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This study evaluated the correlation between radiation-induced lung injury (RILI) and dosimetric parameters on computed tomography (CT) images of stage I non-small cell lung cancer (NSCLC) patients undergoing intensity-modulated radiotherapy (IMRT). Sixty-three stage I NSLC patients who underwent IMRT were enrolled in the study. The patients underwent CT within 6 months (acute phase) and 1.5 years (late phase) after radiotherapy. These were fused with the planned irradiation CT. The range of RILI was measured from 10% to 100%, with an IC in 10% increments. The median interval from completion of radiotherapy to acute and late phase CT was 92 and 440 days, respectively. The median RILI ranges of the acute and late phases were in the 80% (20–100%) and 70% dose regions (20–100%), respectively. The significantly narrower range of RILI when lung V20 in the acute phase was less than 19.2% and that of V5 in the late phase was less than 27.6% at the time of treatment planning. This study showed that RILI occurred in a localized range in stage I NSCLC patients who underwent IMRT. The range of RILI was correlated with V20 in the acute phase and V5 in the late phase.KEY MESSAGESRILI correlated with V20 in acute and V5 in late phase.The shadow of RILI occurred in 80% dose region in acute and 70% in late phase.No relationship exists between radiographic changes in RILI and PTV volume. RILI correlated with V20 in acute and V5 in late phase. The shadow of RILI occurred in 80% dose region in acute and 70% in late phase. No relationship exists between radiographic changes in RILI and PTV volume.

Background: Comorbidity is an important prognostic marker and a treatment indicator for lung cancer patients. Register-based studies often describe the burden of comorbidity by the Charlson comorbidity index (CCI) based on hospital discharge data. We assessed the association between somatic and psychiatric comorbidity and death within one year in early lung cancer and, furthermore, the burden of comorbidity according to treatment type. Material and methods: We conducted a population-based matched case-control study of stage I lung cancer identifying all treated patients who died (all-cause) within one year after diagnosis (early death group, cases). On the basis of data from the Danish Lung Cancer Registry these patients were then matched with two controls who survived more than one year (survivors). Through a review of the medical records, we validated inclusion criteria and collected data on somatic and psychiatric comorbidity. We assessed the association between comorbidity and early death with multivariate conditional logistic regression. Results: We included 221 cases and 410 controls. The mean CCI score in the early death group was 2.3 vs. 1.3 in the survivor group (p

BACKGROUND: There is paucity of evidence regarding the optimal follow-up (FU) regimen for lung cancer. Consequently, FU is organized differently across countries. The Danish FU regimen has short FU intervals with a computed tomography (CT) scan of the chest and upper abdomen every three months in the early phase (first 2 years), then every six months in the late phase of FU (3rd, 5th year). Characterizing recurrences missed by the FU program in terms of site, tumor histology, department, and phase of FU, could improve the FU program.MATERIAL AND METHOD: A case-control study of curatively treated stage I lung cancer patients who attended the Danish FU-program and had recurrence identified through the follow-up program (controls, FU group) or outside FU program (cases, symptomatic group).RESULTS: Of 233 included patients with recurrence, the FU group constituted 85% (n = 197). Among the 15% (n = 36) in the symptomatic group, 53% had involvement of the central nervous system compared with 3% in the FU group. The unadjusted odds ratio (OR) for having an isolated brain recurrence (IBR) in the symptomatic group was 52.3 (95%CI: 15.1-181.4) as compared with the FU group. The OR for having a symptomatic recurrence in the early phase of FU was 2.5 (95%CI: 0.7-8.7) compared with the late phase.CONCLUSIONS: The FU program did not identify the majority of patients with IBR. Including cerebral imaging in the FU program may result in an earlier detection of brain metastases. These matters should be studied in a prospective setting.

We retrospectively evaluated whether preoperative percutaneous transthoracic needle biopsy (PTNB) affected the incidence of pleural recurrence in pathological stage I lung cancer patients. Pleural recurrence occurred in pure solid nodule (PSN) cases but not in ground-glass nodule cases, as evaluated using thin-section computed tomographic imaging. When the cases were restricted to sub-pleural PSN, the incidence of recurrence tended to be higher in a PTNB group (63 patients diagnosed by PTNB) than in a non-PTNB group (86 patients diagnosed by transbronchial biopsy or intraoperative diagnosis) (25% vs. 4%, p =.050). PTNB should not be performed in patients with a sub-pleural PSN.

Video-assisted thoracoscopic surgery (VATS) for pulmonary lobectomies has recently been introduced as a minimally invasive technique for selected patients. Herein I describe an original technique, which allows for lobectomies under the direct vision of a surgeon respecting the principles that are the basis of the thoracoscopic techniques. The originality of the technique consists in the supine position of the patient and the use of a modified retractor for lower lobectomies. This approach required two ports, an access incision (6-7 cm), and an additional port which may be used for lower lobectomies. Utilizing this technique I operated on twenty patients affected by stage I lung cancer with poor respiratory function. The ability to perform lobectomies with this method allows for shorter operative time than when utilizing previous techniques (80 min. mean operative time) including the lymph nodal dissection. Moreover, cosmetic results were good and patients benefited from excellent early pulmonary function and fast recovery time. I recommend the use of this approach which is a safe technique for the patient and an advantageous procedure for both surgeon and anaesthesiologist.