Lung Cancer

Nov 012011
 

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]

Oct 272011
 

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]

Oct 122011
 

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]

Oct 092011
 

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]

Oct 022011
 

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]

Oct 012011
 

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.

Sep 282011
 

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]

Sep 222011
 

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]

Aug 252011
 

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]

Aug 062011
 

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]

Jul 172011
 

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]

May 122011
 

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]