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1. A pilot study of stereotactic body radiation therapy (SBRT) after surgery for stage III non-small cell lung cancer

Author

Anurag K. Singh, Mark Hennon, Sung Jun Ma, Todd L. Demmy, Anthony Picone, Elizabeth U. Dexter, Chumy Nwogu, Kristopher Attwood, Wei Tan, Gregory M. Hermann, Simon Fung-Kee-Fung, Harish K. Malhotra, Sai Yendamuri, and Jorge A. Gomez-Suescun

Subjects
Post-operative, Adjuvant, SABR, RT, Mediastinum, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Abstract Background Standard therapy for stage III non-small cell lung cancer with chemotherapy and conventional radiation has suboptimal outcomes. We hypothesized that a combination of surgery followed by stereotactic body radiation therapy (SBRT) would be a safe alternative. Methods Patients with stage IIIA (multistation N2) or IIIB non-small cell lung cancer were enrolled from March 2013 to December 2015. The protocol included transcervical extended mediastinal lymphadenectomy (TEMLA) followed by surgical resection, 10 Gy SBRT directed to the involved mediastinum/hilar stations and/or positive surgical margins, and adjuvant systemic therapy. Patients not suitable for anatomic lung resection were treated with 30 Gy to the primary tumor. The primary efficacy end-point was the proportion of patients with grade 3 or higher adverse events (AE) or toxicities. Results Of 10 patients, 7 patients underwent neoadjuvant chemotherapy. All patients had TEMLA. Nine of 10 patients underwent surgical resection. The remaining patient had an unresectable tumor and received 30 Gy SBRT to the primary lesion. All patients had post-operative SBRT. Median follow-up was 18 months. There were no perioperative mortalities. Six patients had any grade 3 AEs with no grade 4–5 AEs. Of these, 4 were not attributable to radiation. Pulmonary-related grade 3 AEs were experienced by 2 patients. There were no failures within the 10 Gy volume. Overall survival and progression-free survival rates at 2 years were 68% (90% CI 36–86) and 40% (90% CI 16–63), respectively. Conclusions In carefully selected patients with locally advanced non-small cell lung cancer, combining surgery with SBRT was well tolerated with no local failure. Trial registration ClinicalTrials.gov identifying number NCT01781741. Registered February 1, 2013.

Published
2018
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2. Sarcopenia is a predictor of outcomes after lobectomy

Author

Athar Battoo, Elisabeth U. Dexter, Anthony Picone, Kristopher Attwood, Kassem Harris, Chukwumere Nwogu, James A. Miller, Charles Roche, Samjot Singh Dhillon, Todd L. Demmy, Mark Hennon, and Sai Yendamuri

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, business.industry, Standard treatment, medicine.medical_treatment, Mortality rate, Odds ratio, 030204 cardiovascular system & hematology, medicine.disease, Surgery, 03 medical and health sciences, 0302 clinical medicine, 030220 oncology & carcinogenesis, Sarcopenia, Video-assisted thoracoscopic surgery, medicine, Erector spinae muscles, Original Article, Pectoralis Muscle, business, Body mass index
Abstract

Background: As screening for lung cancer rises, an increase in the diagnosis of early stage lung cancers is expected. Lobectomy remains the standard treatment, but there are alternatives, consideration of which requires an estimation of the risk of surgery. Sarcopenia, irrespective of body mass index, confers a worse prognosis in many groups of patients including those undergoing surgery. Here we examine the association of muscle mass with outcomes for patients undergoing lobectomy. Methods: Consecutive patients undergoing lobectomy were retrospectively reviewed. Preoperative computed tomography scans were reviewed, and cross-sectional area of the erector spinae muscles and pectoralis muscles was determined and normalized for height. Univariate and multivariate analyses were then done to examine for an association of muscle mass with morbidity and short- and long-term mortality. Results: During the study period, there were 299 lobectomies, 278 of which were done by video assisted thoracoscopic surgery. The average age of the patients was 67.5±10.6 years. Overall complication rate was 52.2%, pneumonia rate was 8.7%, and the 30-day mortality rate was 1.3%. Mean height adjusted-erector spinae muscle cross-sectional area was 10.6±2.6 cm 2 /m 2 , and mean height adjusted-pectoralis muscle cross sectional area was 13.3±3.8 cm 2 /m 2 . The height adjusted cross sectional areas of the erector spinae and pectoralis muscles were not associated with overall complication rate, rate of pneumonia, readmission, or intensive care unit length of stay. The height adjusted-erector spinae muscle cross sectional area was inversely correlated with 30-day mortality risk, odds ratio 0.77 (95% CI, 0.60–0.98, P=0.036). Mean length of stay was 7.0 days (95% CI, 5.5–8.4 days). Multivariate analysis demonstrated a significant inverse association of the height adjusted-erector spinae muscle cross sectional area with length of stay (P=0.019). Conclusions: The height adjusted-erector spinae muscle cross sectional area was significantly associated with 30-day mortality and length of stay in the hospital. Measurement of muscle mass on preoperative computed tomography imaging may have a role to help predict risk of morbidity and mortality prior to lobectomy.

Published
2018

3. Endobronchial anthracosis with concurrent primary lung cancer

Author

Jessie Bower, Abdul Hamid Alraiyes, Anthony Picone, and Pichapong Tunsupon

Subjects
medicine.medical_specialty, Tuberculosis, Lung Neoplasms, Lymphadenopathy, Physical examination, Asymptomatic, Article, 03 medical and health sciences, 0302 clinical medicine, Hydrochlorothiazide, Internal medicine, Medicine, Humans, 030212 general & internal medicine, Lung cancer, Anthracosis, Aged, 80 and over, Lung, medicine.diagnostic_test, business.industry, General Medicine, Environmental exposure, Environmental Exposure, medicine.disease, medicine.anatomical_structure, 030228 respiratory system, medicine.symptom, business, medicine.drug
Abstract

An 86-year-old man was evaluated for asymptomatic persistent right upper lung (RUL) consolidation measuring 4×5 cm. He had worked as a welder in an automobile plant for 40 years and had, without protective gear, been exposed to smoke and dust from combustion of fuels. He had quit smoking 15 years prior to the work up for lung consolidation, with a previous 10 pack-year cigarette smoking history. He denied travelling to endemic areas of tuberculosis and sick contact exposure. His medications included hydrochlorothiazide and lisinopril for blood pressure control. Physical examination and laboratory work up were unremarkable. RUL consolidation …

Published
2016

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