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Surgical Staging of Lung Cancer for Advances in Radiation Oncology of Lung Cancer

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Advances in Radiation Oncology in Lung Cancer

Part of the book series: Medical Radiology ((Med Radiol Radiat Oncol))

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Abstract

This chapter reviews surgical approaches to determining T, N, and M status for lung cancer; an expanded description of individual mediastinal staging modalities; the evidence for invasive mediastinal staging procedures and multi-modality staging strategies; and staging practices in the community at large.

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Abbreviations

AJCC:

American Joint Committee on Cancer

CT:

Computed tomography

EBUS:

Endobronchial ultrasound

EUS:

Esophageal endoscopic ultrasound

IASLC:

International Association for the Study of Lung Cancer

UICC:

International Union Against Cancer

MRI:

Magnetic resonance imaging

NSCLC:

Non-small cell lung cancer

PET:

Positron emission tomography

SCLC:

Small cell lung cancer

TBNBx:

Transbronchial needle biopsy

TTNBx:

Transthoracic needle biopsy

VATS:

Video-assisted thoracic surgery

References

  • Adams K, Shah PL, Edmonds L, Lim E (2009) Test performance of endobronchial ultrasound and transbronchial needle aspiration biopsy for mediastinal staging in patients with lung cancer: systematic review and meta-analysis. Thorax 64:757–762

    Article  PubMed  CAS  Google Scholar 

  • Allen MS, Darling GE, Pechet TTV, Mitchell JD, Herndon JE II, Landreneau RJ, Inculet RI, Jones DR, Meyers BF, Harpole DH, Putnam JB Jr, Rusch VW, The ACOSOG Z0030 Study Group (2006) Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg 81:1013–1020

    Article  PubMed  Google Scholar 

  • Al-Sarraf N, Aziz R, Gately K, Lucey J, Wilson L, McGovern E, Young V (2008) Pattern and predictors of occult mediastinal lymph node involvement in non-small cell lung cancer patients with negative mediastinal uptake on positron emission tomography. Eur J Cardiothorac Surg 33(1):104–109

    Article  PubMed  Google Scholar 

  • American Joint Committee on Cancer (2010) AJCC Cancer Staging Manual, 7th edn. Springer, New York

    Google Scholar 

  • Annema JT, Van Meerbeeck JP, Rintoul RC, Dooms C, Deschepper E, Dekkers OM, De Leyn P, Braun J, Carroll NR, Praet M, de Ryck F, Vansteenkiste J, Vermassen F, Versteegh MI, Veseliç M, Nicholson AG, Rabe KF, Tournoy KG (2010) Mediastinoscopy vs endosonography for mediastinal nodal staging of lung cancer: a randomized trial. J Am Med Assoc 304(20):2245–2252

    Article  CAS  Google Scholar 

  • Cangemi V, Volpino P, Drudi FM, D’Andrea N, Cangemi R, Piat G (1996) Assessment of the accuracy of diagnostic chest CT scanning. impact on lung cancer management. Int Surg 81(1):77–82

    PubMed  CAS  Google Scholar 

  • Cerfolio RJ, Bryant AS, Eloubeidi MA (2006) Routine mediastinoscopy and esophageal ultrasound fine-needle aspiration in patients with non-small cell lung cancer who are clinically N2 negative. a prospective study. Chest 130:1791–1795

    Article  PubMed  Google Scholar 

  • CTCAE and National Cancer Institute (2006) Common terminology criteria for adverse events v.3.0. http://ctep.cancer.gov/forms/CTCAEv3.pdf. Accessed 2006

  • Cybulsky IJ, Bennett WF (1994) Mediastinoscopy as a routine outpatient procedure. Ann Thorac Surg 58:176–178

    Article  PubMed  CAS  Google Scholar 

  • Darling GE, Allen MS, Decker PA, Ballman K, Malthaner RA, Inculet RI, Jones DR, McKenna RJ, Landreneau RJ, Putnam JB Jr (2010) Number of lymph nodes harvested from a mediastinal lymphadenectomy: results of the randomized, prospective ACOSOG Z0030 trial. doi: 10.1378/chest.10-0859

  • De Giacomo T, Rendina EA, Venuta F, Della Rocca G, Ricci C (1997) Thoracoscopic staging of IIIB non-small cell lung cancer before neoadjuvant therapy. Ann Thorac Surg 64:1409–1411

    Article  PubMed  Google Scholar 

  • Defranchi SA, Cassivi SD, Nichols FC, Allen MS, Shen KR, Deschamps C, Wigle DA (2009) N2 disease in T1 non-small cell lung cancer. Ann Thorac Surg 88(3):924–928

    Article  PubMed  Google Scholar 

  • Detterbeck FC, Jantz MA, Wallace M, Vansteenkiste J, Silvestri GA, The American College of Chest Physicians (2007) Invasive mediastinal staging of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 132(3 Suppl):202S–220S

    Article  PubMed  Google Scholar 

  • Eggeling S, Martin T, Böttger J, Beinert T, Gellert K (2002) Invasive staging of non-small cell lung cancer—a prospective study. Eur J Cardiothorac Surg 22(5):679–684

    Article  PubMed  CAS  Google Scholar 

  • Ettinger DS, Akerley W, Bepler G, Blum MG, Chang A, Cheney RT, Chirieac LR, D’Amico TA, Demmy TL, Ganti AK, Govindan R, Grannis FW Jr, Jahan T, Jahnanzeb M, Johnson DH, Kessinger A, Komaki R, Kong FM, Kris MG, Krug LM, Le Q-T, Lennes IT, Martins R, O’Malley J, Osarogiagbon RU, Otterson GA, Patel JD, Pisters KM, Reckamp K, Riely GJ, Rohren E, Simon GR, Swanson SJ, Wood DE, Yang SC, NCCN Non-Small Cell Lung Cancer Panel Members (2010) Non-small cell lung cancer. J Natl Compr Canc Netw 8(7):740–801

    PubMed  CAS  Google Scholar 

  • Farjah F, Flum DR, Ramsey SD, Heagerty PJ, Symons RG, Wood DE (2009) Multi-modality mediastinal staging for lung cancer among medicare beneficiaries. J Thorac Oncol 4(3):355–363

    Article  PubMed  Google Scholar 

  • Felip E, Rosell R, Maestre JA, Rodriguez-Paniagua JM, Morán T, Astudillo J, Alonso G, Borro JM, González-Larriba JL, Torres A, Camps C, Guijarro R, Isla D, Aguiló R, Alberola V, Sánchez-Palencia A, Sánchez JJ, Hermosilla E, Massuti B, The Spanish Lung Cancer Group (2010) Preoperative chemotherapy plus surgery versus surgery plus adjuvant chemotherapy versus surgery alone in early-stage non-small cell lung cancer. J Clin Oncol 28(19):3138–3145

    Article  PubMed  CAS  Google Scholar 

  • Fischer B, Lassen U, Mortensen J, Larsen S, Loft A, Bertelsen A, Ravn J, Clementsen P, Hogholm A, Larsen K, Rasmussen T, Keiding S, Dirksen A, Gerke O, Skov B, Steffensen I, Hansen H, Vilmann P, Jacobsen G, Backer V, Maltbaek N, Pedersen J, Madsen H, Nielsen H, Hojgaard L (2009) Preoperative staging of lung cancer with combined PET-CT. N Engl J Med 361:32–39

    Article  PubMed  CAS  Google Scholar 

  • Gilligan D, Nicolson M, Smith I, Groen H, Dalesio O, Goldstraw P, Hatton M, Hopwood P, Manegold C, Schramel F, Smit H, van Meerbeeck J, Nankivell M, Parmar M, Pugh C, Stephens R (2007) Preoperative chemotherapy in patients with resectable non-small cell lung cancer: results of the MRC LU22/NVALT 2/EORTC 08012 multicentre randomised trial and update of systematic review. Lancet 369:1929–1937

    Article  PubMed  CAS  Google Scholar 

  • Gould MK, Kuschner WG, Rydzak CE, Maclean CC, Demas AN, Shigemitsu H, Chan JK, Owens DK (2003) Test performance of positron emission tomography and computed tomography for mediastinal staging in patients with non-small cell lung cancer. a meta-analysis. Ann Int Med 139:879–892

    Article  PubMed  Google Scholar 

  • Herder GJM, Kramer H, Hoekstra OS, Smit EF, Pruim J, van Tinteren H, Comans EF, Verboom P, Uyl-de-Groot CA, Welling A, Paul MA, Boers M, Postmus PE, Teule GJ, Groen HJM (2006) Traditional versus up-front [18F] fluorodeoxyglucose-positron emission tomography staging of non-small cell lung cancer: a Dutch cooperative randomized study. J Clin Oncol 24:1800–1806

    Article  PubMed  Google Scholar 

  • Holty JE, Kuschner WG, Gould MK (2005) Accuracy of transbronchial needle aspiration for mediastinal staging of non-small cell lung cancer: a meta-analysis. Thorax 60(11):949–955

    Article  PubMed  Google Scholar 

  • International Union Against Cancer (2009) TNM classification of malignant tumours, 7th edn. Wiley-Blackwell, Oxford

    Google Scholar 

  • Kanzaki R, Higashiyama M, Fujiwara A, Tokunaga T, Maeda J, Okami J, Kozuka T, Hosoki T, Hasegawa Y, Takami M, Tomita Y, Kodama K (2011) Occult mediastinal lymph node metastasis in NSCLC patients diagnosed as clinical N0–1 by preoperative integrated FDG-PET/CT and CT: risk factors, pattern, and histopathological study. Lung Cancer 71(3):333–337

    Article  PubMed  Google Scholar 

  • Larsen SS, Vilmann P, Krasnik M, Dirksen A, Clementsen P, Maltbaek N, Lassen U, Skov BG, Jacobsen GK (2005) Endoscopic ultrasound guided biopsy performed routinely in lung cancer staging spares futile thoracotomies: prelminary results form a randomised clinical trial. Lung Cancer 49(3):377–385

    Article  PubMed  Google Scholar 

  • LeBlanc JK, Espada R, Ergun G (2003) Non-small cell lung cancer staging techniques and endoscopic ultrasound: tissue is still the issue. Chest 123:1718–1725

    Article  PubMed  Google Scholar 

  • Lee PC, Port JL, Korst RJ, Liss Y, Meherally DN, Altorki NK (2007) Risk factors for occult mediastinal metastases in clinical stage I non-small cell lung cancer. Ann Thorac Surg 84:177–181

    Article  PubMed  Google Scholar 

  • Lemaire A, Nikolic I, Petersen T, Haney JC, Toloza EM, Harpole DH Jr, D’Amico TA, Burfeind WR (2006) Nine-year single center experience with cervical mediastinoscopy: complications and false negative rate. Ann Thorac Surg 82(4):1185–1189

    Article  PubMed  Google Scholar 

  • Little AG, Rusch VW, Bonner JA, Gaspar LE, Green MR, Webb WR, Stewart AK (2005) Patterns of surgical care of lung cancer patients. Ann Thorac Surg 80:2051–2056

    Article  PubMed  Google Scholar 

  • Little AG, Gay EG, Gaspar LE, Stewart AK (2007) National survey of non-small cell lung cancer in the United States: epidemiology, pathology and patterns of care. Lung Cancer 57(3):253–260

    Article  PubMed  Google Scholar 

  • Ludwig MS, Goodman M, Miller DL, Johnstone PA (2005) Postoperative survival and the number of lymph nodes sampled during resection of node-negative non-small cell lung cancer. Chest 128(3):1545–1550

    Article  PubMed  Google Scholar 

  • Manfredi R, Pirronti T, Bonomo L, Marano P (1996) Accuracy of computed tomography and magnetic resonance imaging in staging bronchogenic carcinoma. MAGMA 4(3–4):257–262

    Article  PubMed  CAS  Google Scholar 

  • Maziak DE, Darling GE, Inculet RI, Gulenchyn KY, Driedger AA, Ung YC, Miller JD, Gu C-S, Cline KJ, Evans WK, Levine MN (2009) Positron emission tomography in staging early lung cancer. Ann Intern Med 151:221–228

    Article  PubMed  Google Scholar 

  • Micames CG, McCrory DC, Pavey DA, Jowell PS, Gress FG (2007) Endoscopic ultrasound-guided fine-needle aspiration for non-small cell lung cancer staging: a systematic review and metaanalysis. Chest 131(2):539–548

    Article  PubMed  Google Scholar 

  • Rivera MP, Mehta AC, The American College of Chest Physicians (2007) Initial diagnosis of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 132(Suppl 3):131S–148S

    Article  PubMed  Google Scholar 

  • Robinson LA, Ruckdeschel JC, Wagner H Jr, Stevens CW, The American College of Chest Physicians (2007) Treatment of non-small cell lung cancer - stage IIIA: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 132(Suppl 3):243S–265S

    Article  PubMed  Google Scholar 

  • Sebastián-Quetglás F, Molins L, Baldó X, Buitrago J, Vidal G, The Spanish Video-Assisted Thoracic Surgery Group (2003) Clinical value of video-assisted thoracoscopy for preoperative staging of non-small cell lung cancer. a prospective study of 105 patients. Lung Cancer 42:297–301

    Article  PubMed  Google Scholar 

  • Silvestri GA, Gould MK, Margolis ML, Tanoue LT, McCrory D, Toloza E, Detterbeck F, The American College of Chest Physicians (2007) Noninvasive staging of non-small cell lung cancer: ACCP evidenced-based clinical practice guidelines (2nd edition). Chest 132(3 Suppl):178S–201S

    Article  PubMed  Google Scholar 

  • Song WA, Zhou NK, Wang W, Chu XY, Liang CY, Tian XD, Guo JT, Liu X, Liu Y, Dai WM (2010) Survival benefit of neodjuvant chemotherapy in non-small cell lung cancer: an updated meta-analysis of 13 randomized control trials. J Thorac Oncol 5(4):510–516

    Article  PubMed  Google Scholar 

  • Tournoy KG, de Ryck F, Vanwalleghem LR, Vermassen F, Praet M, Aerts JG, Van Maele G, Van Meerbeeck JP (2008) Endoscopic ultrasound reduces surgical mediastinal staging in lung cancer: a randomized trial. Am J Respir Crit Care Med 177(5):531–535

    Article  PubMed  Google Scholar 

  • Vallières E, Pagé A, Verdant A (1991) Ambulatory mediastinoscopy and anterior mediastinotomy. Ann Thorac Surg 52:1122–1126

    Article  PubMed  Google Scholar 

  • van Tinteren H, Hoekstra OS, Smit EF, van den Bergh HJAM, Schreurs AJM, Stallaert RALM, van Velthoven PCM, Comans EFI, Diepenhorst FW, Verboom P, van Mourik JC, Postmus PE, Boers M, Teule GJJ, The PLUS Study Group (2002) Effectiveness of positron emission tomography in the preoperative assessment of patients with suspected non-small cell lung cancer: the PLUS multicentre randomised trial. Lancet 359:1388–1392

    Article  PubMed  Google Scholar 

  • Varadarajulu S, Schmulewitz N, Wildi SF, Roberts S, Ravenel J, Reed CE, Block M, Hoffman BJ, Hawes RH, Wallace MB (2004) Accuracy of EUS in staging of T4 lung cancer. Gastrointest Endosc 59:345–348

    Article  PubMed  Google Scholar 

  • Viney RC, Boyer MJ, King MT, Kenny PM, Pollicino CA, McLean JM, McCaughan BC, Fulham MJ (2004) Randomized controlled trial of the role of positron emission tomography in the management of Stage I and II non-small cell lung cancer. J Clin Oncol 22:2357–2362

    Article  PubMed  Google Scholar 

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Correspondence to Valerie W. Rusch .

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Farjah, F., Rusch, V.W. (2011). Surgical Staging of Lung Cancer for Advances in Radiation Oncology of Lung Cancer. In: Jeremic, B. (eds) Advances in Radiation Oncology in Lung Cancer. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2011_261

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  • DOI: https://doi.org/10.1007/174_2011_261

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