Search

DR. DONINGTON: Thank you for being here. The idea is to give the readers an idea of how you approach superior sulcus tumors, since you are some of the most accomplished surgeons in the country at these complex resections. So we will start with just some overview. How many of these cases do you see a year? Do you think you are seeing more or seeing less? DR. SWISHER: It’s just a hard disease to know for sure because it’s such a referral-based disease, and it goes up and down, and everybody in our group at MD Anderson Cancer Center sees these patients. I get a sense it’s going down, but I don’t know for sure. DR. BAINS: Personally, I may see a couple of them, 2 or 3 at the very least, but as a whole group, we may see 5-10 a year, but closer to 5. DR. VAILLERES: But I think it fluctuates. If you asked me that question last year, I think we did 2, and we have already done 3 this year. So I think, it comes and goes. I am not sure if the incidence is going down or not. I think it is, but I am not sure. And if it’s going down, why? Are we picking up the apical upper lobar lesions before they start invading into structures? I have no idea. DR. SWISHER: I agree, it is variable. I am also concerned because these tumors, for the most part, are tumors that should be treated at highvolume centers, and it remains to be seen how this disease is going to be affected by the changes in health care reform. It is an orphan disease since so few patients have it, but to impact it, we need to treat these patients in high-volume, multidisciplinary approaches.

The Lung Cancer Study Group consensus recommending lobectomy for stage I non-small-cell lung cancer (NSCLC) to reduce local recurrence associated with sublobar resections has directed NSCLC care since its 1995 publication. However, enhancements in imaging technology and in our understanding of the molecular biology of NSCLC over the past 2 decades have produced large cohorts of patients with smaller, better staged, and more indolent tumors than evaluated by the Lung Cancer Study Group. Numerous single-institution trials have demonstrated that in well-selected patients, sublobar resection can afford comparable survival and recurrence rates with lobectomy with a more favorable risk profile. This review of recent literature will focus on 2 separate issues with regard to the use of sublobar resections for stage I NSCLC: (1) a comparison to nonoperative ablative therapies in medically unfit patients, and (2) identifying in which subset of the noncompromised standard-risk population, sublobar resections provide equivalent outcome to lobectomy.

mained stable in size, while the other 50% grew at a rate of approximately 3 mm per year. These lesions, while generally peripheral or subpleural in location, are distributed evenly throughout all lobes of the lung. A subset of hamartomas, endobronchial hamartomas, account for 1% to 20% of lesions and are more likely to cause signs or symptoms such as dyspnea, wheezing, or recurrent infections due to airway obstruction. 5,6 Endobronchial hamartomas are particularly interesting because cytogenetics studies have shown specific chromosomal abnormalities that suggest a clonal origin of these lesions. 7

Historically, lung cancer has been viewed as a male disease, but during the past 50 years there has been a dramatic increase in the incidence of lung cancer in women. Lung cancer is currently the most common cause of cancer death in American women, accounting for more than one quarter of all cancer deaths. This has been attributed to a significant increase in tobacco consumption by women; however, approximately 1 in 5 women with lung cancer never smoked. As the incidence of lung cancer in women has increased, significant gender-based differences in epidemiology, biology, and treatment responses have become evident and warrant further investigation to advance the treatment of lung cancer in all patients.