Literature Review |

Top Ten List in Lung Cancer* FREE TO VIEW

Lary A. Robinson, MD, FCCP
Author and Funding Information

*From the Thoracic Oncology Program, Division of Cardiovascular and Thoracic Surgery, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida College of Medicine, Tampa, FL.

Correspondence to: Lary A. Robinson, MD, FCCP, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL 33612-9497; e-mail: robinson@moffitt.usf.edu

Chest. 2000;118(1):228-229. doi:10.1378/chest.118.1.228
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1. Iribarren C, Tekawa IS, Sidney S, et al. Effect of cigar smoking on the risk of cardiovascular disease, COPD, and cancer in men. N Engl J Med 1999; 340:1773–1780

In a cohort study of 17,774 men, regular cigar smoking was found to increase the risk of coronary artery disease, COPD, cancers of the upper aerodigestive tract, and especially lung cancer (relative risk, 2.14) independent of other risk factors.

2. Johnson B. Second lung cancers in patients after treatment for an initial lung cancer. J Natl Cancer Inst 1998; 90:1335–1345

The risk of developing a second lung cancer in patients who survived resection of a non-small cell lung cancer is approximately 1 to 2% per patient per year. Approximately 50% of these second cancers are resectable. Survivors who continue to smoke have an increased risk of developing a second lung cancer.

3. Henschke CI, McCauley DI, Yankelevitz DF, et al. Early Lung Cancer Action Project: overall design and findings from baseline screening. Lancet 1999; 354:99–105

Smith IE. Screening for lung cancer: time to think positive[ editorial]. Lancet 1999; 354:86–87

In 1,000 smokers, malignant disease was detected in 27 by CT and 7 by chest radiograph. Ninety-six percent of the CT-discovered cancers were resectable, and 85% were stage I. Low-dose CT can greatly improve the likelihood of detection of small noncalcified nodules, and thus of lung cancer at an earlier and potentially curable stage.

4. Lam S, Kennedy T, Unger M, et al. Localization of bronchial intraepithelial neoplastic lesions by fluorescence bronchoscopy. Chest 1998; 113:696–702

In a study of 173 patients, the relative sensitivity of white-light bronchoscopy and fluorescence bronchoscopy compared to white-light bronchoscopy alone was 6.3 for intraepithelial neoplastic lesions and 2.71 when invasive carcinomas were also included.

5. Gupta NC, Graeber GM, Bishop HA. Comparative efficacy of positron emission tomography with fluorodeoxyglucose in evaluation of small (< 1 cm), intermediate (1 to 3 cm), and large (> 3 cm) lymph node lesions. Chest 2000; 117:773–778

In a prospective study of 54 patients with lung cancer, positron emission tomography and chest CT were used to evaluate 168 mediastinal lymph nodes of various sizes in 72 nodal stations. Invasive surgery was then used to document the accuracy of these two tests. Combining the three size groups overall, the sensitivity, specificity, and accuracy of positron emission tomography for staging mediastinal lymph nodes was 96, 93, and 94%, as compared to 68, 65, and 66% with CT.

6. Mountain CF. Revisions of the International System for Staging Lung Cancer. Chest 1997; 111:1710–1717

Based on analysis of a collected database of 5,319 patients treated for primary lung cancer, the International System for Staging Lung Cancer was revised and expanded to more accurately reflect the appropriate treatment options and prognoses of the various subsets.

7. Silvestri GA, Handy J, Lackland D, et al. Specialists achieve better outcomes than generalists for lung cancer surgery. Chest 1998; 114:675–680

The provider-specific demographics of lung cancer surgery of all major resections in South Carolina in a recent 4-year period were examined, specifically comparing mortality by specialty adjusted for case mix. Thoracic surgeons experienced a significantly lower operative mortality for lung resections compared to general surgeons performing the same procedures. The thoracic surgeons’ lower mortality rate difference was even more pronounced in the subsets of older patients and for those with more extreme comorbidities.

8. Pisters KM, Ginsberg RJ, Giroux DJ, et al, and the Bimodality Lung Oncology Team (BLOT). Induction chemotherapy before surgery for early-stage lung cancer: a novel approach. J Thorac Cardiovasc Surg 2000; 119:429–439

This is a prospective phase II trial of preoperative induction chemotherapy using two cycles of paclitaxel and carboplatin followed by resection, with a subsequent three cycles of chemotherapy postoperatively in stages IB, IIA, and IIB non-small cell lung cancer. After induction chemotherapy, 56% of patients had a major objective response. Induction chemotherapy in resectable lung cancer produces a high response rate with acceptable mortality and morbidity rates. Median survival rates have not yet been reached. A randomized trial of this approach is just beginning.

9. Furuse K, Fukuoka M, Kawahara M, et al. Phase III study of concurrent vs sequential thoracic radiotherapy in combination with mitomycin, vindesine, and cisplatin in unresectable stage III nonsmall lung cancer. J Clin Oncol 1999; 17:2692–2699

This is a prospective, randomized trial of 320 patients with unresectable stage III lung cancer who were randomized to concurrent vs sequential treatment arms. In this selected group of patients, the concurrent approach yielded a significantly increased response rate and enhanced median survival duration (16.5 months) when compared with the sequential approach (13.5 months). Myelosuppression was greater among patients in the concurrent arm, but the mortality rate was very low (< 1%) and not significantly different in both groups.

10. Younes RN, Gross JL, Deheinzelin D. Follow-up in lung cancer: how often and for what purpose? Chest 1999; 115:1494–1499

Downey RJ. Follow-up of patients with completely resected lung cancer [editorial]. Chest 1999; 115:1487–1488

This is a retrospective evaluation of 130 patients who underwent a complete resection of non-small cell lung cancer and who were placed into a routine follow-up group or a symptom-driven follow-up group. There was no significant difference in the disease-free interval until the first detection of recurrence. The costs associated with the two groups were significantly different. Routine imaging follow-up is of questionable value. A more cost-effective routine follow-up scheme should be recommended for patients with completely resected lung cancer.




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