Appropriate clinical staging of mediastinal lymph nodes in non-small-cell lung cancer (NSCLC) patients has important therapeutic and prognostic implications. Because of the wide variations in practice patterns among community and academic physicians, we reviewed the literature so that we could provide evidence-based recommendations on the use of imaging studies in the pretreatment clinical staging of NSCLC patients. We concluded that the most sensitive and accurate method of noninvasive mediastinal nodal staging is a positron emission tomography/computed tomography fusion scan; we believe this tool should be a component of clinical staging of all NSCLC patients. Given insufficient sensitivity with currently available imaging studies, mediastinal nodal staging should also include histologic evaluation.
[Show abstract][Hide abstract] ABSTRACT: Chest radiography, computed tomography (CT), positron emission tomography (PET), and PET-CT are powerful imaging tools used worldwide for the diagnosis and treatment strategy of NSCLC. Furthermore, we present examples of CT imaging using an exciting new anticancer drug, Lipoplatin, a liposomal nanoparticle formulation of cisplatin. The ability of Lipoplatin™ to target primary tumors and metastases, using the permeability of the vasculature and the growing tumor for its preferential extravasation, and to cause a greater damage to tumor tissue as compared to normal tissue has been demonstrated in animal and human studies. It was demonstrated that Lipoplatin™ can target and kill tumor endothelial cells and, thus, it has the properties of a chemotherapeutic and of an antiangiogenesis drug, combined together. CT scans from patients participating in a multicenter Phase III clinical study demonstrate appraisal of response to Lipoplatin plus paclitaxel as first line treatment in NSCLC. Our results and literature review suggest that key factors for effective chemotherapy treatment and response of NSCLC relate to histological type and early diagnosis. We further suggest that liposomes endowed with tumor targeting properties can be used as carriers of radioactive material in cancer imaging.
[Show abstract][Hide abstract] ABSTRACT: In lung cancer patients without distant metastases, the status of the mediastinal lymph nodes is a key determinant of therapy and prognosis, often calling for invasive staging with pathological verification. The synergic use of invasive and non-invasive techniques is an important option that we should not allow ourselves, through narrow-mindedness, to overlook. Greater understanding of the potential and challenges offered by the different staging methods, and of the effectiveness of their combined use, may help us to optimise the diagnosis and treatment of these patients.
European journal of nuclear medicine and molecular imaging 08/2008; 35(7):1388-91. DOI:10.1007/s00259-008-0812-3 · 5.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Patients with clinical stage IIIAN2 non-small cell lung cancer (NSCLC) are a heterogeneous subgroup in term of prognosis and therapeutic management. The optimal management of this patient group is a major focus for thoracic oncology research and the concept of multimodality treatment has recently been introduced. This approach combines induction chemotherapy or radiochemotherapy followed by surgery in the case of mediastinal lymph node down-staging. positron emission tomography computed tomography with [18F]-fluorodesoxyglucose (FDG-PET) is a molecular and metabolic imaging modality which combines the metabolic data of PET with morphological data from CT. FDG-PET has become a standard in lung cancer management since the different indications listed in the standards, options and recommendations (SOR) of the FNCLCC. However, the potential specific importance of FDG-PET in IIIAN2 patients needs to be addressed further. In this setting, the authors' objective is to review the potential role of metabolic imaging in stage IIIAN2 NSCLC, taking into account new multimodality treatments. In stage IIIAN2, FDG-PET has performed better than morphoradiological imaging for baseline and postinduction lymph node staging, the identification of distant metastasis, and determining prognosis, as well as assessing the response to treatment.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.