A study in 25 patients with mesothelioma, a type of lung cancer associated with exposure to asbestos, suggests that radiation treatment before surgery can significantly increase survival. Patients were treated using a new approach dubbed SMART (Surgery for Mesothelioma After Radiation Therapy). They received an accelerated, 5-day course of intensity-modulated radiation therapy (IMRT), which conforms the radiation dose around the tumors while sparing nearby healthy tissues. They then underwent surgery to remove the affected lung. Seventy-two percent of patients survived 3 years or more after treatment; 3-year survival rates without SMART rank at 32%. People with known exposure to asbestos who experience shortness of breath, weight loss, and fatigue for more than 3 weeks should be evaluated by a doctor to ensure speedy access to treatment.
In a past clinical trial, researchers identified a collection of 15 genes whose expression pattern predicted the relative risk of death in people with early-stage non-small cell lung cancer (NSCLC). Now, a new study has confirmed these findings in a larger, independent group of patients. Early-stage NSCLC patients who were classified into high- or low-risk groups based on testing the expression of the 15 genes differed significantly in their overall 5-year survival. These gene expression patterns may therefore help distinguish patients at higher risk who would benefit from adjuvant chemotherapy (chemotherapy given after tumor removal surgery), from lower-risk patients who could avoid the side effects of chemotherapy. Indeed, the Pervenio test, which looks at the expression of 14 genes, is already used to identify the patient who may benefit from aduvant chemotherapy.
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.
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 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.
The tissue types present in early-stage lung adenocarcinomas, a type of non-small cell lung cancer (NSCLC), may help predict the chances of the cancer returning after surgery. A retrospective study examined outcomes among adenocarcinoma patients whose tumors were 2 cm in diameter or smaller. Patients whose tumors contained 5% or more of a so-called ‘micropapillary’ tissue structure had a higher risk of the cancer returning if they had just the tumor removed. This difference was not found in patients who underwent lobectomy (removal of an entire subsection of lung). The higher risk of recurrence in patients with 5%-plus micropapillary tissue in their tumor may make them better candidates for the more invasive lobectomy procedure.
Disagreement persists about the best treatment for non-small cell lung cancer (NSCLC) patients with stage IIIA(N2) disease, that is, cancer that has spread to lymph nodes just outside the lung. A recent study compared the outcomes of different treatments. Patients who had received neoadjuvant chemoradiotherapy (chemotherapy and radiation administered before surgery) followed by lobectomy (removal of the lung subsection containing the cancer) had higher 5-year survival rates than patients treated with:
-neoadjuvant chemoradiotherapy and pneumonectomy (removal of the whole lung containing the cancer);
-either lobectomy or pneumonectomy plus adjuvant therapy (chemotherapy and/or radiation administered after surgery);
-concurrent chemoradiotherapy (chemotherapy and radiation delivered at the same time, without surgery).
These findings suggest that neoadjuvant chemoradiotherapy followed by lobectomy is the preferable treatment for stage IIIA(N2) NSCLC.
Researchers have constructed a model to assess the cost-effectiveness of different treatments for stage I non-small cell lung cancer (NSCLC) based on treatment costs, predicted life expectancy, and expected quality of life. Model simulations indicate that lobectomy (removal of an entire subsection of the lungs) is the most cost-effective treatment for patients whose cancer is clearly operable. For patients who are only borderline eligible for surgery due to poor health (‘marginally operable’), who often cannot withstand lobectomy, a type of radiotherapy called stereotactic body radiation therapy (SBRT), also known as stereotactic ablative radiotherapy (SABR), was found to be more cost-effective than wedge resection (removal of a small piece of lung containing the cancer).