Cáncer de Pulmón Revisión Anual Mauro Zamboni, MD, FCCP Neumólogo, Coordinador del Grupo de Oncologia Torácica – INCA/MS Rio de Janeiro Brasil
Thoracoscopic lobectomy is associated with lower morbiditiy than open lobectomy: a propensity-matched analysis from STS database.
Subroto P, Altorki NK, Sheng S, et al J Thorac Cardiovasc Surg 2010; 139:366-378
Is Video-Assisted Thoracoscopic Surgery Becoming More Popular? . There are multiple reports showing that VATS is associated with fewer postoperative complications compared with open thoracotomy. . There are no randomized phase III trials comparing the two approaches. . 2002 – 2007 – Society of Thoracic Surgeons General Thoracic Database – selected 2 groups of 1281 pts. (VATS x Open Thoracotomy) . During this period, the percentage of pts undergoing VATS increased from 10% to 27%.
. The were no differences in operative mortality between the two groups .
. No surgical complications: . VATS – 73.8% - Open Thoracotomy – 65.3%
. VATS was associated with a significantly lower incidence: . Arrhytmias ( 7.3% x 11.5%) . Pulmonary complications (7.5% x 12.1%). . Shorter length of stay (4 x 6 days) . VATS – its use has steadily increased during the past 6 years
Age- and sex-specific genomic profiles in non-small cell lung cancer
Mostertz W, Stevenson M, Acharya C, et al. JAMA 2010; 303:535-543
Despite clinical evidence for improved survival in patients with younger age and female gender, there is limited information on the biologic differences that could explain this variability in outcome. They evaluated 787 NSCLC pat tumor samples, with corresponding clinical data from four independent data sets. Pat. with stages I to IIIA were subdivide into 4 differents subgroups according to age and gender into < 70 y, > 70 y, men and women. The relapse-free survival was significantly better in younger pts and women.
Younger pts with high-risk for relapse had increased probability of activation on the Src and TNF gene signatures compared with the lowrisk counterpart, whereras older pat in the high-risk category had increased activation of gene signatures for wound healing and invasiveness. Men had an increased probability of activation in the chromosomal instability, epigenetic stem cell, invasiveness. Women had increased probability of activation in the E2F1 pathways
Although these findings still require validation, this study represents a step forward in the understanding of biologic differences among demographic variables, with likely implication for individualized therapy.
Lung Function predicts Lung Cancer Risk in Smokers: a tool for targeting screening programmes
E. Calabrò, G Randi, C La Vecchia, N Sverzellati, A Marchiano, M Villani, M Zompatori, R Cassandro, S Harari, U Pastorino Eur Resp J 2010; 35:146-151
The relantionship between smoking, lung cancer and airflow obstruction is well recognised. However, it is unclear whether the presence of airflow obstruction constitutes a significant risk factor for development of lung cancer, independently from smoking.
The aim of the present study is to identify in a population of heavy smokers, recruited in prospective screening trials with annual thorax CT, those individuals with higher lung cancer risk on the basis of functional damage, and to establish whether a cut-off value of lung obstruction can be assumed as a discriminanting parameter for early detection lung cancer trials.
COPD Dx – GOLD criteria – VEF1 < 70%
The present study therefore indicates the role of lung function tests, a noninvasive, low cost and very fast examination, to identifiy optimal candidates for early detection trials. Defining reliable criteria for the assessment of a higher individual risk of lung cancer in heavy smokers might improve future prevention strategies, early detection approaches and clinical management of such lethal disease. . Airflow obstruction as surrogate marker for carcinogenic damage of the airways may be better than pack-yrs alone in predicting risk and can be used to select subjects for screening programmes.
Effectiveness of Radiation Therapy for Elderly Patients with Unresected Stage I and II Non-smal Cell Lung Cancer
JP Wisnivesky, E Halm, M Bonomi, C Powell, E Bagiella Am J Respir Crit Care Med 2010; 181:264-269
Radiotherapy is considered the standard treatment for patients with stage I and II NSCLC who are not surgical candidates because of comorbities or preferences against surgery. Objective: To compare the outcomes of patients treated with radiotherapy alone with those who were untreated to assess the effect of RT on survival. Methods: Using SEER the authors identified 6,065 unresected patients with histologically confirmed stage I and stage II NSCLC, diagnosed between 1992 and 2002.
Measurements and Main Results: Overall, 59% of patients received RT. The overall and lung cancer-specific survival of unresected patients treated with RT was significantly better compared with the untreated cases (P<0.0001 for both comparisions). RT was associated with a 6-month improvement in median overall survival. Conclusion: RT improves survival of elderly patients with unresected stage I or II lung cancer.
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