The Impact of Margins on Outcomes After Wedge Resection for Stage I Non-Small Cell Lung Cancer

Wolf, Andrea; Swanson, Scott J.; Yip, Rowena; Liu, Bian; Tarras, Elizabeth S.; Yankelevitz, David F.; Henschke, Claudia I.; Taioli, Emanuela; Flores, Raja M.; Investigators, I-Elcap

doi:10.1016/j.athoracsur.2017.04.024

Cited by 64 publications

(53 citation statements)

References 19 publications

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“…Analysis of prior data on sublobar resections from I-ELCAP institutions as well as others found that an increasing distance between the cancer and the margin of the resected specimen was associated with lower risk of recurrence (odds ratio ¼ 0.90; 95% confidence interval: 0.83 -0.98), and with longer lungcancer survival (hazard ratio ¼ 0.94; 95% confidence interval: 0.90 -0.98). 37 A margin size of 9 mm or more was associated with longest recurrence-free interval and a margin size of 11 mm or more was associated with the longest overall survival. To improve the standardization of margin assessment for sublobar resection, the IEL-CART protocol requires a measurement by each surgeon to be made in the operating room, in addition to the measurement routinely performed by pathologists on the surgical specimen.…”

Section: Current Practice For Treatment Of Early Small Nsclcsmentioning

confidence: 88%

Initiative for Early Lung Cancer Research on Treatment: Development of Study Design and Pilot Implementation

Flores¹,

Taioli²,

Yankelevitz³

et al. 2018

Journal of Thoracic Oncology

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Section: Current Practice For Treatment Of Early Small Nsclcsmentioning

confidence: 88%

Initiative for Early Lung Cancer Research on Treatment: Development of Study Design and Pilot Implementation

Flores¹,

Taioli²,

Yankelevitz³

et al. 2018

Journal of Thoracic Oncology

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“…Yet, Mohiuddin et al . reported that in wedge resection for NSCLC, increasing the margin distance ≥15 mm significantly decreased the local recurrence risk, without evidence of additional benefit beyond 15 mm, while Wolf et al . found that a margin distance >11 mm was associated with longest overall survival.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of lung cancer with adjacent lobe invasion in relation to fissure integrity

et al. 2019

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Background: Tumor with adjacent lobe invasion (T-ALI) is an uncommon condition. Controversy still exists regarding the optimal resection of adjacent lobe invasion, and the prognostic value in relation to fissure integrity at the tumor invasion point. The aims of this paper were to evaluate the prognosis of T-ALI with regard to fissure integrity, and type of resection. Methods: This was a retrospective multicenter study which included all consecutive patients with T-ALI undergoing surgical treatment. Based on radiological, intraoperative and histological findings, T-ALI patients were differentiated into two groups based on whether the fissure was complete (T-ALI-A group) or incomplete (T-ALI-D Group) at the level of tumor invasion point. Clinicopathological features and survival of two study groups were analyzed and compared. Results: Study population included 135 patients, of these 98 (72%) were included into T-ALI-A group, and 37 (38%) into T-ALI-D Group. T-ALI-D patients had better overall survival than T-ALI-A patients (63.9 AE 7.0 vs. 48.9 AE 3.9; respectively, P = 0.01) who presented with a higher incidence of lymph node involvement (35% vs. 4%; P = 0.004), and recurrence rate (43% vs. 16%; P = 0.01). At multivariable analysis, T-ALI-D (P = 0.01), pN0 stage (P = 0.0002), and pT≤5 cm (P = 0.0001) were favorable survival prognostic factors. Conclusions: T-ALI-D presented a better prognosis than T-ALI-A while extent of resection had no effect on survival. Thus, in patients with small T-ALI-D and without lymph node involvement, sublobar resection of adjacent lobe rather than lobectomy could be indicated. Key points• The extent of resection of adjacent lobe had no effect on survival while T-ALI-D, pN0 stage, and pT≤5 cm were significant prognostic factors. • In patients with small T-ALI-D and without lymph node involvement, sublobar resection of adjacent lobe could be indicated as an alternative to lobectomy.

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“…72 Even negative margins after wedge resections, if less than a centimeter, are associated with increased LRR and worse OS rates. 73 Sublobar resections are associated with higher rates of positive margins (wedge, 4.0%; segmentectomy, 2.1%; lobectomy, 1.4%; P < .001), inadequate nodal evaluation (fewer than 4 lymph nodes), and decreased median OS (wedge, 67.9 months; segmentectomy, 73.7 months; lobectomy, 94.5 months; P = .0008). 74 Stereotactic body radiotherapy (SBRT) is an alternative treatment option to surgery for patients with stage I NSCLC, especially those who have medical comorbidities that preclude surgery.…”

Section: Non-small Cell Lung Cancermentioning

confidence: 94%

“…A trial in 975 patients who had resectable NSCLC reported that sublobar resection, stage IA or greater, squamous or large‐cell histology, and the presence of lymphovascular invasion were independently associated with higher rates of LRR on multivariate analysis . Even negative margins after wedge resections, if less than a centimeter, are associated with increased LRR and worse OS rates . Sublobar resections are associated with higher rates of positive margins (wedge, 4.0%; segmentectomy, 2.1%; lobectomy, 1.4%; P < .001), inadequate nodal evaluation (fewer than 4 lymph nodes), and decreased median OS (wedge, 67.9 months; segmentectomy, 73.7 months; lobectomy, 94.5 months; P = .0008) …”

Section: Non–small Cell Lung Cancermentioning

confidence: 99%

Local Cancer Recurrence: The Realities, Challenges, and Opportunities for New Therapies

Mahvi

Liu

Grinstaff

et al. 2018

CA A Cancer J Clinicians

247

167

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Locoregional recurrence negatively impacts both long-term survival and quality of life for a number of malignancies. For appropriate-risk patients with an isolated, resectable local recurrence, surgery represents the only potentially curative therapy. However, oncologic outcomes remain inferior for patients with locally recurrent disease even after macroscopically complete resection. Unfortunately, these operations are often extensive with significant perioperative morbidity and mortality. This review highlights selected malignancies (mesothelioma, sarcoma, lung cancer, breast cancer, rectal cancer, peritoneal surface malignancies) in which surgical resection is a key treatment modality and where local recurrence plays a significant role in overall oncologic outcome with regards to survival and quality of life. For each type of cancer, the current, state-of-the-art treatment strategies and their outcomes are assessed. The need for additional therapeutic options is presented given the limitations of the current standard therapies. New and emerging treatment modalities, including polymer films and nanoparticles, are highlighted as potential future solutions for both prevention and treatment of locally recurrent cancers. Finally, we identify additional clinical and research opportunities, and propose future research strategies based on the varying patterns of local recurrence among the different cancers.

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The Impact of Margins on Outcomes After Wedge Resection for Stage I Non-Small Cell Lung Cancer

Cited by 64 publications

References 19 publications

Initiative for Early Lung Cancer Research on Treatment: Development of Study Design and Pilot Implementation

Initiative for Early Lung Cancer Research on Treatment: Development of Study Design and Pilot Implementation

Surgical treatment of lung cancer with adjacent lobe invasion in relation to fissure integrity

Local Cancer Recurrence: The Realities, Challenges, and Opportunities for New Therapies

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