Advertisement

General Thoracic and Cardiovascular Surgery

, Volume 64, Issue 8, pp 470–475 | Cite as

Multicenter prospective study of sublobar resection for c-stage I non-small cell lung cancer patients unable to undergo lobectomy (KLSG-0801): complete republication

  • Nobumasa Takahashi
  • Noriyoshi Sawabata
  • Masafumi Kawamura
  • Takashi Ohtsuka
  • Hirotoshi Horio
  • Hirozou Sakaguchi
  • Mitsuo Nakayama
  • Katsuo Yoshiya
  • Masayuki Chida
  • Eishin Hoshi
Original Article

Abstract

Background

Local therapy for stage I non-small cell lung cancer (NSCLC) is divided into surgical and radiation treatment, and given to patients unable to tolerate a lobectomy. A prospective phase II study of cases that received stereotactic body radio therapy (SBRT) (JCOG0403) revealed an overall 3-year survival rate (3-YSR) of 76.0 %, 3-year relapse free survival rate (3-YRFS) of 69.0 %, and rate of morbidity of grade 3 or greater of 9 %. However, few prospective multicenter studies have reported regarding surgery for high-risk stage I NSCLC patients.

Methods

We investigated this issue in the setting of a prospective multicenter observational study. Thirty-two high-risk NSCLC patients (30 males, 2 females; median age 74 years, 61–85 years) were analyzed.

Results

Two (6.3 %) showed morbidity of grade 3 or greater, though there were no postoperative deaths. The margin local control rate was 97.0 % (surgical margin recurrence, 1) and local recurrence control rate was 75.0 % (ipsilateral thorax recurrence, 8), while the 3-YSR and 3-YRFS was 79.0 and 75.9 %, respectively.

Conclusion

A sublobar pulmonary resection for patients unable to tolerate a lobectomy with stage I NSCLC was shown to be safe and provided results comparable with those of SBRT.

Keywords

Non-small cell lung cancer Stage I Conservative limited pulmonary resection Prospective study 

Notes

Compliance with ethical standards

Conflict of interest

None of the authors have conflicts of interest to declare in regard to this study.

References

  1. 1.
    Onishi H, Araki T. Stereotactic body radiation therapy for stage I non-small-cell lung cancer: a historical overview of clinical studies. Jpn J Clin Oncol. 2013;43:345–50.CrossRefPubMedGoogle Scholar
  2. 2.
    El-Sherif A, Gooding WE, Santos R, Pettiford B, Ferson PF, Fernando HC, et al. Outcomes of sublobar resection versus lobectomy for stage I non-small cell lung cancer: a 13-year analysis. Ann Thorac Surg. 2006;82:408–15.CrossRefPubMedGoogle Scholar
  3. 3.
    Landreneau RJ, Sugarbaker DJ, Mack MJ, Hazelrigg SR, Luketich JD, Fetterman L, et al. Wedge resection versus lobectomy for stage I (T1N0M0) non-small cell lung cancer. J Thorac Cardiovasc Surg. 1997;113:691–700.CrossRefPubMedGoogle Scholar
  4. 4.
    Errett LE, Wilson J, Chiu RC, Munro DD. Wedge resection as an alternative procedure for peripheral bronchogenic carcinoma in poor risk patients. J Thorac Cardiovasc Surg. 1985;90:656–61.PubMedGoogle Scholar
  5. 5.
    Strauss G, Kwiatkoski D, De-Camp M, Godleski J, Swanson S, Richards W, et al. Extent of surgical resection influences survival in stage IA non-small cell lung cancer (NSCLC). Proc ASCO. 1998;17:462a.Google Scholar
  6. 6.
    Miller JI, Hatcher CR Jr. Limited resection of bronchogenic carcinoma in the patients with marked impairment of pulmonary function. Ann Thorac Surg. 1987;44:340–3.CrossRefPubMedGoogle Scholar
  7. 7.
    Kutschera W. Segment resection for lung cancer. Thorac Cardiovasc Surg. 1984;32:102–4.CrossRefPubMedGoogle Scholar
  8. 8.
    Pastorino U, Valente M, Bedini V, Infante M, Tavecchio L, Ravasi G. Limited resection for stage I lung cancer. Eur J Surg Oncol. 1991;17:42–6.PubMedGoogle Scholar
  9. 9.
    Lewis RJ, Caccavale RJ, Sisler GE, Mackenzie JW. Video-assisted thoracic surgical resection of malignant lung tumors. J Thorac Cardiovasc Surg. 1992;104:1679–85.PubMedGoogle Scholar
  10. 10.
    Sawabata N, Karube Y, Umezu H, Tamura M, Seki N, Ishihama H, et al. Cytologically malignant margin without continuous pulmonary tumor lesion: cases of wedge resection, segmentectomy and lobectomy. Interact Cardiovasc Thorac Surg. 2008;7:1044–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Japanese translation of common terminology criteria for adverse events (CTCAE), and instructions and guidelines. Int J Clin Oncol 2004; 9(Suppl III):1–82.Google Scholar
  12. 12.
    Zierhut D, Bettscheider C, Schubert K, van Kampen M, Wannenmacher M. Radiation therapy of stage I and II non-small cell lung cancer (NSCLC). Lung Cancer. 2001;34:S39–43.CrossRefPubMedGoogle Scholar
  13. 13.
    Onishi H, Shirato H, Nagata Y, Hiraoka M, Fujino M, Gomi K, et al. Hypofractionated sterotactic radiotherapy (HypoFXSRT) for stage I non-small cell lung cancer: updated results of 257 patients in a Japanese multi-institutional study. J Thorac Oncol. 2007;2:94–100.CrossRefGoogle Scholar
  14. 14.
    Fernando HC, De Hoyos A, Landreneau RJ, Gilbert S, Gooding WE, Buenaventura PO, et al. Radiofrequency ablation for the treatment of non-small cell lung cancer in marginal surgical candidates. J Thorac Cardiovasc Surg. 2005;129:639–44.CrossRefPubMedGoogle Scholar
  15. 15.
    Kawamura M, Izumi Y, Tsukada N, Asakura K, Sugiura H, Yashiro H, et al. Percutaneous cryoablation of small pulmonary malignant tumors under computed tomographic guidance with local anesthesia for nonsurgical candidates. J Thorac Cardiovasc Surg. 2006;131:1007–13.CrossRefPubMedGoogle Scholar
  16. 16.
    Nagata Y, Takayama K, Matsuo Y, Norihisa Y, Mizowaki T, Sakamoto T, et al. Clinical outcomes of a phase I/II study of 48 Gy of stereotactic body radiotherapy in 4 fractions for primary lung cancer using a stereotactic body frame. Int J Radiat Oncol Biol Phys. 2005;63:1427–31.CrossRefPubMedGoogle Scholar
  17. 17.
    Timmerman R, McGarry R, Yiannoutsos C, Papiez L, Tudor K, DeLuca J, et al. Excessive toxicity when treating central tumors in a phase II study of stereotactic body radiation therapy for medically inoperable early stage lung cancer. J Clin Oncol. 2006;24:4833–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Zimmermann FB, Geinitz H, Schill S, Thamm R, Nieder C, Schratzenstaller U, et al. Stereotactic hypofractionated radiotherapy in stage I (T1–2 N0 M0) non-small-cell lung cancer (NSCLC). Acta Oncol. 2006;45:796–801.CrossRefPubMedGoogle Scholar
  19. 19.
    Fakiris AJ, McGarry RC, Yiannoutsos CT, Papiez L, Williams M, Henderson MA, et al. Stereotactic body radiation therapy for early stage non-small-cell lung carcinoma: four-year results of a prospective phase II study. Int J Radiat Oncol Biol Phys. 2009;75:677–82.CrossRefPubMedGoogle Scholar
  20. 20.
    Baumann P, Nyman J, Lax I, Friesland S, Hoyer M, Rehn Ericsson S, et al. Factors important for efficacy of stereotactic body radiotherapy of medically inoperable stage I lung cancer. A retrospective analysis of patients treated in the Nordic countries. Acta Oncol. 2006;45:787–95.CrossRefPubMedGoogle Scholar
  21. 21.
    Timmerman R, Paulus R, Galvin J, Michalski J, Straube W, Bradley J, et al. Stereotactic body radiation therapy for inoperable early stage lung cancer. JAMA. 2010;303:1070–6.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Ricardi U, Filippi AR, Guarneri A, Giglioli FR, Ciammella P, Franco P, et al. Stereotactic body radiation therapy for early stage non-small cell lung cancer: results of a prospective trial. Lung Cancer. 2010;68:72–7.CrossRefPubMedGoogle Scholar
  23. 23.
    Nagata Y, Hiraoka M, Shibata T, Onishi H, Kokubo M, Karasawa K, et al. A phase II trial of stereotactic body radiation therapy for operable T1N0M0 non-small cell lung cancer: Japan Clinical Oncology Group (JCOG0403). Int J Radiat Oncol Biol Phys. 2010;78:S27.CrossRefGoogle Scholar
  24. 24.
    Sawabata N, Ohta M, Matsumura A, Nakagawa K, Hirano H, Maeda H, Thoracic Surgery Study Group of Osaka University, et al. Optimal distance of malignant negative margin in excision of nonsmall cell lung cancer: a multicenter prospective study. Ann Thorac Surg. 2004;77:415–20.CrossRefPubMedGoogle Scholar
  25. 25.
    Sawabata N, Maeda H, Matsumura A, Ohta M, Okumura M, Thoracic Surgery Study Group of Osaka University. Clinical implications of the margin cytology findings and margin/tumor size ratio in patients who underwent pulmonary excision for peripheral non-small cell lung cancer. Surg Today. 2012;42:238–44.CrossRefPubMedGoogle Scholar
  26. 26.
    Chang JY, Senan S, Paul MA, Mehran RJ, Louie AV, Balter P, et al. Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-cell lung cancer: a pooled analysis of two randomised trials. Lancet Oncol. 2015;16:630–7.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Masuda M, Kuwano H, Okumura M, Amano J, Arai H, Endo S, et al. Thoracic and cardiovascular surgery in Japan during 2012 Annual report by The Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2014;62:734–64.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© The Japanese Association for Thoracic Surgery 2016

Authors and Affiliations

  • Nobumasa Takahashi
    • 1
  • Noriyoshi Sawabata
    • 2
    • 3
  • Masafumi Kawamura
    • 4
  • Takashi Ohtsuka
    • 5
  • Hirotoshi Horio
    • 6
  • Hirozou Sakaguchi
    • 7
  • Mitsuo Nakayama
    • 8
  • Katsuo Yoshiya
    • 9
  • Masayuki Chida
    • 10
  • Eishin Hoshi
    • 1
  1. 1.General Thoracic SurgerySaitama Cardiovascular and Respiratory CenterKumagayaJapan
  2. 2.Division of General Thoracic Surgery, Hoshigaoka Medical CenterJapan Community Healthcare Organization (JCHO)HirakataJapan
  3. 3.Division of Health CareOsaka University Graduate School of MedicineSuitaJapan
  4. 4.Division of SurgeryTeikyo University School of MedicineItabashiJapan
  5. 5.General Thoracic SurgeryKeio UniversityShinjyukuJapan
  6. 6.General Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalBunkyouJapan
  7. 7.General Thoracic SurgerySaitama Medical University International Medical CenterHidakaJapan
  8. 8.General Thoracic SurgerySaitama Medical University Saitama Medical CenterKawagoeJapan
  9. 9.General Thoracic SurgeryNiigata Cancer Center HospitalNiigataJapan
  10. 10.General Thoracic SurgeryDokkyo Medical UniversityTokyoJapan

Personalised recommendations