A nice pro/con soundoff between Gerard Silvestri (con) and James Jett & David Midthun (pro) over whether lung cancer screening with chest CT should be national policy, in the wake of the positive findings of the National Lung Screening Trial. Silvestri (of MUSC) argues that we don’t have a handle on the harms of screening [… read more]
25% of smokers undergoing chest CT have incidentally discovered pulmonary nodules. As questions of national policy re: lung cancer screening with chest CT are considered, Soylemez Wiener et al report the complication rates of 15,865 adults who had transthoracic needle biopsy of a pulmonary nodule in 4 states over the past decade, using a database [… read more]
Resection of isolated pulmonary metastasis resulted in surprising longevity in this study by Hornbech et al. They report a series of 248 patients, 97% of whom had a complete resection of their pulmonary metastasis, following them for an average of 5 years. The five year survival rates after pulmonary metastasectomy were as follows: Colorectal cancer: [… read more]
The elderly have been largely excluded from clinical trials on non-small cell lung cancer (NSCLC), as their surgical risks have been perceived as too high to benefit as a group from lung resection. Many people believe that in practice, elderly people with NSCLC have often been excluded from consideration for lung resection solely based on [… read more]
Smoking cessation counseling may feel like a waste of the time and effort required, since most smokers don’t quit. But evidence shows that even the <10% success rate of smoking cessation counseling saves millions of lives, compared to doing nothing. According to a recent smoking cessation review in the NEJM: Even those not ready to quit do 8% of the time [… read more]
So you’ve referred your patient with stage III non-small cell lung cancer (N2 or N3 mediastinal nodes) to receive neoadjuvant chemoradiation therapy in the hopes of eliminating cancer from the mediastinal nodes, “downstaging” her to a resectable N0 status. How do you re-evaluate the lymph nodes to ensure resection may be curative? von Bartheld et [… read more]
Deppen et al report that PET-CT’s specificity for lung cancer was only 40% among 211 patients undergoing resection for presumed lung cancer at Vanderbilt in Nashville, TN, an area endemic for histoplasmosis. Twenty-two of 43 benign nodules were granulomas; most were positive on PET-CT (~60%). Ann Thorac Surg 2011;92:428-433.
37 Canadian oncologists got together in a consensus panel to talk about biomarkers and histologic subtypes of non-small cell lung cancer. The take-home: All NSCLC should be tested for the EGFR mutation, as tyrosine kinase inhibitors can prolong survival for eligible patients. There is insufficient evidence to recommend routine testing for other mutations (KRAS, p53, [… read more]
In 161 patients with known extrathoracic malignancy and enlarged hilar/mediastinal lymph nodes, endobronchial ultrasound FNA was very helpful at identifying metastasis to the chest. EBUS found lymph node mets in 44% of the patients and a new lung cancer in 12%. Sarcoidosis was discovered in 9%. Neal et al followed-up these 161 patients for 6 months [… read more]
Annual Review of Advances in Non-small Cell Lung Cancer Research: A Report for the Year 2010 Stinchcombe, Thomas E. et al. Journal of Thoracic Oncology. 6(8):1443-1450, August 2011.
Sun et al pooled 21 studies (n=3,266) over 20 years. Autofluorescence added to traditional white light bronchoscopy appeared to possibly improve the sensitivity of detecting intraepithelial neoplasia, but not invasive lung cancer. J Thorac Oncol 2011;6(8):1336-1344. Review.
Wisnivesky et al crunched through the SEER data on 3,399 people who underwent resection for N1 non-small cell lung cancer. They found that the number of cancerous lymph nodes predicted survival: 1 positive N1 lymph node: 8.8 years mean lung cancer-specific survival 2-3 positive N1 lymph nodes: 8.2 years 4-8 positive N1 lymph nodes: 6.0 [… read more]
Darling et al report findings from the Early Lung PET trial for non-small cell lung cancer. PET-CT had 70% sensitivity and 94% specificity for identifying cancerous mediastinal lymph nodes (with invasive staging as the reference standard). Sounds good. However, among the 22 patients with PET-CT scans positive for mediastinal nodes, 8 did not have cancer [… read more]
Anraku et al report a series of 40 patients previously treated for lung cancer who underwent endobronchial ultrasound guided transbronchial needle aspiration for new mediastinal or hilar abnormalities between 2008-2010 at University of Toronto. After EBUS-TBNA of mediastinal/hilar lymph nodes, 28 of 40 were found to have lung cancer. In 21, an identical cell type [… read more]
Diseases of the pleura (edited by Richard Light), and neoplasms of the lung (edited by Alan Fein and David Ost). 80 pages. Curr Opin Pulm Med 2011;17(4):215-295.
Schuchert et al looked back at 107 patients with stage IA subcentimeter non-small cell lung cancer, and found that 5-year survival was similar (~88%) for those undergoing wedge resection (n=35), segmentectomy (n=40), or lobectomy (n=32). Ann Thorac Surg 2011;91:1681-1688.
van der Aalst et al report that in the Dutch lung cancer screening NELSON trial, smokers with 1 or more indeterminate CT scans continued to smoke at the same rate as those with normal CT scans (reported by questionnaire 2 years later). Those with the abnormal CTs did report more attempts at smoking cessation, though. [… read more]
Complete mediastinal lymph node dissection (MLND) is recommended during all surgical reactions of lung cancer — yet “complete” has never been defined, and in a community study, 43% of patients got no MLND. In prospective randomized clinical trial data on 524 patients, Darling et al found that 99% of patients had at least 6 LNs removed, and 90% had 10 [… read more]
Lung cancer diagnosis and treatment: summary of updated NICE guidance. Baldwin DR et al, BMJ 2011;342:d2110. Lung cancer review.
Lung cancer in COPD: enhancing surgical options and outcomes, Raviv S et al, AJRCCM 2011;183:1138-1146.