Lung Cancer: An Overview & Discussion of Minimally Invasive Surgical Therapy
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Presentation of "Lung Cancer: An Overview & Discussion of Minimally Invasive Surgical Therapy," by Dr. Conrad Vial, Director of Cardiothoracic Surgery, Mills-Peninsula Health Services.
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- A 60 year old smoker presented for a routine physical and was found to have an abnormality on chest x-ray
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- A 60 year old smoker presented for a routine physical and was found to have an abnormality on chest x-ray
- The next appropriate test would be a CT scan of the chest with IV contrast to further characterize any lung lesions found on CXR
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3. The roles of postoperative radiotherapy and chemotherapy are examined based on clinical trials, with chemoradiation found potentially beneficial in stage III disease but not stage I/II, and cisplatin-based chemotherapy improving survival in stage II/III
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Lung cancer is the most common cancer worldwide, with over 1.8 million new cases diagnosed annually. Smoking is the primary risk factor, responsible for over 75% of cases. Treatment depends on the stage and size of the tumor, with lobectomy being the standard surgical approach for early stage disease. Multimodal therapy involving chemotherapy and radiation is often used for more advanced locally invasive or metastatic cancers. Minimally invasive surgical techniques such as video-assisted thoracoscopic surgery are becoming more common for early stage lung cancers.
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Small cell lung cancer (SCLC) accounts for 15-20% of lung cancers. It is an aggressive disease with rapid growth and early metastasis. The median survival is 2-4 months without treatment. Pathology shows dense sheets of small cells with scant cytoplasm and frequent mitoses. Immunohistochemistry markers include CD56, chromogranin, and synaptophysin. SCLC commonly causes paraneoplastic syndromes. Treatment involves chemotherapy with cisplatin and etoposide combined with early, accelerated thoracic radiotherapy to improve survival outcomes. Prognosis remains poor, especially in extensive stage disease.
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2. It describes expanding the gross tumor volume (GTV) to create the clinical target volume (CTV) with margins of 4cm above and below the tumor and 1-1.5cm radially, plus inclusion of involved lymph nodes.
3. The planning target volume (PTV) is created by expanding the CTV by 0.5-1cm to account for setup variability and organ motion.
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Acute lunginjurycuropinanaesthesiol
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Nsclc port
This document summarizes information about lung cancer types, risk factors, staging, and the role of radiotherapy in treatment. It notes that non-small cell lung cancer (NSCLC) accounts for 80% of cases, with the most common subtypes being adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. Smoking is the primary risk factor. Radiotherapy can play definitive, adjuvant, or palliative roles. For early-stage NSCLC, stereotactic body radiotherapy is recommended. For locally advanced NSCLC, concurrent chemoradiotherapy is standard. Post-operative radiotherapy may improve outcomes for patients with pathological N2 disease but not for N0-1 disease.
Treatment Of Stage Iii Nsclc The Role Of Radiation Therapy
1. Chemo-radiotherapy is the standard of care for stage III non-small cell lung cancer (NSCLC) based on randomized clinical trial outcomes, though local control and toxicity remain issues.
2. Advances in radiation therapy techniques like 3D conformal radiation therapy and intensity modulated radiation therapy may help improve local control and reduce toxicity by better sparing healthy tissues.
3. Patient-specific factors like tumor volume, nodal disease extent, co-morbidities, and dosimetry parameters should be considered to select optimal combined modality treatments and minimize risks.
SBRT/SABR for Early Stage Lung Cancer: A Brief Overview
SBRT/SABR indications and results, just a brief overview; also, our results at NEARMC in Anniston, AL, 2013-2016
SBRTweb.nearmc
The document discusses stereotactic body radiotherapy (SBRT) for early stage lung cancer. It notes that while SBRT and standard lung radiotherapy aim for high precision and accuracy, SBRT differs primarily through higher fractional doses over fewer treatments. Studies show SBRT achieves high local control rates comparable to surgery with less risk. Ongoing trials are comparing SBRT to surgery, but available evidence suggests SBRT is underutilized for lung cancer patients.
Post Mastectomy Radiotherapy
Post-mastectomy radiotherapy (PMRT) involves delivering radiation to the chest wall and surrounding lymph node areas after a mastectomy. Studies have shown PMRT reduces the risk of local recurrence by around 20% and decreases breast cancer mortality by around 4%. While PMRT provides benefits, it also carries risks of side effects and increased non-breast cancer mortality. Current guidelines recommend PMRT for patients with large tumors, many positive lymph nodes, or an otherwise high risk of local recurrence despite optimal surgery and systemic therapy. Ongoing research continues to refine PMRT indications and techniques to maximize benefits and minimize risks.
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Rheumatic mitral stenosis is a progressive disease that carries significant risks if left untreated. Percutaneous transvenous mitral commissurotomy (PTMC) is a standard nonsurgical procedure that can help delay the need for mitral valve replacement by enlarging the valve opening. The document reports a case of successful PTMC in a 71-year-old woman with severe mitral stenosis, enlarged left atrium, and mitral valve score of 7. Immediate results found improved hemodynamics and mitral valve area over 1.5 cm2. At 5-month follow up, echocardiography showed sustained benefits with trivial regurgitation and normal left ventricular function. PTMC can thus be an effective treatment even
Case report cardivascj20136(1)68 70
Rheumatic mitral stenosis is a progressive disease that carries significant risks if left untreated. Percutaneous transvenous mitral commissurotomy (PTMC) is a standard nonsurgical procedure that can help delay the need for mitral valve replacement by enlarging the valve opening. The document reports a case of successful PTMC performed in a 71-year-old woman with severe mitral stenosis, enlarged left atrium, and mitral valve score of 7. Immediate results found an increased mitral valve area and decreased pressures. Follow up after 5 months showed maintained benefits with trivial regurgitation and good left ventricular function. PTMC can thus be an effective treatment even in elderly patients with mitral stenosis who are not candidates
Management dell’organ motion nei trattamenti stereo-RT e radiochirurgici:
Management dell’organ motion nei trattamenti stereo-RT e radiochirurgici: Gemelli Advanced Radiation Therapy
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
17 marzo 2014: Management dell’organ motion nei trattamenti stereo-RT e radiochirurgici: ruolo di fiducials e on-board imaging Small Cell Lung Cancer
Small cell lung cancer (SCLC) accounts for 13% of lung cancers and is strongly linked to smoking. SCLC typically presents as a large mass in the mediastinal lymph nodes. It is classified as limited stage, confined to one lung, or extensive stage with distant metastases. Treatment involves chemotherapy with cisplatin and etoposide, and sometimes radiation therapy. For limited stage SCLC, surgery may be an option for early tumors. While initial response rates are high, most patients experience relapse. Prophylactic cranial irradiation can reduce the risk of brain metastases. Even with optimal treatment, the 5-year survival rate remains low at 5-10% for extensive stage and 30-40% for limited stage disease
11.Lungcancer
Lung cancer is a leading cause of cancer death worldwide. Non-small cell lung cancer (NSCLC) accounts for 80-85% of lung cancer cases. Treatment for NSCLC depends on the stage - surgery is recommended for early stage disease, while later stages may involve chemotherapy, radiation therapy, or a combination. New targeted therapies and immunotherapy agents are improving survival rates for advanced NSCLC.
10 lung cancer
The document discusses lung cancer, including:
1) Lung cancer incidence and mortality rates have increased in China since 1990, becoming the leading cause of cancer death.
2) Risk factors for lung cancer include cigarette smoking, air pollution, certain occupations, and genetic factors.
3) Diagnosis involves imaging like chest X-rays and CT scans, as well as procedures like bronchoscopy to obtain tissue samples.
4) Treatment depends on cancer type and stage, and may involve surgery, chemotherapy, radiation therapy, targeted therapy, and other approaches. Adjuvant chemotherapy provides a limited survival benefit for non-small cell lung cancer.
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Lung Cancer: An Overview & Discussion of Minimally Invasive Surgical Therapy
- 1. Lung Cancer: an overview & discussion of minimally invasive surgical therapy Conrad Massimo Vial, MD Director of Cardiothoracic Surgery Mills Peninsula Health System
- 8. Tumor T1 T2 T3 T4 Nodes N0 N1 N2 N3 IA IB IIB IIIB Stage IV = M1 Stage IIIB and IV generally unresectable Lung Cancer IIIB IIIB IIIB IIIB IIIA IIIA IIIA IIIB IIA IIB IIIA IIIB
- 9. 5-yr survival for treated NSCLC according to surg-path state: Stage I: ≈ 70% Stage II: ≈ 50% Stage III: ≈ 20%
- 10. Minimally Invasive Lung Cancer Operations Video Assisted Thoracoscopic (VATS) Lobectomy & Lung Sparing Operations
- 11. The Traditional Approach Open Thoracotomy
- 12. Video Assisted Thoracoscopy (VATS)
- 13. VATS Lobectomy
- 18. Lung Sparing Operations Bronchoplasties & Sleeve Resections
- 23. What are we doing? What are our results? Conrad M Vial, MD Tomomi Oka, MD
- 24. Program in CT Surgery Overall Volume & Outcomes 2008-2010 TOTAL CASES = 1216 MORTALITY = 0.7% MAJOR MORBIDITY = 3.9% CARDIAC CASES = 529 MORTALITY = 1.5% MAJOR MORBIDITY = 6.2% THORACIC CASES = 687 MORTALITY = 0.4% MAJOR MORBIDITY = 2.8%
- 25. Diversity & Complexity of Major Thoracic Operations
- 26. Diversity & Complexity of Major Thoracic Lung Operations Bronchoplasty and/or Sleeve Resection n=15 Thoracoscopic Lobectomy n=107
- 27. STS NATIONAL DATABASE Influence of Functional Score in Resections for Lung Cancer ZUBROD SCORE MORTALITY LOS > 14 DAYS COMPLICATIONS 0 1.3% 4.8% 32% 1 1.8% 6.8% 35% 2 3.5% 12% 41% 3 7% 14% 46% 4 16% 21% 51%
- 28. STS NATIONAL DATABASE Influence of FEV 1 in Resections for Lung Cancer Preop FEV 1 MORTALITY LOS > 14 DAYS COMPLICATIONS > 80% pred 1.1% 4% 30% 61-79% pred 2% 8% 39% < 60% pred 2% 9% 41%
- 29. Diversity & Complexity of Major Thoracic Operations for Lung Ca Bronchoplasty and/or Sleeve Resection n=15 Thoracoscopic Lobectomy n=107
- 30. CRUDE Benchmarking “Best Case” vs Non-risk adjusted Best Case Lung Ca Resection STS Scenario Mortality LOS > 14 days Complications Preop FEV 1 > 80% pred & Zubrod Score 0 ~1.2% ~4% ~30%
- 31. THANK YOU !