Quality of surgical resection for nonsmall cell lung cancer in a US metropolitan area

Abstract

The leader peptide of a recombinant MnSOD (rMnSOD‐Lp) constitutes the carrier that allows rMnSOD to penetrate tumor cells. A synthetic preparation of rMnSOD‐Lp was 68Ga labeled (rMnSOD‐Lp‐68Ga) and injected into animals bearing spontaneous mammary cancers, followed by PET examinations, which demonstrated unambiguously the tumor sites in all the animals, suggesting that if rMnSOD‐Lp was able to transport the radioisotope into tumor cells, it would also be able to deliver cytotoxic molecules. The rMnSOD‐Lp was, therefore, conjugated to cisplatin (rMnSOD‐Lp‐CC) and added to cultured tumor cells. Equal concentrations of cisplatin were used for the tests. After treating the ovarian cancer cells with 11.1 μg of cisplatin alone, analysis by atomic absorbance spectrophotometry was able to detect only 6 ng of platinum, whereas when the same cells were treated with the same amount of cisplatin conjugated to leader peptide rMnSOD, 387 ng of platinum were detected, i.e., an amount 80 times greater. Only the tumor cells died following treatment with rMnSOD‐Lp‐CC; molecular analysis revealed that its addition generated an increasing expression of Erk‐2 and Bax products, which could be inhibited only by a selective MAP/ERK kinase inhibitor (PD98059), revealing that rMnSOD‐Lp‐CC has an apoptotic function, exactly as occurs when using the cisplatin alone. Data are statistically significant and indicate that by using rMnSOD‐Lp‐CC, the cisplatin can be transformed from an agent with antireplicative activity into a specific and selective antitumor molecule, increasing its therapeutic index. We think that rMnSOD‐Lp‐CC deserves to be considered as a new antitumor agent.

Decision Making in Lung Cancer – How Applicable are the Guidelines?

“…Allen et al [12] identified measures of good-quality surgery from NCCN guidelines and two surgical studies. Of the 746 patients who underwent surgery in Memphis, USA from 2004 to 2007, only 8.2% were completely concordant with these quality measures.…”

Quality Gaps and Comparative Effectiveness in Lung Cancer Staging and Diagnosis

“…1,3 This problem of underuse of mediastinal lymph node sampling has been described previously. 5,21,22 Studies of patients undergoing surgery for lung cancer have shown a low rate of mediastinal lymph node biopsy. 5,22 Although there are fewer data on TBNA and EBUS underuse, surveys of pulmonologists and pulmonary fellows have shown that bronchoscopy training varies signifi cantly, and presumably, practice patterns vary accordingly.…”

Improved lymph node staging in early-stage lung cancer in the national cancer database: commentary

“…While, the CoC recommends that at least 10 LNs should be removed and pathologically reviewed, the European Society of Thoracic Surgeons suggests a complete mediastinal dissection of all LN stations with additional guidelines on the pathological dissection of specimens. However, these guidelines are poorly adhered to and do not necessarily reflect applicability in broader clinical practice (14). Recently, as aforementioned, a notable increase has been detected in the number of LNs assessed for clinical stage I lung cancer, and these developments have been observed across all hospital types, possibly because the impact of the z0030 trial might have been large enough to emphasize the importance of nodal assessment more broadly.…”