Early Lung Cancer – American Society of Clinical Oncology Meetings, Chicago2013, and Journal Updates

Abstract 7571

“Outcomes of early stage lung cancer treatments in older patients: A SEER database analysis”

Conclusion: 

This multivariate logistic regression outcome analysis of over 10,000 patients diagnosed with stage I or II lung cancer, ages <65, 65-75, and greater than age 75  compared outcomes in patients that had observation only, radiation, or surgery. Age-related 5-year survival in patients with stage I lung cancer having surgery was excellent with lung cancer specific mortality 19% (<65), 26% (65-75), and 30% (>75). Results with surgery in stage II patients were similar. In patients receiving radiation only, 5-year lung cancer specific mortality was greater than 60% for all three groups.

Comments:

This retrospective data analysis provides powerful support for surgical intervention in those elderly patients with early stage lung cancer who are surgical candidates. The survival outcomes for patients treated with radiation only need to be interpreted with great caution because of presumed selection bias.

 

New England Journal of Medicine May 23, 2013

“Results of Initial Low-Dose Computed Tomographic Screening for Lung Cancer”

Study:

Over 50,000 individuals with at least 30 pack year history of smoking, from 33 different centers, were randomized to either CXR of CT of the chest to screen for lung cancer on an annual basis for 3 consecutive years. Plan design was interesting in that for CT screening purposes a positive screening result was defined as the presence of non-calcified nodules 4mm or greater in diameter. For plain film of the chest, all nodules seen were considered a positive finding for screening purposes.

Results:   

CT screening was positive in over 27% and CXR screening was positive in 9% of study participants. Lung cancer was ultimately diagnosed in 1.1% of study participants screened by CT and in 0.7% of participants screened by CXR. The authors of this very important study comment that the difference in lung cancer diagnosis rates was almost completely attributed to the higher incidence of stage IA lung cancer found by low dose CT imaging of the chest.

Conclusion:

Because of the larger number of patients diagnosed with stage IA lung cancer, the authors concluded that screening with low dose CT of the chest may result in increased lung cancer survival.

Comment:

The results of the study and implications for potential lung cancer survival are consistent with other studies. Cost-benefit analysis will likely be a moving target in favor of screening, as the cost for low dose screening CT of the chest is anticipated to drop.

To discuss this, or any of Dr. Mamus's other topics, please don't hesitate to contact him.

 

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08 July 2013, 15:30
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