Lung cancer staging

Fig. 3. Patient with lung cancer Staging with C F]-FLT-PET versus C F]-FDG-PET.

Groen et al. 2004 Non-small cell lung cancer stage IIIA/B Conventional fractionation 60 Gy vs. 60 Gy plus carboplatin 2-Year local control rate 38 vs. 72%... 

ZiMMERMANN et al. 2005 Non-small cell lung cancer stage I Hypofractionated stereotactic radiotherapy 2-Year-freedom-from-local-recurrence rate 87% 2-Year disease-free survival 72%... 

XiA et al. 2006 Non-small cell lung cancer stage I/II Hypofractionated stereotactic radiotherapy 3-Year local control rate 95% 3-Year overall survival 78%... 

Stathopoulos GP, Dafn i UG, Malamos NA, Rigatos S, Kouvat-seas G, Moschopoulos N (1999) Induction chemotherapy in non small cell lung cancer stage Illa-b and IV and second-line treatment. Anticancer Res 19(4C) 3543-3548 Stehlin JS (1969) Hyperthermic perfusion with chemotherapy for cancers of the extremities. Surg Gynecol Obstet 129 305-308... 

Scitovsky et al. (1986) calculated the average cost per AIDS-related hospital admission as US 9,024 ranging from US 7,026 to US 23,425. A more comprehensive picture is presented by Scitovsky and Rice (1987), who estimated provider cost of the AIDS epidemic in the United States in 1985, 1986, and 1991, based on prevalence estimates provided by the Center for Disease Control (CDC). They predicted that the core provider costs of AIDS would rise from US 630 million in 1985 to US 1.1 billion in 1986 and to US 8.5 billion in 1991. The authors compared their estimates of the cost of AIDS in the USA with the estimates for end-stage renal disease (US 2.2 billion), traffic accidents (US 5.6 billion), lung cancer (US 2.7 billion), and breast cancer (US 2.2 billion). They concluded that the core provider costs of AIDS were relatively low in comparison with the provider costs of all illness as well as the costs of these other diseases. However, they also assessed the non-care costs (e.g., for research) to rise from US 319 million in 1985 to US 542 million in 1986 and to US 2.3 billion in 1991. 

Understand staging of lung cancer patients and how it influences treatment decisions. 

Surgical resection of the tumor is the mainstay of treatment in early-stage non-small cell lung cancer and produces the longest survival rates. 

The treatment goals in lung cancer are cure (early-stage disease), prolongation of survival, and maintenance or improvement of quality of life through alleviation of symptoms. 

The most commonly used system of staging SCLC was developed originally by the Veterans Administration Lung Cancer Study Group. This system categorizes SCLC into two classifications limited and extensive disease.16... 

The first step in treatment of NSCLC involves confirmation of the clinical stage and determination of resectability of the tumor. This decision always should be made by a thoracic surgeon who routinely performs lung cancer surgery. Treatment options depend on the advancement of disease (i.e., local, locally advanced, or metastatic). 

LP is a 58-year-old man with newly diagnosed stage IIIA non-small cell lung cancer who presents to the clinic complaining of loss of appetite, excess thirst, nausea and vomiting, and confusion x 2 days. The medication history lists NKDA, hydrochlorothiazide 50 mg by mouth daily for hypertension, and naproxen 500 mg by mouth twice daily for arthritis. 

The World Health Organization has established a TNM staging classification for lung cancer based on the primary tumor size and extent (T), regional lymph node involvement (N), and the presence or absence of distant metastases (M). 

The above data are based on the review of studies reported by Xin et al.29 Note that ECT was conducted on patients who were either in advanced stages of lung cancer and/or had failed radiotherapy and/or chemotherapy. 

Takeda et al. (64) performed a phase I/II study consisting of low-dose CDDP (6-10 mg/m2/d) and UFT (600 mg/d) combined with radiotherapy (50 Gy/25 fractions) as postoperative adjuvant therapy following curative resection for patients with nonsmallcell lung cancer (NSCLC). The combined therapy was well tolerated and resulted in a disease-free survival rate of 78% at 2 yr. Another study in a small number of patients with unresectable stage III nonsmall-cell lung cancer, UFT (400 mg/m2 on d 1-52) and CDDP (80 mg/m2 on d 8,29, and 50) were administered with radiation therapy (total dose of 60.8 Gy in 38 fractions on d 1-52). Among 17 evaluable patients, 94% (16 patients) achieved partial responses with median time to tumor progression of 30 wk, and the... 

The earliest combination chemotherapy and radiation trials in nonsmall-cell lung cancer included cisplatin and 5-fluorouracil and concurrent radiation therapy and found survival results comparable to those for sequential chemotherapy and radiation or to daily cisplatin and radiation therapy without surgery (119,121). Phase II studies of stage Ilia and Illb nonsmall-cell lung cancer patients treated with the combination of cisplatin with etoposide and 5 -fluorouracil and either single daily radiation fractionation or twice daily radiation fractionation prior to surgery produced similar clinical results (119,121). Complete surgical resection was accomplished in 70% of the patients, the median survival was 22 mo and the 2-yr survival rate was 45%. 

Bonomi P. Treatment of stage III non-small cell lung cancer with thoracic radiation therapy and simultaneous platinum chemotherapy. Semin Oncol 1994 21(Suppl 6) 101-108. 

Weiden PL, Piantodosi S. Preoperative chemotherapy cisplatin and fluorouracil and radiation therapy in stage III non-small cell lung cancer A phase II study of the Lung Cancer Study Group. JNatl Cancer Oust 1991 83 266-272. 

Rusch VW, Albain KS, Crowley J J, et al. Surgical resection of stage Ilia and stage Illb non-small cell lung cancer after concurrent induction chemoradiotherapy. J Thoracic Cardiovasc Surg 1993 105 97-106. 

Trovo MG, Minotel E, Fravelun G, et al. Radiotherapy versus radiotherapy enhanced by cisplatin in stage III non-small cell lung cancer. Int J Radiat Oncol Biol Phys 1992 24 11-16. 

Ravasl G, Bodini AV, Milani F, et al. Continuous infusion of cisplatin and concurrent radiotherapy in non-resectable stage III lung cancer. Lung Cancer 1991 7 164. 

Belani CP, Slawson R, Van Echo D, et al. Concurrent carboplatin and radiotherapy for unresectable stage III non-small cell lung cancer. Lung Cancer 1991 7 159. 

There is certainly less data available on the role of concurrent docetaxel with radiation in the treatment of locally advanced nonsmall-cell lung cancer. Koukourakis et al. (66) have reported on their phase I/II experience of administering radiation concurrently with docetaxel for stage IIIB NSCLC. In the phase II portion of their study, 30 mg/m2 of docetaxel was given weekly with concurrent 64 Gy of thoracic radiation. Esophagitis was the main side effect of the regimen wherein 17% of patients needed a two-week treatment delay and another 31 % of patients required minor delays (3-7 d). Thirty-five patients were enrolled and evaluable, and the overall response rate was 80% (34% CR). The median survival was 12 mo, and 1-yr survival rate was reported as being 48%. 

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