Surgery compared to stereotactic body radiation therapy for early-stage non-small cell lung cancer: better, equivalent or worse?

Schil, Paul Van

doi:10.21037/jtd.2017.10.36

Cited by 4 publications

(2 citation statements)

References 18 publications

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“…Therapeutic strategies depend on the subtype of adenocarcinoma classification. Patients with pre/MIA are more amenable to sublobar resection (wedge resection or segmentectomy) to preserve more pulmonary function to be able withstand further pulmonary resection if a second primary lung cancer develops in the future (15,16). However, patients with IA should more preferably undergo lobectomy (17).…”

Section: Introductionmentioning

confidence: 99%

Value of TSCT Features for Differentiating Preinvasive and Minimally Invasive Adenocarcinoma From Invasive Adenocarcinoma Presenting as Subsolid Nodules Smaller Than 3 cm

et al. 2020

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Background: To distinguish preinvasive (adenocarcinoma in situ/atypical adenomatous hyperplasia) and minimally invasive adenocarcinoma (MIA) from invasive adenocarcinoma (IA) appearing as solitary subsolid nodules (SSNs) less than 3 cm based on thin-section computed tomography (TSCT) features to guide therapeutic approaches.Methods: A total of 154 lesions that were histopathologically confirmed to have pre/minimally invasive adenocarcinoma (hereafter pre/ MIA) and IA presenting as part-solid nodules (PSNs) or pure ground-glass nodules (pGGNs) were retrospectively reviewed. The TSCT features, including diameter, area, CT value, shape, air bronchogram, margins, and location, were compared and assessed. Receiver operating characteristic analyses were conducted to determine the cut-off values for the qualitative variables and their diagnostic performances.Results: Of 154 nodules, 89 IA, 53 MIA, eight adenocarcinoma in situ, and four atypical adenomatous hyperplasia lesions were found. Univariate and multivariate logistic regression of the pre/MIA and IA lesions were compared and analyzed among PSNs and pGGNs. Among pGGNs, a significant difference was found in the area (p = 0.004, odds ratio [OR] = 0.124, 95% confidence interval [CI] = 0.300À0.515) between the pre/MIA and IA groups. In PSNs, significant differences were found in the diameter (p = 0.001, OR = 0.171, 95% CI = 0.063À0.467) and CT value (p = 0.001, OR = 0.996, 95% CI = 0.993À0.998) between the pre/MIA and IA groups. According to the corresponding receiver operating characteristic curves, the optimal cut-off tumor area in pGGNs to differentiate pre/MIA from IA was 0.595 cm 2 . A higher CT value of the lesion ( ¡298.500 HU) and a larger diameter (1.450 cm) in PSNs were significantly associated with IA.Conclusion: Imaging features from TSCT contribute to distinguishing pre/MIA from IA in solitary subsolid nodules and may contribute to guide the clinical management of these lesions.Abbreviations: SSN subsolid nodule, PSN part-solid nodule, pGGN pure ground-glass nodule, AIS adenocarcinoma in situ, MIA minimal invasive adenocarcinoma, IA invasive adenocarcinoma, AAH atypical adenomatous hyperplasia, TSCT thin-section computed tomography, HRCT high-resolution computed tomography, CT computed tomography, ROC receiver operating characteristic, HU Hounsfield unit, ROI region of interest, OR odds ratio, 95% CI 95% confidence interval

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Section: Introductionmentioning

confidence: 99%

Value of TSCT Features for Differentiating Preinvasive and Minimally Invasive Adenocarcinoma From Invasive Adenocarcinoma Presenting as Subsolid Nodules Smaller Than 3 cm

et al. 2020

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“…Such a difference affects the treatment strategies and follow-up protocols. Patients with pre-MIA are more suitable for sublobar resection (wedge resection or segmentectomy), which can better preserve pulmonary function to withstand further pulmonary resection if a second primary lung cancer happens in the future (18,19). However, for patients with IA, lobectomy is the preferred treatment (20).…”

Section: Introductionmentioning

confidence: 99%

Association between quantitative spectral CT parameters, Ki-67 expression, and invasiveness in lung adenocarcinoma manifesting as ground-glass nodules

Cao

Wang

et al. 2022

Acta Radiol

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Background Few studies about lung ground-glass nodules (GGNs) have been done using non-enhancement spectral computed tomography (CT) imaging. Purpose To examine the association between spectral CT parameters, Ki-67 expression, and invasiveness in lung adenocarcinoma manifesting as GGNs. Material and Methods Spectral CT parameters were analyzed in 106 patients with lung GGNs. The Ki-67 labeling index (Ki-67 LI) was measured, and patients were divided into low expression and high expression groups according to the number of positive-stained cells (low expression ≤10%; high expression >10%). Spectral CT parameters were compared between low and high expression groups. The correlation between spectral CT parameters and Ki-67 LI was estimated by Spearman correlation analysis. Cases were divided into a preinvasive and minimally invasive adenocarcinoma (MIA) group (atypical adenomatous hyperplasia, adenocarcinoma in situ, and MIA) and invasive adenocarcinoma (IA) group. Spectral CT parameters were compared between the two groups. The diagnostic performance was evaluated using receiver operating characteristic analysis. Results There were significant differences in water concentration of lesions (WCL) and monochromatic CT values between the low and high expression groups. CT 40 keV had the highest correlation coefficient with Ki-67 LI. WCL and monochromatic CT values were significantly higher in the IA group than in the pre/MIA group. The value of area under the curve of CT 40 keV was 0.946 (95% confidence interval=0.905–0.988) for differentiating the two groups; the cutoff was −280.66 Hu. Conclusion Spectral CT is an effective non-invasive method for the prediction of proliferation and invasiveness in lung adenocarcinoma manifesting as GGNs.

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Which patients benefit most from stereotactic body radiotherapy or surgery in medically operable non‐small cell lung cancer? An in‐depth look at patient characteristics on both sides of the debate

Chua

2019

Thoracic Cancer

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The role of stereotactic body radiotherapy (SBRT) in early stage medically operable non‐small cell lung cancer is currently under debate. SBRT's advantage is its ability to provide high radiotherapy doses to a tumor in a short timeframe, without the risk of postoperative complications and mortality. Currently, in part due to limited prospective data comparing both treatments, international guidelines continue to recommend surgical resection as the gold standard for medically operable patients. However, not all patients possess uniform characteristics, and there is some evidence that certain subgroups of patients would benefit more from one form of treatment ‐ SBRT or surgery ‐ than the other. The aim of this review is to provide a brief summary of the evidence comparing SBRT to surgery, followed by a deeper discussion of the subgroups of patients who would benefit most from surgery: those with large tumors, centrally located tumors, increased risk of occult nodal metastases, increased risk of toxicity from radiotherapy and radioresistant histological tumor subtypes. Meanwhile, patients who could benefit most from SBRT might include elderly patients, those with reduced lung function or cardiac comorbidities, those with synchronous lung nodules, and those with specific tumor mutational status. We hope that this review will aid in the clinical decision‐making process regarding patient selection for either treatment.

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Surgery compared to stereotactic body radiation therapy for early-stage non-small cell lung cancer: better, equivalent or worse?

Cited by 4 publications

References 18 publications

Value of TSCT Features for Differentiating Preinvasive and Minimally Invasive Adenocarcinoma From Invasive Adenocarcinoma Presenting as Subsolid Nodules Smaller Than 3 cm

Value of TSCT Features for Differentiating Preinvasive and Minimally Invasive Adenocarcinoma From Invasive Adenocarcinoma Presenting as Subsolid Nodules Smaller Than 3 cm

Association between quantitative spectral CT parameters, Ki-67 expression, and invasiveness in lung adenocarcinoma manifesting as ground-glass nodules

Which patients benefit most from stereotactic body radiotherapy or surgery in medically operable non‐small cell lung cancer? An in‐depth look at patient characteristics on both sides of the debate

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