Lung cancer is one of the most common types of cancer. The lungs are a pair of cone-shaped organs situated inside the chest, they bring oxygen into the body and take out waste carbon dioxide. There is a strong link between smoking and lung cancer. There are two main categories of lung cancer; Small Cell Lung Cancer (SCLC) , and Non-Small Cell Lung Cancer (NSCLC). World-wide over 1 million people are diagnosed with lung cancer each year.
GLCC Established in 2001, the GLCC comprises 28 non-government patient organisations from around the world. It aims include increasing awareness and destigmatising the disease amongst patients, the medical community, policy makers, the general public and the media, by delivering highest quality information and programmes through its member groups,
National Cancer Institute PDQ summaries are written and frequently updated by editorial boards of experts Further info. Information about methods of cancer detection including new imaging technologies, tumor markers, and biopsy procedures.
An independently incorporated, international, educational and scientific society, founded in 1905, with a focus on respiratory and critical care medicine. There is a detailed public site with detailed information and also a members area.
Founded in 2002 to increase awareness about lung cancer, support patients living with lung cancer and the individuals who care for them and provide educational resources to lung cancer patients, their family members and health care professional.
LCFA Founded in 2002 LCFA aims to improve the survival rate of lung cancer by raising money from the private sector and channeling those funds to lung cancer researchers, so that researchers find effective ways to predict, detect, and treat lung cancer.
PubMed Central search for free-access publications about Lung Cancer MeSH term: Lung Neoplasms US National Library of Medicine PubMed has over 22 million citations for biomedical literature from MEDLINE, life science journals, and online books. Constantly updated.
National Cancer Institute PDQ summaries are written and frequently updated by editorial boards of experts Further info. Information about methods of cancer detection including new imaging technologies, tumor markers, and biopsy procedures.
ALTG ALTG is a multi-disciplinary organization dedicated to reducing the incidence, morbidity and mortality of lung and other thoracic cancers and improving the quality of life of these patients, carers and families in Australia and New Zealand through the coordination and facilitation of high quality clinical research.
Royal College of Physicians Since 2010 this project joins up healthcare teams including doctors and nurses from different NHS Trusts to share best practice in diagnosing, treating and supporting patients with lung cancer, and to look for the underlying differences in rates of lung cancer survival at different Trusts.
Johns Hopkins Medical Institute The Registry was established at The Johns Hopkins Medical Institutions in September 1993. Over 270 lung cancer families are registered to date. So far, research with these families includes studies of DNA repair capacity and genetic markers and their relationship to environmental factors. Risk Factors and Prevention of Lung Cancer
TAKD is a professional association for lung cancer and tobacco control established in 2003. The society represents multidisciplinary approach in the lung cancer care policy and education. Risk Factors and Prevention of Lung Cancer
This list of publications is regularly updated (Source: PubMed).
Karlsson K, Nyman J, Baumann P, et al. Retrospective cohort study of bronchial doses and radiation-induced atelectasis after stereotactic body radiation therapy of lung tumors located close to the bronchial tree. Int J Radiat Oncol Biol Phys. 2013; 87(3):590-5 [PubMed] Related Publications
PURPOSE: To evaluate the dose-response relationship between radiation-induced atelectasis after stereotactic body radiation therapy (SBRT) and bronchial dose. METHODS AND MATERIALS: Seventy-four patients treated with SBRT for tumors close to main, lobar, or segmental bronchi were selected. The association between incidence of atelectasis and bronchial dose parameters (maximum point-dose and minimum dose to the high-dose bronchial volume [ranging from 0.1 cm(3) up to 2.0 cm(3)]) was statistically evaluated with survival analysis models. RESULTS: Prescribed doses varied between 4 and 20 Gy per fraction in 2-5 fractions. Eighteen patients (24.3%) developed atelectasis considered to be radiation-induced. Statistical analysis showed a significant correlation between the incidence of radiation-induced atelectasis and minimum dose to the high-dose bronchial volumes, of which 0.1 cm(3) (D(0.1cm3)) was used for further analysis. The median value of D(0.1cm3) (α/β = 3 Gy) was EQD(2,LQ) = 147 Gy3 (range, 20-293 Gy3). For patients who developed atelectasis the median value was EQD(2,LQ) = 210 Gy3, and for patients who did not develop atelectasis, EQD(2,LQ) = 105 Gy3. Median time from treatment to development of atelectasis was 8.0 months (range, 1.1-30.1 months). CONCLUSION: In this retrospective study a significant dose-response relationship between the incidence of atelectasis and the dose to the high-dose volume of the bronchi is shown.
Matney J, Park PC, Bluett J, et al. Effects of respiratory motion on passively scattered proton therapy versus intensity modulated photon therapy for stage III lung cancer: are proton plans more sensitive to breathing motion? Int J Radiat Oncol Biol Phys. 2013; 87(3):576-82 [PubMed] Article available free on PMC after 01/11/2014 Related Publications
PURPOSE: To quantify and compare the effects of respiratory motion on paired passively scattered proton therapy (PSPT) and intensity modulated photon therapy (IMRT) plans; and to establish the relationship between the magnitude of tumor motion and the respiratory-induced dose difference for both modalities. METHODS AND MATERIALS: In a randomized clinical trial comparing PSPT and IMRT, radiation therapy plans have been designed according to common planning protocols. Four-dimensional (4D) dose was computed for PSPT and IMRT plans for a patient cohort with respiratory motion ranging from 3 to 17 mm. Image registration and dose accumulation were performed using grayscale-based deformable image registration algorithms. The dose-volume histogram (DVH) differences (4D-3D [3D = 3-dimensional]) were compared for PSPT and IMRT. Changes in 4D-3D dose were correlated to the magnitude of tumor respiratory motion. RESULTS: The average 4D-3D dose to 95% of the internal target volume was close to zero, with 19 of 20 patients within 1% of prescribed dose for both modalities. The mean 4D-3D between the 2 modalities was not statistically significant (P<.05) for all dose-volume histogram indices (mean ± SD) except the lung V5 (PSPT: +1.1% ± 0.9%; IMRT: +0.4% ± 1.2%) and maximum cord dose (PSPT: +1.5 ± 2.9 Gy; IMRT: 0.0 ± 0.2 Gy). Changes in 4D-3D dose were correlated to tumor motion for only 2 indices: dose to 95% planning target volume, and heterogeneity index. CONCLUSIONS: With our current margin formalisms, target coverage was maintained in the presence of respiratory motion up to 17 mm for both PSPT and IMRT. Only 2 of 11 4D-3D indices (lung V5 and spinal cord maximum) were statistically distinguishable between PSPT and IMRT, contrary to the notion that proton therapy will be more susceptible to respiratory motion. Because of the lack of strong correlations with 4D-3D dose differences in PSPT and IMRT, the extent of tumor motion was not an adequate predictor of potential dosimetric error caused by breathing motion.
Chen YY, Wang LB, Zhu HL, et al. Relationship between programmed death-ligand 1 and clinicopathological characteristics in non-small cell lung cancer patients. Chin Med Sci J. 2013; 28(3):147-51 [PubMed] Related Publications
OBJECTIVE: To evaluate the correlation between programmed death-ligand 1 (PD-L1) expression in primary lung cancer cells, tumor associated macrophages (TAM) and patients' clinicopathological characteristics. METHODS: From 2008 to 2010, 208 non-small cell lung cancer patients who underwent surgery or CT-guided biopsy were recruited from Huadong Hospital, Fudan University. Immunohistochemistry staining was performed to evaluate the PD-L1 expression in both primary lung cancer cells and CD68 positive TAM. The relationship between PD-L1 expression and the clinical pathology was evaluated using χ(2) test. Spearman's rank correlations were used to determine the correlation between PD-L1 expression in tumor cells and macrophages. RESULTS: Positive PD-L1 expression in primary cancer cells was found in 136 (65.3%) patients, which were negatively correlated with lymph node metastasis (P=0.009) and smoking history (P=0.036). Besides, TAM with PD-L1 expression (found in 116 patients) was positively associated with smoking history (P=0.034), well-differentiation (P=0.029) and negative lymph node metastasis (P=0.0096). A correlation between PD-L1 expression in primary tumor cells and non-small cell lung cancer associated macrophages was found (r=0.228, P=0.021). CONCLUSION: PD-L1, secreted from TAM, might induce cancer cells apoptosis, and decrease lymph node metastasis.
Obuchowska I, Pawluczuk B, Mariak Z Exophthalmos as a first manifestation of the systemic spread of small cell lung cancer. Klin Oczna. 2013; 115(2):135-40 [PubMed] Related Publications
Small cell lung cancer is characterized by rapid growth and early metastases. The most frequent locations of the secondary lesions include adrenal glands, brain, liver, and skeleton. On initial diagnosis, up to 70% of patients with small cell lung cancer have metastases. Metastases to the eye or orbit developed approximately 0.7-12% of patients with lung cancer. Clinical signs and symptoms of orbital metastases may include exophthalmos, diplopia, pain, limited ocular motility, blurred vision, swollen eyelid, conjunctival hyperemia and edema, increased ocular pressure and papilledema. Here, we report a rare case of exophthalmos as the first manifestation of a metastatic tumor of orbit due to small cell lung cancer.
Chawińska E, Tukiendorf A, Miszczyk L Unemployment and lung cancer incidence in the Province of Opole. Brief report. Cent Eur J Public Health. 2013; 21(2):118-20 [PubMed] Related Publications
In this geostatistical analysis we present the results of interrelation between unemployment rate and lung cancer incidence ratios in the Province of Opole, Poland. In the study, unemployment statistics and population data were analyzed together with the registered (histopathologically confirmed) lung cancer cases (C34, ICD10) in sex-stratified working age population (18-65 years). The data were collected in the years 2006-2008 in the Statistical Office in Opole and Opole Cancer Registry, Poland. The statistically significant positive correlation/interrelation between unemployment rate and lung cancer incidence ratios in male population was established; in females, this effect was statistically insignificant. The obtained results are consistent with the most up-to-date reports supporting the thesis that a higher burden of disease is observed in more deprived areas. The statistics may have practical relevance in terms of improving health status of the local population following economic reforms.
Kawamura K, Hiroshima K, Suzuki T, et al. CD90 is a diagnostic marker to differentiate between malignant pleural mesothelioma and lung carcinoma with immunohistochemistry. Am J Clin Pathol. 2013; 140(4):544-9 [PubMed] Related Publications
OBJECTIVES: To pathologically distinguish mesothelioma from lung carcinoma, particularly adenocarcinoma. METHODS: We conducted immunohistochemical analyses on clinical specimens, including 26 cases of mesothelioma, 28 cases of lung adenocarcinoma, and 33 cases of lung squamous cell carcinoma. RESULTS: We found that CD90 expression was useful in making a differential diagnosis between epithelioid mesothelioma and lung adenocarcinoma, whereas sarcomatoid mesothelioma and lung carcinoma specimens, irrespective of the histologic types, were negative in general. The sensitivity and specificity of CD90 expression in epithelioid mesothelioma and lung adenocarcinoma were comparable to those of well-established markers used for the differential diagnosis. CONCLUSIONS: These data collectively indicate that CD90 is a novel diagnostic marker that contributes to a diagnosis of epithelioid mesothelioma.
Shmueli A, Fraifeld S, Peretz T, et al. Cost-effectiveness of baseline low-dose computed tomography screening for lung cancer: the Israeli experience. Value Health. 2013 Sep-Oct; 16(6):922-31 [PubMed] Related Publications
OBJECTIVE: Reduced mortality with low-dose computed tomography (LDCT) lung cancer screening was demonstrated in a large randomized controlled study of high-risk individuals. Cost-effectiveness must be assessed before routine LDCT screening is considered. We aimed to evaluate the cost-effectiveness of LDCT lung cancer screening in Israel. METHODS: A decision analytic framework was used to evaluate the decision to screen or not screen from the health system perspective. The screening arm included 842 moderate-to-heavy smokers aged 45 years or older, screened at Hadassah-Hebrew University Medical Center from 1998 to 2004. In the usual-care arm, stage distribution and stage-specific life expectancy were obtained from the Israel National Cancer Registry data for 1994 to 2006. Lifetime stage-specific costs were estimated from medical records of patients diagnosed and treated at Hadassah Medical Center in the period 2003 to 2004. The analysis considered possible biases-lead time, overdiagnosis, and self-selection. Cost per quality-adjusted-life-year (QALY) gained by screening was estimated. RESULTS: Base-case incremental cost per QALY gained was $1464 (2011 prices). Extensive sensitivity analysis affirmed the low cost per QALY gained. The cost per QALY gained is lower than $10,000 with probability 0.937 and is lower than $20,000 with probability 0.978. CONCLUSIONS: Our analysis suggests that baseline LDCT lung cancer screening in Israel presents a good value for the money and should be considered for inclusion in the National List of Health Services financed publicly.
Overestimation of the frequency and impact of over-diagnosis bias in lung cancer screening has contributed to long delays in implementation of lung cancer screening programs. Literature review reveals little evidence of substantial numbers of over-diagnosed non-lethal lung cancer. There is now strong evidence that lung cancers that would not cause symptoms or kill during normal anticipated survival are uncommon and mostly limited to in situ adenocarcinomas, identifiable as CT non-solid nodules. Prevention of overtreatment is possible within well-constructed diagnostic algorithms.
Mohiuddin K, Swanson SJ Maximizing the benefit of minimally invasive surgery. J Surg Oncol. 2013; 108(5):315-9 [PubMed] Related Publications
Minimal invasive surgery is an excellent approach for the diagnosis and treatment of a wide range of thoracic disorders that previously required sternotomy or open thoracotomy. The notable benefits of minimal invasive surgery to patients include less postoperative pain, fewer operative and post-operative major complications, shortened hospital stay, faster recovery times, less scarring, less stress on the immune system, smaller incision, and for some procedures reduced operating time and reduced costs.
Zhang Y, Li S, Cao K, et al. Mechanism research on combination of decoction for reinforcing lung qi and argon helium lancet in treatment of non-small cell lung cancer. J Tradit Chin Med. 2013; 33(3):307-11 [PubMed] Related Publications
OBJECTIVE: To observe the effect of decoction for reinforcing lung Qi on T-lymphocytic function, interleukin-2 (IL-2) and tumor necrosis factor-alpha (TNF-alpha) in peripheral blood of patients with non-small cell lung cancer after operation with argon helium lancet in order to explore its mechanism. METHODS: A total of 76 patients suffering from non-small cell lung cancer without surgical indication were randomly divided into a treatment group treated with decoction for reinforcing lung Qi and argon helium lancet and a control group treated with argon helium lancet only to observe lymphocytic proliferation, detect the percentage of positive cells in the T-lymphocyte CD28 with flow cytometry and detect the expression of IL-2 and TNF-alpha in peripheral blood with enzyme linked immunosorbent assay. RESULTS: Proliferation of T-lymphocytes and expression of CD28, IL-2 and TNF-alpha in peripheral blood after treatment in the treatment group were more obviously strengthened than those before treatment and those in the control group (all P < 0.05). CONCLUSION: The mechanism of using decoction for reinforcing lung Qi and argon helium lancet to treat lung cancer may be realized through promoting T-lymphocytic proliferation, up-regulating expression of CD28, IL-2 and TNF-alpha, and activating T-cells.
Liu J, Liu Y Influence of erbanxiao solution on inhibiting angiogenesis in stasis toxin stagnation of non-small cell lung cancer. J Tradit Chin Med. 2013; 33(3):303-6 [PubMed] Related Publications
OBJECTIVE: To investigate the effects and mechanisms of Erbanxiao solution in inhibiting tumor angiogenesis. METHODS: We observed the effects and mechanisms of Chinese medicines on inhibiting tumor angiogenesis and studied the theories and results of treatment. Sixty patients with lung cancer were randomized into two groups (n = 30). Patients in the control group were given compound Kushen injection, and patients in the treatment group were given Erbanxiao solution. The effect of Erbanxiao solution on vascular endothelium growth factor (VEGF), basic fibroblast growth factor (bFGF), and tumor necrosis factor-alpha (TNF-alpha) was observed. RESULTS: The effective rate of the treatment group was 60% while the control group was 36%. There was a significant difference between the two groups (P < 0.05). VEGF, bFGF, and TNF-alpha levels of the two groups were significantly different before and after treatment (P < 0.01). These Traditional Chinese Medicines significantly inhibited tumor angiogenesis, possibly by changing levels of VEGF, bFGF, and TNF-alpha. CONCLUSION: It is necessary to further explore the potential of Traditional Chinese Medicine in the treatment of angiogenesis in tumor patients.
Yun HS, Hong EH, Lee SJ, et al. Depletion of hepatoma-derived growth factor-related protein-3 induces apoptotic sensitization of radioresistant A549 cells via reactive oxygen species-dependent p53 activation. Biochem Biophys Res Commun. 2013; 439(3):333-9 [PubMed] Related Publications
Biomarkers based on functional signaling have the potential to provide greater insight into the pathogenesis of cancer and may offer additional targets for anticancer therapeutics. Here, we identified hepatoma-derived growth factor-related protein-3 (HRP-3) as a radioresistance-related gene and characterized the molecular mechanism by which its encoded protein regulates the radio- and chemoresistant phenotype of lung cancer-derived A549 cells. Knockdown of HRP-3 promoted apoptosis of A549 cells and potentiated the apoptosis-inducing action of radio- and chemotherapy. This increase in apoptosis was associated with a substantial generation of reactive oxygen species (ROS) that was attributable to inhibition of the Nrf2/HO-1 antioxidant pathway and resulted in enhanced ROS-dependent p53 activation and p53-dependent expression of PUMA (p53 upregulated modulator of apoptosis). Therefore, the HRP-3/Nrf2/HO-1/ROS/p53/PUMA cascade is an essential feature of the A549 cell phenotype and a potential radiotherapy target, extending the range of targets in multimodal therapies against lung cancer.
Van Schil PE, Sihoe AD, Travis WD Pathologic classification of adenocarcinoma of lung. J Surg Oncol. 2013; 108(5):320-6 [PubMed] Related Publications
Recently, the 1999/2004 World Health Organization (WHO) classification of adenocarcinoma became less useful from a clinical standpoint as most adenocarcinomas belonged to the mixed subtype and the term bronchioloalveolar carcinoma (BAC) gave rise to much confusion among clinicians. For these reasons a new adenocarcinoma classification was introduced in 2011 by a joint working group of the International Association for the Study of Lung Cancer (IASLC), American Thoracic Society (ATS), and European Respiratory Society (ERS). This represents an international, multidisciplinary effort joining pathologists, molecular biologists, pulmonary physicians, thoracic oncologists, radiologists, and thoracic surgeons. Currently, a distinction is made between pre-invasive lesions, minimally invasive and invasive lesions. The confusing term BAC is not used anymore and new subcategories include adenocarcinoma in situ and minimally invasive adenocarcinoma. Several aspects of this classification are discussed with main emphasis on its correlation with imaging techniques and its impact on diagnosis, treatment and prognosis. On chest computed tomography (CT) a distinction is made between solid and subsolid nodules, the latter comprising ground glass opacities (GGO), and partly solid lesions. Several studies incorporating CT and positron emission tomographic (PET) data show a good imaging-pathologic correlation. With the implementation of screening programs early lung cancer has become a hotly debated topic and sublobar resection is currently reconsidered for early lesions without lymph node involvement. This new classification will also have an impact on the TNM classification. Thoracic surgeons will continue to play a major role in the application, evaluation and further refinement of this new adenocarcinoma classification.
Aberle DR, DeMello S, Berg CD, et al. Results of the two incidence screenings in the National Lung Screening Trial. N Engl J Med. 2013; 369(10):920-31 [PubMed] Related Publications
BACKGROUND: The National Lung Screening Trial was conducted to determine whether three annual screenings (rounds T0, T1, and T2) with low-dose helical computed tomography (CT), as compared with chest radiography, could reduce mortality from lung cancer. We present detailed findings from the first two incidence screenings (rounds T1 and T2). METHODS: We evaluated the rate of adherence of the participants to the screening protocol, the results of screening and downstream diagnostic tests, features of the lung-cancer cases, and first-line treatments, and we estimated the performance characteristics of both screening methods. RESULTS: At the T1 and T2 rounds, positive screening results were observed in 27.9% and 16.8% of participants in the low-dose CT group and in 6.2% and 5.0% of participants in the radiography group, respectively. In the low-dose CT group, the sensitivity was 94.4%, the specificity was 72.6%, the positive predictive value was 2.4%, and the negative predictive value was 99.9% at T1; at T2, the positive predictive value increased to 5.2%. In the radiography group, the sensitivity was 59.6%, the specificity was 94.1%, the positive predictive value was 4.4%, and the negative predictive value was 99.8% at T1; both the sensitivity and the positive predictive value increased at T2. Among lung cancers of known stage, 87 (47.5%) were stage IA and 57 (31.1%) were stage III or IV in the low-dose CT group at T1; in the radiography group, 31 (23.5%) were stage IA and 78 (59.1%) were stage III or IV at T1. These differences in stage distribution between groups persisted at T2. CONCLUSIONS: Low-dose CT was more sensitive in detecting early-stage lung cancers, but its measured positive predictive value was lower than that of radiography. As compared with radiography, the two annual incidence screenings with low-dose CT resulted in a decrease in the number of advanced-stage cancers diagnosed and an increase in the number of early-stage lung cancers diagnosed. (Funded by the National Cancer Institute; NLST ClinicalTrials.gov number, NCT00047385.).
McWilliams A, Tammemagi MC, Mayo JR, et al. Probability of cancer in pulmonary nodules detected on first screening CT. N Engl J Med. 2013; 369(10):910-9 [PubMed] Related Publications
BACKGROUND: Major issues in the implementation of screening for lung cancer by means of low-dose computed tomography (CT) are the definition of a positive result and the management of lung nodules detected on the scans. We conducted a population-based prospective study to determine factors predicting the probability that lung nodules detected on the first screening low-dose CT scans are malignant or will be found to be malignant on follow-up. METHODS: We analyzed data from two cohorts of participants undergoing low-dose CT screening. The development data set included participants in the Pan-Canadian Early Detection of Lung Cancer Study (PanCan). The validation data set included participants involved in chemoprevention trials at the British Columbia Cancer Agency (BCCA), sponsored by the U.S. National Cancer Institute. The final outcomes of all nodules of any size that were detected on baseline low-dose CT scans were tracked. Parsimonious and fuller multivariable logistic-regression models were prepared to estimate the probability of lung cancer. RESULTS: In the PanCan data set, 1871 persons had 7008 nodules, of which 102 were malignant, and in the BCCA data set, 1090 persons had 5021 nodules, of which 42 were malignant. Among persons with nodules, the rates of cancer in the two data sets were 5.5% and 3.7%, respectively. Predictors of cancer in the model included older age, female sex, family history of lung cancer, emphysema, larger nodule size, location of the nodule in the upper lobe, part-solid nodule type, lower nodule count, and spiculation. Our final parsimonious and full models showed excellent discrimination and calibration, with areas under the receiver-operating-characteristic curve of more than 0.90, even for nodules that were 10 mm or smaller in the validation set. CONCLUSIONS: Predictive tools based on patient and nodule characteristics can be used to accurately estimate the probability that lung nodules detected on baseline screening low-dose CT scans are malignant. (Funded by the Terry Fox Research Institute and others; ClinicalTrials.gov number, NCT00751660.).
Field JK, Chen Y, Marcus MW, et al. The contribution of risk prediction models to early detection of lung cancer. J Surg Oncol. 2013; 108(5):304-11 [PubMed] Related Publications
Low-dose computed tomography screening is a strategy for early diagnosis of lung cancer. The success of such screening will be dependent upon identifying populations at sufficient risk in order to maximise the benefit-to-harm ratio of the intervention. To facilitate this, the lung cancer risk prediction community has established several risk models with good predictive performance. This review focuses on current progress in risk modelling for lung cancer prediction, with some views on future development.
Tyng CJ, Baranauskas MV, Bitencourt AG, et al. Preoperative computed tomography-guided localization of ground-glass opacities with metallic clip. Ann Thorac Surg. 2013; 96(3):1087-9 [PubMed] Related Publications
Intraoperative localization of ground-glass opacities is difficult because they are not easy to palpate and may be invisible at radioscopy. Therefore, various techniques have been developed to improve intraoperative localization of these lesions, allowing an adequate surgical resection. The aim of this study is to report two cases of preoperative localization of ground-glass opacities through computed tomography-guided placement of a metallic clip inside the lesion and to discuss this new technique in comparison with those previously described.
Fitzsimons MG, Ng J, Wright C, et al. Carinal resection requiring cardiopulmonary bypass in a pregnant patient. Ann Thorac Surg. 2013; 96(3):1085-7 [PubMed] Related Publications
A 35-year-old woman at 13 weeks gestation presented with adenoid cystic carcinoma of the distal left mainstem bronchus with chronic collapse of the left lung requiring carinal pneumonectomy. The extent of the tumor and need for significant retraction during dissection and pneumonectomy resulted in the need for cardiopulmonary bypass. The patient underwent successful left carinal pneumonectomy and subsequently delivered a healthy baby.
Maillart JF, Lacroix V, Camboni A, Poncelet AJ Mediastinal teratoma with coexisting parenchymal pulmonary cystic lesion. Ann Thorac Surg. 2013; 96(3):1081-3 [PubMed] Related Publications
A double-located mediastinal and intrapulmonary cystic teratoma is a rare condition to be considered by thoracic surgeons. Clinical or radiologic diagnosis of a ruptured mediastinal teratoma into adjacent structures may be highly suggestive. An atypical presentation may indicate cautiousness for complete surgical excision. We report the case of a 14-year-old girl presenting with chronic chest pain. The radiologic work-up showed a large cystic mediastinal tumor and a heterogeneous intrapulmonary left upper-lobe lesion. We discuss the radiologic differential diagnosis of this atypical double-located thoracic tumor and the surgical strategy for complete excision.
Zhang C, Myers JL Crystal-storing histiocytosis complicating primary pulmonary marginal zone lymphoma of mucosa-associated lymphoid tissue. Arch Pathol Lab Med. 2013; 137(9):1199-204 [PubMed] Related Publications
Crystal-storing histiocytosis is an uncommon form of nonneoplastic histiocytic proliferation that in most patients complicates an underlying lymphoproliferative or plasma cell disorder. Lung is a common site of involvement in patients with localized disease. We present an illustrative example from a 54-year-old woman with an asymptomatic solitary lung nodule. The tumor was characterized by sheets of histiocytes with abundant cytoplasm expanded by distinctive eosinophilic inclusions. Focal necrosis was present. Aggregates of monocytoid lymphocytes and clusters of peribronchiolar plasma cells were overshadowed by the histiocytic infiltrate. Immunohistochemical stains showed CD68 staining in nonneoplastic histiocytes and CD20 staining in monocytoid lymphocytes. In situ hybridization studies showed κ light-chain restriction in plasma cells. These results, combined with the histologic findings, supported the diagnosis of crystal-storing histiocytosis complicating marginal zone lymphoma of mucosa-associated lymphoid tissue. We review the literature pertaining to pulmonary crystal-storing histiocytosis, highlighting the differential diagnosis for this rare phenomenon.
Cagle PT, Allen TC, Olsen RJ Lung cancer biomarkers: present status and future developments. Arch Pathol Lab Med. 2013; 137(9):1191-8 [PubMed] Related Publications
The publication of the "Molecular Testing Guideline for Selection of Lung Cancer Patients for EGFR and ALK Tyrosine Kinase Inhibitors: Guideline From the College of American Pathologists, International Association for the Study of Lung Cancer, and Association for Molecular Pathology" has now provided a guideline for biomarker testing for first-generation lung cancer tyrosine kinase inhibitors. Biomarker testing has forever altered the role of pathologists in the management of patients with lung cancer. Current, unresolved issues in the precision medicine of lung cancer will be addressed by the development of new biomarker tests, new drugs, and new test technologies and by improvement in the cost to benefit ratio of biomarker testing.
Kaushik G, Kaushik T, Yadav SK, et al. Curcumin sensitizes lung adenocarcinoma cells to apoptosis via intracellular redox status mediated pathway. Indian J Exp Biol. 2012; 50(12):853-61 [PubMed] Related Publications
The present study demonstrates that curcumin acts as pro-oxidant and sensitizes human lung adenocarcinoma epithelial cells (A549) to apoptosis via intracellular redox status mediated pathway. Results indicated that curcumin induced cell toxicity (light microscopy and MTT assay) and apoptosis (AnnexinV-FITC/PI labeling and caspase-3 activity) in these cells. These events seem to be mediated through generation of reactive oxygen species (ROS) and superoxide radicals (SOR) and enhanced levels of lipid peroxidation. These changes were accompanied by increase in oxidized glutathione (GSSG), reduced glutathione (GSH) and gamma-glutamylcysteine synthetase (gamma-GCS) activity, but decrease in GSH/GSSG ratio. The induction of apoptosis and decrease in GSH/GSSG ratio was also accompanied by sustained phosphorylation and activation of p38 mitogen activated protein kinase (MAPK). On the other hand, addition of N-acetyl cysteine (NAC), an antioxidant, blocked the curcumin-induced ROS production and rescued malignant cells from curcumin-induced apoptosis through caspase-3 deactivation. However, L-buthionine sulfoximine (BSO), a GSH synthesis blocking agent, further enhanced curcumin-induced ROS production and apoptosis in A549 cells. Decreased GSH/GSSG ratio seems to be a crucial factor for the activation of MAPK signaling cascade by curcumin. The study therefore, provides an insight into the molecular mechanism involved in sensitization of lung adenocarcinoma cells to apoptosis by curcumin.
Strauss GM, Dominioni L Chest X-ray screening for lung cancer: overdiagnosis, endpoints, and randomized population trials. J Surg Oncol. 2013; 108(5):294-300 [PubMed] Related Publications
Publication of the National Lung Screening Trial (NLST) generated excitement by concluding that CT screening reduces lung cancer mortality when compared to chest X-ray (CXR) screening. In contrast, CXR screening has long been considered to be ineffective. This is because randomized population trials (RPTs) have failed to demonstrate significant mortality reductions in populations randomized to CXR screening. While these studies demonstrate that CXR screening is associated with significant survival advantages, these advantages have been widely interpreted as spurious, due to the inference that CXR screening leads to substantial lung cancer overdiagnosis. Indeed, the reality of the overdiagnosis hypothesis is the only alternative to the conclusion that CXR screening was effective in these trials and that survival more accurately reflected the benefit of CXR screening than mortality. Mortality comparisons would be biased if randomization fails to create comparison groups with an equal probability of mortality from the target cancer. The objective of this manuscript is to review existing RPTs on CXR screening for lung cancer, and to analyze which endpoint most accurately reflects screening efficacy. We conclude that the evidence supports that CXR screening is superior to no screening, and the magnitude of overdiagnosis is minimal in the context of CXR screening.
Yoshida T, Ishii G, Goto K, et al. Solid predominant histology predicts EGFR tyrosine kinase inhibitor response in patients with EGFR mutation-positive lung adenocarcinoma. J Cancer Res Clin Oncol. 2013; 139(10):1691-700 [PubMed] Related Publications
BACKGROUND: The efficacy of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) differs in patients with lung adenocarcinoma harboring EGFR-activating mutations. Although lung adenocarcinoma with EGFR-activating mutations has heterogeneous morphologic features, the predictive role of histologic subtype of lung adenocarcinoma with regard to the effectiveness of EGFR-TKIs in patients with EGFR-activating mutations has not been well defined. METHODS: Among 134 postoperative recurrence patients with lung adenocarcinoma harboring EGFR-activating mutation (L858R or exon 19 deletion) treated with EGFR-TKIs, we retrospectively analyzed 61 patients treated with EGFR-TKIs as first-line chemotherapy. All the tumors were classified according to the new histologic classification proposed by the International Association for the Study of Lung Cancer (IASLC), American Thoracic Society (ATS), and European Respiratory Society (ERS) into the following subtypes: lepidic, papillary, acinar, micropapillary, or solid predominant subtype. We evaluated the correlation between the histologic subtype and the clinical efficacy of EGFR-TKIs. RESULTS: In overall response rate, adenocarcinoma with solid predominant subtype is significantly worse than with non-solid predominant subtype (61 vs. 88 %, P = 0.03). The median progression-free survival (PFS) and overall survival after EGFR-TKI treatment were significantly shorter for the patients with solid predominant subtype than for those with non-solid predominant subtype (median PFS of 7.7 vs. 13.5 months, P = 0.002, and median OS of 21.5 vs. 31.0 months, P = 0.028). CONCLUSIONS: This study indicated that among patients with lung adenocarcinoma harboring activating EGFR mutations treated with EGFR-TKIs, solid predominant subtype according to IASLC/ATS/ERS classification is a response predictor for EGFR-TKI.
Field JK, Oudkerk M, Pedersen JH, Duffy SW Prospects for population screening and diagnosis of lung cancer. Lancet. 2013; 382(9893):732-41 [PubMed] Related Publications
Deaths from lung cancer exceed those from any other type of malignancy, with 1·5 million deaths in 2010. Prevention and smoking cessation are still the main methods to reduce the death toll. The US National Lung Screening Trial, which compared CT screening with chest radiograph, yielded a mortality advantage of 20% to participants in the CT group. International debate is ongoing about whether sufficient evidence exists to implement CT screening programmes. When questions about effectiveness and cost-effectiveness have been answered, which will await publication of the largest European trial, NELSON, and pooled analysis of European CT screening trials, we discuss the main topics that will need consideration. These unresolved issues are risk prediction models to identify patients for CT screening; radiological protocols that use volumetric analysis for indeterminate nodules; options for surgical resection of CT-identified nodules; screening interval; and duration of screening. We suggest that a demonstration project of biennial screening over a 4-year period should be undertaken.
Rosell R, Bivona TG, Karachaliou N Genetics and biomarkers in personalisation of lung cancer treatment. Lancet. 2013; 382(9893):720-31 [PubMed] Related Publications
Non-small-cell lung cancer is often diagnosed at the metastatic stage, with median survival of just 1 year. The identification of driver mutations in the epidermal growth factor receptor (EGFR) as the primary oncogenic event in a subset of lung adenocarcinomas led to a model of targeted treatment and genetic profiling of the disease. EGFR tyrosine kinase inhibitors confer remission in 60% of patients, but responses are short-lived. The pre-existing EGFR Thr790Met mutation could be a subclonal driver responsible for these transient responses. Overexpression of AXL and reduced MED12 function are hallmarks of resistance to tyrosine kinase inhibitors in EGFR-mutant non-small-cell lung cancer. Crosstalk between signalling pathways is another mechanism of resistance; therefore, identification of the molecular components involved could lead to the development of combination therapies cotargeting these molecules instead of EGFR tyrosine kinase inhibitor monotherapy. Additionally, novel biomarkers could be identified through deep sequencing analysis of serial rebiopsies before and during treatment.
Reck M, Heigener DF, Mok T, et al. Management of non-small-cell lung cancer: recent developments. Lancet. 2013; 382(9893):709-19 [PubMed] Related Publications
Non-small-cell lung cancer is one of the leading causes of deaths from cancer worldwide. Therefore, improvements in diagnostics and treatments are urgently needed. In this review, we will discuss the evolution of lung cancer staging towards more non-invasive, endoscopy-based, and image-based methods, and the development of stage-adapted treatment. A special focus will be placed on the role of novel surgical approaches and modern radiotherapy strategies for early stages of disease, the effect of multimodal treatment in locally advanced disease, and ongoing developments in the treatment of patients with metastatic disease. In particular, we will include an emphasis on targeted therapies, which are based on the assumption that a treatable driver mutation or gene rearrangement is present within the tumour. Finally, the position of lung cancer treatment on the pathway to personalised therapy will be discussed.
Perfusion CT permits evaluation of lung cancer angiogenesis and response to therapy by demonstrating alterations in lung tumor vascularity. It is advocated that perfusion CT performed shortly after initiating therapy may provide a better evaluation of physiological changes rather than the conventional size assessment obtained with RECIST. The radiation dose,the volume of contrast medium delivered to the patient and the reproducibility of blood flow parameters remain an issue for this type of investigation.
The role of imaging in the evaluation of tumor response is expanding rapidly. The current response evaluation criteria in solid tumors (RECIST) based on anatomical changes suffers from many limitations related mainly to the inter- and intra-observer variability to delineate the tumoral edges. Consequently, there is a need to update and integrate the RECIST criteria beyond the classical anatomical changes with other more sophisticated methods using three-dimensional and functional criteria. The goal of this paper is to review the current criteria of RECIST measurements (RECIST 1.1) with their limitations and to evaluate the emerging solutions available with the new imaging techniques like PET-CT.
Oudkerk M, Heuvelmans MA Screening for lung cancer by imaging: the Nelson study. JBR-BTR. 2013 May-Jun; 96(3):163-6 [PubMed] Related Publications
The NELSON trial is the first randomised lung cancer screening trial in which pulmonary nodule management is based on volumetry. This led to considerably less false-positive referrals compared to other lung cancer screening trials, with very high negative predictive values found in the first and second screening rounds. Mortality results are still pending, but the knowledge already gained in the NELSON trial and its side-studies provide valuable information in the field of screening for lung cancer.