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Clinical Lung Cancer May 2018Stereotactic ablative body radiotherapy (SABR) is popular because of the high rates of local control with low toxicity seen in lung cancer patients. In this study we... (Comparative Study)
Comparative Study Meta-Analysis
Comparing the Outcomes of Stereotactic Ablative Radiotherapy and Non-Stereotactic Ablative Radiotherapy Definitive Radiotherapy Approaches to Thoracic Malignancy: A Systematic Review and Meta-Analysis.
Stereotactic ablative body radiotherapy (SABR) is popular because of the high rates of local control with low toxicity seen in lung cancer patients. In this study we compared clinically significant toxicity and overall survival for SABR and non-SABR definitive radiotherapy (conformal radiotherapy) patients. A PUBMED search of all human, English language articles on SABR and non-SABR radically treated early stage lung cancer patients was performed until June 2016. Results of these searches were filtered in accordance with a set of eligibility criteria and analyzed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eighty-seven SABR and 25 non-SABR articles were reviewed. There was no significant difference in pneumonitis rates between patients receiving SABR (11.4%; 95% confidence interval [CI], 9.7-13.3) and non-SABR treatment (14.4%; 95% CI, 10.6-18.8; P = .20). Esophagitis was the most common mediastinal toxicity reported with 15% of all non-SABR patients versus 1% of all SABR patients reporting developing Grade ≥2 toxicity. The proportion of patient surviving at 2 and 3 years was superior for SABR patients (P < .001). Treatment-related deaths were rare (approximately 1% for both treatments). Both radiotherapy approaches had low rates of pneumonitis, mediastinal toxicity, and treatment-related deaths. However, significant heterogeneity in the patient population and study regimens limit the power of direct comparison, showing that further high-quality studies are required to define the role of SABR in higher risk and operable patients.
Topics: Aged; Aged, 80 and over; Female; Humans; Lung Neoplasms; Male; Middle Aged; Radiosurgery; Radiotherapy, Conformal; Treatment Outcome
PubMed: 29370978
DOI: 10.1016/j.cllc.2017.11.006 -
Annals of Nuclear Medicine Jul 2012To systematically review published data on the role of positron emission tomography (PET) or PET/computed tomography (PET/CT) using either Carbon-11 ((11)C) or... (Review)
Review
To systematically review published data on the role of positron emission tomography (PET) or PET/computed tomography (PET/CT) using either Carbon-11 ((11)C) or Fluorine-18 ((18)F) choline tracer in tumors other than prostatic cancer. A comprehensive literature search of studies published in PubMed/MEDLINE and Embase databases through January 2012 and regarding (11)C-choline or (18)F-choline PET or PET/CT in patients with tumors other than prostatic cancer was carried out. Fifty-two studies comprising 1800 patients were included and discussed. Brain tumors were evaluated in 15 articles, head and neck tumors in 6, thoracic tumors (including lung and mediastinal neoplasms) in 14, liver tumors (including hepatocellular carcinoma) in 5, gynecologic malignancies (including breast tumors) in 5, bladder and upper urinary tract tumors in 5, and musculoskeletal tumors in 7. Radiolabeled choline PET or PET/CT is useful to differentiate high-grade from low-grade gliomas and malignant from benign brain lesions, to early detect brain tumor recurrences and to guide the stereotactic biopsy sampling. The diagnostic accuracy of radiolabeled choline PET is superior compared to Fluorine-18 fluorodeoxyglucose ((18)F-FDG) PET in this setting. Radiolabeled choline PET or PET/CT seems to be accurate in differential diagnosis between malignant and benign thoracic lesions and in staging lung tumors; nevertheless, a superiority of radiolabeled choline compared to (18)F-FDG has not been demonstrated in this setting, except for the detection of brain metastases. Few but significant studies on radiolabeled choline PET and PET/CT in patients with hepatocellular carcinoma (HCC) and musculoskeletal tumors are reported in the literature. The combination of radiolabeled choline and (18)F-FDG PET increases the detection rate of HCC. The diagnostic accuracy of radiolabeled choline PET or PET/CT seems to be superior compared to (18)F-FDG PET or PET/CT and conventional imaging methods in patients with bone and soft tissue tumors. Limited experience exists about the role of radiolabeled choline PET and PET/CT in patients with head and neck tumors, bladder cancer and gynecologic malignancies including breast cancer.
Topics: Carbon Radioisotopes; Choline; Fluorine Radioisotopes; Humans; Neoplasms; Positron-Emission Tomography
PubMed: 22566040
DOI: 10.1007/s12149-012-0602-7 -
Urology Journal Apr 2015There are many recent observational studies on testicular microlithiasis (TM) and risk of testicular cancer. Whether TM increases the risk of testicular cancer is still... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
There are many recent observational studies on testicular microlithiasis (TM) and risk of testicular cancer. Whether TM increases the risk of testicular cancer is still inconclusive. The objective of this updated meta-analysis was to synthesize evidence from clinical observational studies that evaluated the association between TM and testicular cancer.
MATERIALS AND METHODS
We identified eligible studies by searching the PubMed, Embase and Cochrane Library before March 2014. Adjusted relative risks (RR) with 95% confidence interval (CI) were calculated using random-or fixed-model.
RESULTS
A total of 14 studies involving 35,578 participants were included in the meta-analysis. On the basis of the Newcastle Ottawa Scale systematic review, eleven studies were identified as relatively high-quality. TM was strong association with an increased incidence of testicular cancer (RR = 12.70, 95% CI: 8.18-19.71, P < .001), with significant evidence of heterogeneity among these studies (P for heterogeneity < .001, I2 = 82.1%). The subgroup and sensitivity analysis confirmed the stability of the results and no publication bias was detected.
CONCLUSION
The present meta-analysis suggests that TM is significantly associated with risk of testicular cancer. More researches are warranted to clarify an understanding of the association between TM and risk of testicular cancer.
Topics: Calculi; Global Health; Humans; Incidence; Male; Neoplasms, Germ Cell and Embryonal; Risk Factors; Testicular Diseases; Testicular Neoplasms
PubMed: 25923148
DOI: No ID Found -
Nuklearmedizin. Nuclear Medicine 2009Currently, the German and Austrian S3 guidelines on the evaluation and treatment of lung cancer are about to be published whereas the American Colleague of Chest... (Review)
Review
AIM
Currently, the German and Austrian S3 guidelines on the evaluation and treatment of lung cancer are about to be published whereas the American Colleague of Chest Physicians (ACCP) guidelines were already presented in 2007. An important part of the diagnostic workup of lung cancer will be the evaluation of indeterminate lung lesions and the mediastinal and extrathoracic staging using FDG-PET or PET/CT. The results from the literature on FDG-PET and PET/CT as well as on conventional nuclear medicine staging procedures and the clinical implications are presented.
METHODS
The literature data was amassed in analogy to the meta-analyses drawn for the current ACCP guidelines. In addition, relevant more recent publications were also considered. To answer the important question for the extent of pathological confirmation needed, the residual risk of mediastinal metastases was calculated for certain constellations of FDG-PET and CT findings. Suggested recommendations were characterized with the level of evidence.
RESULTS
FDG-PET (PET/CT) allows the differentiation of indeterminate lung lesions with high accuracy. FDG-PET (PET/CT) is the most accurate non-invasive procedure to assess the mediastinal nodal stage, for non-small cell as well as for small cell lung cancer. It is justified to omit invasive evaluation of enlarged but FDG-PET negative lymph nodes under certain circumstances. Unexpected extrathoracic metastases detected by FDG-PET imply important changes in therapeutic management.
CONCLUSION
The upcoming S3 guideline on lung cancer will recommend FDG-PET in several indications due to its clinical efficacy well proven by data from literature (high level of evidence). The selected use of conventional nuclear medicine procedures remains beyond doubt. FDG-PET (PET/CT) belongs to the standard of care in lung cancer.
Topics: Carcinoma, Small Cell; Fluorodeoxyglucose F18; Humans; Lung Neoplasms; Lymph Nodes; Lymphatic Metastasis; Neoplasm Staging; Positron-Emission Tomography; Prevalence; Tomography, X-Ray Computed
PubMed: 19333516
DOI: No ID Found -
Annals of Surgical Oncology Feb 2013Resection of lung metastases (LM) from colorectal cancer (CRC) is increasingly performed with a curative intent. It is currently not possible to identify those CRC... (Review)
Review
BACKGROUND
Resection of lung metastases (LM) from colorectal cancer (CRC) is increasingly performed with a curative intent. It is currently not possible to identify those CRC patients who may benefit the most from this surgical strategy. The aim of this study was to perform a systematic review of risk factors for survival after lung metastasectomy for CRC.
METHODS
We performed a meta-analysis of series published between 2000 and 2011, which focused on surgical management of LM from CRC and included more than 40 patients each. Pooled hazard ratios (HR) were calculated by using random effects model for parameters considered as potential prognostic factors.
RESULTS
Twenty-five studies including a total of 2925 patients were considered in this analysis. Four parameters were associated with poor survival: (1) a short disease-free interval between primary tumor resection and development of LM (HR 1.59, 95 % confidence interval [CI] 1.27-1.98); (2) multiple LM (HR 2.04, 95 % CI 1.72-2.41); (3) positive hilar and/or mediastinal lymph nodes (HR 1.65, 95 % CI 1.35-2.02); and (4) elevated prethoracotomy carcinoembryonic antigen (HR 1.91, 95 % CI 1.57-2.32). By comparison, a history of resected liver metastases (HR 1.22, 95 % CI 0.91-1.64) did not achieve statistical significance.
CONCLUSIONS
Clinical variables associated with prolonged survival after surgery for LM in CRC patients include prolonged disease-free interval between primary tumor and metastatic spread, normal prethoracotomy carcinoembryonic antigen, absence of thoracic node involvement, and a single pulmonary lesion.
Topics: Colorectal Neoplasms; Humans; Lung Neoplasms; Meta-Analysis as Topic; Metastasectomy; Prognosis; Review Literature as Topic; Risk Factors; Survival Rate
PubMed: 23104709
DOI: 10.1245/s10434-012-2726-3 -
Acta Oncologica (Stockholm, Sweden) 2001A systematic review of chemotherapy trials in several tumour types was performed by The Swedish Council of Technology Assessment in Health Care (SBU). The procedures for... (Review)
Review
A systematic review of chemotherapy trials in several tumour types was performed by The Swedish Council of Technology Assessment in Health Care (SBU). The procedures for the evaluation of the scientific literature are described separately (Acta Oncol 2001; 40: 155-65). This synthesis of the literature on chemotherapy for Hodgkin's disease (HD) is based on 113 scientific reports including four meta-analyses, 44 randomised studies, 18 prospective studies and 40 retrospective studies. These studies involve 69,196 patients. The conclusions reached can be summarised into the following points: Chemotherapy is of utmost importance for the cure of HD. At early stages, extended field radiotherapy cures most patients. For the majority of patients with relapse after radiotherapy, chemotherapy is curative and the total proportion of cured early stage patients is 75-90%. Chemotherapy in addition to extended field radiotherapy reduces recurrences but does not improve long-term survival. In early stage HD with a large mediastinal mass and/or with systemic symptoms, combined treatment with chemotherapy and radiotherapy is recommended. It is likely that chemotherapy will play a greater role in the future in the treatment also of early stage patients in order to reduce late consequences from extended field radiotherapy. However, this conclusion remains to be better documented in the literature. At advanced stages, chemotherapy or a combination of chemotherapy and limited field radiotherapy are effective treatment options and, using the regimens available 10-20 years ago, 40-50% of the patients are cured. Based upon more favourable short-term (three to eight years) results of more recently developed regimens, it can be expected that today a higher proportion of the patients will become long-term survivors. Several chemotherapy regimens containing four to eight drugs are effective in HD. The best regimen considering both antitumour activity and acute and late side-effects is not known. The choice of regimen is probably best done after considering various pre-treatment factors such as the number of poor prognostic signs, concomitant diseases and individual preferences. The results of chemotherapy are more favourable in young than in elderly patients. The development of less toxic but still effective treatment programmes is therefore particularly important for the elderly. High dose chemotherapy with stem cell support is presently often used in patients who are chemotherapy induction failures, who relapse after a short initial remission or after a longer initial remission and treated initially with seven or eight drugs, or who have had multiple relapses. However, this use is based on data from uncontrolled or small controlled studies, not being fully convincing with respect to effect on survival. Persistent side-effects of treatment are common among long-term survivors, although most patients have an apparently normal life. The relative contributions of chemotherapy and radiotherapy to the persistent effects are not well documented.
Topics: Antineoplastic Combined Chemotherapy Protocols; Dose-Response Relationship, Drug; Hematopoietic Stem Cell Transplantation; Hodgkin Disease; Humans; Neoplasm Staging; Prognosis; Radiotherapy, Adjuvant; Survival Analysis
PubMed: 11441931
DOI: 10.1080/02841860151116240 -
European Journal of Surgical Oncology :... Jan 2022Routine lymphadenectomy during metastasectomy for pulmonary metastases of colorectal cancer has been recommended by several recent expert consensus meetings. However,...
BACKGROUND
Routine lymphadenectomy during metastasectomy for pulmonary metastases of colorectal cancer has been recommended by several recent expert consensus meetings. However, evidence supporting lymphadenectomy is limited. The aim of this study was to perform a systematic review of the literature on the impact of simultaneous lymph node metastases on patient survival during metastasectomy for colorectal pulmonary metastases (CRPM).
METHODS
A systematic review was conducted according to the PRISMA guidelines of studies on lymphadenectomy during pulmonary metastasectomy for CRPM. Articles published between 2000 and 2020 were identified from Medline, Embase and the Cochrane Library without language restriction. Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to assess the risk of bias and applicability of included studies. Survival rates were assessed and compared for the presence and level of nodal involvement.
RESULTS
Following review of 8054 studies by paper and abstract, 27 studies comprising 3619 patients were included in the analysis. All patients included in these studies underwent lymphadenectomy during pulmonary metastasectomy for CRPM. A total of 690 patients (19.1%) had simultaneous lymph node metastases. Five-year overall survival for patients with and without lymph node metastases was 18.2% and 51.3%, respectively (p < .001). Median survival for patients with lymph node metastases was 27.9 months compared to 58.9 months in patients without lymph node metastases (p < .001). Five-year overall survival for patients with N1 and N2 lymph node metastases was 40.7% and 10.9%, respectively (p = .064).
CONCLUSION
Simultaneous lymph node metastases of CRPM have a detrimental impact on survival and this is most apparent for mediastinal lymph node metastases. Therefore, lymphadenectomy during pulmonary metastasectomy for CRPM can be advised to obtain important prognostic value.
Topics: Adenocarcinoma; Colorectal Neoplasms; Humans; Lung Neoplasms; Lymph Node Excision; Lymph Nodes; Mediastinum; Metastasectomy; Pneumonectomy; Survival Rate
PubMed: 34656390
DOI: 10.1016/j.ejso.2021.09.020 -
Chest Feb 2007Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) is a minimally invasive alternative technique for mediastinal staging of non-small cell lung cancer. A... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) is a minimally invasive alternative technique for mediastinal staging of non-small cell lung cancer. A metaanalysis was performed to estimate the diagnostic accuracy of EUS-FNA for staging mediastinal lymph nodes (N2/N3 disease) in patients with lung cancer.
METHODS
Relevant studies were identified using Medline (1966 to November 2005), CINAHL, and citation indexing. Included studies used histology or adequate clinical follow-up (> 6 months) as the "gold standard," and provided sufficient data for calculating sensitivity and specificity. Summary receiver operating characteristic curves metaanalysis was performed to estimate the pooled sensitivity and specificity.
RESULTS
In 18 eligible studies, EUS-FNA identified 83% of patients (95% confidence interval [CI], 78 to 87%) with positive mediastinal lymph nodes (pooled sensitivity) and 97% of patients (95% CI, 96 to 98%) with negative mediastinal lymph nodes (pooled specificity). In eight studies that were limited to patients who had abnormal mediastinal lymph nodes seen on CT scans, the sensitivity was 90% (95% CI, 84 to 94%) and the specificity was 97% (95% CI, 95 to 98%). In patients without abnormal mediastinal lymph nodes seen on CT scans (four studies), the pooled sensitivity was 58% (95% CI, 39 to 75%). Minor complications were reported in 10 cases (0.8%). There were no major complications.
CONCLUSIONS
EUS-FNA is a safe modality for the invasive staging of lung cancer that is highly sensitive when used to confirm metastasis to mediastinal lymph nodes seen on CT scans. In addition, among lung cancer patients with normal mediastinal adenopathy seen on CT scans, despite lower sensitivity, it has the potential to prevent unnecessary surgery in a large proportion of cases missed by CT scanning.
Topics: Biopsy, Fine-Needle; Carcinoma, Non-Small-Cell Lung; Endosonography; Humans; Lung Neoplasms; Neoplasm Staging; ROC Curve; Surgery, Computer-Assisted
PubMed: 17296659
DOI: 10.1378/chest.06-1437 -
Journal of the National Cancer Institute Dec 2007Lung cancer is the leading cause of cancer-related death in industrialized countries. The overall mortality rate for lung cancer is high, and early diagnosis provides... (Review)
Review
Lung cancer is the leading cause of cancer-related death in industrialized countries. The overall mortality rate for lung cancer is high, and early diagnosis provides the best chance for survival. Diagnostic tests guide lung cancer management decisions, and clinicians increasingly use diagnostic imaging in an effort to improve the management of patients with lung cancer. This systematic review, an expansion of a health technology assessment conducted in 2001 by the Institute for Clinical and Evaluative Sciences, evaluates the accuracy and utility of 18fluorodeoxyglucose positron emission tomography (PET) in the diagnosis and staging of lung cancer. Through a systematic search of the literature, we identified relevant health technology assessments, randomized trials, and meta-analyses published since the earlier review, including 12 evidence summary reports and 15 prospective studies of the diagnostic accuracy of PET. PET appears to have high sensitivity and reasonable specificity for differentiating benign from malignant lesions as small as 1 cm. PET appears superior to computed tomography imaging for mediastinal staging in non-small cell lung cancer (NSCLC). Randomized trials evaluating the utility of PET in potentially resectable NSCLC report conflicting results in terms of the relative reduction in the number of noncurative thoracotomies. PET has not been studied as extensively in patients with small-cell lung cancer, but the available data show that it has good accuracy in staging extensive- versus limited-stage disease. Although the current evidence is conflicting, PET may improve results of early-stage lung cancer by identifying patients who have evidence of metastatic disease that is beyond the scope of surgical resection and that is not evident by standard preoperative staging procedures. Further trials are necessary to establish the clinical utility of PET as part of the standard preoperative assessment of early-stage lung cancer.
Topics: Carcinoma, Non-Small-Cell Lung; Diagnosis, Differential; Fluorodeoxyglucose F18; Humans; Lung Neoplasms; Lymphatic Metastasis; Mediastinal Neoplasms; Neoplasm Staging; Positron-Emission Tomography; Radiopharmaceuticals; Sensitivity and Specificity; Solitary Pulmonary Nodule; Technology Assessment, Biomedical
PubMed: 18042932
DOI: 10.1093/jnci/djm232 -
Journal of Thoracic Oncology : Official... Mar 2010Many clinicians use restaging after induction therapy as a way to select patients for surgery. (Review)
Review
BACKGROUND
Many clinicians use restaging after induction therapy as a way to select patients for surgery.
METHODS
A systematic review was conducted to define the reliability of restaging tests after induction therapy for stage III(N2) lung cancer, when compared with pathologic findings at surgery.
RESULTS
A complete response at all sites carries a false-negative (FN) rate of 50% for computed tomography and 30% for positron emission tomography. Mediastinal node involvement has FN and false-positive rates of 33% and 33% by computed tomography, and 25% and 33% by positron emission tomography. The FN rate of invasive restaging is 22% by repeat mediastinoscopy, 14% by esophageal ultrasound and needle aspiration in expert hands (reliable results are not yet available for endobronchial ultrasound), and 9% by primary mediastinoscopy done with optimal thoroughness. These results are not significantly affected by the type of induction therapy or the timing of restaging.
CONCLUSION
The ability to identify patients who have achieved mediastinal downstaging other than by a careful primary mediastinoscopy is poor.
Topics: Carcinoma, Non-Small-Cell Lung; Clinical Trials as Topic; Humans; Lung Neoplasms; Mediastinoscopy; Neoplasm Staging; Positron-Emission Tomography; Prognosis; Remission Induction; Survival Rate; Tomography, X-Ray Computed
PubMed: 20186025
DOI: 10.1097/JTO.0b013e3181ce3e5e