Early Stage NSCLC Flashcards
Definition of early stage lung cancer
Stage I or Stage II
Percentage of patients diagnosed with NSCLC that are considered early stage
~15% (13%)
Early stage (Stage I or II)
Leading risk factors for development of NSCLC
- Smoking (largest)
- Radon gas exposure
- Asbestos
Most patients with NSCLC present with __ stage disease
Locally advanced or metastatic disease
Primary results of National Lung Screening Trial (NLST)
- 20% reduction in lung-cancer specific mortality with low-dose helical CT vs CXR
- 7% reduction in all-cause mortality with low-dose helical CT vs CXR
NCCN Guidelines for Staging of Early-Stage biopsy proven NSCLC
- CT (chest and abdomen through adrenals)
- PET/CT
- Brain MRI (stage > Ib)
Characteristics of suspicious appearing MLN on CT or PET/CT for lung cancer
- MLN > 1cm in long-axis diameter
- PET hypermetaboic (SUV >= 2.5)
Approach to adrenal masses detected on staging workup for NSCLC
- Assess for funcitoning tumor (pheo/cortisol/etc)
- FNA biopsy of mass if non-functioning
All primary tumor biopsy specimens should undergo pathologic review for what
- Histologic subtype
- Molecular markers (dictate adjuvant treatment)
- EGFR
- K-ras
- ELM4/ALK
- ERCC1
MLN biopsy techniques and respective accessability patterns
- Cervical mediastinoscopy (stations 2,4,7)
- EBUS-TBNA (stations 1,2,3,4,7,10,11)
- EUS-FNA (stations 2R,2L,4L,7,8,9 + left adrenal masses)
Comparision of efficacy between mediastioscopy and EBUS-TBNA for MLN biopsy
Likely similar sensitivity, specificiy and diagnostic accuracy
(no direct head-to-head comparisons)
POC (Standard of Care) for early-stage lung cancer
Lobectomy (vs. sublobar resection)
- Lower 5-year overall and cancer-specific mortality (67-90%)
- Lower local recurrence rate (1-12%)
Approximate Local Recurrence (LR) and 5-year Survival (5-S) Rates for:
Lobectomy
Segmentectomy
Wedge Resection
- Lobectomy (1-12% LR, 65-90% 5-S)
- Segmentectomy (2-23% LR, 40-90% 5-S)
- Wedge Resection (15-30% LR, 25-70% 5-S)
Evidence comparing lobectomy to sublobar resection for stage I NSCLC
Lung Cancer Study Group (1995)
- Multi-institution RCT
- Lobectomy vs. Sublobar resection
- Results:
- No differnece in morbidity or PFTs
- 3x increase in local recurrance after wedge resection
- 2.4x increase in local recurrence after segmentectomy
- Tumor size (even if < 1cm) did not affect local recurrence
Surgical option for early stage NSCLC patients with poor cardiopulmonary fitness or other medical comorbidities precluding lobectomy
Segmentectomy with margins equal to size of primary tumor
(Preferable to wedge resection)
Surgical option for proximal tumors
Sleeve resection (key is tension-free repair)
- Sleeve prefereable to pneumonectomy
- Anastomosis should be buttressed
- Intercostal muscle
- Omentum
- Pericarium