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Video-assisted thoracoscopic surgery lobectomy versus open lobectomy in patients with clinical stage Ⅰ non-small cell lung cancer: A meta-analysis.

Eur J Surg Oncol. 2013 Jul 8;

Authors: Chen FF, Zhang D, Wang YL, Xiong B

Abstract
AIMS: Video-assisted thoracoscopic surgery (VATS) lobectomy for early lung cancer has been shown to be technically feasible. Weather VATS lobectomy has equivalent or better clinical effect compared with open lobectomy for early lung cancer patients remains controversial. The purpose is to assess the value of VATS compared with thoracotomy for stage Ⅰ non-small cell lung cancer (NSCLC) by meta-analysis.
METHODS: We searched databases of EMBASE, PubMed, and ScienceDirect for relevant articles published between January 1990 and January 2013. Eligible studies were randomized controlled trials (RCTs) or comparative studies of VATS lobectomy and open lobectomy for clinical stage Ⅰ NSCLC. Data on operation time, intra-operative blood loss, length of chest tube drainage and hospital stay, complications incidence and 5 year survival rate were meta-analyzed using Review Manager 5.0.
RESULTS: 20 studies with 3457 clinical stage Ⅰ NSCLC patients were included. There was no difference in operation time between the two groups (P = 0.14), but distinct advantages in terms of intra-operative blood loss, chest drainage time, hospital stay and complication incidence were found in the VATS group (P < 0.01). Moreover, the 5 year survival rate of VATS group was significantly higher than thoracotomy group (OR 1.82, 95% CI, 1.43-2.31, P < 0.01).
CONCLUSION: Compared with thoracotomy group, VATS achieved better surgical and oncological outcomes and was a more favorable treatment for stage Ⅰ NSCLC patients.

PMID: 23845704 [PubMed - as supplied by publisher]

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Volumetric computer tomography screening for lung cancer: three rounds of the NELSON trial.

Eur Respir J. 2013 Jul 11;

Authors: Horeweg N, van der Aalst CM, Vliegenthart R, Zhao Y, Xie X, Th Scholten E, Mali W, Thunnissen E, Weenink C, Groen HJ, Lammers JW, Nackaerts K, van Rosmalen J, Oudkerk M, de Koning HJ

Abstract
Several medical associations recommended lung cancer screening by low-dose computer tomography (LDCT) scanning for high-risk groups. Counselling of the candidates on the potential harms and benefits and their lung cancer risk is a prerequisite for screening.In the NELSON trial, screenings are considered positive for (part) solid lung nodules with a volume >500 mm(3) and for (part) solid or non-solid nodules with a volume-doubling time <400days. For this study, the performance of the NELSON strategy in three screening rounds was evaluated and risk calculations were made for a follow-up period of 5.5 years.458 (6%) of the 7.582 screened participants had a positive screen result and 200 (2.6%) were diagnosed with lung cancer. The positive screenings had a predictive value of 40.6% and only 1.2% of all scan results were false-positive. In a period of 5.5 years, the risk of screen-detected lung cancer strongly depends on the result of the first scan: 1.0% after a negative baseline result, 5.7% after an indeterminate baseline and 48.3% after a positive baseline.The screening strategy yielded few positive and false-positive scans with a reasonable positive predictive value. The 5.5-year lung cancer risk calculations aid clinicians in counselling candidates for lung cancer screening with LDCT.

PMID: 23845716 [PubMed - as supplied by publisher]

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Marijuana use and risk of lung cancer: a 40-year cohort study.

Cancer Causes Control. 2013 Jul 12;

Authors: Callaghan RC, Allebeck P, Sidorchuk A

Abstract
PURPOSE: Cannabis (marijuana) smoke and tobacco smoke contain many of the same potent carcinogens, but a critical-yet unresolved-medical and public-health issue is whether cannabis smoking might facilitate the development of lung cancer. The current study aimed to assess the risk of lung cancer among young marijuana users.
METHODS: A population-based cohort study examined men (n = 49,321) aged 18-20 years old assessed for cannabis use and other relevant variables during military conscription in Sweden in 1969-1970. Participants were tracked until 2009 for incident lung cancer outcomes in nationwide linked medical registries. Cox regression modeling assessed relationships between cannabis smoking, measured at conscription, and the hazard of subsequently receiving a lung cancer diagnosis.
RESULTS: At the baseline conscription assessment, 10.5 % (n = 5,156) reported lifetime use of marijuana and 1.7 % (n = 831) indicated lifetime use of more than 50 times, designated as "heavy" use. Cox regression analyses (n = 44,284) found that such "heavy" cannabis smoking was significantly associated with more than a twofold risk (hazard ratio 2.12, 95 % CI 1.08-4.14) of developing lung cancer over the 40-year follow-up period, even after statistical adjustment for baseline tobacco use, alcohol use, respiratory conditions, and socioeconomic status.
CONCLUSION: Our primary finding provides initial longitudinal evidence that cannabis use might elevate the risk of lung cancer. In light of the widespread use of marijuana, especially among adolescents and young adults, our study provides important data for informing the risk-benefit calculus of marijuana smoking in medical, public-health, and drug-policy settings.

PMID: 23846283 [PubMed - as supplied by publisher]

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Systemic therapy for small cell lung cancer.

J Natl Compr Canc Netw. 2013 Jul 1;11(7):780-7

Authors: Levy B, Saxena A, Schneider BJ

Abstract
Small cell lung cancer is an aggressive tumor characterized by genetic complexity, rapid doubling time, and early development of disseminated disease. Unfortunately, few chemotherapeutic advances have been made in the treatment of extensive-stage disease, and cisplatin/etoposide has remained the standard of care for more than 30 years. Other regimens with comparable efficacy include cisplatin/irinotecan and carboplatin/etoposide. Each of these combinations is associated with a different toxicity profile that must be considered when selecting an initial regimen. Several strategies, including maintenance chemotherapy, 3-drug combinations, alternating combination chemotherapy regimens, and high-dose chemotherapy, have consistently failed to demonstrate improvements in survival when compared with 4 to 6 cycles of platinum doublets. Several options are available for patients who experience progression during or relapse after induction therapy, although topotecan is the only FDA-approved agent for second-line treatment. Recently, scientific efforts have identified potentially actionable genetic alterations in small cell tumors that may lead to the development of effective, targeted therapies.

PMID: 23847216 [PubMed - in process]