Optimal distance of malignant negative margin in excision of nonsmall cell lung cancer: a multicenter prospective study

Sawabata, Noriyoshi; Ohta, Mitsunori; Matsumura, Akira; Nakagawa, Katsuhiro; Honda, Hiroshi; Maeda, Hitoshi; Matsuda, Hikaru

doi:10.1016/s0003-4975(03)01511-x

Cited by 217 publications

(132 citation statements)

References 18 publications

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“…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. 31 Because the elderly have a high prevalence of COPD, pulmonologists were reluctant to perform invasive staging procedures.…”

Section: Discussionsupporting

confidence: 76%

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

Haasbeek

Lagerwaard

Antonisse

et al. 2009

Cancer

163

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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: Discussionsupporting

confidence: 76%

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

Haasbeek

Lagerwaard

Antonisse

et al. 2009

Cancer

163

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“…Resection margin distance is also an important factor for locoregional recurrence after sublobar resection (22). According to NCCN guidelines, segmentectomy and wedge resection should achieve parenchymal resection margin width greater or equal to the nodule size.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for recurrence after sublobar resection in patients with small (2 cm or less) non-small cell lung cancer presenting as a solid-predominant tumor on chest computed tomography

et al. 2016

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Background: Sublobar resection is considered controversial for non-small cell lung cancer (NSCLC) presenting as a solid-predominant nodule. The aim of this study was to identify risk factors related to recurrence in small-sized NSCLC presenting as a solid-predominant nodule. Methods: We conducted a retrospective chart review of 118 patients who were treated for clinical N0 NSCLC sized ≤2 cm and who underwent sublobar resection with clear resection margins. We assigned them to two groups according to radiologic features: ground glass opacity (GGO)-predominant tumor and solidpredominant tumor. Clinicopathological characteristics and survival were analyzed in both groups. Risk factors for recurrence were analyzed in the solid-predominant tumor group. Results: Seventy-three patients had a GGO-predominant tumor, and 45 patients had a solid-predominant tumor. Five-year recurrence-free survival (RFS) in the solid-predominant tumor and GGO-predominant tumor groups was 64.9% and 95.5%, respectively. A multivariate analysis was performed to determine factors associated with recurrence after sublobar resection in the solid-predominant tumor group; it indicated that SUVmax [hazard ratio (HR) =1.482, 95% confidence interval (CI): 1.123-1.956, P=0.005] and histologic types other than adenocarcinoma (squamous cell carcinoma, HR =8.789, 95% CI: 1.572-49.134, P=0.013; other types, HR =53.569, 95% CI: 2.616-1096.849, P=0.010) were significant risk factors for recurrence.Conclusions: Risk factors in solid-predominant tumors sized ≤2 cm after sublobar resection are a high SUVmax and histologic types other than adenocarcinoma. Thus, lobectomy should be considered for solidpredominant NSCLC sized ≤2 cm with a high SUVmax or non-adenocarcinoma types.

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“…To evaluate the potential impact of this possible confounder, we performed a sensitivity analysis testing whether differences in the rate of positive margins across treatment groups could explain the observed association of postoperative treatments with survival (20). To conduct this analysis, we used published data on the prevalence of positive margins in patients with early-stage disease treated with limited resection and the relative increase in the hazard of death among patients with positive margins, to assess the robustness of our findings across different scenarios (21)(22)(23).…”

Section: Discussionmentioning

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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Optimal distance of malignant negative margin in excision of nonsmall cell lung cancer: a multicenter prospective study

Cited by 217 publications

References 18 publications

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

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

Risk factors for recurrence after sublobar resection in patients with small (2 cm or less) non-small cell lung cancer presenting as a solid-predominant tumor on chest computed tomography

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

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