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: Accurate staging of non-small cell lung cancer (NSCLC) is critical for optimal management. Minimally invasive pathologic assessment of mediastinal lymphadenopathy is increasingly being performed. The cost-benefit (minimization of health care costs) of such approaches, in comparison with traditional surgical methods, is yet to be established.
Decision-tree analysis was applied to compare downstream costs of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), conventional TBNA, and surgical mediastinoscopy. Calculations were based on real costs derived from actual patient data at a major teaching hospital in Melbourne, Australia. One- and two-way sensitivity analyses were undertaken to account for potential variation in input parameter values.
For the base-case analysis, initial evaluation with EBUS-TBNA (with negative results being surgically confirmed) was the most cost-beneficial approach (AU$2961) in comparison with EBUS-TBNA (negative results not surgically confirmed) ($3344), conventional TBNA ($3754), and mediastinoscopy ($8859). The sensitivity of EBUS-TBNA for detecting disease had the largest impact on cost, whereas the prevalence of mediastinal lymph node metastases determined whether surgical confirmation of negative EBUS-TBNA results remained cost-beneficial.
Our study confirms that minimally invasive staging of NSCLC is cost-beneficial in comparison with traditional surgical techniques. EBUS-TBNA was the most cost-beneficial approach for mediastinal staging of patients with NSCLC across all studied parameters.
Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer 10/2010; 5(10):1564-70. DOI:10.1097/JTO.0b013e3181e8b2e6 · 5.28 Impact Factor
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