Limited Resection of Bronchogenic Carcinoma in the Patient with Marked Impairment of Pulmonary Function

Miller, Joseph I.; Hatcher, Charles R.

doi:10.1016/s0003-4975(10)63785-x

Cited by 157 publications

(51 citation statements)

References 6 publications

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“…Few cases with an M/T [ 1 have positive margin cytology findings, thus removal of a greater amount of pulmonary parenchyma is associated with a lower potential for relapse. The reported ratio of local recurrence in cases of pulmonary excision for NSCLC varies between 14 and 25% [12][13][14][15], with a median of 19%. By contrast, that ratio varies from 2 to 21% in cases of segmentectomy for LSCLC [3,[16][17][18][19][20][21], with a median of 9%.…”

Section: Discussionmentioning

confidence: 99%

Clinical implications of the margin cytology findings and margin/tumor size ratio in patients who underwent pulmonary excision for peripheral non-small cell lung cancer

et al. 2011

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Section: Discussionmentioning

confidence: 99%

Clinical implications of the margin cytology findings and margin/tumor size ratio in patients who underwent pulmonary excision for peripheral non-small cell lung cancer

et al. 2011

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“…This trial showed that lobectomy should be preferred over more limited surgical approaches (such as wedge resection or segmentectomy) because of a significantly lower risk of locoregional recurrence. However, lobectomy is frequently contraindicated in patients with early-stage lung cancer who have limited pulmonary reserve or multiple comorbidities related to older age or long smoking histories; these patients are, in general, treated with limited resection (7,8). Postoperative radiotherapy (PORT) and adjuvant chemotherapy may improve the long-term outcomes of patients undergoing limited resection by reducing the risk of recurrence.…”

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confidence: 99%

Adjuvant Treatment for Elderly Patients with Early-Stage Lung Cancer Treated with Limited Resection

Mhango

Bonomi²,

Neugut

et al. 2013

Annals ATS

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Objectives: Limited resection is commonly used for treating older patients with early-stage non-small cell lung cancer (NSCLC) who cannot tolerate lobectomy. However, parenchymal-sparing procedures leave patients at increased risk of recurrence. The role of postoperative radiotherapy (PORT) and chemotherapy after limited resection is not established. Methods:We identified 1,929 patients with stage I-II (<5 cm in size) NSCLC who underwent limited resection (wedge or segmentectomy) from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Using propensity score methods, we compared toxicity and survival of patients treated with limited resection alone, PORT, adjuvant chemotherapy, or PORT and chemotherapy. We conducted secondary analysis stratifying the sample by size (.2-5 cm), stage (IA vs. IB/IIA), and type of limited resection (wedge resection vs. segmentectomy).Measurements and Main Results: Overall, 1,656 (85.8%), 159 (8.3%), 74 (3.8%), and 40 (2.1%) patients were treated with limited resection alone, PORT, adjuvant chemotherapy, or PORT and chemotherapy, respectively. Adjusted analysis using inverse probability weighting showed that PORT (hazard ratio [HR], 1.57; 95% confidence interval [CI], 1.45-1.69), adjuvant chemotherapy (HR, 1.48; 95% CI, 1.36-1.61), and PORT and chemotherapy (HR, 1.73; 95% CI, 1.61-1.86) were associated with worse survival compared with limited resection alone. Similar results were obtained in secondary analyses. Compared with limited resection alone, the adjusted odds ratios for toxicity were 1.97 (95% CI, 1.6-2.4), 3.15 (95% CI, 2.58-3.85), 2.59 (95% CI, 2.0-3.4) for PORT, chemotherapy, and PORT and chemotherapy, respectively.Conclusions: PORT and adjuvant chemotherapy are not beneficial and appear to be associated with increased toxicity and worse survival after limited resection in elderly patients with early-stage NSCLC. Alternative strategies should be explored to improve local control.

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“…Our overall control rate of 72% is comparable to the 65% control rate by Hilaris et al [10,1 I] in 23 patients who underwent implant alone, without resection. These results are nearly equivalent to limited resections in other surgical series where local control ranges from 67-94% [2,4,6] and superior to external beam radiation alone where local failures range from 39-70% [7,12]. Improved control is probably the result of two factors: 1) interstitial brachytherapy allows much higher doses (8,000-20,000 cGy) to be delivered to a smaller volume of lung than is capable with external beam radiation (5,000-7,000 cGy); and 2) more accurate coverage of the tumor is possible due to open operative source placement within the mass.…”

Section: Discussionmentioning

confidence: 54%

Iodine¹²⁵ interstitial brachytherapy in the treatment of carcinoma of the lung

Fleischman

Kagan

Streeter

et al. 1992

Journal of Surgical Oncology

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In a prospective study, 14 patients with primary non-oat cell lung carcinoma were treated with intraoperative Iodine125 (I125) implantation of the lung tumor via lateral thoracotomy or median sternotomy. Staging mediastinal node dissection was performed in each case. Patients were selected when wedge or segmental resections were not technically feasible, such that lobectomy or completion pneumonectomy would have been required or pulmonary function studies were poor. Doses ranged from 8,000 cGy at the periphery to 20,000 cGy at the center. With a minimum 12 month follow-up, mean and median survivals were 16.7 and 15.1 months, respectively. Local control was achieved in 10 of 14 patients (71%) with all local failures occurring in pathologic stage III patients. When separated according to tumor size, local control was obtained in six of seven tumors of less than 3 cm and four of five tumors of 3-5 cm. Both cases with masses greater than 5 cm failed locally. There was one operative mortality and two postoperative complications. All other patients were discharged within one week of surgery. There was no radiation pneumonitis. I125 lung brachytherapy is an excellent alternative treatment for T1 and T2 tumors when medical conditions preclude curative resection.

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Limited Resection of Bronchogenic Carcinoma in the Patient with Marked Impairment of Pulmonary Function

Cited by 157 publications

References 6 publications

Clinical implications of the margin cytology findings and margin/tumor size ratio in patients who underwent pulmonary excision for peripheral non-small cell lung cancer

Clinical implications of the margin cytology findings and margin/tumor size ratio in patients who underwent pulmonary excision for peripheral non-small cell lung cancer

Adjuvant Treatment for Elderly Patients with Early-Stage Lung Cancer Treated with Limited Resection

Iodine¹²⁵ interstitial brachytherapy in the treatment of carcinoma of the lung

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Limited Resection of Bronchogenic Carcinoma in the Patient with Marked Impairment of Pulmonary Function

Cited by 157 publications

References 6 publications

Clinical implications of the margin cytology findings and margin/tumor size ratio in patients who underwent pulmonary excision for peripheral non-small cell lung cancer

Clinical implications of the margin cytology findings and margin/tumor size ratio in patients who underwent pulmonary excision for peripheral non-small cell lung cancer

Adjuvant Treatment for Elderly Patients with Early-Stage Lung Cancer Treated with Limited Resection

Iodine125 interstitial brachytherapy in the treatment of carcinoma of the lung

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Product

Resources

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Iodine¹²⁵ interstitial brachytherapy in the treatment of carcinoma of the lung