Is lung cancer resection indicated in patients with idiopathic pulmonary fibrosis?

Watanabe, Atsushi; Higami, Tetsuya; Ohori, Syunsuke; Koyanagi, Toshiya; Nakashima, Shinji; Mawatari, Tohru

doi:10.1016/j.jtcvs.2008.07.016

Cited by 132 publications

(134 citation statements)

References 25 publications

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“…The surgical option is also associated with poor outcomes for this patient population. The American College of Chest Physicians and Society of Thoracic Surgeons consensus recently identified patients with IPF as high-risk patients with increased risk of complications following surgical resection with overall reduced survival and increased risk of mortality and pulmonary complication (34)(35)(36).…”

Section: Toxicities and Pulmonary Fibrosismentioning

confidence: 99%

Excellent Cancer Outcomes Following Patient-adapted Robotic Lung SBRT But a Case for Caution in Idiopathic Pulmonary Fibrosis

Bahig

Filion

et al. 2014

Technol Cancer Res Treat

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The aim of this study is to report outcomes and prognostic factors for early stage non-small cell lung cancer treated with patient-adapted Cyberknife stereotactic body radiotherapy. A retrospective analysis of 150 patients with T1-2N0 non-small cell lung cancer treated with stereotactic body radiotherapy was conducted. An algorithm based on tumor and patient's characteristics was used to orient patients towards soft tissue (Xsight Lung), fiducials or adjacent bone (Xsight Spine) tracking. Median biological effective dose without correction for tissue inhomogeneities was 180 Gy 10 for peripheral tumors and 113 Gy 10 for central tumors. Median follow-up was 22 months. Actuarial 2 years local control, overall survival and disease-specific survival were respectively 96%, 87% and 95%. Every 1 cm increase in tumor diameter was associated with a relative risk for regional or distant relapse of 2 (95%CI 5 1.2-3.6, p 5 0.009). With doses 132 Gy 10 and 132 Gy 10 , local control was 98% vs. 82% (p 5 0.07), disease-specific survival 97% vs. 78% (p 5 0.02) and overall survival 93% vs. 76% (p 5 0.01), respectively. Better disease-specific survival and a trend for better overall survival was observed for peripheral vs. central tumors (96% vs. 79%, p 5 0.05 and 92% vs. 74%, p 5 0.08, respectively). A higher Charlson comordibity score (4) predicted lower overall survival (79% vs. 98%, p 5 0.01). Toxicities included 3 patients with idiopathic pulmonary fibrosis who developed grade 5 pneumonitis and 2 patients with grade 3 pneumonitis.We therefore report excellent local control and disease-specific survival following patientadapted Cyberknife lung stereotactic body radiotherapy. Although toxicities were in general minimal, patients with pulmonary fibrosis might be at greater risk of severe complications.Small size, peripheral location, dose  132 Gy 10 and a low Charlson co-morbidity score seem to be associated with better outcomes.

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Section: Toxicities and Pulmonary Fibrosismentioning

confidence: 99%

Excellent Cancer Outcomes Following Patient-adapted Robotic Lung SBRT But a Case for Caution in Idiopathic Pulmonary Fibrosis

Bahig

Filion

et al. 2014

Technol Cancer Res Treat

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“…Unsurprisingly, patients with IPF who undergo resection for lung cancer have significantly higher rates of post-operative mortality and morbidity, as well as worse long-term outcomes, than patients without IPF who undergo pulmonary resection. Hospital mortality rates for IPF patients range from 7.1% to 18.2% with post-operative acute exacerbations of IPF the major cause of death [42][43][44][45]. Rates of post-operative exacerbations of IPF are related to the extent of resection, with significantly higher rates in patients undergoing pneumonectomy than lobectomy and no significant difference in post-operative mortality and morbidity in patients with pulmonary fibrosis undergoing limited resections (segmentectomy or wedge resection) compared with the general lung cancer population [42,43].…”

Section: Prognosis and Treatmentmentioning

confidence: 99%

“…Hospital mortality rates for IPF patients range from 7.1% to 18.2% with post-operative acute exacerbations of IPF the major cause of death [42][43][44][45]. Rates of post-operative exacerbations of IPF are related to the extent of resection, with significantly higher rates in patients undergoing pneumonectomy than lobectomy and no significant difference in post-operative mortality and morbidity in patients with pulmonary fibrosis undergoing limited resections (segmentectomy or wedge resection) compared with the general lung cancer population [42,43]. Some studies have suggested that pre-operative pulmonary function tests may predict increased risk of postoperative exacerbations [42,45], but other studies have not found a link between pre-operative pulmonary status and post-operative acute exacerbations [43].…”

Section: Prognosis and Treatmentmentioning

confidence: 99%

“…Watanabe et al [43] reported a 5 year actuarial survival rate of 61% in patients with Stage I lung cancer and IPF compared with 83% in the general lung cancer population. A proportion of late deaths are due to IPF complications but some studies have also reported higher rates of second lung cancers in the IPF patient group than in the general lung cancer population.…”

Section: Prognosis and Treatmentmentioning

confidence: 99%

“…Acute exacerbations of other fibrotic lung diseases, including idiopathic NSIP and fibrotic hypersensitivity pneumonitis, have also been described, with some suggestion that outcome of acute exacerbation in NSIP may be better than in UIP [51][52][53]. Although the trigger for acute exacerbation is unknown, an association with surgical lung biopsy or resection has been suggested [42][43][44][45]50]. Prognosis of acute exacerbation is very poor with death occurring in the majority of patients within weeks or a few months [50,51].…”

Section: Acute Exacerbation Of Ipfmentioning

confidence: 99%

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High-resolution CT of complications of idiopathic fibrotic lung disease

Lloyd¹,

Walsh²,

Hansell³

2011

BJR

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ABSTRACT. Idiopathic pulmonary fibrosis (IPF) has a more variable clinical course than has been traditionally recognised. Many patients will remain stable over time while others experience relatively rapid deterioration. The prognosis and clinical course of patients with other fibrosing lung diseases is also variable. A number of conditions may complicate the clinical course of the idiopathic fibrosing lung diseases, which results in morbidity and mortality, but also represents potentially treatable causes of worsening symptoms. Infection and malignancy have a long-recognised association with IPF while other conditions, particularly pulmonary hypertension and acute exacerbation of IPF, are being increasingly recognised in this patient population. Many of these patients have serial high-resolution CT (HRCT) examinations that may demonstrate one or more of these supervening conditions. In this article we review the more common conditions that may complicate the course of idiopathic fibrosing lung disease with an emphasis on the HRCT appearance, which the reporting radiologist should be aware of.

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Genetic alterations in squamous cell lung cancer associated with idiopathic pulmonary fibrosis

Hata

Nakajima

Matsusaka

et al. 2021

Intl Journal of Cancer

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Patients with idiopathic pulmonary fibrosis (IPF) are at higher risk of developing lung cancers including squamous cell lung carcinoma (SCC), which typically carries a poor prognosis. Although the molecular basis of cancer development subsequent to IPF has not been fully investigated, we recently reported two epigenetic phenotypes characterized by frequent and infrequent DNA hypermethylation in SCC, and an association of the infrequent hypermethylation phenotype with IPF-associated SCCs.Here, we conducted targeted exon sequencing in SCCs with and without IPF using the Human Lung Cancer Panel to investigate the genetic basis of IPF-associated SCC.SCCs with and without IPF displayed comparable numbers of total mutations (137 ± 22 vs 131 ± 27, P = .5), nonsynonymous mutations (72 ± 14 vs 69 ± 16, P = .5), indels (3.0 ± 3.5 vs 3.0 ± 3.9, P = 1) and synonymous mutations (62 ± 9.1 vs 60 ± 12, P = .5). Signature 1 was the predominant signature in SCCs with and without IPF. SETD2 and NFE2L2 mutations were significantly associated with IPF (44% vs 13%, P = .03 for SETD2; 38% vs 10%, P = .04 for NFE2L2). MYC amplification, assessed by copy number variant analysis, was also significantly associated with IPF (18.8% vs 0%, P = .04). Mutations in TP53 and CDKN2A were observed relatively frequently in SCCs with frequent hypermethylation (P = .02 for TP53 and P = .06 for CDKN2A). Survival analysis revealed that the SETD2 mutation was significantly associated with worse prognosis (P = .04). Collectively, we found frequent involvement of SETD2 and NFE2L2 mutations and MYC amplification in SCCs with IPF, and an association of a SETD2 mutation with poorer prognosis.

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Is lung cancer resection indicated in patients with idiopathic pulmonary fibrosis?

Cited by 132 publications

References 25 publications

Excellent Cancer Outcomes Following Patient-adapted Robotic Lung SBRT But a Case for Caution in Idiopathic Pulmonary Fibrosis

Excellent Cancer Outcomes Following Patient-adapted Robotic Lung SBRT But a Case for Caution in Idiopathic Pulmonary Fibrosis

High-resolution CT of complications of idiopathic fibrotic lung disease

Genetic alterations in squamous cell lung cancer associated with idiopathic pulmonary fibrosis

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