Surgery Improves Survival in Lung Cancer That Has Not Spread to Lymph Nodes

“Resection resulted in greater overall survival and disease-specific survival rates compared with no surgery for patients with lung cancer, according to study results.

“Dan J. Raz, MD, of the City of Hope Medical Center in Duarte, California, and colleagues analyzed data from 4,111 patients to determine differences in survival for patients who had and did not have surgery for biopsy specimen-proven lymph node-negative carcinoid tumors. The data was from the National Cancer Institute’s Surveillance, Epidemiology, and End Results program for the period between 1988 and 2010.

“The overall survival after 5 years was 93% for patients undergoing lobectomy, 92% for patients undergoing sublobar resection and 69% for patients forgoing surgery (P < .0001, for all). Disease-specific survival rates at 5 years were 97%, 98% and 88%, respectively (P < .0001, for all).

“After controlling for age, sex, race and ethnicity, as well as tumor stage, patients who declined surgery had a greater mortality risk than patients who underwent lobectomy (HR = 2.23; 95% CI, 1.67-2.96).”

Benefits of Surgical Resection for Small Cell Lung Cancer Remain Unclear

“Although surgical resection resulted in reasonable outcomes among well-chosen patients with early-stage small cell lung cancer, use of the treatment approach in this setting remains controversial, according to study results.

“Intrathoracic recurrence — the most common treatment failure in the study — occurred more frequently in patients who underwent limited resections. Thus, the researchers determined additional research is needed to assess the overall efficacy of combining surgery with chemotherapy and radiation therapy.

“ ‘Small cell lung cancer (SCLC) accounts for approximately 15% of the primary lung cancer diagnoses in the United States each year,’ Yolanda I. Garces, MD, of the department of radiation oncology at the Mayo Clinic in Rochester, Minnesota, and colleagues wrote. ‘The current National Comprehensive Cancer Network guidelines recommend surgical resection as the preferred first-line treatment for patients with early-stage, node-negative disease. The purpose of this study was to evaluate clinical outcomes and patterns of recurrence in a single-institution series of patients undergoing curative resection of SCLC.’ ”

Survey Sheds Light on Common Clinical Practice for Incompletely Resected Lung Cancer

“A landmark survey of more than 700 specialists provides crucial real-world insight into the treatments most oncologists choose for lung cancer patients whose tumour has been incompletely resected, an expert from the European Society for Medical Oncology (ESMO) says.

“Jean Yves Douillard, from the ICO Institut de Cancerologie de l’Ouest René Gauducheau, France, Chair of the ESMO Educational Committee, was commenting on a paper published in the journal Lung Cancer. In the study, researchers led by Raffaele Califano of The Christie NHS Foundation Trust, Manchester, UK, surveyed 768 oncologists from 41 European countries about the treatments they offered patients who had ‘R1 resected’ non-small-cell lung cancer.”

Major Lung Resection Safer than Ever, Especially at the Busiest Hospitals

“Major lung surgery has become progressively safer over the last few decades, although higher death rates at low-volume hospitals and an unexpected increase in mortality at 90 days compared to 30 days were observed. The study further suggests that choosing a center that performs major lung surgery regularly can have a strong impact on survival.”

Survival Rates after Lung Cancer Surgery Essentially Unchanged Since 1950s

Despite advances in cancer research, the survival rates of lung cancer patients after surgery have not changed significantly in the last 60 years, highlighting the need for better therapies. After specialist chest surgery, patients have a 5-year survival rate of 25% and a 10-year survival rate of 15%; survival rates are lower in patients whose cancer is inoperable or who are too weak to receive surgery. However, lung cancer patients are now much more likely to be treated by a chest specialist surgeon than they were in the 1950s. Nevertheless, referral rates to chest specialist units for lung cancer patients can and should still be improved. These concerns, along with other challenges facing lung cancer research, are discussed in a new book on the history of lung cancer.

HDAC Inhibitor Confers Radiosensitivity to Prostate Stem-Like Cells

“Background: Radiotherapy can be an effective treatment for prostate cancer, but radiorecurrent tumours do develop. Considering prostate cancer heterogeneity, we hypothesised that primitive stem-like cells may constitute the radiation-resistant fraction. Methods: Primary cultures were derived from patients undergoing resection for prostate cancer or benign prostatic hyperplasia. After short-term culture, three populations of cells were sorted, reflecting the prostate epithelial hierarchy, namely stem-like cells (SCs, α2β1integrinhi/CD133+), transit-amplifying (TA, α2β1integrinhi/CD133−) and committed basal (CB, α2β1integrinlo) cells. Radiosensitivity was measured by colony-forming efficiency (CFE) and DNA damage by comet assay and DNA damage foci quantification. Immunofluorescence and flow cytometry were used to measure heterochromatin. The HDAC (histone deacetylase) inhibitor Trichostatin A was used as a radiosensitiser. Results: Stem-like cells had increased CFE post irradiation compared with the more differentiated cells (TA and CB). The SC population sustained fewer lethal double-strand breaks than either TA or CB cells, which correlated with SCs being less proliferative and having increased levels of heterochromatin. Finally, treatment with an HDAC inhibitor sensitised the SCs to radiation. Interpretation: Prostate SCs are more radioresistant than more differentiated cell populations. We suggest that the primitive cells survive radiation therapy and that pre-treatment with HDAC inhibitors may sensitise this resistant fraction.”


Previously Neglected Lymph Nodes are Significant in Mesothelioma

To assess cancer stage, that is, how far advanced a cancer is, doctors routinely examine lymph nodes. However, a subset of lymph nodes located between the ribs near the spine, the so-called posterior intercostal lymph nodes, are not usually assessed in cancer staging. In a retrospective study of patients who had undergone surgery for mesothelioma (a type of lung cancer associated with asbestos exposure), researchers found that the cancer had spread to the posterior intercostal lymph nodes in over half of these patients. Patients who had no evidence of cancer in the posterior intercostal lymph nodes lived nearly 2.5 years longer, on average, than those who had. The posterior intercostal lymph nodes appear to be highly significant and should be biopsied routinely in mesothelioma patients.

Trial Investigating Iressa After Lung Cancer Surgery Terminated Early

A clinical trial investigating whether the cancer drug gefinitib (Iressa) can improve outcomes after lung cancer surgery has been ended early. The trial followed patients who were given either Iressa or a placebo after receiving surgery to completely remove their non-small cell lung cancer (NSCLC). When two other studies showed no benefit of Iressa in similar disease situations, the trial was terminated. Due to the early termination of the trial, no firm conclusions can be drawn from the results. However, analysis of the already collected data suggests that Iressa likely did not improve survival, or delay cancer recurrence in this patient population, and may have indeed been harmful.

Selenium Does Not Prevent Lung Cancer Recurrence

Selenium has been suggested to have preventive effects against lung cancer. In a recent clinical trial, patients with stage I non-small cell lung cancer (NSCLC) that had been completely surgically removed were given either selenium supplements or a placebo for 2 years after surgery. Interim results showed that patients receiving selenium were no less likely to have their lung cancer return than those given a placebo. Because there were hints that selenium-treated patients may be indeed more likely to develop new tumors, the study was halted. Final analyses show no harm from taking selenium, but no protection against lung cancer either.