Faculty Collaboration Database

Surgical patterns of care in operable lung carcinoma treated with radiation. J Thorac Oncol 2006 Jul;1(6):526-31

Date

04/06/2007

Pubmed ID

17409912

DOI

10.1097/01243894-200607000-00005

Scopus ID

2-s2.0-34247847916 (requires institutional sign-in at Scopus site)   4 Citations

Abstract

PURPOSE: To determine the national surgical practice patterns of care for operable lung cancer patients treated with radiation.

MATERIALS AND METHODS: A nationwide survey of a stratified random sample of institutions was conducted for patients who had non-metastatic lung cancer, Karnofsky Performance Scores (KPS) > or =60, and who had received radiation therapy as definitive or adjuvant treatment. Among 541 patients, representing a weighted sample size of 42,335 patients nationwide, 131 (19.8%) underwent surgery as part of their therapy. Pearson chi statistics were used to analyze characteristics of this subset of patients.

RESULTS: Of the 131 patients who underwent surgery, 126 patients who had non-small cell lung cancer (NSCLC) were analyzed. Surgical patients were younger, had less weight loss, higher KPS, and higher forced expiratory volume within 1 second (FEV1) values than those treated without surgery. Surgical patients had more stage I/II (53.5% vs 32.2%; p = 0.0004) and less clinical N2/N3 disease (28.8% vs 47.5%; p = 0.002) than nonsurgical patients. Surgery consisted of lobectomy or bilobectomy in 63.2% of patients, pneumonectomy in 23.5%, and wedge resection in 5.9%. Of the patients, 80.4% received radiation in the adjuvant setting and 9.9% in the neoadjuvant setting.

CONCLUSIONS: Patients with non-metastatic lung cancer who are treated surgically and with radiation have clinically less advanced disease than those treated with radiation alone. Most radiation therapy in this setting is administrated postoperatively and secondary to hilar and/or mediastinal nodal involvement undetected before surgery. Improved preoperative nodal staging and neoadjuvant approaches may alter these practice patterns.

Author List

Chang JY, Moughan J, Johnstone DW, Komaki R, Goldberg M, Langer CJ, Beadle BM, Owen J, Movsas B

Author

David Johnstone MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Age Factors
Aged
Aged, 80 and over
Carcinoma, Non-Small-Cell Lung
Cohort Studies
Female
Humans
Immunohistochemistry
Karnofsky Performance Status
Logistic Models
Lung Neoplasms
Male
Middle Aged
Neoadjuvant Therapy
Neoplasm Staging
Pneumonectomy
Probability
Prognosis
Radiotherapy Dosage
Retrospective Studies
Risk Assessment
Sex Factors
Survival Analysis
Treatment Outcome