening

Gierada

Bai

Spraker

et al. 2022

JTO Clinical and Research Reports

View full text Add to dashboard Cite

“…Under current guidelines, millions of patients in the US could miss out on a lifesaving screening LDCT simply because they may not be optimal surgical candidates. As shown by Milligan et al, 6 nonoperative interventions, such as SBRT, are critical tools to have available for the medically diverse early-stage lung cancer population, and an expanded menu of treatment options seems likely to lead to better tailored recommendations for individual patients. During multidisciplinary decision-making, we should ensure that radiation oncologists have a seat at the table.…”

mentioning

confidence: 99%

Involvement of Radiation Oncologists in Multidisciplinary Decision-making for Early-Stage Lung Cancer

Arvold

2022

JAMA Netw Open

View full text Add to dashboard Cite

There has been a marked inrease in the detection of pulmonary nodules during the last 2 decades. By 2012, the number of pulmonary nodules detected incidentally on medical imaging had already increased 10-fold over prior reports, 1,2 with more than 1.5 million patients estimated to have a pulmonary nodule detected annually in the United States. 3 This increase was followed in 2015 by Medicare approval of lung cancer screening with low-dose computed tomography (LDCT) of the chest among patients with a heavy smoking burden, leading to many more nodules detected among patients each year in the United States. 4 Although most pulmonary nodules, whether detected incidentally or by screening, are not cancerous, they require follow-up because some of them will represent early-stage lung cancer, most commonly non-small cell lung cancer (NSCLC). For patients with nodules that enlarge on serial imaging and/or have concerning features, referral to specialists for multidisciplinary evaluation and potential treatment is warranted.But which specialists should see these patients? Historically, early-stage lung cancer had 1 predominant curative treatment option: surgical resection. Lobectomy with mediastinal lymph node dissection has remained the standard of care for decades among most patients with early-stage lung cancer who could undergo surgery, with much higher survival observed compared with other interventions, including conventional radiotherapy delivered during multiple weeks. Therefore, patients with a concerning pulmonary nodule have been seen appropriately in a multidisciplinary fashion by pulmonologists, interventional radiologists, and thoracic surgeons for evaluation of earlystage NSCLC, which has remained the dominant clinical pathway for these patients. However, this model was established before the advent of high-dose ablative conformal radiotherapy delivered to lung tumors typically for 1 week or less, synonymously termed stereotactic body radiotherapy (SBRT) or stereotactic ablative radiotherapy. During the past decade, SBRT has emerged as a primary treatment option for patients with early-stage NSCLC who cannot undergo or who refuse surgery, with high tumor control and lung cancer-specific survival rates. 5 Elsewhere in JAMA Network Open, Milligan et al 6 highlight the importance of the evolution in the multidisciplinary evaluation of patients with pulmonary nodules. This prospective cohort study examined outcomes from a pulmonary nodule and lung cancer screening clinic at a major tertiary care hospital from 2012 to 2019, with a focus on patient management before and after radiation oncologists joined the multidisciplinary clinic in 2015. The authors evaluated 1150 patients, and of the 237 patients who ultimately received treatment for an early-stage lung cancer, 70 (29.5%) received SBRT; among patients specifically with screen-detected nodules, a notable 24.4% received SBRT.Treatment with SBRT was well tolerated with no grade 3 or higher toxic effects, and 2-year survival rates were 96% for local control, 94%...

show abstract