Definitive radiotherapy for stage I nonsmall cell lung cancer: A population-based study of survival.

Cancer. 2012 Apr 27;

Authors: Milano MT, Zhang H, Usuki KY, Singh DP, Chen Y

Abstract
BACKGROUND: The current study characterizes the overall survival (OS) and cause-specific survival (CSS) of patients with stage I nonsmall cell lung cancer (NSCLC) who were treated with radiotherapy alone, and analyzes the variables potentially affecting survival outcomes. METHODS: A total of 8524 patients with stage I NSCLC (according to the sixth edition of the American Joint Committee on Cancer staging manual) who were diagnosed between 1988 and 2008 were retrospectively analyzed using the population-based Surveillance, Epidemiology, and End Results database. Cox regression analysis was used to calculate hazard ratios (HR) from multivariate analyses. RESULTS: The 1-year, 2-year, and 5-year OS rates were 62%, 37%, and 11%, respectively; the corresponding lung cancer CSS survival rates were 68%, 45%, and 20%, respectively. Approximately 77% of deaths were from lung cancer (5292 of 6891 total deaths). Cardiac (n = 477 deaths) and pulmonary (other than lung cancer deaths; n = 475 deaths) deaths accounted for 14% of deaths. From Cox proportional hazards analyses, male sex (HR, 1.2) and squamous cell carcinoma histology (HR, > 1.1) were found to be significantly (P < .0001) adverse prognostic factors for both OS and lung cancer CSS. A more recent calendar year of diagnosis was associated with significantly (P < .0001) improved OS (HR, 0.84 per decade) and lung cancer CSS. This trend was also significant (P < 0.0001) when restricting analyses to those patients with tumors measuring ≤ 5 cm (n = 5402 patients). T1 classification (vs T2 or T unknown) and smaller tumor size were found to be significantly (P < .0001) favorable factors. CONCLUSIONS: From a population-based registry analysis of patients with stage I NSCLC, significant (albeit modest) improvements in survival in more recent years were appreciated, which likely reflect technologic advances in the diagnosis of, staging of, and radiotherapy for NSCLC. Cancer 2012;. © 2012 American Cancer Society.

PMID: 22544655 [PubMed - as supplied by publisher]

Epigenetic Biomarkers in Lung Cancer.

Cancer Lett. 2012 Apr 27;

Authors: Liloglou T, Bediaga NG, Brown B, Field JK, Davies MP

Abstract
Lung cancer mortality is strongly associated with the predominant diagnosis of late stage lesions that hampers effective therapy. Molecular biomarkers for early lung cancer detection is an unmet public health need and the lung cancer research community worldwide is putting a lot of effort to utilise major lung cancer population programmes in order to develop such molecular tools. The study of cancer epigenetics in the last decade has radically altered our views in cancer pathogenesis, providing new insights in biomarker development for risk assessment, early detection and therapeutic stratification. DNA methylation and miRNAs have rapidly emerged as potential biomarkers in body fluids showing promise to assist the clinical management of lung cancer. These new developments are exemplified in this review, demonstrating the huge potential of clinical cancer epigenetics, but also critically discussing the necessary validation steps to bring epigenetic biomarkers towards clinical implementation and the weaknesses of current biomarker studies.

PMID: 22546286 [PubMed - as supplied by publisher]

Single agent maintenance therapy for advanced stage non-small cell lung cancer: A meta-analysis.

Lung Cancer. 2012 Apr 28;

Authors: Behera M, Owonikoko TK, Chen Z, Kono SA, Khuri FR, Belani CP, Ramalingam SS

Abstract
BACKGROUND: Maintenance therapy is a new treatment paradigm for advanced non-small cell lung cancer (NSCLC). We conducted a meta-analysis of randomized studies with single agent maintenance therapy. METHODS: An electronic literature search of public databases (MEDLINE, EMBASE, Cochrane library) and manual search of relevant conference proceedings was performed. A formal meta-analysis was conducted using Comprehensive Meta Analysis software (Version 2.0). Outcome data were pooled and reported as hazard ratio (HR). The primary outcome of interest was overall survival (OS) and secondary outcome was progression free survival (PFS). RESULTS: Twelve studies were included (5 meeting abstracts, 7 full manuscripts) with a total of 4286 patients (maintenance arm/control arm - 2449/1837, median age 61years, males - 69%). The OS (HR 0.86, 95% confidence intervals [CI] 0.80-0.92; P=0.0003) and PFS (HR 0.80, 95% CI 0.77-0.84; P<0.0001) were superior with maintenance therapy. 'Switch' maintenance was associated with significant OS and PFS improvement (OS HR 0.84, 95% CI 0.77-0.91; P=0.00026; PFS HR 0.62, 95% CI 0.57-0.67; P<0.0001). Despite a modest improvement in PFS (HR 0.90, 95%CI 0.85-0.95; P=0.007), "continuation" maintenance was not associated with survival benefit (HR 0.927, 95%CI 0.78-1.09; P=0.33). Improvements in OS and PFS were observed with both EGFR-targeted agents (HR 0.83, 95% CI 0.74-0.92; P=0.004; HR 0.64, 95% CI 0.58-0.71 P<0.0001) and cytotoxic agents (HR 0.89, 95% CI 0.80-0.98; P=0.018; HR 0.85, 95% CI 0.80-0.89; P<0.0001). CONCLUSIONS: Single agent maintenance therapy improves overall survival, though statistical significance was only noted with 'switch' maintenance.

PMID: 22546678 [PubMed - as supplied by publisher]

A New Method to Predict Values for Postoperative Lung Function and Surgical Risk of Lung Resection by Quantitative Breath Sound Measurements.

Am J Clin Oncol. 2012 Apr 27;

Authors: Westhoff M, Herth F, Albert M, Dienemann H, Eberhardt R

Abstract
OBJECTIVES:: We evaluated quantitative acoustic measurements, as a simpler alternative to perfusion scintigraphy, for estimation of predicted postoperative (ppo) lung function after resection surgery in our patient population. METHODS:: Patients with lung cancer, considered as candidates for lung resection, were enrolled in the study. All patients underwent lung function testing and quantitative breath sound testing by vibration response imaging (VRI) on the same day. A subset of patients also had perfusion testing. Forced expiratory volume in 1 second (FEV1) and diffusing capacity of the lung for carbon monoxide (DLCO) predictions derived from VRI testing were compared with perfusion values and actual FEV1 values at 1 month postoperatively. RESULTS:: Fifty-three subjects (40 males; age 66±8 y) participated. There was high correlation between both methods for the calculation of ppoFEV1% (R=0.94; n=39) and ppoFEV (L) (R=0.90; n=39). PpoFEV1 were 58±18% versus 56±20% and 1.69±0.49 L versus 1.62±0.52 L, based on perfusion and VRI methods, respectively. In 92% (36/39) of calculations, the difference between the 2 methods was <10%. High correlations also existed between VRI and perfusion for the calculation of ppoDLCO% (R=0.95; n=37) and ppoDLCO mL/min/mm Hg (R=0.90; n=37). VRI predictions showed good correlation for the 34 patients with actual postoperative lung function (R=0.88 and R=0.80 for FEV1% and FEV1L, respectively). Accuracy of the VRI to predict surgical risk (<40% cutoff threshold for ppo values) compared with actual postoperative values was 85% (29/34). CONCLUSIONS:: Predictions of postoperative lung function using VRI agree well with radionuclide techniques and actual measured postoperative values. VRI may provide a noninvasive, simpler alternative for estimation of ppo values, particularly when perfusion testing is not readily available.

PMID: 22547008 [PubMed - as supplied by publisher]