Medicine › Pulmonary and Respiratory Medicine

Lung Cancer Diagnosis and Treatment

Works Count: 106544

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Description

This cluster of papers focuses on the diagnosis and treatment of lung cancer, including topics such as CT screening, radiotherapy, chemotherapy, tumor staging, adjuvant therapy, positron emission tomography, stereotactic body radiation therapy, non-small cell lung cancer, and pulmonary nodules.

Keywords

Lung Cancer; CT Screening; Radiotherapy; Chemotherapy; Tumor Staging; Adjuvant Therapy; Positron Emission Tomography; Stereotactic Body Radiation Therapy; Non-Small Cell Lung Cancer; Pulmonary Nodules

The National Lung Screening Trial: Overview and Study Design

2010-11-03

Constantine A. Gatsonis , Denise R. Aberle , Christine D. Berg +7 more

The National Lung Screening Trial (NLST) is a randomized multicenter study comparing low-dose helical computed tomography (CT) with chest radiography in the screening of older current and former heavy smokers … The National Lung Screening Trial (NLST) is a randomized multicenter study comparing low-dose helical computed tomography (CT) with chest radiography in the screening of older current and former heavy smokers for early detection of lung cancer, which is the leading cause of cancer-related death in the United States. Five-year survival rates approach 70% with surgical resection of stage IA disease; however, more than 75% of individuals have incurable locally advanced or metastatic disease, the latter having a 5-year survival of less than 5%. It is plausible that treatment should be more effective and the likelihood of death decreased if asymptomatic lung cancer is detected through screening early enough in its preclinical phase. For these reasons, there is intense interest and intuitive appeal in lung cancer screening with low-dose CT. The use of survival as the determinant of screening effectiveness is, however, confounded by the well-described biases of lead time, length, and overdiagnosis. Despite previous attempts, no test has been shown to reduce lung cancer mortality, an endpoint that circumvents screening biases and provides a definitive measure of benefit when assessed in a randomized controlled trial that enables comparison of mortality rates between screened individuals and a control group that does not undergo the screening intervention of interest. The NLST is such a trial. The rationale for and design of the NLST are presented.

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Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening

2011-06-30

The aggressive and heterogeneous nature of lung cancer has thwarted efforts to reduce mortality from this cancer through the use of screening. The advent of low-dose helical computed tomography (CT) … The aggressive and heterogeneous nature of lung cancer has thwarted efforts to reduce mortality from this cancer through the use of screening. The advent of low-dose helical computed tomography (CT) altered the landscape of lung-cancer screening, with studies indicating that low-dose CT detects many tumors at early stages. The National Lung Screening Trial (NLST) was conducted to determine whether screening with low-dose CT could reduce mortality from lung cancer.

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The IASLC Lung Cancer Staging Project: Proposals for Revision of the M Descriptors in the Forthcoming (Seventh) Edition of the TNM Classification of Lung Cancer

2007-08-01

Pieter E. Postmus , Élisabeth Brambilla , Kari Chansky +4 more

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Phase III Study of Concurrent Versus Sequential Thoracic Radiotherapy in Combination With Mitomycin, Vindesine, and Cisplatin in Unresectable Stage III Non–Small-Cell Lung Cancer

1999-09-01

Kiyoyuki Furuse , Masahiro Fukuoka , Masaaki Kawahara +5 more

PURPOSE: A phase III study was performed to determine whether concurrent or sequential treatment with radiotherapy (RT) and chemotherapy (CT) improves survival in unresectable stage III non–small-cell lung cancer (NSCLC). … PURPOSE: A phase III study was performed to determine whether concurrent or sequential treatment with radiotherapy (RT) and chemotherapy (CT) improves survival in unresectable stage III non–small-cell lung cancer (NSCLC). PATIENTS AND METHODS: Patients were assigned to the two treatment arms. In the concurrent arm, chemotherapy consisted of cisplatin (80 mg/m 2 on days 1 and 29), vindesine (3 mg/m 2 on days 1, 8, 29, and 36), and mitomycin (8 mg/m 2 on days 1 and 29). RT began on day 2 at a dose of 28 Gy (2 Gy per fraction and 5 fractions per week for a total of 14 fractions) followed by a rest period of 10 days, and then repeated. In the sequential arm, the same CT was given, but RT was initiated after completing CT and consisted of 56 Gy (2 Gy per fraction and 5 fractions per week for a total of 28 fractions). RESULTS: Three hundred twenty patients were entered onto the study. Pretreatment characteristics were well balanced between the treatment arms. The response rate for the concurrent arm was significantly higher (84.0%) than that of the sequential arm (66%) (P = .0002). The median survival duration was significantly superior in patients receiving concurrent therapy (16.5 months), as compared with those receiving sequential therapy (13.3 months) (P = .03998). Two-, 3-, 4-, and 5-year survival rates in the concurrent group (34.6%, 22.3%, 16.9%, and 15.8%, respectively) were better than those in the sequential group (27.4%, 14.7%, 10.1%, and 8.9%, respectively). Myelosuppression was significantly greater among patients on the concurrent arm than on the sequential arm (P = .0001). CONCLUSION: In selected patients with unresectable stage III NSCLC, the concurrent approach yields a significantly increased response rate and enhanced median survival duration when compared with the sequential approach.

Introduction to The 2015 World Health Organization Classification of Tumors of the Lung, Pleura, Thymus, and Heart

2015-08-21

William D. Travis , Élisabeth Brambilla , Allen Burke +2 more

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Standard-dose versus high-dose conformal radiotherapy with concurrent and consolidation carboplatin plus paclitaxel with or without cetuximab for patients with stage IIIA or IIIB non-small-cell lung cancer (RTOG 0617): a randomised, two-by-two factorial phase 3 study

2015-01-16

Jeffrey D. Bradley , Rebecca Paulus , Ritsuko Komaki +7 more

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Staging of Non–Small-Cell Lung Cancer with Integrated Positron-Emission Tomography and Computed Tomography

2003-06-19

Didier Lardinois , Walter Weder , Thomas F. Hany +5 more

We compared the diagnostic accuracy of integrated positron-emission tomography (PET) and computed tomography (CT) with that of CT alone, that of PET alone, and that of conventional visual correlation of … We compared the diagnostic accuracy of integrated positron-emission tomography (PET) and computed tomography (CT) with that of CT alone, that of PET alone, and that of conventional visual correlation of PET and CT in determining the stage of disease in non–small-cell lung cancer.

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A New International Staging System for Lung Cancer

1986-04-01

Clifton F. Mountain

High Performance of <sup>18</sup>F-Fluorodeoxyglucose Positron Emission Tomography and Contrast-Enhanced CT in a Rapid Outpatient Diagnostic Program for Patients with Suspected Lung Cancer

2013-04-16

Pepijn Brocken , Erik H.F.M. van der Heijden , P.N.R. Dekhuijzen +2 more

Revisions in stage grouping of the TNM subsets (T=primary tumor, N=regional lymph nodes, M=distant metastasis) in the International System for Staging Lung Cancer have been adopted by the American Joint … Revisions in stage grouping of the TNM subsets (T=primary tumor, N=regional lymph nodes, M=distant metastasis) in the International System for Staging Lung Cancer have been adopted by the American Joint Committee on Cancer and the Union Internationale Contre le Cancer. These revisions were made to provide greater specificity for identifying patient groups with similar prognoses and treatment options with the least disruption of the present classification: T1N0M0, stage IA; T2N0M0, stage IB; T1N1M0, stage IIA; T2N1M0 and T3N0M0, stage IIB; and T3N1M0, T1N2M0, T2N2M0, T3N2M0, stage IIIA. The TNM subsets in stage IIIB-T4 any N M0, any T N3M0, and in stage IV-any T any N M1, remain the same. Analysis of a collected database representing all clinical, surgical-pathologic, and follow-up information for 5,319 patients treated for primary lung cancer confirmed the validity of the TNM and stage grouping classification schema.

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The Lung Image Database Consortium (LIDC) and Image Database Resource Initiative (IDRI): A Completed Reference Database of Lung Nodules on CT Scans

2011-01-24

Samuel G. Armato , Geoffrey McLennan , Luc Bidaut +7 more

Purpose: The development of computer‐aided diagnostic (CAD) methods for lung nodule detection, classification, and quantitative assessment can be facilitated through a well‐characterized repository of computed tomography (CT) scans. The Lung … Purpose: The development of computer‐aided diagnostic (CAD) methods for lung nodule detection, classification, and quantitative assessment can be facilitated through a well‐characterized repository of computed tomography (CT) scans. The Lung Image Database Consortium (LIDC) and Image Database Resource Initiative (IDRI) completed such a database, establishing a publicly available reference for the medical imaging research community. Initiated by the National Cancer Institute (NCI), further advanced by the Foundation for the National Institutes of Health (FNIH), and accompanied by the Food and Drug Administration (FDA) through active participation, this public‐private partnership demonstrates the success of a consortium founded on a consensus‐based process. Methods: Seven academic centers and eight medical imaging companies collaborated to identify, address, and resolve challenging organizational, technical, and clinical issues to provide a solid foundation for a robust database. The LIDC/IDRI Database contains 1018 cases, each of which includes images from a clinical thoracic CT scan and an associated XML file that records the results of a two‐phase image annotation process performed by four experienced thoracic radiologists. In the initial blinded‐read phase, each radiologist independently reviewed each CT scan and marked lesions belonging to one of three categories (“ ,” “ ,” and “non‐ ”). In the subsequent unblinded‐read phase, each radiologist independently reviewed their own marks along with the anonymized marks of the three other radiologists to render a final opinion. The goal of this process was to identify as completely as possible all lung nodules in each CT scan without requiring forced consensus. Results: The Database contains 7371 lesions marked “nodule” by at least one radiologist. 2669 of these lesions were marked “ ” by at least one radiologist, of which 928 (34.7%) received such marks from all four radiologists. These 2669 lesions include nodule outlines and subjective nodule characteristic ratings. Conclusions: The LIDC/IDRI Database is expected to provide an essential medical imaging research resource to spur CAD development, validation, and dissemination in clinical practice.

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Revisions in the International System for Staging Lung Cancer

1997-06-01

Clifton F. Mountain

Guidelines for Management of Small Pulmonary Nodules Detected on CT Scans: A Statement from the Fleischner Society

2005-11-01

Heber MacMahon , John H. M. Austin , G Gamsu +5 more

Lung nodules are detected very commonly on computed tomographic (CT) scans of the chest, and the ability to detect very small nodules improves with each new generation of CT scanner. … Lung nodules are detected very commonly on computed tomographic (CT) scans of the chest, and the ability to detect very small nodules improves with each new generation of CT scanner. In reported studies, up to 51% of smokers aged 50 years or older have pulmonary nodules on CT scans. However, the existing guidelines for follow-up and management of noncalcified nodules detected on nonscreening CT scans were developed before widespread use of multi-detector row CT and still indicate that every indeterminate nodule should be followed with serial CT for a minimum of 2 years. This policy, which requires large numbers of studies to be performed at considerable expense and with substantial radiation exposure for the affected population, has not proved to be beneficial or cost-effective. During the past 5 years, new information regarding prevalence, biologic characteristics, and growth rates of small lung cancers has become available; thus, the authors believe that the time-honored requirement to follow every small indeterminate nodule with serial CT should be revised. In this statement, which has been approved by the Fleischner Society, the pertinent data are reviewed, the authors' conclusions are summarized, and new guidelines are proposed for follow-up and management of small pulmonary nodules detected on CT scans.

Methods for Staging Non-small Cell Lung Cancer

2013-05-01

Gerard A. Silvestri , Anne V. Gonzalez , Michael A. Jantz +5 more

Early Lung Cancer Action Project: overall design and findings from baseline screening

1999-07-01

Claudia I. Henschke , Dorothy I. McCauley , David F. Yankelevitz +7 more

BackgroundThe Early Lung Cancer Action Project (ELCAP) is designed to evaluate baseline and annual repeat screening by low-radiation-dose computed tomography (low-dose CT) in people at high risk of lung cancer. … BackgroundThe Early Lung Cancer Action Project (ELCAP) is designed to evaluate baseline and annual repeat screening by low-radiation-dose computed tomography (low-dose CT) in people at high risk of lung cancer. We report the baseline experience.MethodsELCAP has enrolled 1000 symptom-free volunteers, aged 60 years or older, with at least 10 pack-years of cigarette smoking and no previous cancer, who were medically fit to undergo thoracic surgery. After a structured interview and informed consent, chest radiographs and low-dose CT were done for each participant. The diagnostic investigation of screen-detected non-calcified pulmonary nodules was guided by ELCAP recommendations, which included short-term high-resolution CT follow-up for the smallest non-calcified nodules.FindingsNon-calcified nodules were detected in 233 (23% [95% CI 21-26]) participants by low-dose CT at baseline, compared with 68 (7% [5-9]) by chest radiography. Malignant disease was detected in 27 (2·7% [1·8–3·8]) by CT and seven (0·7% [0·3–1·3]) by chest radiography, and stage I malignant disease in 23 (2·3% [1·5–3·3]) and four (0·4% [0·1–0·9]), respectively. Of the 27 CT-detected cancers, 26 were resectable. Biopsies were done on 28 of the 233 participants with non-calcified nodules; 27 had malignant non-calcified nodules and one had a benign nodule. Another three individuals underwent biopsy against the ELCAP recommendations; all had benign non-calcified nodules. No participant had thoracotomy for a benign nodule.InterpretationLow-dose CT can greatly improve the likelihood of detection of small non-calcified nodules, and thus of lung cancer at an earlier and potentially more curable stage. Although false-positive CT results are common, they can be managed with little use of invasive diagnostic procedures.

Regional Lymph Node Classification for Lung Cancer Staging

1997-06-01

Clifton F. Mountain , Carolyn M. Dresler

Evaluation of Individuals With Pulmonary Nodules: When Is It Lung Cancer?

2013-05-01

Michael K. Gould , Jessica Donington , William R. Lynch +4 more

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Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer

1995-09-01

Robert J. Ginsberg , Larry Rubinstein

The IASLC Lung Cancer Staging Project: A Proposal for a New International Lymph Node Map in the Forthcoming Seventh Edition of the TNM Classification for Lung Cancer

2009-05-01

Valerie W. Rusch , Hisao Asamura , Hirokazu Watanabe +3 more

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The IASLC Lung Cancer Staging Project: Proposals for the Revision of the TNM Stage Groupings in the Forthcoming (Seventh) Edition of the TNM Classification of Malignant Tumours

2007-08-01

Peter Goldstraw , John Crowley , Kari Chansky +6 more

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Accuracy of Positron Emission Tomography for Diagnosis of Pulmonary Nodules and Mass Lesions

2001-02-21

Michael K. Gould , Courtney C. Maclean , Ware G. Kuschner +2 more

ContextFocal pulmonary lesions are commonly encountered in clinical practice, and positron emission tomography (PET) with the glucose analog 18-fluorodeoxyglucose (FDG) may be an accurate test for identifying malignant lesions.ObjectiveTo estimate … ContextFocal pulmonary lesions are commonly encountered in clinical practice, and positron emission tomography (PET) with the glucose analog 18-fluorodeoxyglucose (FDG) may be an accurate test for identifying malignant lesions.ObjectiveTo estimate the diagnostic accuracy of FDG-PET for malignant focal pulmonary lesions.Data SourcesStudies published between January 1966 and September 2000 in the MEDLINE and CANCERLIT databases; reference lists of identified studies; abstracts from recent conference proceedings; and direct contact with investigators.Study SelectionStudies that examined FDG-PET or FDG with a modified gamma camera in coincidence mode for diagnosis of focal pulmonary lesions; enrolled at least 10 participants with pulmonary nodules or masses, including at least 5 participants with malignant lesions; and presented sufficient data to permit calculation of sensitivity and specificity were included in the anaylsis.Data ExtractionTwo reviewers independently assessed study quality and abstracted data regarding prevalence of malignancy and sensitivity and specificity of the imaging test. Disagreements were resolved by discussion.Data SynthesisWe used a meta-analytic method to construct summary receiver operating characteristic curves. Forty studies met inclusion criteria. Study methodological quality was fair. Sample sizes were small and blinding was often incomplete. For 1474 focal pulmonary lesions of any size, the maximum joint sensitivity and specificity (the upper left point on the receiver operating characteristic curve at which sensitivity and specificity are equal) of FDG-PET was 91.2% (95% confidence interval, 89.1%-92.9%). In current practice, FDG-PET operates at a point on the summary receiver operating characteristic curve that corresponds approximately to a sensitivity and specificity of 96.8% and 77.8%, respectively. There was no difference in diagnostic accuracy for pulmonary nodules compared with lesions of any size (P = .43), for semiquantitative methods of image interpretation compared with qualitative methods (P = .52), or for FDG-PET compared with FDG imaging with a modified gamma camera in coincidence mode (P = .19).ConclusionsPositron emission tomography with 18-fluorodeoxyglucose is an accurate noninvasive imaging test for diagnosis of pulmonary nodules and larger mass lesions, although few data exist for nodules smaller than 1 cm in diameter. In current practice, FDG-PET has high sensitivity and intermediate specificity for malignancy.

Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-cell lung cancer: a pooled analysis of two randomised trials

2015-05-14

Joe Y. Chang , Suresh Senan , Marinus A. Paul +7 more

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A Randomized Trial Comparing Preoperative Chemotherapy Plus Surgery with Surgery Alone in Patients with Non-Small-Cell Lung Cancer

1994-01-20

R. Rosell , José Gómez‐Codina , Carlos Camps +7 more

The efficacy of surgery for patients with non-small-cell lung cancer is limited, although recent studies suggest that preoperative chemotherapy may improve survival. We conducted a randomized trial to examine the … The efficacy of surgery for patients with non-small-cell lung cancer is limited, although recent studies suggest that preoperative chemotherapy may improve survival. We conducted a randomized trial to examine the possible benefit of preoperative chemotherapy and surgery for the treatment of patients with non-small-cell lung cancer.

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Meta-Analysis of Concomitant Versus Sequential Radiochemotherapy in Locally Advanced Non–Small-Cell Lung Cancer

2010-03-30

Anne Aupérin , C. Le Péchoux , Estelle Rolland +7 more

The previous individual patient data meta-analyses of chemotherapy in locally advanced non-small-cell lung cancer (NSCLC) showed that adding sequential or concomitant chemotherapy to radiotherapy improved survival. The NSCLC Collaborative Group … The previous individual patient data meta-analyses of chemotherapy in locally advanced non-small-cell lung cancer (NSCLC) showed that adding sequential or concomitant chemotherapy to radiotherapy improved survival. The NSCLC Collaborative Group performed a meta-analysis of randomized trials directly comparing concomitant versus sequential radiochemotherapy.Systematic searches for trials were undertaken, followed by central collection, checking, and reanalysis of updated individual patient data. Results from trials were combined using the stratified log-rank test to calculate pooled hazard ratios (HRs). The primary outcome was overall survival; secondary outcomes were progression-free survival, cumulative incidences of locoregional and distant progression, and acute toxicity.Of seven eligible trials, data from six trials were received (1,205 patients, 92% of all randomly assigned patients). Median follow-up was 6 years. There was a significant benefit of concomitant radiochemotherapy on overall survival (HR, 0.84; 95% CI, 0.74 to 0.95; P = .004), with an absolute benefit of 5.7% (from 18.1% to 23.8%) at 3 years and 4.5% at 5 years. For progression-free survival, the HR was 0.90 (95% CI, 0.79 to 1.01; P = .07). Concomitant treatment decreased locoregional progression (HR, 0.77; 95% CI, 0.62 to 0.95; P = .01); its effect was not different from that of sequential treatment on distant progression (HR, 1.04; 95% CI, 0.86 to 1.25; P = .69). Concomitant radiochemotherapy increased acute esophageal toxicity (grade 3-4) from 4% to 18% with a relative risk of 4.9 (95% CI, 3.1 to 7.8; P < .001). There was no significant difference regarding acute pulmonary toxicity.Concomitant radiochemotherapy, as compared with sequential radiochemotherapy, improved survival of patients with locally advanced NSCLC, primarily because of a better locoregional control, but at the cost of manageable increased acute esophageal toxicity.

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Radiotherapy plus chemotherapy with or without surgical resection for stage III non-small-cell lung cancer: a phase III randomised controlled trial

2009-07-25

Kathy S. Albain , Ruth Swann , Valerie W. Rusch +7 more

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Probability of Cancer in Pulmonary Nodules Detected on First Screening CT

2013-09-04

Annette McWilliams , Martin C. Tammemägi , John R. Mayo +7 more

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 … 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.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.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.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.).

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Stereotactic Body Radiation Therapy for Inoperable Early Stage Lung Cancer

2010-03-16

Robert Timmerman

<h3>Context</h3>Patients with early stage but medically inoperable lung cancer have a poor rate of primary tumor control (30%-40%) and a high rate of mortality (3-year survival, 20%-35%) with current management.<h3>Objective</h3>To … <h3>Context</h3>Patients with early stage but medically inoperable lung cancer have a poor rate of primary tumor control (30%-40%) and a high rate of mortality (3-year survival, 20%-35%) with current management.<h3>Objective</h3>To evaluate the toxicity and efficacy of stereotactic body radiation therapy in a high-risk population of patients with early stage but medically inoperable lung cancer.<h3>Design, Setting, and Patients</h3>Phase 2 North American multicenter study of patients aged 18 years or older with biopsy-proven peripheral T1-T2N0M0 non–small cell tumors (measuring <5 cm in diameter) and medical conditions precluding surgical treatment. The prescription dose was 18 Gy per fraction × 3 fractions (54 Gy total) with entire treatment lasting between 1½ and 2 weeks. The study opened May 26, 2004, and closed October 13, 2006; data were analyzed through August 31, 2009.<h3>Main Outcome Measures</h3>The primary end point was 2-year actuarial primary tumor control; secondary end points were disease-free survival (ie, primary tumor, involved lobe, regional, and disseminated recurrence), treatment-related toxicity, and overall survival.<h3>Results</h3>A total of 59 patients accrued, of which 55 were evaluable (44 patients with T1 tumors and 11 patients with T2 tumors) with a median follow-up of 34.4 months (range, 4.8-49.9 months). Only 1 patient had a primary tumor failure; the estimated 3-year primary tumor control rate was 97.6% (95% confidence interval [CI], 84.3%-99.7%). Three patients had recurrence within the involved lobe; the 3-year primary tumor and involved lobe (local) control rate was 90.6% (95% CI, 76.0%-96.5%). Two patients experienced regional failure; the local-regional control rate was 87.2% (95% CI, 71.0%-94.7%). Eleven patients experienced disseminated recurrence; the 3-year rate of disseminated failure was 22.1% (95% CI, 12.3%-37.8%). The rates for disease-free survival and overall survival at 3 years were 48.3% (95% CI, 34.4%-60.8%) and 55.8% (95% CI, 41.6%-67.9%), respectively. The median overall survival was 48.1 months (95% CI, 29.6 months to not reached). Protocol-specified treatment-related grade 3 adverse events were reported in 7 patients (12.7%; 95% CI, 9.6%-15.8%); grade 4 adverse events were reported in 2 patients (3.6%; 95% CI, 2.7%-4.5%). No grade 5 adverse events were reported.<h3>Conclusion</h3>Patients with inoperable non–small cell lung cancer who received stereotactic body radiation therapy had a survival rate of 55.8% at 3 years, high rates of local tumor control, and moderate treatment-related morbidity.

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Benefits and Harms of CT Screening for Lung Cancer

2012-05-20

Peter B. Bach , Joshua N. Mirkin , Thomas K. Oliver +7 more

<h3>Context</h3>Lung cancer is the leading cause of cancer death. Most patients are diagnosed with advanced disease, resulting in a very low 5-year survival. Screening may reduce the risk of death … <h3>Context</h3>Lung cancer is the leading cause of cancer death. Most patients are diagnosed with advanced disease, resulting in a very low 5-year survival. Screening may reduce the risk of death from lung cancer.<h3>Objective</h3>To conduct a systematic review of the evidence regarding the benefits and harms of lung cancer screening using low-dose computed tomography (LDCT). A multisociety collaborative initiative (involving the American Cancer Society, American College of Chest Physicians, American Society of Clinical Oncology, and National Comprehensive Cancer Network) was undertaken to create the foundation for development of an evidence-based clinical guideline.<h3>Data Sources</h3>MEDLINE (Ovid: January 1996 to April 2012), EMBASE (Ovid: January 1996 to April 2012), and the Cochrane Library (April 2012).<h3>Study Selection</h3>Of 591 citations identified and reviewed, 8 randomized trials and 13 cohort studies of LDCT screening met criteria for inclusion. Primary outcomes were lung cancer mortality and all-cause mortality, and secondary outcomes included nodule detection, invasive procedures, follow-up tests, and smoking cessation.<h3>Data Extraction</h3>Critical appraisal using predefined criteria was conducted on individual studies and the overall body of evidence. Differences in data extracted by reviewers were adjudicated by consensus.<h3>Results</h3>Three randomized studies provided evidence on the effect of LDCT screening on lung cancer mortality, of which the National Lung Screening Trial was the most informative, demonstrating that among 53 454 participants enrolled, screening resulted in significantly fewer lung cancer deaths (356 vs 443 deaths; lung cancer−specific mortality, 247 vs 309 events per 100 000 person-years for LDCT and control groups, respectively; relative risk, 0.80; 95% CI, 0.73-0.93; absolute risk reduction, 0.33%; P = .004). The other 2 smaller studies showed no such benefit. In terms of potential harms of LDCT screening, across all trials and cohorts, approximately 20% of individuals in each round of screening had positive results requiring some degree of follow-up, while approximately 1% had lung cancer. There was marked heterogeneity in this finding and in the frequency of follow-up investigations, biopsies, and percentage of surgical procedures performed in patients with benign lesions. Major complications in those with benign conditions were rare.<h3>Conclusion</h3>Low-dose computed tomography screening may benefit individuals at an increased risk for lung cancer, but uncertainty exists about the potential harms of screening and the generalizability of results.

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Prospective Randomized Trial of Docetaxel Versus Best Supportive Care in Patients With Non–Small-Cell Lung Cancer Previously Treated With Platinum-Based Chemotherapy

2000-05-10

Frances A. Shepherd , Janet Dancey , Rodryg Ramlau +7 more

PURPOSE: To evaluate whether treatment with single-agent docetaxel would result in longer survival than would best supportive care in patients with non–small-cell lung cancer who had previously been treated with … PURPOSE: To evaluate whether treatment with single-agent docetaxel would result in longer survival than would best supportive care in patients with non–small-cell lung cancer who had previously been treated with platinum-based chemotherapy. Secondary end points included assessment of response (docetaxel arm only), toxicity, and quality of life. PATIENTS AND METHODS: Patients with performance statuses of 0 to 2 and stage IIIB/IV non–small-cell lung cancer with either measurable or evaluable lesions were eligible for entry onto the study if they had undergone one or more platinum-based chemotherapy regimens and if they had adequate hematology and biochemistry parameters. They were excluded if they had symptomatic brain metastases or if they had previously been treated with paclitaxel. Patients were stratified by performance status and best response to cisplatin chemotherapy and were then randomized to treatment with docetaxel 100 mg/m 2 (49 patients) or 75 mg/m 2 (55 patients) or best supportive care. Patients in both arms were assessed every 3 weeks. RESULTS: One hundred four patients (103 of whom were eligible for entry onto the study) were well balanced for prognostic factors. Of 84 patients with measurable lesions, six (7.1%) achieved partial responses (three patients at each dose level). Time to progression was longer for docetaxel patients than for best supportive care patients (10.6 v 6.7 weeks, respectively; P < .001), as was median survival (7.0 v 4.6 months; log-rank test, P = .047). The difference was more significant for docetaxel 75 mg/m 2 patients, compared with corresponding best supportive care patients (7.5 v 4.6 months; log-rank test, P = .010; 1-year survival, 37% v 11%; χ 2 test, P = .003). Febrile neutropenia occurred in 11 patients treated with docetaxel 100 mg/m 2 , three of whom died, and in one patient treated with docetaxel 75 mg/m 2 . Grade 3 or 4 nonhematologic toxicity, with the exception of diarrhea, occurred at a similar rate in both the docetaxel and best supportive care groups. CONCLUSION: Treatment with docetaxel is associated with significant prolongation of survival, and at a dose of 75 mg/m 2 , the benefits of docetaxel therapy outweigh the risks.

A Randomized Trial Comparing Perioperative Chemotherapy and Surgery With Surgery Alone in Resectable Stage IIIA Non-Small-Cell Lung Cancer

1994-05-04

Jack A. Roth , Frank V. Fossella , R. Komaki +7 more

Patients with resectable stage IIIA non-small-cell lung cancer have a low survival rate following standard surgical treatment. Nonrandomized trials in which induction chemotherapy or a combination of chemotherapy and radiation … Patients with resectable stage IIIA non-small-cell lung cancer have a low survival rate following standard surgical treatment. Nonrandomized trials in which induction chemotherapy or a combination of chemotherapy and radiation prior to surgery were used to treat patients with regionally advanced primary cancers have suggested that survival is improved when compared with treatment by surgery alone.We performed a prospective, randomized study of patients with previously untreated, potentially resectable clinical stage IIIA non-small-cell lung cancer to compare the results of perioperative chemotherapy and surgery with those of surgery alone.This trial was designed to test the null hypothesis that the proportion of patients surviving 3 years is 12% for either treatment group against the alternate hypothesis that the 3-year survival rate would be 12% in the surgery alone group and 32% in the perioperative chemotherapy group. The estimated required sample size was 65 patients in each group. The trial was terminated at an early time according to the method of O'Brien and Fleming following a single unplanned interim analysis. The decision to terminate the trial was based on ethical considerations, the magnitude of the treatment effect, and the high degree of statistical significance attained. In total, 60 patients were randomly assigned between 1987 and 1993 to receive either six cycles of perioperative chemotherapy (cyclophosphamide, etoposide, and cisplatin) and surgery (28 patients) or surgery alone (32 patients). For patients in the former group, tumor measurements were made before each course of chemotherapy and the clinical tumor response was evaluated after three cycles of chemotherapy; they then underwent surgical resection. Patients who had documented tumor regression after preoperative chemotherapy received three additional cycles of chemotherapy after surgery.After three cycles of preoperative chemotherapy, the rate of clinical major response was 35%. Patients treated with perioperative chemotherapy and surgery had an estimated median survival of 64 months compared with 11 months for patients who had surgery alone (P < .008 by log-rank test; P < .018 by Wilcoxon test). The estimated 2- and 3-year survival rates were 60% and 56% for the perioperative chemotherapy patients and 25% and 15% for those who had surgery alone, respectively.In this trial, the treatment strategy using perioperative chemotherapy and surgery was more effective than surgery alone.This clinical trial strengthens the validity of using perioperative chemotherapy in the management of patients with resectable stage IIIA non-small-cell lung cancer. Further investigation of the perioperative chemotherapy strategy in earlier stage lung cancer is warranted.

Screening for Lung Cancer: U.S. Preventive Services Task Force Recommendation Statement

2013-12-30

Virginia A. Moyer

Description: Update of the 2004 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for lung cancer. Methods: The USPSTF reviewed the evidence on the efficacy of low-dose computed tomography, … Description: Update of the 2004 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for lung cancer. Methods: The USPSTF reviewed the evidence on the efficacy of low-dose computed tomography, chest radiography, and sputum cytologic evaluation for lung cancer screening in asymptomatic persons who are at average or high risk for lung cancer (current or former smokers) and the benefits and harms of these screening tests and of surgical resection of early-stage non–small cell lung cancer. The USPSTF also commissioned modeling studies to provide information about the optimum age at which to begin and end screening, the optimum screening interval, and the relative benefits and harms of different screening strategies. Population: This recommendation applies to asymptomatic adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. Recommendation: The USPSTF recommends annual screening for lung cancer with low-dose computed tomography in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. (B recommendation)

American Society of Clinical Oncology Treatment of Unresectable Non–Small-Cell Lung Cancer Guideline: Update 2003

2003-12-23

David G. Pfister , David H. Johnson , Christopher G. Azzoli +7 more

The American Society of Clinical Oncology (ASCO) previously published evidencebased guidelines for the treatment of unresectable non–small-cell lung cancer (NSCLC) [1]. ASCO guidelines are updated periodically by the responsible Expert … The American Society of Clinical Oncology (ASCO) previously published evidencebased guidelines for the treatment of unresectable non–small-cell lung cancer (NSCLC) [1]. ASCO guidelines are updated periodically by the responsible Expert Panel (Appendix) [2]. For the 2003 update, a methodology similar to that applied in the original ASCO practice guidelines for treatment of unresectable NSCLC was used. Pertinent information published from 1996 through March 2003 was reviewed. The MEDLINE database (1996 through October 2002; National Library of Medicine, Bethesda, MD) was searched to identify relevant information from the published literature for this update. A series of searches was conducted using the medical subject headings, “carcinoma, non–small-cell lung,” “diagnostic imaging,” “neoplasm staging,” “mediastinoscopy,” “bone neoplasms,” “brain neoplasms,” “liver neoplasms,” “adrenal gland neoplasms,” “non–small-cell lung cancer,” “radionuclide imaging,” “bisphosphonates,” “radiotherapy,” “smoking,” “chemoprevention,” and the text words “chemotherapy,” “bone scan,” “PET,” and “zoledronic acid.” These terms were combined with the study design–related subject headings or text words “meta-analysis” and “randomized controlled trial.” Search results were limited to human studies and English-language articles. The Cochrane Library was searched in October 2002 using the phrase “lung cancer.” Directed searches based on the bibliographies of primary articles were also performed. Randomized trials published in the literature since October 2002, as well as data presented at ASCO Annual Meetings, were added to the evidence for these guidelines at the discretion of members of the Expert Panel. The entire update committee met once to discuss strategy and assign responsibilities for the update. A writing committee subsequently met to further review the literature searches, collate different sections of the update, and refine the manuscript. A draft update was circulated to the full Expert Panel for review and approval. The final document was also reviewed by ASCO’s Health Services Research Committee and the ASCO Board of Directors. Each recommendation from the 1997 guideline is listed below, and is followed by an updated (2003) recommendation, if applicable. “No change” is indicated if a particular recommendation has not been revised. A summary of the evidence follows thereafter. In order to preserve the framework of the 1997 guideline, information and recommendations regarding major topics, such as fluorodeoxyglucose positron emission tomography (FDGPET), have been divided and distributed to the appropriate section of the text. ASCO considers adherence to these guidelines to be voluntary. The ultimate determination regarding their application is to be made by the physician in light of each From the American Society of Clinical Oncology, Alexandria, VA.

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Sequential vs Concurrent Chemoradiation for Stage III Non-Small Cell Lung Cancer: Randomized Phase III Trial RTOG 9410

2011-09-08

Walter J. Curran , Rebecca Paulus , Corey J. Langer +7 more

The combination of chemotherapy with thoracic radiotherapy (TRT) compared with TRT alone has been shown to confer a survival advantage for good performance status patients with stage III non–small cell … The combination of chemotherapy with thoracic radiotherapy (TRT) compared with TRT alone has been shown to confer a survival advantage for good performance status patients with stage III non–small cell lung cancer. However, it is not known whether sequential or concurrent delivery of these therapies is the optimal combination strategy. A total of 610 patients were randomly assigned to two concurrent regimens and one sequential chemotherapy and TRT regimen in a three-arm phase III trial. The sequential arm included cisplatin at 100 mg/m 2 on days 1 and 29 and vinblastine at 5 mg/m 2 per week for 5 weeks with 60 Gy TRT beginning on day 50. Arm 2 used the same chemotherapy regimen as arm 1 with 60 Gy TRT once daily beginning on day 1. Arm 3 used cisplatin at 50 mg/m 2 on days 1, 8, 29, and 36 with oral etoposide at 50 mg twice daily for 10 weeks on days 1, 2, 5, and 6 with 69.6 Gy delivered as 1.2 Gy twice-daily fractions beginning on day 1. The primary endpoint was overall survival, and secondary endpoints included tumor response and time to tumor progression. Kaplan–Meier analyses were used to assess survival, and toxic effects were examined using the Wilcoxon rank sum test. All statistical tests were two-sided. Median survival times were 14.6, 17.0, and 15.6 months for arms 1–3, respectively. Five-year survival was statistically significantly higher for patients treated with the concurrent regimen with once-daily TRT compared with the sequential treatment (5-year survival: sequential, arm 1, 10% [20 patients], 95% confidence interval [CI] = 7% to 15%; concurrent, arm 2, 16% [31 patients], 95% CI = 11% to 22%, P = .046; concurrent, arm 3, 13% [22 patients], 95% CI = 9% to 18%). With a median follow-up time of 11 years, the rates of acute grade 3–5 nonhematologic toxic effects were higher with concurrent than sequential therapy, but late toxic effects were similar. Concurrent delivery of cisplatin-based chemotherapy with TRT confers a long-term survival benefit compared with the sequential delivery of these therapies.

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Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

2017-05-05

Pieter E. Postmus , Keith M. Kerr , Matthijs Oudkerk +5 more

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Adjuvant vinorelbine plus cisplatin versus observation in patients with completely resected stage IB–IIIA non-small-cell lung cancer (Adjuvant Navelbine International Trialist Association [ANITA]): a randomised controlled trial

2006-08-18

Jean‐Yves Douillard , Rafael Rosell , Mario De Lena +7 more

Excessive Toxicity When Treating Central Tumors in a Phase II Study of Stereotactic Body Radiation Therapy for Medically Inoperable Early-Stage Lung Cancer

2006-10-18

Robert Timmerman , Ronald C. McGarry , Constantin T. Yiannoutsos +7 more

Surgical resection is standard therapy in stage I non-small-cell lung cancer (NSCLC); however, many patients are inoperable due to comorbid diseases. Building on a previously reported phase I trial, we … Surgical resection is standard therapy in stage I non-small-cell lung cancer (NSCLC); however, many patients are inoperable due to comorbid diseases. Building on a previously reported phase I trial, we carried out a prospective phase II trial using stereotactic body radiation therapy (SBRT) in this population.Eligible patients included clinically staged T1 or T2 (< or = 7 cm), N0, M0, biopsy-confirmed NSCLC. All patients had comorbid medical problems that precluded lobectomy. SBRT treatment dose was 60 to 66 Gy total in three fractions during 1 to 2 weeks.All 70 patients enrolled completed therapy as planned and median follow-up was 17.5 months. The 3-month major response rate was 60%. Kaplan-Meier local control at 2 years was 95%. Altogether, 28 patients have died as a result of cancer (n = 5), treatment (n = 6), or comorbid illnesses (n = 17). Median overall survival was 32.6 months and 2-year overall survival was 54.7%. Grade 3 to 5 toxicity occurred in a total of 14 patients. Among patients experiencing toxicity, the median time to observation was 10.5 months. Patients treated for tumors in the peripheral lung had 2-year freedom from severe toxicity of 83% compared with only 54% for patients with central tumors.High rates of local control are achieved with this SBRT regimen in medically inoperable patients with stage I NSCLC. Both local recurrence and toxicity occur late after this treatment. This regimen should not be used for patients with tumors near the central airways due to excessive toxicity.

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Overdiagnosis in Cancer

2010-04-22

H. Gilbert Welch , William C. Black

This article summarizes the phenomenon of cancer overdiagnosis-the diagnosis of a "cancer" that would otherwise not go on to cause symptoms or death. We describe the two prerequisites for cancer … This article summarizes the phenomenon of cancer overdiagnosis-the diagnosis of a "cancer" that would otherwise not go on to cause symptoms or death. We describe the two prerequisites for cancer overdiagnosis to occur: the existence of a silent disease reservoir and activities leading to its detection (particularly cancer screening). We estimated the magnitude of overdiagnosis from randomized trials: about 25% of mammographically detected breast cancers, 50% of chest x-ray and/or sputum-detected lung cancers, and 60% of prostate-specific antigen-detected prostate cancers. We also review data from observational studies and population-based cancer statistics suggesting overdiagnosis in computed tomography-detected lung cancer, neuroblastoma, thyroid cancer, melanoma, and kidney cancer. To address the problem, patients must be adequately informed of the nature and the magnitude of the trade-off involved with early cancer detection. Equally important, researchers need to work to develop better estimates of the magnitude of overdiagnosis and develop clinical strategies to help minimize it.

Survival of Patients with Stage I Lung Cancer Detected on CT Screening

2006-10-25

Claudia I. Henschke , David F. Yankelevitz , Daniel M. Libby +3 more

The outcome among patients with clinical stage I cancer that is detected on annual screening using spiral computed tomography (CT) is unknown.In a large collaborative study, we screened 31,567 asymptomatic … The outcome among patients with clinical stage I cancer that is detected on annual screening using spiral computed tomography (CT) is unknown.In a large collaborative study, we screened 31,567 asymptomatic persons at risk for lung cancer using low-dose CT from 1993 through 2005, and from 1994 through 2005, 27,456 repeated screenings were performed 7 to 18 months after the previous screening. We estimated the 10-year lung-cancer-specific survival rate among participants with clinical stage I lung cancer that was detected on CT screening and diagnosed by biopsy, regardless of the type of treatment received, and among those who underwent surgical resection of clinical stage I cancer within 1 month. A pathology panel reviewed the surgical specimens obtained from participants who underwent resection.Screening resulted in a diagnosis of lung cancer in 484 participants. Of these participants, 412 (85%) had clinical stage I lung cancer, and the estimated 10-year survival rate was 88% in this subgroup (95% confidence interval [CI], 84 to 91). Among the 302 participants with clinical stage I cancer who underwent surgical resection within 1 month after diagnosis, the survival rate was 92% (95% CI, 88 to 95). The 8 participants with clinical stage I cancer who did not receive treatment died within 5 years after diagnosis.Annual spiral CT screening can detect lung cancer that is curable.

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The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer

2016-01-01

Peter Goldstraw , Kari Chansky , John Crowley +7 more

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A Randomized Trial of Induction Chemotherapy plus High-Dose Radiation versus Radiation Alone in Stage III Non-Small-Cell Lung Cancer

1990-10-04

Robert O. Dillman , Stephen L. Seagren , Kathleen J. Propert +6 more

For patients with locally or regionally advanced non-small-cell lung cancer radiation is the standard treatment, but survival remains poor. We therefore conducted a randomized trial to determine whether induction chemotherapy … For patients with locally or regionally advanced non-small-cell lung cancer radiation is the standard treatment, but survival remains poor. We therefore conducted a randomized trial to determine whether induction chemotherapy before irradiation improves survival.

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Pulmonary Nodule Detection in CT Images: False Positive Reduction Using Multi-View Convolutional Networks

2016-03-01

Arnaud Arindra Adiyoso Setio , Francesco Ciompi , Geert Litjens +7 more

We propose a novel Computer-Aided Detection (CAD) system for pulmonary nodules using multi-view convolutional networks (ConvNets), for which discriminative features are automatically learnt from the training data. The network is … We propose a novel Computer-Aided Detection (CAD) system for pulmonary nodules using multi-view convolutional networks (ConvNets), for which discriminative features are automatically learnt from the training data. The network is fed with nodule candidates obtained by combining three candidate detectors specifically designed for solid, subsolid, and large nodules. For each candidate, a set of 2-D patches from differently oriented planes is extracted. The proposed architecture comprises multiple streams of 2-D ConvNets, for which the outputs are combined using a dedicated fusion method to get the final classification. Data augmentation and dropout are applied to avoid overfitting. On 888 scans of the publicly available LIDC-IDRI dataset, our method reaches high detection sensitivities of 85.4% and 90.1% at 1 and 4 false positives per scan, respectively. An additional evaluation on independent datasets from the ANODE09 challenge and DLCST is performed. We showed that the proposed multi-view ConvNets is highly suited to be used for false positive reduction of a CAD system.

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Preoperative Staging of Non–Small-Cell Lung Cancer with Positron-Emission Tomography

2000-07-27

Remge M. Pieterman , John W.G. van Putten , J. J. Meuzelaar +6 more

Determining the stage of non–small-cell lung cancer often requires multiple preoperative tests and invasive procedures. Whole-body positron-emission tomography (PET) may simplify and improve the evaluation of patients with this tumor. Determining the stage of non–small-cell lung cancer often requires multiple preoperative tests and invasive procedures. Whole-body positron-emission tomography (PET) may simplify and improve the evaluation of patients with this tumor.

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Treatment of Stage I and II Non-small Cell Lung Cancer

2013-05-01

John A. Howington , Matthew G. Blum , Andrew C. Chang +2 more

The Eighth Edition Lung Cancer Stage Classification

2016-10-22

Frank C. Detterbeck , Daniel J. Boffa , Anthony W. Kim +1 more

Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017

2017-03-01

Heber MacMahon , David P. Naidich , Jin Mo Goo +7 more

The Fleischner Society Guidelines for management of solid nodules were published in 2005, and separate guidelines for subsolid nodules were issued in 2013. Since then, new information has become available; … The Fleischner Society Guidelines for management of solid nodules were published in 2005, and separate guidelines for subsolid nodules were issued in 2013. Since then, new information has become available; therefore, the guidelines have been revised to reflect current thinking on nodule management. The revised guidelines incorporate several substantive changes that reflect current thinking on the management of small nodules. The minimum threshold size for routine follow-up has been increased, and recommended follow-up intervals are now given as a range rather than as a precise time period to give radiologists, clinicians, and patients greater discretion to accommodate individual risk factors and preferences. The guidelines for solid and subsolid nodules have been combined in one simplified table, and specific recommendations have been included for multiple nodules. These guidelines represent the consensus of the Fleischner Society, and as such, they incorporate the opinions of a multidisciplinary international group of thoracic radiologists, pulmonologists, surgeons, pathologists, and other specialists. Changes from the previous guidelines issued by the Fleischner Society are based on new data and accumulated experience. © RSNA, 2017 Online supplemental material is available for this article. An earlier incorrect version of this article appeared online. This article was corrected on March 13, 2017.

Global Epidemiology of Lung Cancer

2019-01-01

Julie A. Barta , Charles A. Powell , Juan P. Wisnivesky

While lung cancer has been the leading cause of cancer-related deaths for many years in the United States, incidence and mortality statistics - among other measures - vary widely worldwide. … While lung cancer has been the leading cause of cancer-related deaths for many years in the United States, incidence and mortality statistics - among other measures - vary widely worldwide. The aim of this study was to review the evidence on lung cancer epidemiology, including data of international scope with comparisons of economically, socially, and biologically different patient groups. In industrialized nations, evolving social and cultural smoking patterns have led to rising or plateauing rates of lung cancer in women, lagging the long-declining smoking and cancer incidence rates in men. In contrast, emerging economies vary widely in smoking practices and cancer incidence but commonly also harbor risks from environmental exposures, particularly widespread air pollution. Recent research has also revealed clinical, radiologic, and pathologic correlates, leading to greater knowledge in molecular profiling and targeted therapeutics, as well as an emphasis on the rising incidence of adenocarcinoma histology. Furthermore, emergent evidence about the benefits of lung cancer screening has led to efforts to identify high-risk smokers and development of prediction tools. This review also includes a discussion on the epidemiologic characteristics of special groups including women and nonsmokers. Varying trends in smoking largely dictate international patterns in lung cancer incidence and mortality. With declining smoking rates in developed countries and knowledge gains made through molecular profiling of tumors, the emergence of new risk factors and disease features will lead to changes in the landscape of lung cancer epidemiology.

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End-to-end lung cancer screening with three-dimensional deep learning on low-dose chest computed tomography

2019-05-20

Diego Ardila , Atilla P. Kiraly , Sujeeth Bharadwaj +7 more

Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial

2020-01-29

Harry J. de Koning , Carlijn M. van der Aalst , Pim A. de Jong +7 more

There are limited data from randomized trials regarding whether volume-based, low-dose computed tomographic (CT) screening can reduce lung-cancer mortality among male former and current smokers. There are limited data from randomized trials regarding whether volume-based, low-dose computed tomographic (CT) screening can reduce lung-cancer mortality among male former and current smokers.

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Lung Cancer 2020

2020-01-31

Brett C. Bade , Charles S. Dela Cruz

Screening for Lung Cancer

2021-03-09

Alex H. Krist , Karina W. Davidson , Carol M. Mangione +7 more

<h3>Importance</h3> Lung cancer is the second most common cancer and the leading cause of cancer death in the US. In 2020, an estimated 228 820 persons were diagnosed with lung … <h3>Importance</h3> Lung cancer is the second most common cancer and the leading cause of cancer death in the US. In 2020, an estimated 228 820 persons were diagnosed with lung cancer, and 135 720 persons died of the disease. The most important risk factor for lung cancer is smoking. Increasing age is also a risk factor for lung cancer. Lung cancer has a generally poor prognosis, with an overall 5-year survival rate of 20.5%. However, early-stage lung cancer has a better prognosis and is more amenable to treatment. <h3>Objective</h3> To update its 2013 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review on the accuracy of screening for lung cancer with low-dose computed tomography (LDCT) and on the benefits and harms of screening for lung cancer and commissioned a collaborative modeling study to provide information about the optimum age at which to begin and end screening, the optimal screening interval, and the relative benefits and harms of different screening strategies compared with modified versions of multivariate risk prediction models. <h3>Population</h3> This recommendation statement applies to adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. <h3>Evidence Assessment</h3> The USPSTF concludes with moderate certainty that annual screening for lung cancer with LDCT has a moderate net benefit in persons at high risk of lung cancer based on age, total cumulative exposure to tobacco smoke, and years since quitting smoking. <h3>Recommendation</h3> The USPSTF recommends annual screening for lung cancer with LDCT in adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. (B recommendation) This recommendation replaces the 2013 USPSTF statement that recommended annual screening for lung cancer with LDCT in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years.

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Neoadjuvant Nivolumab plus Chemotherapy in Resectable Lung Cancer

2022-04-11

Patrick M. Forde , Jonathan Spicer , Shun Lü +7 more

Neoadjuvant or adjuvant chemotherapy confers a modest benefit over surgery alone for resectable non–small-cell lung cancer (NSCLC). In early-phase trials, nivolumab-based neoadjuvant regimens have shown promising clinical activity; however, data … Neoadjuvant or adjuvant chemotherapy confers a modest benefit over surgery alone for resectable non–small-cell lung cancer (NSCLC). In early-phase trials, nivolumab-based neoadjuvant regimens have shown promising clinical activity; however, data from phase 3 trials are needed to confirm these findings.

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Ingenuity of Lobectomy in Reduced Port Robot-assisted Thoracic Surgery Using the Two Ports and One-window Method in Fusion Surgery.

2025-07-20

Tomohiko Matsuzaki , Tomoki Higeta , Keitaro Matsuo +7 more | PubMed

In 1992, we devised an operation using the two-window method in which ports are created at only two sites in the thoracic wall for malignant lung tumors. However, in robot-assisted … In 1992, we devised an operation using the two-window method in which ports are created at only two sites in the thoracic wall for malignant lung tumors. However, in robot-assisted thoracic surgery (RATS), five ports are considered necessary for most thoracic approaches, which is in contrast to the concept of minimal invasiveness. This study aimed to determine the outcome of the two ports and one-window method using fusion surgery for RATS. Twenty-one RATSs were performed between November 2023 and September 2024. We performed the two ports and one-window method in all patients. Among 21 planned RATSs for anatomical pulmonary resections, there were no conversions to thoracotomy and no requirement for extra ports. The mean surgery time was 121.0 minutes and the mean console time was 73.1 minutes. The mean intraoperative blood loss volume was 20.7 mL. The mean duration of chest tube drainage and hospital stay were 3.1 and 4.4 days, respectively. There were no postoperative complications or mortalities. Our early results suggest that the two ports and one-window method is safe, feasible, and provides excellent perioperative outcomes.

Minimally Invasive Interventions in the Thorax for Tumor Treatment and Palliation

2025-06-26

| Radiographics

BronchoGAN: anatomically consistent and domain-agnostic image-to-image translation for video bronchoscopy

2025-06-25

A. A. Soliman , Ron Keuth , Marian Himstedt | International Journal of Computer Assisted Radiology and Surgery

Recruitment Strategies for Lung Cancer Screening: An Umbrella Review Protocol

2025-06-25

Barbara Cushing , Benjamin Jacob , Xiu Hui Low +5 more | HRB Open Research

<ns3:p>Background Lung cancer is the leading cause of cancer-related mortality worldwide. Low-dose CT (LDCT) lung cancer screening (LCS) reduces lung cancer-specific mortality by 20%, yet participation remains low, often below … <ns3:p>Background Lung cancer is the leading cause of cancer-related mortality worldwide. Low-dose CT (LDCT) lung cancer screening (LCS) reduces lung cancer-specific mortality by 20%, yet participation remains low, often below 15%, compared with 60–75% for other cancer screening programmes. Barriers such as limited accessibility, stigma, fear of diagnosis, and misconceptions contribute to poor uptake, particularly among high-risk groups, including heavy smokers, ethnic minorities, and individuals from lower socioeconomic backgrounds. Various recruitment strategies—such as personalised invitations, media campaigns, and primary care referrals—have been implemented, but their effectiveness across different populations remains unclear. This umbrella review will synthesise evidence from systematic reviews to identify the most effective recruitment strategies for improving LCS participation. Methods This umbrella review will follow Joanna Briggs Institute guidelines and the PRIOR reporting framework. A systematic search of PubMed, Embase, Scopus, Web of Science, Cochrane Library, and systematic review registries will identify systematic reviews published before 31 October 2024. Eligible reviews must evaluate LCS recruitment strategies and report on at least one of the following: population reach, screening up take, adherence, patient experience, or implementation barriers. Quality will be assessed using AMSTAR 2, and overlapping primary studies will be mapped to prevent duplication. A narrative synthesis will categorise recruitment strategies, and a qualitative effectiveness ranking will summarise key findings. Implications Findings will inform LCS recruitment strategies in Europe, contributing to the EU4Health-funded EUCanScreen programme. This review will support efforts to improve uptake, reduce disparities, and enhance early detection and survival outcomes of lung cancer.</ns3:p>

The clinicopathologic characteristics and tumor immune microenvironment of pulmonary enteric adenocarcinoma

2025-06-25

Lan Yang , Lingru Chen , Jiali Gong +1 more | Annals of Medicine

Pulmonary enteric adenocarcinoma (PEAC) as a rare subtype of lung adenocarcinoma is sparsely reported. Currently, to achieve effective treatment and accurate prognosis prediction, the exploration of molecular markers is ongoing. … Pulmonary enteric adenocarcinoma (PEAC) as a rare subtype of lung adenocarcinoma is sparsely reported. Currently, to achieve effective treatment and accurate prognosis prediction, the exploration of molecular markers is ongoing. This study retrospectively enrolled 10 patients with PEAC confirmed by pathology at Zhejiang Cancer Hospital from April 2015 to July 2021. The investigation focused on their clinicopathological features and the tumor immune microenvironment. The expression of LAG-3, PD-L1, and MMR proteins was determined by immunohistochemistry in 7 patients with adequate tissue. Simultaneously, the levels and distribution of CD3, CD8A, CD45RO and PanCK in PEAC patients were measured by multiple immunohistochemical methods to explore and analyze the classification of TIME. A total of 10 patient pathologically diagnosed as PEAC, the mean age at diagnosis is 60.3 years, and 60% of them were male. The median follow-up for PFS subjects was 16.7 months (95%CI: 4.92-28.48 months). The median OS was 93.9 months (95% CI: 0-216.03 months). All the 7 patients in this study exhibited microsatellite stability (MSS), and PD-L1 expression was negative. Of the 7 patients, only one expressed LAG-3. The analysis of TIME in PEAC patients suggested 'cold tumors', meaning these patients may not benefit from immunotherapy. PEAC is a rare histological variant of LAUD that occurs predominantly in middle-aged and elderly males. Its morphological characteristics are similar to colorectal adenocarcinoma, and the NaspinA, TTF-1, CK7, CDX2 and CK20 are beneficial for diagnosis. In this study, PEAC patients showed low CD8+ T cell, CD45RO+ T cell and LAG-3 expression, and negative PD-L1 expression. And all patients were MMS.

Application of 3-dimensional reconstruction via modified pulmonary artery computed tomography angiography in anatomic pulmonary segmentectomy

2025-06-24

Weiwei Min , Jianbin Zhang , Yilv Zhu +1 more | Journal of Cardiothoracic Surgery

This retrospective study aimed to summarize the application of 3-dimensional(3D) reconstruction via modified pulmonary artery computed tomography angiography(CTA), as well as to compare the surgical outcomes of 3D versus high … This retrospective study aimed to summarize the application of 3-dimensional(3D) reconstruction via modified pulmonary artery computed tomography angiography(CTA), as well as to compare the surgical outcomes of 3D versus high resolution CT(HRCT) in anatomic pulmonary segmentectomy(APS). A total of 93 patients who underwent thoracoscopic APS were enrolled in the study. They were divided into 3D group (n = 30) and HRCT group (n = 63), and than matched at 1:1 ratio using the propensity score matching (PSM) method. Clinical characteristics, surgical status, and postoperative recovery were compared between two groups, additionally, variations of segmental structures were summarized. 60 cases were matched by PSM with 30 cases in each group. There were no significant differences between two groups in clinical characteristics, intraoperative blood loss and postoperative recovery (including total chest drainage, length of postoperative hospital stay)(P > 0.05 for all). 8(26.7%) patients in 3D group manifesting unique variations of segmental structures underwent anatomical segmentectomy accurately. Despite the 3D group exhibited higher anatomic variations compared to the HRCT group, it demonstrated shorter operation times and lower incidence of pulmonary infection. (P < 0.05 for all). Preoperative 3D reconstruction has advantages in APS, particularly for patients with complex anatomic variations. Reconstruction via modified pulmonary artery CTA is also feasible for preoperative planning and intraoperative navigation in thoracoscopic APS.

First European Experience of Shape-Sensing Robotic-assisted bronchoscopy: Learning Curve Analysis

2025-06-24

Judith Brock , A. Susanne Dittrich , Konstantina Kontogianni +5 more | Respiration

Shape-sensing robotic-assisted bronchoscopy (ssRAB) is an emerging approach in Europe to diagnose peripheral pulmonary nodules (PPN). There is limited data on how quickly this new technology can be learned. This … Shape-sensing robotic-assisted bronchoscopy (ssRAB) is an emerging approach in Europe to diagnose peripheral pulmonary nodules (PPN). There is limited data on how quickly this new technology can be learned. This study presents a post-hoc analysis of learning curves from a single-centre prospective study in which PPN were diagnosed by ssRAB combined with standalone (non-integrated) mobile cone-beam computed tomography (mCBCT) by two experienced proceduralists both nascent to ssRAB and mCBCT. All sections of procedure times, number of mCBCT spins, and tool-in-lesion (TIL) were assessed by cumulative sum (CUSUM) analysis. A total of 45 patients were included in the study with biopsies attempted in 40 subjects (n=17 proceduralist 1, n=23 proceduralist 2), with a median (IQR) nodule size of 20.0 (17.0, 24.0) mm. Median procedure time improved for both proceduralists after case 6. Navigation time showed no learning pattern, while there were different learning patterns for parts of the procedure for both proceduralists. Proceduralist 1 had statistically significantly shorter procedure times compared to proceduralist 2, mostly due to more biopsies taken from proceduralist 2. Both proceduralists were able to obtain TIL confirmed by mCBCT from the first case and demonstrated proficiency after 8 cases. Competence in ssRAB can be achieved quickly, and procedure times decrease after a few cases. However, as learning curves vary between proceduralists, a sufficient number of cases should be considered to achieve ssRAB proficiency. Not all learning parameters, such as anesthetic or endoscopic staff learning, can be represented in statistical analyses.

Outcomes of Incidental Pulmonary Nodules Detected in Oral and Oropharyngeal Cancer Patients

2025-06-24

Hung‐Pei Tsai , Omar Breik | International Journal of Oral and Maxillofacial Surgery

Retrospective Clinical Outcome of 148 MRONJ-Patients after surgical treatment over one decade

2025-06-24

Antoine Assaf , Robert Köhnke , Lina Maria Matthies | International Journal of Oral and Maxillofacial Surgery

Failure patterns analysis of three-dimensional radiotherapy for stage IV non-small cell lung cancer primary tumours

2025-06-24

Wei Zhang , Xin Wu , Jie Liu +3 more | Cancer/Radiothérapie

In Regard to Thariat et al

2025-06-24

Juliette Thariat , Antoine Falcoz , François‐Régis Ferrand +2 more | International Journal of Radiation Oncology*Biology*Physics

The Ups and Downs of Atelectasis in Thoracic Radiation Therapy

2025-06-24

Thomas J. Dilling , Esteban Celis | International Journal of Radiation Oncology*Biology*Physics

MGASM-Net: morphology-guided multi-task learning network with anatomic spatial mamba for 3D airway segmentation

2025-06-24

Yi Xu , Huamin Yang , Zhengang Jiang +4 more | Complex & Intelligent Systems

Lung Cancer Screening Disparities in Asian American Subgroups in a Large Integrated Health System

2025-06-24

Seth Tivakaran , Julia Raghu , Jane Leung +7 more | The American Surgeon

Background Lung cancer is the leading cause of cancer-related deaths worldwide in Asian Americans (AsA), yet AsA lung cancer screening (LCS) rates are unknown. We examined LCS rates in AsA … Background Lung cancer is the leading cause of cancer-related deaths worldwide in Asian Americans (AsA), yet AsA lung cancer screening (LCS) rates are unknown. We examined LCS rates in AsA within Kaiser Permanente Northern California (KPNC), a large integrated healthcare system where LCS is a member benefit. The California LCS rate is 0.7%. Methods This cohort study analyzed KPNC 2015-2022 electronic health records. Lung cancer screening rates were compared among AsA subgroups, controlling for sociodemographics, considering both more restrictive 2013 (n = 2,273) and more inclusive 2021 (n = 5,823) United States Preventive Services Task Force (USPSTF) LCS guidelines, which differ by age range and years post-smoking cessation. Results Overall KPNC LCS rates for eligible AsA patients were 4.3% and 2.7% using USPSTF 2013 and 2021 guidelines, respectively. Lung cancer screening rates varied by AsA subgroup. Under 2021 guidelines, Chinese (4.0%) were screened more than Korean (3.57%), Southeast Asian (3.52%), Japanese (3.19%), Asian (Other) (2.28%), Pacific Islander (1.91%), and Filipino (1.55%). Under 2013 guidelines, Southeast Asian (6.54%) were screened more than Chinese (6.51%), Japanese (5.36%), Asian (Other) (3.95%), and Filipino (1.93%). Discussion This is the first study to demonstrate significant heterogeneity in LCS rates for disaggregated AsA subgroups. Kaiser Permanente Northern California LCS rates were 4× California rates. When payment alone is not a care barrier, systemic and culturally sensitive interventions are necessary to increase overall LCS screening rates and address population-specific disparities.

Influence of Cycles of Neoadjuvant Chemoimmunotherapy on Treatment Response in Stage IIIA–N2IIIB Non-small Cell Lung Cancer: Experience from a Large-Volume Center

2025-06-24

Pengfei Li , Kaili Huang , Qiang Wu +2 more | Annals of Surgical Oncology

Interpreting Changes to Lung Adenocarcinoma Prognosis over Two Decades

2025-06-24

Fiona Stanaway , Armando Teixeira-Pinto | NEJM Evidence

[18F]FDG PET/CT in the Preoperative Diagnostic and Staging of Lung Cancer—A Pictorial Evaluation

2025-06-23

Nathalie Viohl , Matthias Steinert , Anke Werner +3 more | Journal of Clinical Medicine

Background/Objectives: Lung cancer is one of the most prevalent malignant diseases in humans. Numerous studies have demonstrated the significance of [18F]fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in the staging … Background/Objectives: Lung cancer is one of the most prevalent malignant diseases in humans. Numerous studies have demonstrated the significance of [18F]fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in the staging of this condition. Methods: The pictorial evaluation is based on a recent study comparing preoperative imaging with postoperative histopathological findings following thoracic surgery. It confirmed the value of PET/CT in assessing primary tumor extent and metastatic lymph node involvement; but also revealed discrepancies in primary tumor (T) and lymph nodes (N) classification in 25% and 14% of patients, respectively. Results: The aim of this pictorial review is to highlight and further analyze the causes of inaccurate staging, identify potential diagnostic pitfalls, and provide practical recommendations to help avoid misinterpretation of PET/CT findings. Additionally, the impact of the newly introduced ninth edition of the International Association for the Study of Lung Cancer (IASLC) primary tumor, lymph nodes, and metastasis (TNM) staging system for lung cancer is discussed. Conclusions: In this pictorial review, we presented various sources of error in preoperative staging observed at our institution. Awareness of these potential pitfalls may aid in improving staging accuracy and distinguishing physiological or reactive (benign) processes from pathological findings.

Robotic versus Electromagnetic Bronchoscopy for Pulmonary LesIon AssessmeNT using integrated intraprocedural imaging: study protocol for the RELIANT 2 trial.

2025-06-23

Rafael Paez , Ankush P. Ratwani , Jennifer D. Duke +7 more

Abstract Background Robotic assisted bronchoscopy (RAB) and electromagnetic navigational bronchoscopy (ENB) are two approaches to biopsy peripheral pulmonary lesions (PPLs). A recently completed cluster randomized controlled trial, RELIANT ( NCT05705544 … Abstract Background Robotic assisted bronchoscopy (RAB) and electromagnetic navigational bronchoscopy (ENB) are two approaches to biopsy peripheral pulmonary lesions (PPLs). A recently completed cluster randomized controlled trial, RELIANT ( NCT05705544 ), showed no difference in diagnostic yield between these two modalities. The ENB platform used in RELIANT included integrated digital tomosynthesis, allowing for real-time assessment of PPL location for more precise targeting at the time of biopsy. RAB has since been integrated with cone beam computed tomography (CBCT) to accomplish the same intraprocedural correction. It is unclear if the diagnostic yield of RAB with integrated CBCT (RAB-CBCT) is superior to ENB with integrated digital tomosynthesis (ENB-DT). Methods R obotic versus E lectromagnetic Bronchoscopy for Pulmonary L es I on A ssessme NT using integrated intraprocedural imaging (RELIANT 2) is an investigator-initiated, multicenter, open label, superiority, cluster randomized trial. At each participating institution, procedural rooms are randomly assigned to either RAB-CBCT or ENB-DT, with each procedure room-day considered a cluster. All adult patients undergoing navigational bronchoscopy for evaluation of PPL(s) are eligible. Allocation is concealed from schedulers, proceduralists, and patients until the morning of procedure when each room is randomized to a platform. The primary endpoint is the diagnostic yield, defined as the proportion of cases yielding a specific benign or malignant diagnosis per current ATS/ACCP definition. Secondary and safety endpoints include procedure duration and procedural complications. Enrollment began on November 11, 2024 and is expected to enroll approximately 440 patients in 220 clusters. Discussion RELIANT 2 is an ongoing cluster randomized trial comparing the diagnostic yield of RAB-CBCT to that of ENB-DT in patients undergoing bronchoscopy to biopsy PPLs. This trial will help address some of the limitations of the recently published RELIANT trial. Trial Registration The trial was registered in ClinicalTrials.gov ( NCT06654271 ) on October 21, 2024, prior to patient enrollment.

CAAF-ResUNet: Adaptive Attention Fusion with Boundary-Aware Loss for Lung Nodule Segmentation

2025-06-22

Quốc Thắng Phạm , Thái Hoàng Lê , Khai Dinh Lai +6 more | Medicina

Background and Objectives: The accurate segmentation of pulmonary nodules in computed tomography (CT) remains a critical yet challenging task due to variations in nodule size, shape, and boundary ambiguity. This … Background and Objectives: The accurate segmentation of pulmonary nodules in computed tomography (CT) remains a critical yet challenging task due to variations in nodule size, shape, and boundary ambiguity. This study proposes CAAF-ResUNet (Context-Aware Adaptive Attention Fusion ResUNet), a novel deep learning model designed to address these challenges through adaptive feature fusion and edge-sensitive learning. Materials and Methods: Central to our approach is the Adaptive Attention Controller (AAC), which dynamically adjusts the contribution of channel and position attention based on contextual features in each input. To further enhance boundary localization, we incorporate three complementary boundary-aware loss functions: Sobel, Laplacian, and Hausdorff. Results: An extensive evaluation of two benchmark datasets demonstrates the superiority of the proposed model, achieving Dice scores of 90.88% on LUNA16 and 85.92% on LIDC-IDRI, both exceeding prior state-of-the-art methods. A clinical validation of a dataset comprising 804 CT slices from 35 patients at the University Medical Center of Ho Chi Minh City confirmed the model’s practical reliability, yielding a Dice score of 95.34% and a notably low Miss Rate of 4.60% under the Hausdorff loss configuration. Conclusions: These results establish CAAF-ResUNet as a robust and clinically viable solution for pulmonary nodule segmentation, offering enhanced boundary precision and minimized false negatives, two critical properties in early-stage lung cancer diagnosis and radiological decision support.

Efficacy and safety in synchronous core-needle biopsy and cryoablation for highly suspicious malignant pulmonary nodule

2025-06-21

Tongyin Zhang , Qiaoyu Xu , Yuwan Hu +7 more | Cancer Imaging

Percutaneous computed tomography (CT)-guided biopsy and cryoablation are commonly used techniques for diagnosing and treating pulmonary malignant tumors. Performing these procedures simultaneously allows for tissue diagnosis while potentially offering therapeutic … Percutaneous computed tomography (CT)-guided biopsy and cryoablation are commonly used techniques for diagnosing and treating pulmonary malignant tumors. Performing these procedures simultaneously allows for tissue diagnosis while potentially offering therapeutic benefits. This study aimed to evaluate whether the efficacy and safety of simultaneous percutaneous CT-guided biopsy and cryoablation in managing pulmonary tumors suspected of malignancy are comparable to those of sequential procedures. This retrospective study involved 124 patients with 131 highly suspicious malignant pulmonary nodules. Patients either underwent synchronous percutaneous core-needle biopsy and cryoablation (Group A) or separately underwent these procedures (Group B) from December 2020 to May 2024. All procedures were performed under CT guidance using a percutaneous approach. We analyzed technical success rates, complications, diagnostic yield, and local tumor control. Technical success rates were 100% in both groups. The rate of pneumothorax was 42.1% (16/38) in Group A and 34.9% (30/86) in Group B. In Group A, hemoptysis and pleural effusion rates were 18.4% (7/38) and 23.7% (9/38), respectively, while in Group B, these rates were 16.3% (14/86) and 12.8% (11/86). These differences were not statistically significant. The diagnostic positive rate in Group A was 87.5%. The mean follow-up duration was 11.8 months (95% confidence interval [CI], 10.2-13.4), with local tumor control rates of 97% for Group A and 88% for Group B. The effectiveness rates of synchronous and separate procedures were similar. Synchronous biopsy-ablation is an effective method for obtaining tumor pathology and local treatment of lung tumors simultaneously. It is a viable option for select patients where expedited diagnosis-therapy is clinically justified, particularly when molecular profiling is not immediately indicated.

A retrospective analysis of the diagnostic utility of endobronchial ultrasound guided–intranodal forceps biopsy (EBUS-IFB) in the evaluation of mediastinal adenopathy

2025-06-21

Richu Bob Kurien , Priya Nadesan , Balamugesh Thangakunam +3 more | Egyptian Journal of Bronchology

Abstract Background Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the preferred diagnostic modality for evaluating mediastinal lymphadenopathy. However, its diagnostic yield is significantly reduced in conditions such as sarcoidosis, tuberculosis, … Abstract Background Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the preferred diagnostic modality for evaluating mediastinal lymphadenopathy. However, its diagnostic yield is significantly reduced in conditions such as sarcoidosis, tuberculosis, and lymphoma. To address this limitation, EBUS-guided intranodal forceps biopsy (EBUS-IFB) has been proposed as an adjunct technique to enhance diagnostic accuracy in these challenging cases. This study aimed to evaluate the diagnostic yield of EBUS-IFB in the assessment of mediastinal lymphadenopathy. Methods We retrospectively reviewed patients with mediastinal lymphadenopathy who underwent EBUS-guided intranodal forceps biopsy (EBUS-IFB). Diagnostic yield was determined using a composite reference standard (CRS), which was considered positive if a definitive diagnosis was established by any of the following: rapid on-site evaluation (ROSE), EBUS-TBNA, EBUS-IFB, bronchial biopsy, or transbronchial lung biopsy. To specifically evaluate the incremental diagnostic yield of EBUS-IFB, cases with non-diagnostic ROSE results were analysed separately. Results Of the 40 cases with undiagnosed mediastinal lymphadenopathy, CRS was obtained in 31 cases (77.5%), while the remainder were diagnosed as reactive lymphadenopathy. Sampling adequacy was achieved in 39 out of 40 cases (97.5%). The overall diagnostic yield for EBUS-TBNA, EBUS-IFB, and combined EBUS-TBNA along with IFB (combined approach) were 54.8%, 83.9% ( p value:0.03), and 90.3% ( p value: 0.004) respectively. The additional diagnostic yield for EBUS-IFB and the combined approach (EBUS-TBNA + IFB) were 29.0% and 35.5% respectively, as compared to EBUS-TBNA alone. The sensitivity and specificity EBUS-IFB were 84% and 100% respectively. In subgroup analysis for cases with non-diagnostic ROSE, the diagnostic yield for EBUS-TBNA, EBUS-IFB, and the combined approach (EBUS-TBNA + IFB) were 48.2%, 85.2% ( p value: 0.009) and 88.9% ( p value: 0.003) respectively. The additional diagnostic yield for EBUS-IFB and the combined approach (EBUS-TBNA + IFB) were 37.0% and 40.7% respectively, as compared to EBUS-TBNA alone. The sensitivity and specificity of EBUS-IFB when ROSE was non-diagnostic were 85.2% and 100% respectively. No major complications were noted. Conclusion The addition of IFB to routine TBNA significantly improves the diagnostic yield of EBUS, particularly in cases of non-diagnostic ROSE, with no added procedural complications.

Neoadjuvant, Perioperative, and Adjuvant Immunotherapy in Early-Stage Surgically Resectable Non-Small Cell Lung Cancer: Updates and Future Perspectives

2025-06-21

Diamone Gathers , Cameron Oswalt , Laura Alder +4 more | Cancers

Historically, systemic therapy for resectable non-small cell lung cancer (NSCLC) has been associated with a modest impact on overall survival. The current treatment options for early-stage resectable NSCLC include neoadjuvant, … Historically, systemic therapy for resectable non-small cell lung cancer (NSCLC) has been associated with a modest impact on overall survival. The current treatment options for early-stage resectable NSCLC include neoadjuvant, adjuvant, and perioperative immunotherapy in combination with chemotherapy. In this review, we explore the current treatment paradigms and emerging opportunities for improved survival outcomes from using immunotherapeutic approaches in the treatment of early-stage resectable NSCLC. The incorporation of immunotherapy into neoadjuvant, adjuvant, and perioperative treatment of surgically resectable NSCLC has yielded improved outcomes beyond chemotherapy-alone approaches. Despite this, there remains a margin for improving survival outcomes for patients. Clinical trials utilizing novel agents and approaches that modulate the anti-tumor immune response are currently ongoing and will likely inform the future treatment landscape for early-stage surgically resectable NSCLC.

Review of Outcomes Between Robotic and Thoracoscopic Thoracic Surgery: A Retrospective Cohort Study

2025-06-20

Amira Barmanwalla , Sriram Rangarajan , Aaron Fowler +7 more | Cureus

Artificial Intelligence‐Based Methods: The Path Forward in Achieving Equity in Lung Cancer Screening and Evaluation

2025-06-20

Stephen Kuperberg , David C. Christiani | Cancer Innovation

Although lung cancer remains a global threat to public health, evidenced based advances in screening and prevention hold promise for reducing its impact on mortality. An ongoing challenge facing the … Although lung cancer remains a global threat to public health, evidenced based advances in screening and prevention hold promise for reducing its impact on mortality. An ongoing challenge facing the clinical and research community are the glaring disparities in access to preventive services faced by ethnically and socioeconomically marginalized groups. In this context, novel approaches are needed to improve research methods and thus bolster our ability to improve outcomes. Artificial intelligence (AI) applications such as machine learning and natural language processing hold promise as catalysts in this process, enhancing speed, accuracy and capability. This perspective will highlight the potential of AI methods as essential tool for growth across the lung cancer diagnostic continuum from screening to diagnosis.

Prognostic value of spread through air spaces in operated lung squamous cell carcinoma patients: A meta-analysis

2025-06-20

Yuan Yuan , Peng Yu | Medicine

The presence of spread through air spaces (STAS) predicts poor long-term survival of lung cancer patients. However, the association between STAS and prognosis of operated lung squamous cell carcinoma (LSCC) … The presence of spread through air spaces (STAS) predicts poor long-term survival of lung cancer patients. However, the association between STAS and prognosis of operated lung squamous cell carcinoma (LSCC) remains unclear at this time. The aim of this meta-analysis was to further identify the prognostic value of STAS in surgical LSCC patients. Several electronic databases were searched up to April 12, 2025 for relevant studies. The primary and secondary outcomes were progression-free survival and overall survival/cancer-specific survival, respectively. The hazard ratios (HRs) and 95% confidence intervals (CIs) were combined and all statistical analyses were conducted by STATA 15.0 software. A total of 9 studies involving 2884 cases were included and reviewed. The pooled results demonstrated that the presence of STAS was significantly associated with poor progression-free survival (HR = 1.84, 95% CI: 1.57-2.16, P< .001). Besides, STAS predicted poorer overall survival (HR = 1.75, 95% CI: 1.23-2.51, P = .002) and cancer-specific survival (HR = 1.73, 95% CI: 1.33-2.26, P < .001) in surgical LSCC. Based on current evidence, STAS was identified as a novel and valuable prognostic risk factor for operated LSCC patients. However, more prospective high-quality studies are still needed to verify above findings.

Differences Between the 8th and 9th Editions of the TNM Staging System in Predicting Mortality in Non-Small Cell Lung Cancer Patients Staged with EBUS

2025-06-20

Ezgi Demirdöğen , Orkun Eray Terzi , Özge Aydın Güçlü +2 more | Diagnostics

Background: The distinction between N2a and N2b in the lung cancer TNM 9th edition staging system has reduced the heterogeneity of prognosis using the previous staging system. Moreover, this distinction … Background: The distinction between N2a and N2b in the lung cancer TNM 9th edition staging system has reduced the heterogeneity of prognosis using the previous staging system. Moreover, this distinction may enable new treatment approaches in non-small-cell lung cancer (NSCLC). We aimed to evaluate the differences in survival between 8th- and 9th-edition staging and the mortality prediction of the TNM 9th edition in NSCLC patients who did not undergo surgical staging and who were “N”-staged with solely endobronchial ultrasound–transbronchial needle aspiration (EBUS–TBNA) without endoscopic ultrasonography (EUS). Methods: Lung cancer patients who were newly diagnosed and staged with EBUS between May 2016 and January 2023 were retrospectively reviewed. Patients were divided into two groups, “All M0 = Model 1” and “T1–2 N1–2–3 M0 = Model 2”, and compared according to their survival for both the 8th and 9th edition TNM staging systems. Cox regression analyses were performed for independent predictors of 2-year mortality. Results: In this retrospective study, a total of 90 patients were included. Most of the patients were male (84.4%), and the mean age of the study group was 64.0 ± 9.6; deceased patients were older (p = 0.024). There were no differences between groups in terms of smoking habit, comorbidities, tumor PET/CT localization, or 8th and 9th N-staging results with EBUS. The median follow-up period was 26 (0–100) months and longer for living patients than deceased patients in both groups (42 (23–100) vs. 18 (0–74), p = 0.03; 36 (24–100) vs. 20 (1–74), p < 0.001). According to the 8th edition of TNM staging, N2 stage (HR 2.26, 95% CI 1.01–5.05, p = 0.045) and N3 disease (HR 3.31, 95% CI 1.43–7.67, p = 0.005) are independent predictors of two-year mortality for Model 1 patients. When patients were staged according to the 9th edition TNM with EBUS, the relationship between N2a and mortality was not significant, while N2B disease increased the 2-year mortality risk by 2.78-fold (95% 1.07–7.22, p = 0.035), and N3 disease increased it by 3.31-fold (95% 1.43–7.67, p = 0.005). Conclusions: According to the TNM 9th edition staging system, we demonstrated that N2b disease significantly increases the risk of mortality in NSCLC cases using systematic mediastinal staging with EBUS–TBNA alone.

SmokeBERT: A BERT-based Model for Quantitative Smoking History Extraction from Clinical Narratives to Improve Lung Cancer Screening

2025-06-20

Yongkang Xue , Yunzheng Zhu , Luoting Zhuang +6 more | medRxiv (Cold Spring Harbor Laboratory)

Tobacco use is a critical risk factor for diseases such as cancer and cardiovascular disorders. While electronic health records can capture categorical smoking statuses accurately, granular quantitative details, such as … Tobacco use is a critical risk factor for diseases such as cancer and cardiovascular disorders. While electronic health records can capture categorical smoking statuses accurately, granular quantitative details, such as pack years and years since quitting, are often embedded in clinical narratives. This information is crucial for assessing disease risk and determining eligibility for lung cancer screening (LCS). Existing natural language processing (NLP) tools excelled at identifying smoking statuses but struggled with extracting detailed quantitative data. To address this, we developed SmokeBERT, a fine-tuned BERT-based model optimized for extracting detailed smoking histories. Evaluations against a state-of-the-art rule-based NLP model demonstrated its superior performance on F1 scores (0.97 vs. 0.88 on the hold-out test set) and identification of LCS-eligible patients (e.g., 98% vs. 60% for ≥20 pack years). Future work includes creating a multilingual, language-agnostic version of SmokeBERT by incorporating datasets in multiple languages, exploring ensemble methods, and testing on larger datasets.

Recurrence Pattern of Left Upper Lobectomies and Trisegmentectomies: Systematic Review and Meta-Analysis

2025-06-19

Borja Aguinagalde , Juan A. Ferrer-Bonsoms , Iker López +5 more | Journal of Clinical Medicine

Background: Surgical resection remains the standard treatment for early-stage non-small-cell lung cancer (NSCLC). Traditionally, lobectomy has been considered the procedure of choice; however, emerging evidence suggests that trisegmentectomy may offer … Background: Surgical resection remains the standard treatment for early-stage non-small-cell lung cancer (NSCLC). Traditionally, lobectomy has been considered the procedure of choice; however, emerging evidence suggests that trisegmentectomy may offer comparable outcomes. This meta-analysis evaluates whether left upper lobe trisegmentectomy provides non-inferior or superior oncologic outcomes compared to left upper lobectomy, with particular attention to recurrence patterns. Methods: Following PRISMA guidelines, we included comparative studies evaluating left upper lobectomy versus trisegmentectomy. Outcomes assessed included recurrence (locoregional and distant), morbidity, and the length of hospital stay. A meta-analysis was conducted using the metabin function from the R meta package. Results: Of 14 identified articles, 9 met the inclusion criteria. No significant differences were observed in locoregional recurrence. However, distant recurrence was significantly lower in the trisegmentectomy group (OR 0.58; 95% CI 0.41-0.82). While overall morbidity showed no significant difference (OR 0.95), analysis of matched studies favored trisegmentectomy (OR 0.73; 95% CI 0.56-0.96). Hospital stay was significantly shorter in the trisegmentectomy group (OR -0.94; 95% CI -1.26 to -0.63). Conclusions: Trisegmentectomy and lobectomy exhibit distinct recurrence patterns, with lobectomy associated with a higher rate of distant recurrence. Trisegmentectomy may provide oncologic and perioperative advantages in appropriately selected patients. The systematic review and meta-analysis are registered in PROSPERO (registration number: CRD420251066445).

Letter From Slovenia

2025-06-19

Aleš Rozman | Respirology

Artificial Intelligence‐assisted Endoscopy and Examiner Confidence: A Study on Human–Artificial Intelligence Interaction in Barrett's Esophagus (With Video)

2025-06-19

D Röser , M. Meinikheim , Anna Muzalyova +7 more | DEN Open

Despite high stand-alone performance, studies demonstrate that artificial intelligence (AI)-supported endoscopic diagnostics often fall short in clinical applications due to human-AI interaction factors. This video-based trial on Barrett's esophagus aimed … Despite high stand-alone performance, studies demonstrate that artificial intelligence (AI)-supported endoscopic diagnostics often fall short in clinical applications due to human-AI interaction factors. This video-based trial on Barrett's esophagus aimed to investigate how examiner behavior, their levels of confidence, and system usability influence the diagnostic outcomes of AI-assisted endoscopy. The present analysis employed data from a multicenter randomized controlled tandem video trial involving 22 endoscopists with varying degrees of expertise. Participants were tasked with evaluating a set of 96 endoscopic videos of Barrett's esophagus in two distinct rounds, with and without AI assistance. Diagnostic confidence levels were recorded, and decision changes were categorized according to the AI prediction. Additional surveys assessed user experience and system usability ratings. AI assistance significantly increased examiner confidence levels (p < 0.001) and accuracy. Withdrawing AI assistance decreased confidence (p < 0.001), but not accuracy. Experts consistently reported higher confidence than non-experts (p < 0.001), regardless of performance. Despite improved confidence, correct AI guidance was disregarded in 16% of all cases, and 9% of initially correct diagnoses were changed to incorrect ones. Overreliance on AI, algorithm aversion, and uncertainty in AI predictions were identified as key factors influencing outcomes. The System Usability Scale questionnaire scores indicated good to excellent usability, with non-experts scoring 73.5 and experts 85.6. Our findings highlight the pivotal function of examiner behavior in AI-assisted endoscopy. To fully realize the benefits of AI, implementing explainable AI, improving user interfaces, and providing targeted training are essential. Addressing these factors could enhance diagnostic accuracy and confidence in clinical practice.

A comparative analysis of YOLO models for efficient lung tumor detection using CT images

2025-06-19

Dhananjay K. Sharma , Manoj K. Pal , Ashutosh Kumar Singh | Health and Technology

Precision Medicine in Lung Cancer Screening: A Paradigm Shift in Early Detection—Precision Screening for Lung Cancer

2025-06-19

Hsin‐Hung Chen , Yun-Ju Wu , Fu‐Zong Wu | Diagnostics

Lung cancer remains the leading cause of cancer-related mortality globally, largely due to late-stage diagnoses. While low-dose computed tomography (LDCT) has improved early detection and reduced mortality in high-risk populations, … Lung cancer remains the leading cause of cancer-related mortality globally, largely due to late-stage diagnoses. While low-dose computed tomography (LDCT) has improved early detection and reduced mortality in high-risk populations, traditional screening strategies often adopt a one-size-fits-all approach based primarily on age and smoking history. This can lead to limitations, such as overdiagnosis, false positives, and the underrepresentation of non-smokers, which are especially prevalent in Asian populations. Precision medicine offers a transformative solution by tailoring screening protocols to individual risk profiles through the integration of clinical, genetic, environmental, and radiological data. Emerging tools, such as risk prediction models, radiomics, artificial intelligence (AI), and liquid biopsies, enhance the accuracy of screening, allowing for the identification of high-risk individuals who may not meet conventional criteria. Polygenic risk scores (PRSs) and molecular biomarkers further refine stratification, enabling more personalized and effective screening intervals. Incorporating these innovations into clinical workflows, alongside shared decision-making (SDM) and robust data infrastructure, represents a paradigm shift in lung cancer prevention. However, implementation must also address challenges related to health equity, algorithmic bias, and system integration. As precision medicine continues to evolve, it holds the promise of optimizing early detection, minimizing harm, and extending the benefits of lung cancer screening to broader and more diverse populations. This review explores the current landscape and future directions of precision medicine in lung cancer screening, emphasizing the need for interdisciplinary collaboration and population-specific strategies to realize its full potential in reducing the global burden of lung cancer.

Thirteen Years’ Experience of Stereotactic Body Radiation Therapy for Ultra-Central Lung Tumours in Hong Kong

2025-06-18

J.S-Y. Ng , Michael K. M. Kam , Kevin Wong +3 more | Hong Kong Journal of Radiology

Surgical Management of Oligometastatic Non-Small Cell Lung Cancer

2025-06-18

Susana Fortich , Deniz Piyadeoglu , Nurcan Çelik +1 more | Cancers

Background: Oligometastatic non-small cell lung cancer (NSCLC) represents a biologically and clinically distinct state characterized by limited metastatic spread. Increasing evidence suggests that aggressive local therapies, including surgical resection, may … Background: Oligometastatic non-small cell lung cancer (NSCLC) represents a biologically and clinically distinct state characterized by limited metastatic spread. Increasing evidence suggests that aggressive local therapies, including surgical resection, may confer a survival benefit in this population. The objective of this review is to evaluate the current role of surgery in the management of oligometastatic NSCLC, with emphasis on patient selection, surgical strategy, integration with systemic therapy, and ongoing clinical investigations. Methods: This narrative review synthesizes retrospective and prospective clinical data, meta-analyses, major consensus guidelines, and ongoing trials since 2012. We highlight prognostic factors, staging strategies, and the evolving role of molecular and biomarker-based stratification. Results: Multiple retrospective studies and several randomized trials have demonstrated improved progression-free and overall survival with local consolidative therapy in oligometastatic NSCLC. Prognostic factors associated with favorable outcomes include a limited number of metastases (≤3), good performance status, absence of mediastinal nodal disease, metachronous presentation, and actionable molecular alterations. The integration of surgery with systemic therapies, including targeted agents and immunotherapy, has become increasingly common in selected patients. Ongoing trials such as LONESTAR, NORTHSTAR, and BRIGHTSTAR are expected to further define the role of surgery in this setting. Conclusions: Surgery is emerging as a key component of multimodal treatment for carefully selected patients with oligometastatic NSCLC. Future efforts should focus on refining patient selection through molecular stratification and expanding prospective trial data to guide personalized biology-driven treatment strategies.

Risk factors and clinical risk stratification of distant metastasis in early-stage lung cancer in never smokers

2025-06-18

Dongsheng Wu , Xiaohu Hao , Zhipeng Gong +3 more | World Journal of Surgical Oncology

Risk factors for distant metastasis in early-stage lung cancer in never smokers (LCINS) remain poorly understood. This study aimed to identify key risk factors and to develop a clinical risk … Risk factors for distant metastasis in early-stage lung cancer in never smokers (LCINS) remain poorly understood. This study aimed to identify key risk factors and to develop a clinical risk stratification model for early-stage LCINS. We retrospectively analyzed patients diagnosed with early-stage LCINS at West China Hospital, Sichuan University, from 2015 to 2020. Univariable and multivariable Cox regression analyses were performed to identify independent risk factors for distant metastasis. A predictive model was developed and internally validated using bootstrap resampling, with performance assessed by the concordance index (C-index), area under the receiver operating characteristic curve (AUC), calibration plot, and decision curve analysis. A total of 1,406 patients with pathological stage I-II LCINS were included, among whom 76 (5.41%) developed distant metastasis during follow-up. Multivariable Cox regression analysis revealed that independent risk factors included advanced pathological T and N stages, higher consolidation-to-tumor ratio, and histologic subtype, particularly solid/micropapillary predominant adenocarcinoma. Based on these predictors, a predictive model was developed, demonstrating strong discrimination with a C-index of 0.799 and AUC values of 0.809, 0.791, and 0.783 for predicting 1-, 2-, and 3-year distant metastasis, respectively. Calibration and decision curve analyses confirmed the reliability and clinical utility of the model. This study identified risk factors and developed a clinical risk stratification model for distant metastasis in early-stage LCINS. This validated model enables risk stratification and personalized monitoring to facilitate early detection of distant recurrence in LCINS.

Relationship between preoperative body mass index and overall mortality in patients who have undergone lobectomy for lung cancer

2025-06-18

Dan Su , Xianning Wu , Ting Zhang +1 more | World Journal of Surgical Oncology

Preoperative body mass index (BMI) has been shown to be an important prognostic factor after lobectomy in patients with lung cancer. However, few studies have investigated the relationship between preoperative … Preoperative body mass index (BMI) has been shown to be an important prognostic factor after lobectomy in patients with lung cancer. However, few studies have investigated the relationship between preoperative BMI and overall mortality in these patients. In this study, we aimed to identify the range of BMI that heralds a favorable prognosis in patients who have undergone lobectomy for lung cancer. The association between BMI and overall survival was examined using primary data from an affiliated hospital database and fitted adjusted Cox regression models. The restricted cubic spline (RCS) method was used to report the relationship between preoperative BMI and overall mortality. Fully adjusted models were stratified by and adjusted for sex, age, disease stage, respiratory function, and adjuvant chemotherapy. Of 3307 patients identified to have undergone radical resection of lung cancer between November 2009 and July 2019, 2365 underwent lobectomy and 558 died. BMI had a J-shaped association with overall mortality; we estimated that the overall mortality risk reached a nadir at BMI values of 23.2-29.4, with an inverse association below 23.2 (hazard ratio 0.104 per 5-unit decrease; 95% confidence interval 0.089-0.119), a positive association above 29.4 (hazard ratio 0.022 per 5-unit increase; 95% confidence interval 0.004-0.040), and the lowest mortality at 25.7. Preoperative BMI is an important prognostic factor after lobectomy in patients with lung cancer. A BMI of 23.2-29.4 has a prognostic benefit.

Optimizing stereotactic ablative body radiotherapy for ultra-central lung lesions: a comparative dosimetric analysis

2025-06-18

Dan Tao , Lisi Sun , Lulu Wang +4 more | Radiation Oncology

Stereotactic radiotherapy for oligometastatic mediastinal lymph-nodes: a multicentre retrospective experience

2025-06-18

Francesco Cuccia , Maria Campione , Gianluca Mortellaro +7 more | Clinical & Experimental Metastasis

From pilot to policy: what Korea’s LDCT program teaches us about National Lung Cancer Screening

2025-06-18

Lisa Jungblut | European Radiology

Lung cancer detection and classification with optimal feature selection and two-fold-deep-learning-classifiers

2025-06-18

Babu Kumar S. , M. Vinoth Kumar | Multimedia Tools and Applications

Innovative technologies and their clinical prospects for early lung cancer screening

2025-06-18

Zisu Deng , Xiaocao Ma , Shubiao Zou +2 more | Clinical and Experimental Medicine

Lung cancer remains the leading cause of cancer-related mortality worldwide, due to lacking effective early-stage screening approaches. Imaging, such as low-dose CT, poses radiation risk, and biopsies can induce some … Lung cancer remains the leading cause of cancer-related mortality worldwide, due to lacking effective early-stage screening approaches. Imaging, such as low-dose CT, poses radiation risk, and biopsies can induce some complications. Additionally, traditional serum tumor markers lack diagnostic specificity. This highlights the urgent need for precise and non-invasive early detection techniques. This systematic review aims to evaluate the limitations of conventional screening methods (imaging/biopsy/tumor markers), seek breakthroughs in liquid biopsy for early lung cancer detection, and assess the potential value of Artificial Intelligence (AI), thereby providing evidence-based insights for establishing an optimal screening framework. We systematically searched the PubMed database for the literature published up to May 2025. Key words include "Artificial Intelligence", "Early Lung cancer screening", "Imaging examination", "Innovative technologies", "Liquid biopsy", and "Puncture biopsy". Our inclusion criteria focused on studies about traditional and innovative screening methods, with an emphasis on original research concerning diagnostic performance or high-quality reviews. This approach helps identify critical studies in early lung cancer screening. Novel liquid biopsy techniques are non-invasive and have superior diagnostic efficacy. AI-assisted diagnostics further enhance accuracy. We propose three development directions: establishing risk-based liquid biopsy screening protocols, developing a stepwise "imaging-AI-liquid biopsy" diagnostic workflow, and creating standardized biomarker panel testing solutions. Integrating traditional methodologies, novel liquid biopsies, and AI to establish a comprehensive early lung cancer screening model is important. These innovative strategies aim to significantly increase early detection rates, substantially enhancing lung cancer control. This review provides both theoretical guidance for clinical practice and future research.

Radiotherapy combined with drug-eluting bead bronchial artery chemoembolization for stage III non‐small‐cell lung cancer:a retrospective study

2025-06-18

Yun‐Feng Guan , Ran Xiong , Bin Shen | Research Square (Research Square)

<title>Abstract</title> <bold>Background:</bold> Multiple large-scale phase III clinical trials have established concurrent chemoradiotherapy(cCRT)followed by immunotherapy（cCRT→IO）as the standard treatment for unresectable locally advanced non-small cell lung cancer (NSCLC). In clinical practice, many … <title>Abstract</title> <bold>Background:</bold> Multiple large-scale phase III clinical trials have established concurrent chemoradiotherapy(cCRT)followed by immunotherapy（cCRT→IO）as the standard treatment for unresectable locally advanced non-small cell lung cancer (NSCLC). In clinical practice, many patients cannot tolerate cCRT and instead receive sequential therapy or radiotherapy alone, resulting in compromised outcomes. This study aimed to compare the safety and efficacy of radiotherapycombined with drug-eluting bead bronchial artery chemoembolization followed by immunotherapy (RT+DEB-BACE→IO) versus standard cCRT→IO in patients with unresectable stage III NSCLC. <bold>Methods: </bold>We conducted a retrospective analysis of patients with unresectable stage III NSCLC who received either RT+DEB-BACE→IO orcCRT→IO between June 2020 and December 2023. Propensity score matching (PSM) was employed to balance intergroup heterogeneity. Comparative assessments of safety and efficacy outcomes were performed between the two treatment groups. <bold>Results:</bold> Among 182 evaluable patients, RT+DEB-BACE（n=54）demonstrated superior initial objective response rates compared to cCRT (n=128)(70.4% vs 52.3%, <italic>p</italic>=0.025). The survival analysis cohort comprised 161 patients receiving consolidation immunotherapy (RT+DEB-BACE→IO: n=52; cCRT→IO: n=109). PSM created 48 balanced pairs per group. While unmatched analysis showed shorter median progression-free survival with RT+DEB-BACE→IO (12.5 vs 17.3 months, HR 1.58, p=0.038), this difference was non-significant post-matching (13.8 vs 14.7 months, HR 1.10, p=0.733). No significant overall survival difference was observed (2-year OS: 79.8% vs 72.4%, p=0.492). The subgroup analysis demonstrated equivalent clinical outcomes whether DEB-BACE was administered concurrently with or sequentially to radiotherapy prior to immunotherapy. Importantly, RT+DEB-BACE→IO showed significantly fewer grade 3/4 adverse events (9.6% vs 37.6%, <italic>p</italic><0.01), particularly hematologic (7.7% vs 34.9%, <italic>p</italic><0.01). <bold>Conclusions: </bold>For patients with unresectable stage III NSCLC, RT+DEB-BACE showed superior short-term efficacy compared to cCRT；When followed by IO consolidation, the RT+DEB-BACE→IO regimen exhibited significantly improved safety profiles versus cCRT→IO, while achieving comparable long-term survival outcomes. Prospective randomized trials are needed to further validate these findings.

Beyond resection: imaging findings of expected and complicated postoperative changes in lung cancer

2025-06-18

Makiko Murota , Takashi Norikane , Mariko Ishimura +7 more | Japanese Journal of Radiology

Abstract Lung cancer remains the leading cause of cancer-related mortality, with surgical resection as the primary curative treatment for early-stage non-small cell lung cancer. However, distinguishing normal postoperative changes from … Abstract Lung cancer remains the leading cause of cancer-related mortality, with surgical resection as the primary curative treatment for early-stage non-small cell lung cancer. However, distinguishing normal postoperative changes from complications on chest radiographs and CT scans presents a significant diagnostic challenge, necessitating precise radiologic interpretation. Postoperative complications manifest across a broad spectrum of timing and severity. Early complications include persistent air leak, pneumonia, and bronchopleural fistula, while late complications include bronchial anastomotic stricture, lung herniation, and unilateral pleuroparenchymal fibroelastosis. In addition, rare but clinically significant complications, such as lobar torsion, acute exacerbation of interstitial pneumonia, and pulmonary vein stump thrombosis, warrant careful consideration due to their potential for severe morbidity. Accurate identification of expected postoperative imaging findings and complications is essential to ensuring timely diagnosis and preventing unnecessary interventions. This review synthesizes current knowledge on surgical procedures, expected postoperative imaging findings, and key complications to refine radiologists’ diagnostic acumen and ultimately improve patient outcomes.

Impact of preoperative respiratory training on early postoperative recovery in patients undergoing lung cancer surgery: a randomized controlled trial

2025-06-18

Xue-E Su , Wan-Ping Hong , Hefan He +2 more | Supportive Care in Cancer

Robotic Surgery Is a Safe Treatment in Very Elderly Patients with Resectable Lung Cancer

2025-06-17

Pierluigi Novellis , Riccardo Di Fonzo , Edoardo Bottoni +7 more | Journal of Clinical Medicine

Background: Lung cancer represents a significant health concern, particularly among the elderly population. With global life expectancy increasing, the number of very elderly patients is rising. Robotic-assisted thoracic surgery (RATS) … Background: Lung cancer represents a significant health concern, particularly among the elderly population. With global life expectancy increasing, the number of very elderly patients is rising. Robotic-assisted thoracic surgery (RATS) offers potential advantages over both traditional and video-assisted thoracoscopic surgery (VATS). This study aims to evaluate the feasibility and safety of RATS in very elderly patients (VEP) diagnosed with lung cancer. Methods: This retrospective study included patients who underwent major lung resections using RATS between 2015 and 2022 at two specialized centers. Patients were divided into very elderly patients (VEP, ≥80 years) and non-elderly patients (NEP, <80 years). Demographic, clinical, and surgical data were analyzed. Propensity score matching (PSM) at a 1:3 ratio was performed using clinically relevant variables that were significantly different at baseline to balance the two groups. Results: This study included 340 patients: 28 VEP and 312 NEP. Before PSM, VEP had higher ASA scores, more advanced disease stages, and increased comorbidities. Despite these differences, postoperative outcomes were comparable. Complications occurred in 42.9% of VEP and 29.8% of NEP (p = 0.16), but grade III complications were observed in 14.3% of VEP and 6.4% of NEP (p = 0.12), and grade IV complications were observed in 0% of VEP and 0.9% of NEP (p = not estimable). The mean hospital stay was 4 days in both groups (p = 0.99). Even after PSM (26 VEP vs. 71 NEP), complications, hospital stay, and 90-day mortality (3.9% in VEP, 0% in NEP) were similar. Multivariable analysis identified reduced FEV1 as a predictor of complications, while pathological stage I and lobectomy were associated with a decreased risk of complications, both before and after PSM. Conclusions: RATS is a safe and feasible option for selected very elderly patients with lung cancer, yielding outcomes comparable to younger patients.

Impact of Spread Through Air Spaces (<scp>STAS</scp>) on Recurrence and Surgical Trends in Stage I Non‐Small Cell Lung Cancer: A Real‐World Cohort Study

2025-06-17

Cheng‐Hao Chuang , Yu‐Wei Liu , Wei‐An Lai +7 more | The Kaohsiung Journal of Medical Sciences

ABSTRACT Non‐small cell lung cancer (NSCLC) is the most common form of lung cancer, which remains a leading cause of cancer mortality worldwide. Early detection, particularly at Stage I, is … ABSTRACT Non‐small cell lung cancer (NSCLC) is the most common form of lung cancer, which remains a leading cause of cancer mortality worldwide. Early detection, particularly at Stage I, is critical for improving survival outcomes. Low‐dose computed tomography (LDCT) has increased the detection of small asymptomatic tumors, resulting in an earlier diagnosis and facilitating less invasive surgical approaches such as segmentectomy and wedge resection, which preserve lung function while offering survival outcomes comparable to lobectomy. However, the risk factors for recurrence in Stage I NSCLC remain poorly understood. This retrospective study analyzed 1077 Stage I NSCLC patients treated at Kaohsiung Medical University Hospital from 2010 to 2022. Data including AJCC 7th and 8th editions staging, surgical interventions, and pathological features were analyzed. The proportion of Stage I cases increased significantly from 9.3% in 2010 to 33.8% in 2017, with Stage IA cases increasing from 12.1% in 2018 to 38.2% in 2022. Concurrently, the lobectomy rate decreased from 75% in 2010 to 43.6% in 2022, with more sublobar resections performed. Kaplan–Meier analysis found no significant differences in recurrence‐free survival between lobectomy and sublobar resection with regional lymph node dissection. Cox regression identified spread through air spaces (STAS) as an independent risk factor for recurrence (hazard ratio 2.87, p = 0.006), along with male sex, larger tumor size, and visceral pleural invasion. These findings highlight the role of LDCT in early detection and the importance of tailored treatment strategies, particularly addressing STAS, to optimize recurrence‐free survival and improve outcomes of patients with Stage I NSCLC.

Earlier discharge from follow-up for lung cancer screening using artificial intelligence in computed tomography

2025-06-17

Inge A. Gimbel , Minke Bergsma , M.A.J. van de Weijer +3 more | European Journal of Radiology

Development and interpretation of machine learning-based prognostic models for predicting high-risk prognostic pathological components in pulmonary nodules: integrating clinical features, serum tumor marker and imaging features

2025-06-17

Dingxin Wang , Jianhao Qiu , Rongyang Li +1 more | Journal of Cancer Research and Clinical Oncology

With the improvement of imaging, the screening rate of Pulmonary nodules (PNs) has further increased, but their identification of High-Risk Prognostic Pathological Components (HRPPC) is still a major challenge. In … With the improvement of imaging, the screening rate of Pulmonary nodules (PNs) has further increased, but their identification of High-Risk Prognostic Pathological Components (HRPPC) is still a major challenge. In this study, we aimed to build a multi-parameter machine learning predictive model to improve the discrimination accuracy of HRPPC. This study included 816 patients with ≤ 3 cm pulmonary nodules with clear pathology and underwent pulmonary resection. High-resolution chest CT images, clinicopathological characteristics were collected from patients. Lasso regression was utilized in order to identify key features, and a machine learning prediction model was constructed based on the screened key features. The recognition ability of the prediction model was evaluated using (ROC) curves and confusion matrices. Model calibration ability was evaluated using calibration curves. Decision curve analysis (DCA) was used to evaluate the value of the model for clinical applications. Use SHAP values for interpreting predictive models. A total of 816 patients were included in this study, of which 112 (13.79%) had HRPPC of pulmonary nodules. By selecting key variables through Lasso recursive feature elimination, we finally identified 13 key relevant features. The XGB model performed the best, with an area under the ROC curve (AUC) of 0.930 (95% CI: 0.906-0.954) in the training cohort and 0.835 (95% CI: 0.774-0.895) in the validation cohort, indicating that the XGB model had excellent predictive performance. In addition, the calibration curves of the XGB model showed good calibration in both cohorts. DCA demonstrated that the predictive model had a positive benefit in general clinical decision-making. The SHAP values identified the top 3 predictors affecting the HRPPC of PNs as CT Value, Nodule Long Diameter, and PRO-GRP. Our prediction model for identifying HRPPC in PNs has excellent discrimination, calibration and clinical utility. Thoracic surgeons could make relatively reliable predictions of HRPPC in PNs without the possibility of invasive testing.

Case Report: Controversies in managing pulmonary enteric adenocarcinoma: reflections from an early-stage case

2025-06-17

Yuchen Bao , Dongdong Liu , Yanzhe Wang +2 more | Frontiers in Oncology

Pulmonary enteric adenocarcinoma (PEAC) is a rare non-small cell lung cancer subtype characterized by predominant intestinal differentiation (≥50%) and histological resemblance to colorectal adenocarcinoma. We report a 70-year-old male ex-smoker … Pulmonary enteric adenocarcinoma (PEAC) is a rare non-small cell lung cancer subtype characterized by predominant intestinal differentiation (≥50%) and histological resemblance to colorectal adenocarcinoma. We report a 70-year-old male ex-smoker with an incidentally detected 18×11 mm spiculated lung nodule on chest CT, which subsequently demonstrated intense FDG uptake (SUVmax 14.0) on PET-CT. Histopathological evaluation confirmed PEAC. Immunohistochemistry revealed HER2 overexpression (3+) and intestinal differentiation markers (CK7+, CK20+, CDX2+, Villin+), while molecular testing showed wild-type ERBB2 and no actionable mutations. The patient underwent successful R0 resection with no recurrence at 8-month follow-up. This case underscores the critical importance of a multimodal diagnostic approach integrating immunohistochemical markers (notably CK7’s superior specificity), PET-CT imaging, and endoscopic evaluation to reliably differentiate PEAC from metastatic gastrointestinal malignancies. Furthermore, the patient’s favorable outcome following R0 resection without adjuvant therapy reinforces surgical intervention as the cornerstone of treatment for localized PEAC, particularly in early-stage disease. Advanced cases require early multidisciplinary collaboration to develop individualized treatment.