Lymph node dissection, the current standard surgical treatment for localized non-small cell lung cancers, may be unnecessary in certain screen-detected early stage cases , according to a study published in the March issue of the Journal of Thoracic Oncology (JTO), the official journal of the International Association for the Study of Lung Cancer.
The risk of nodal involvement is very low in early-stage cancers with a maximum standard uptake value (maxSUV) of 2.0 or a nodule smaller than 10 millimeters, researchers found.
"As a consequence of advances in diagnostic imaging, such as high-resolution or spiral computed tomography, thoracic surgeons encounter more often than in the past small-sized lung cancers at an earlier and potentially curable stage," said lead researcher Dr. Giulia Veronesi, MD, director of the Lung Cancer Early Detection Unit in the Division of Thoracic Surgery at the European Institute of Oncology in Milan, Italy. "It has thus become increasingly crucial to choose the most advantageous treatment strategy, including surgical intervention."
A total of 5,201 asymptomatic volunteers were recruited for the Continuing Observation of Smoking Subjects (COSMOS) trial in 2004 and 2005. All were 50 years or older, heavy smokers (20 pack years) or former heavy smokers who had quit within the previous 10 years.
Over the course of the next five years, lung cancer was detected by screening in 97 patients who also satisfied the criteria for the study. The tumors in 91 of those patients (94%) were N0 and in six (6.2%) were N+. All patients with tumors smaller than 10 mm or with a maximum SUV of less than 2.0 (62 cases) were N0. Nodal metastases occurred only among the 29 patients (17%) with lung nodules greater than 10 mm and maxSUV of 2.0 or more.
"These two simple variables were reliable predictors of lymph node involvement in early stage lung cancer, and will make it possible to avoid nodal dissection in a considerable number of patients, reducing operating time and invasiveness, and also reducing the morbidity associated with nodal dissection such as recurrent nerve injury and chylothorax," Veronesi said. "By contrast, when both variables were above the cutoffs identified in this study, radical lymph node dissection the risk of occult nodal involvement was fairly high, suggesting a radical lymph node dissection.
"These results imply for the future not only the reduction of cases requiring lymph node dissection but will allow us to propose safely lung-sparing sublobar resections instead of lobectomy in many patients with very initial lung cancer," she said.
About the Journal of Thoracic Oncology:
The Journal of Thoracic Oncology (JTO) is the official monthly journal of the International Association for the Study of Lung Cancer (IASLC). It is a prized resource for medical specialists and scientists who focus on the detection, prevention, diagnosis and treatment of lung cancer. It emphasizes a multidisciplinary approach, including original research (clinical trials and translational or basic research), reviews and opinion pieces.
To find out more about the JTO please visit journals.lww.com. To learn more about the IASLC please visit iaslc.org.
Renée McGaw | EurekAlert!
Advanced analysis of brain structure shape may track progression to Alzheimer's disease
26.10.2016 | Massachusetts General Hospital
Indian roadside refuse fires produce toxic rainbow
26.10.2016 | Duke University
Physicists from the University of Würzburg have designed a light source that emits photon pairs. Two-photon sources are particularly well suited for tap-proof data encryption. The experiment's key ingredients: a semiconductor crystal and some sticky tape.
So-called monolayers are at the heart of the research activities. These "super materials" (as the prestigious science magazine "Nature" puts it) have been...
Ultrafast lasers have introduced new possibilities in engraving ultrafine structures, and scientists are now also investigating how to use them to etch microstructures into thin glass. There are possible applications in analytics (lab on a chip) and especially in electronics and the consumer sector, where great interest has been shown.
This new method was born of a surprising phenomenon: irradiating glass in a particular way with an ultrafast laser has the effect of making the glass up to a...
Terahertz excitation of selected crystal vibrations leads to an effective magnetic field that drives coherent spin motion
Controlling functional properties by light is one of the grand goals in modern condensed matter physics and materials science. A new study now demonstrates how...
Researchers from the Institute for Quantum Computing (IQC) at the University of Waterloo led the development of a new extensible wiring technique capable of controlling superconducting quantum bits, representing a significant step towards to the realization of a scalable quantum computer.
"The quantum socket is a wiring method that uses three-dimensional wires based on spring-loaded pins to address individual qubits," said Jeremy Béjanin, a PhD...
In a paper in Scientific Reports, a research team at Worcester Polytechnic Institute describes a novel light-activated phenomenon that could become the basis for applications as diverse as microscopic robotic grippers and more efficient solar cells.
A research team at Worcester Polytechnic Institute (WPI) has developed a revolutionary, light-activated semiconductor nanocomposite material that can be used...
14.10.2016 | Event News
14.10.2016 | Event News
12.10.2016 | Event News
28.10.2016 | Power and Electrical Engineering
28.10.2016 | Physics and Astronomy
28.10.2016 | Life Sciences