Daniel J. Tandberg

Smoking history predicts for increased risk of second primary lung cancer: A comprehensive analysis

Tobacco use is the most important risk factor for the development of lung cancer. The objective of the current study was to determine the effect of smoking on the development of second primary lung cancers (SPLCs) and other clinical outcomes after surgery for non‐small cell lung cancer (NSCLC).

Early Outcomes of Empiric Embolization of Tumor-related Gastrointestinal Hemorrhage in Patients with Advanced Malignancy☆☆☆

PURPOSE To report short-term results of empiric transcatheter embolization for patients with advanced malignancy and gastrointestinal (GI) hemorrhage directly from a tumor invading the GI tract wall. MATERIALS AND METHODS Between 2005 and 2011, 37 mesenteric angiograms were obtained in 26 patients with advanced malignancy (20 men, six women; mean age, 56.2 y) with endoscopically confirmed symptomatic GI hemorrhage from a tumor invading the GI tract wall. Angiographic findings and clinical outcomes were retrospectively evaluated. Clinical success was defined as absence of signs and symptoms of hemorrhage for at least 30 day following embolization. RESULTS Active extravasation was demonstrated in three cases. Angiographic abnormalities related to a GI tract tumor were identified on 35 of 37 angiograms, including tumor neovascularity (n = 21), tumor enhancement (n = 24), and luminal irregularity (n = 5). In the absence of active extravasation, empiric embolization with particles and/or coils was performed in 25 procedures. Cessation of hemorrhage (ie, clinical success) occurred more frequently when empiric embolization was performed (17 of 25 procedures; 68%) than when embolization was not performed (two of nine; 22%; P = .03). Empiric embolization resulted in clinical success in 10 of 11 patients with acute GI bleeding (91%), compared with seven of 14 patients (50%) with chronic GI bleeding (P = .04). No ischemic complications were encountered. CONCLUSIONS In patients with advanced malignancy, in the absence of active extravasation, empiric transcatheter arterial embolization for treatment of GI hemorrhage from a direct tumor source demonstrated a 68% short-term success rate, without any ischemic complications.

Surgery versus stereotactic body radiation therapy for stage I non-small cell lung cancer: A comprehensive review: Surgery vs SBRT for Stage I NSCLC

Non–small cell lung cancer (NSCLC) is the leading cause of cancer‐related death in the United States. With the implementation of lung cancer screening, the number and proportion of patients diagnosed with early‐stage disease are anticipated to increase. Surgery is currently the standard of care for patients with operable stage I NSCLC. However, promising outcomes with stereotactic body radiation therapy (SBRT) in patients with inoperable disease has led to interest in directly comparing SBRT and surgery in operable patients. Unfortunately, early randomized trials comparing surgery and SBRT closed early because of poor accrual. In this article, the nuances of surgery and SBRT for early‐stage NSCLC are reviewed. Furthermore, retrospective and prospective analyses of SBRT in early‐stage NSCLC are discussed, and active randomized trials comparing these 2 approaches are described. Cancer 2018;124:667‐78.

Patterns of Distant Metastases After Surgical Management of Non-Small-cell Lung Cancer.

Background: Patients with limited metastases, oligometastases (OMs), might have improved outcomes compared with patients with widespread distant metastases (DMs). The incidence and behavior of OMs from non–small‐cell lung cancer (NSCLC) need further characterization. Patients and Methods: The medical records of patients who had undergone surgery for stage I‐III NSCLC from 1995 to 2009 were retrospectively reviewed. All information pertaining to development of the first metastatic progression was recorded and analyzed. Patients with DMs were categorized into OMs (1–3 lesions potentially amenable to local therapy) and DM subgroups. Results: Of 1719 patients reviewed, 368 (21%) developed DMs with a median follow‐up period of 39 months. A single lesion was diagnosed in 115 patients (31%) and 69 (19%) had 2 to 3 lesions (50% oligometastatic). The median survival from the DM diagnosis for oligometastatic and diffuse DM was 12.4 and 6.1 months, respectively (hazard ratio, 0.54; 95% confidence interval, 0.42–0.68; P < .001). Patients with a single metastasis had the longest median survival at 14.7 months. Younger age, OM, the use of chemotherapy for the primary tumor, and DM detection by surveillance imaging were independently associated with improved survival. Conclusion: DMs and OMs are common in surgically managed NSCLC. Overall survival appears to be prolonged with OM. Micro‐Abstract: The patterns of distant metastatic progression after surgery for non–small‐cell lung cancer (NSCLC) have not been well described. The present analysis of 1719 surgically resected NSCLC patients found that 50% of those who developed metastases did so in ≤ 3 locations, with an improved prognosis compared with those with > 3 metastases. This supports efforts to understand the biology of oligometastases and develop novel treatment paradigms.

Radiation Therapy for Cutaneous T-Cell Lymphomas.

Radiation therapy is an extraordinarily effective skin-directed therapy for cutaneous T-cell lymphomas. Lymphocytes are extremely sensitive to radiation and a complete response is generally achieved even with low doses. Radiation therapy has several important roles in the management of mycosis fungoides. For the rare patient with unilesional disease, radiation therapy alone is potentially curative. For patients with more advanced cutaneous disease, radiation therapy to local lesions or to the entire skin can effectively palliate symptomatic disease and provide local disease control. Compared with other skin-directed therapies, radiation therapy is particularly advantageous because it can effectively penetrate and treat thicker plaques and tumors.

Patterns of Failure After Surgery for Non-Small-cell Lung Cancer Invading the Chest Wall.

Introduction The patterns of failure after resection of non–small‐cell lung cancer (NSCLC) invading the chest wall are not well documented, and the role of adjuvant radiation therapy (RT) is unclear, prompting the present analysis. Materials and Methods The present institutional review board–approved study evaluated patients who had undergone surgery from 1995 to 2014 for localized NSCLC invading the chest wall. Patients with superior sulcus tumors were excluded. The clinical outcomes were estimated using the Kaplan‐Meier method and compared using a log‐rank test. The prognostic factors were assessed using a multivariate analysis, and the patterns of failure were scored. Results Seventy‐four patients were evaluated. Most patients had undergone lobectomy or pneumonectomy (85%) with en bloc chest wall resection (80%) and had pathologically node negative findings (81%). The surgical margins were positive in 10 patients (14%) and most commonly involved the chest wall (7 of 10). Adjuvant treatment included RT in 21 (28%) and chemotherapy in 28 (38%). A total of 24 local recurrences developed. The chest wall was a component of local disease recurrence in 19 of 24 cases (79%). The local control rate at 5 years for the entire population was 60% (95% confidence interval, 46%‐74%). The local control rate was 74% with adjuvant RT versus 55% without RT (P = .43). On multivariate analysis, only resection less than lobectomy or pneumonectomy was associated with worse local control. The overall survival rate was 38% with RT versus 34% without RT (P = .59). Conclusion Positive surgical margins and local disease recurrence were common after resection of NSCLC invading the chest wall. The primary pattern of failure was local recurrence in the chest wall. Adjuvant RT was not associated with improved local control or survival. Micro‐Abstract The patterns of failure and role of adjuvant radiation therapy have not been clearly defined for non–small‐cell lung cancer invading the chest wall. In our retrospective analysis of 74 patients, we found that positive surgical margins and local recurrence in the chest wall was common. However, adjuvant radiation therapy had no significant effect on local recurrence or overall survival.