Prognostic Significance of Subcarinal Station in Non-Small Cell Lung Cancer with T1 - 3 N2 Disease

Iwasaki, Atsushi; Shirakusa, T; Miyoshi, Tatsu; Hamada, Tamami; Enatsu, S.; Maekawa, Shigeto; Hiratsuka, Makiko

doi:10.1055/s-2005-865828

Cited by 11 publications

(8 citation statements)

References 14 publications

(15 reference statements)

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“…However, advanced nodal disease was found to be a worse prognostic factor for progression in our series. This is consistent with published literature demonstrating poor prognostic association between mediastinal nodal involvement and disease progression in patients with Stage IIIA disease [24]. In our series age was also a worse prognostic outcome of both regional control and progression free survival.…”

Section: Discussionsupporting

confidence: 93%

Dose escalation with stereotactic body radiation therapy boost for locally advanced non small cell lung cancer

et al. 2013

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IntroductionLow survival outcomes have been reported for the treatment of locally advanced non small cell lung cancer (LA-NSCLC) with the standard of care treatment of concurrent chemoradiation (cCRT). We present our experience of dose escalation using stereotactic body radiosurgery (SBRT) following conventional cCRT for patients with LA-NSCLC.MethodsSixteen patients with a median age of 67.5 treated with fractionated SBRT from 2010 to 2012 were retrospectively analyzed. Nine (56%) of the patients had stage IIIB, 6 (38%) has stage IIIA, and 1 (6%) had recurrent disease. Majority of the patients (63%) presented with N2 disease. All patients had a PET CT for treatment planning. Patients received conventional cCRT to a median dose of 50.40 Gy (range 45–60) followed by an SBRT boost with an average dose of 25 Gy (range 20–30) given over 5 fractions.ResultsWith a median follow-up of 14 months (range, 1–14 months), 1-year overall survival (OS), progression free survival (PFS), local control (LC), regional control (RC), and distant control (DC) rates were, 78%, 42%, 76%, 79%, and 71%, respectively. Median times to disease progression and regional failure were 10 months and 18 months, respectively. On univariate analysis, advanced age and nodal status were worse prognostic factors of PFS (p < 0.05). Four patients developed radiation pneumonitis and one developed hemoptysis. Treatment was interrupted in one patient who required hospitalization due to arrhythmias and pneumonia.ConclusionRisk adaptive dose escalation with SBRT following external beam radiotherapy is possible and generally tolerated treatment option for patients with LA-NSCLC.

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Section: Discussionsupporting

confidence: 93%

Dose escalation with stereotactic body radiation therapy boost for locally advanced non small cell lung cancer

et al. 2013

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“…R1,2 21,24,25,27-32,34 -36 ; multi, all patients 24,25,27,29 -32,34,35 ; R0 resections 42,46,90 -95 ; T3, all patients 21,24,25,27,29,30,34 -36,48 ; R0 resections 42,46,54,96 ; cN2, all patients 24,25,27,29,34 -36,55 ; R0 resections 25,46 ; station 7, all patients 25,27,28,30,32,33,41 ; R0 resections. 90,93,95 B, Positive prognostic factors for patients with pN2 NSCLC. Inclusion criteria: studies of Ն90 pN2 patients reporting survival by prognostic factor.…”

Section: Specific Situationsmentioning

confidence: 99%

What to do with “Surprise” N2?: Intraoperative Management of Patients with Non-small Cell Lung Cancer

Detterbeck

2008

Journal of Thoracic Oncology

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There is debate about how patients should be managed when malignant involvement of mediastinal lymph nodes is encountered at the time of lung resection. A comprehensive review of the literature demonstrates that differences in which outcomes are reported and how extensively patients were staged preoperatively explain much of the conflicting data. Certain negative and positive prognostic factors can be defined, but in general the outcomes justify proceeding with resection unless it is clear that disease will be left behind. Reasonable arguments can be made that the approach should include a mediastinal lymph node dissection and adjuvant therapy.

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“…Lower lobe tumors have the tendency to spread more frequently than upper lobe tumors to the subcarinal station, the passage of the hilar lymph nodes that connects with the contralateral nodes [ 19 ]. Hence, contralateral mediastinal drainage from the non-upper tumors may be more common, leading to unfavorable prognoses [ 20 ]. Moreover, left lung tumors spread to both the contralateral and ipsilateral lymph nodes with the same frequency [ 21 ], and the rate of occult metastasis to the right upper mediastinal nodes in left-sided NSCLC reached 72.7% [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Resectable left lower lobe non–small cell lung cancer with lymph node metastasis is related to unfavorable outcomes

Xie

Yang

et al. 2016

Chin J Cancer

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Background Despite numerous previous studies, the consideration of tumor location as a prognostic factor in resectable non–small cell lung cancer (NSCLC) remains controversial. The present study analyzed the association between tumor location and clinical outcome in patients with resectable NSCLC who had undergone lobectomy with systematic lymphadenectomy and who had presented with varying nodal statuses.MethodsThe data from a cohort of 627 eligible patients treated in Sun Yat-sen University Cancer Center between January 2000 and December 2008 were retrospectively collected, and the nodal statuses of patients with different tumor locations were compared. Cox proportional hazards regression model was used to determine the independent factors related to cancer-specific survival (CSS).Results Multivariate analysis demonstrated that left lower lobe (LLL) tumors [hazard ratio (HR): 1.465, 95% confidence interval (CI) 1.090–1.969, P = 0.011], lymph node metastasis (HR: 2.742, 95% CI 2.145–3.507, P < 0.001), and a tumor size of >4 cm (HR: 1.474, 95% CI 1.151–1.888, P = 0.002) were three independent prognosticators in patients with resectable NSCLC. However, LLL tumors were associated only with CSS in node-positive patients (HR: 1.528, 95% CI 1.015–2.301, P = 0.042), and a tumor size of >4 cm was the only independent risk predictor in the node-negative subgroup (HR: 1.889, 95% CI 1.324–2.696, P < 0.001).ConclusionsTumor location is related to the long-term CSS of NSCLC patients with lymph node metastasis. LLL tumors may be upstaged in node-positive patients to facilitate an optimal treatment strategy.

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Prognostic Significance of Subcarinal Station in Non-Small Cell Lung Cancer with T1 - 3 N2 Disease

Abstract: Surgery for patients with T1-3 N2 NSCLC might be acceptable if subcarinal lymph node metastasis is predicted to be absent.

Cited by 11 publications

References 14 publications

Dose escalation with stereotactic body radiation therapy boost for locally advanced non small cell lung cancer

Dose escalation with stereotactic body radiation therapy boost for locally advanced non small cell lung cancer

What to do with “Surprise” N2?: Intraoperative Management of Patients with Non-small Cell Lung Cancer

Resectable left lower lobe non–small cell lung cancer with lymph node metastasis is related to unfavorable outcomes

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