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Novel Strategy and Technologies in Local and Locoregional Treatment for Lung Cancer

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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (30 November 2023) | Viewed by 11792

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Special Issue Editors

Dr. Francesco Guerrera

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Guest Editor

Department of Surgical Science, University of Torino, Torino, Italy
Interests: lung cancer, thoracic surgery, thymic malignancies, minimally invasive thoracic surgery
Special Issues, Collections and Topics in MDPI journals

Dr. Pietro Bertoglio

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Guest Editor

Division of Thoracic Surgery, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
Interests: thoracic surgery; VATS; robotic surgery; NSCLC; lung adenocarcinoma; MiRNA; multimodality
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In recent years, treatment of lung cancer has undergone a deep and substantial change. The introduction of target therapies and immunotherapy has opened new scenarios; the development and spread of new techniques have allowed surgeons to perform precise interventions with less impact on patients; innovative technologies in radiotherapy have made the delivery of radiation more exact; and lastly, novel techniques in interventional radiology have introduced innovative strategies to deliver local treatments, alone or in combination with surgery.

The increasing speed of development of all these innovations sometimes might be overwhelming, and a focus on the current state of the art might help to better calibrate our everyday working life.

We are pleased to invite you to contribute to our Special Issue which is focused on the current state of the art and possible future innovations in the treatment of local and locoregional lung cancer.

This Special Issue aims to help all readers clarify current standards and the practice-changing studies which are currently ongoing to understand the possible future direction of the treatment of local and locoregional lung cancer.

Articles should focus on novel surgical approaches or describe innovative techniques, report results of trials or studies and outline rare presentations of lung cancer which required tailored treatments.

The manuscripts could focus on treatments of non-small cell and small cell lung cancer and lung metastasis.

In this Special Issue, original research articles and reviews are welcome. Research areas may include (but are not limited to) the following: oncology, radiotherapy, thoracic surgeons, pathologists, pneumologists, radiologists and interventional pneumologists.

We look forward to receiving your contributions.

Dr. Francesco Guerrera
Dr. Pietro Bertoglio
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

non-small cell lung cancer
minimally invasive surgery
clinical trials
new technologies
immunotherapy
target therapies
radiotherapy
lung cancer

Published Papers (7 papers)

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Research

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27 pages, 18187 KiB

Open AccessArticle

Histology-Validated Dielectric Characterisation of Lung Carcinoma Tissue for Microwave Thermal Ablation Applications

by Laura Farina, Giuseppe Ruvio, Ramadan Shatwan, Aliaa Shalaby, Martin O’Halloran, Alexandra White, Alan Soo, David Breen, Aoife Lowery and Anne Marie Quinn

Cancers 2023, 15(14), 3738; https://doi.org/10.3390/cancers15143738 - 23 Jul 2023

Cited by 5 | Viewed by 1085

Abstract

Microwave thermal ablation is a promising emerging treatment for early-stage lung cancer. Applicator design optimisation and treatment planning rely on accurate knowledge of dielectric tissue properties. Limited dielectric data are available in the literature for human lung tissue and pulmonary tumours. In this work, neoplastic and non-neoplastic lung dielectric properties are characterised and correlated with gross and histological morphology. Fifty-six surgical specimens were obtained from twelve patients undergoing lung resection for lung cancer in University Hospital of Galway, Ireland. Dielectric spectroscopy in the microwave frequency range (500 MHz–8.5 GHz) was performed on the ex vivo lung specimens with the open-ended coaxial probe technique (in the Department of Pathology). Dielectric data were analysed and correlated with the tissue histology. The dielectric properties of twelve lung tumours (67% non-small cell carcinoma (NSCC)) and uninvolved lung parenchyma were obtained. The values obtained from the neoplastic lung specimens (relative permittivity: 52.0 ± 5.4, effective conductivity: 1.9 ± 0.2 S/m, at 2.45 GHz) were on average twice the value of the non-neoplastic lung specimens (relative permittivity: 28.3 ± 6.7, effective conductivity: 1.0 ± 0.3 S/m, at 2.45 GHz). Dense fibrosis was comparable with tumour tissue (relative permittivity 49.3 ± 4.6, effective conductivity: 1.8 ± 0.1 S/m, at 2.45 GHz). Full article

(This article belongs to the Special Issue Novel Strategy and Technologies in Local and Locoregional Treatment for Lung Cancer)

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15 pages, 1385 KiB

Open AccessArticle

Multimodality Treatment and Salvage Surgery for the Treatment of Lung Cancer

by Jeesoo Choi, Boris Tocco, Alexander Smith, Shahreen Ahmad, Eleni Josephides and Andrea Bille

Cancers 2023, 15(14), 3586; https://doi.org/10.3390/cancers15143586 - 12 Jul 2023

Viewed by 1088

Abstract

Lung cancer remains the leading cause of cancer deaths in the United Kingdom. For locally advanced disease, multimodality treatment is recommended, which includes a combination of chemotherapy, radiotherapy, surgery and, more recently immunotherapy. Options depend on the resectability of the cancer and there has been debate about the optimal treatment strategy: surgery may be planned to follow chemoradiotherapy (CRT), be offered for residual disease after CRT, or given as salvage therapy for patients treated with CRT who have later relapse of their disease. We conducted a retrospective analysis of all patients who underwent CRT and surgical resection under a single surgical team and performed a descriptive study after dividing the patients into these three groups. For the planned trimodality group, 30-day mortality this was 7% (n = 1) and 1-year survival was 78.6%; the residual disease group had a 30-day mortality rate of 0% and 1-year survival of 81.3%; for the salvage group, the figures were 0% and 62.5%, respectively. The median overall survival of the study population was 35.8 months. Median overall survival in the trimodality group was 35.4 months (20.1–51.7 interquartile range IQR), for the residual group was 34.2 months (18.5–61.0 IQR). and for the salvage group was 35.8 months (32.4–52.7 IQR).) Full article

(This article belongs to the Special Issue Novel Strategy and Technologies in Local and Locoregional Treatment for Lung Cancer)

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11 pages, 288 KiB

Open AccessArticle

Robotic versus Video-Assisted Thoracic Surgery for Lung Cancer: Short-Term Outcomes of a Propensity Matched Analysis

by Savvas Lampridis, Alessandro Maraschi, Corinne Le Reun, Tom Routledge and Andrea Billè

Cancers 2023, 15(8), 2391; https://doi.org/10.3390/cancers15082391 - 21 Apr 2023

Cited by 2 | Viewed by 1378

Abstract

Robot-assisted thoracic surgery (RATS) has gained popularity for the treatment of lung cancer, but its quality outcome measures are still being evaluated. The purpose of this study was to compare the perioperative outcomes of lung cancer resection using RATS versus video-assisted thoracic surgery (VATS). To achieve this aim, we conducted a retrospective analysis of consecutive patients who underwent lung cancer surgery between July 2015 and December 2020. A propensity-matched analysis was performed based on patients’ performance status, forced expiratory volume in 1 s% of predicted, diffusing capacity of the lungs for carbon monoxide% of predicted, and surgical procedure (lobectomy or segmentectomy). Following propensity matching, a total of 613 patients were included in the analysis, of which 328 underwent RATS, and 285 underwent VATS, with satisfactory performance indicators. The results of the analysis indicated that RATS had a significantly longer operating time than VATS (132.4 ± 37.3 versus 122.4 ± 27.7 min; mean difference of 10 min 95% CI [confidence interval], 4.2 to 15.9 min; p = 0.001). On the other hand, VATS had a significantly higher estimated blood loss compared to RATS (169.7 ± 237.2 versus 82.2 ± 195.4 mL; mean difference of 87.5 mL; 95% CI, 48.1 to 126.8 mL; p < 0.001). However, there were no significant differences between the groups in terms of the duration of chest tubes, length of hospital stay, low- and high-grade complications, as well as readmissions and mortality within 30 days after surgery. Moreover, the number of dissected lymph-node stations was significantly higher with VATS than RATS (5.9 ± 1.5 versus 4.8 ± 2.2; mean difference of 1.2; 95% CI, 0.8 to 1.5; p = 0.001). Nonetheless, the percentage of patients who were upstaged after histopathological analysis of the resected lymph nodes was similar between the two groups. In conclusion, RATS and VATS yielded comparable results for most of the short-term outcomes assessed. Further research is needed to validate the implementation of RATS and identify its potential benefits over VATS. Full article

(This article belongs to the Special Issue Novel Strategy and Technologies in Local and Locoregional Treatment for Lung Cancer)

10 pages, 750 KiB

Open AccessArticle

Early Hospital Discharge on Day Two Post Robotic Lobectomy with Telehealth Home Monitoring: A Pilot Study

by Edoardo Bottoni, Giuseppe Mangiameli, Alberto Testori, Federico Piccioni, Veronica Maria Giudici, Emanuele Voulaz, Nadia Ruggieri, Francesca Dalla Corte, Alessandro Crepaldi, Giulia Goretti, Elena Vanni, Martina Pisarra, Umberto Cariboni, Marco Alloisio and Maurizio Cecconi

Cancers 2023, 15(4), 1146; https://doi.org/10.3390/cancers15041146 - 10 Feb 2023

Cited by 2 | Viewed by 1636

Abstract

Despite the adoption of enhanced recovery programs, the reported postoperative length of stay after robotic surgery is 4 days even in highly specialized centers. We report preliminary results of a pilot study for a new protocol of early discharge (on day 2) with telehealth home monitoring after robotic lobectomy for lung cancer. All patients with a caregiver were discharged on postoperative day 2 with a telemonitoring device if they satisfied specific discharge criteria. Teleconsultations were scheduled once in the afternoon of post-operative day 2, twice on postoperative day 3, and then once a day until the chest tube removal. Post-discharge vital signs were recorded by patients at least four times daily through the device and were available for consultation by two surgeons through phone application. In case of sudden variation of vital signs or occurrence of adverse events, a direct telephone line was available for patients as well as a protected re-hospitalization path. Primary outcome was the safety evaluated by the occurrence of post-discharge complications and readmissions. Secondary outcome was the evaluation of resources optimization (hospitalization days) maintaining the standard of care. During the study period, twelve patients satisfied all preoperative clinical criteria to be enrolled in our protocol. Two of twelve enrolled patients were successively excluded because they did not satisfy discharge criteria on postoperative day 2. During telehealth home monitoring a total of 27/427 vital-sign measurements violated the threshold in seven patients. Among the threshold violations, only 1 out of 27 was a critical violation and was managed at home. No postoperative complication occurred neither readmission was needed. A mean number of three hospitalization days was avoided and an estimated economic benefit of about EUR 500 for a single patient was obtained if compared with patients submitted to VATS lobectomy in the same period. These preliminary results confirm that adoption of telemonitoring allows, in selected patients, a safe discharge on postoperative day 2 after robotic surgery for early-stage NSCLC. A potential economic benefit could derive from this protocol if this data will be confirmed in larger sample. Full article

(This article belongs to the Special Issue Novel Strategy and Technologies in Local and Locoregional Treatment for Lung Cancer)

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11 pages, 1143 KiB

Open AccessArticle

A Multicenter Retrospective Cohort Study on Superior Vena Cava Resection in Non-Small-Cell Lung Cancer Surgery

by Andrea Dell’Amore, Alessio Campisi, Luca Bertolaccini, Chunji Chen, Piotr Gabryel, Chunyu Ji, Cezary Piwkowski, Lorenzo Spaggiari, Wentao Fang and Federico Rea

Cancers 2022, 14(24), 6138; https://doi.org/10.3390/cancers14246138 - 13 Dec 2022

Cited by 2 | Viewed by 1141

Abstract

Background: Surgery for non-small-cell lung cancers (NSCLCs) invading the superior vena cava (SVC) is rarely performed due to surgical complexities and reported poor prognoses. Different methods have been described to reconstruct the SVC, such as direct suture, patch use or prosthesis, according to its circumferential involvement. The aim of our study was to analyze the short- and long-term results of different types of SVC resection and reconstruction for T4 NSCLCs. Methods: Between January 2000 and December 2019, 80 patients received an anatomical lung resection with SVC surgery in this multicenter retrospective study. The partial resection and direct suture or patch reconstruction group included 64 patients, while the complete resection and prosthesis reconstruction group included 16 patients. The primary endpoints were as follows: long-term survival and disease-free survival. The secondary endpoints were as follows: perioperative complications and 30- and 90-day mortality. Unpaired t-tests or Mann–Whitney U tests for non-parametric variables were applied to discrete or continuous data, and the chi-square test was applied to dichotomous or categorical data. Survival rates were calculated using the Kaplan–Meier method and compared using the log-rank test. Results: No differences were found between the two groups in terms of general characteristics and surgical, oncological and survival outcomes. In particular, there were no differences in terms of early (50.0% vs. 68.8%, p = 0.178) and late complication frequency (12.5% vs. 12.5%, p = 1.000), 30- and 90-day mortality, R status, recurrence, overall survival (33.89 ± 40.35 vs. 35.70 ± 51.43 months, p = 0.432) and disease-free survival (27.56 ± 40.36 vs. 31.28 ± 53.08 months, p = 0.668). The multivariate analysis demonstrated that age was the only independent predictive factor for overall survival. Conclusions: According to our results, SVC resection has good oncological and survival outcomes, regardless of the proportion of circumferential involvement and the type of reconstruction. Full article

(This article belongs to the Special Issue Novel Strategy and Technologies in Local and Locoregional Treatment for Lung Cancer)

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12 pages, 2693 KiB

Open AccessArticle

VMAT-Based Planning Allows Sparing of a Spatial Dose Pattern Associated with Radiation Pneumonitis in Patients Treated with Radiotherapy for a Locally Advanced Lung Cancer

by Vincent Bourbonne, Francois Lucia, Vincent Jaouen, Julien Bert, Olivier Pradier, Dimitris Visvikis and Ulrike Schick

Cancers 2022, 14(15), 3702; https://doi.org/10.3390/cancers14153702 - 29 Jul 2022

Cited by 1 | Viewed by 1267

Abstract

Introduction: In patients treated with radiotherapy for locally advanced lung cancer, respect for dose constraints to organs at risk (OAR) insufficiently protects patients from acute pulmonary toxicity (APT), such toxicities being associated with a potential impact on the treatment’s completion and the patient’s quality of life. Dosimetric planning does not take into account regional lung functionality. An APT prediction model combining usual dosimetry features with the mean dose (DMeanPmap) received by a voxel-based volume (Pmap) localized in the posterior right lung has been previously developed. A DMeanPmap of ≥30.3 Gy or a predicted APT probability (ProbAPT) of ≥8% were associated with a higher risk of APT. In the present study, the authors aim to demonstrate the possibility of decreasing the DMeanPmap via a volumetric arctherapy (VMAT)-based adapted planning and evaluate the impact on the risk of APT. Methods: Among the 207 patients included in the initial study, only patients who presented with APT of ≥grade 2 and with a probability of APT ≥ 8% based on the prediction model were included. Dosimetry planning was optimized with a new constraint (DMeanPmap < 30.3 Gy) added to the usual constraints. The initial and optimized treatment plans were compared using the t-test for the independent variables and the non-parametric Mann–Whitney U test otherwise, regarding both doses to the OARs and PTV (Planning Target Volume) coverage. Conformity and heterogeneity indexes were also compared. The risk of APT was recalculated using the new dosimetric features and the APT prediction model. Results: Dosimetric optimization was considered successful for 27 out of the 44 included patients (61.4%), meaning the dosimetric constraint on the Pmap region was achieved without compromising the PTV coverage (p = 0.61). The optimization significantly decreased the median DMeanPmap from 28.8 Gy (CI95% 24.2–33.4) to 22.1 Gy (CI95% 18.3–26.0). When recomputing the risk of APT using the new dosimetric features, the optimization significantly reduced the risk of APT (p < 0.0001) by reclassifying 43.2% (19/44) of the patients. Conclusion: Our approach appears to be both easily implementable on a daily basis and efficient at reducing the risk of APT. Regional radiosensitivity should be considered in usual lung dose constraints, opening the possibility of new treatment strategies, such as dose escalation or innovative treatment associations. Full article

(This article belongs to the Special Issue Novel Strategy and Technologies in Local and Locoregional Treatment for Lung Cancer)

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Review

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15 pages, 2388 KiB

Open AccessReview

Transbronchial Techniques for Lung Cancer Treatment: Where Are We Now?

by Joyce W. Y. Chan, Ivan C. H. Siu, Aliss T. C. Chang, Molly S. C. Li, Rainbow W. H. Lau, Tony S. K. Mok and Calvin S. H. Ng

Cancers 2023, 15(4), 1068; https://doi.org/10.3390/cancers15041068 - 08 Feb 2023

Cited by 7 | Viewed by 3169

Abstract

The demand for parenchyma-sparing local therapies for lung cancer is rising owing to an increasing incidence of multifocal lung cancers and patients who are unfit for surgery. With the latest evidence of the efficacy of lung cancer screening, more premalignant or early-stage lung cancers are being discovered and the paradigm has shifted from treatment to prevention. Transbronchial therapy is an important armamentarium in the local treatment of lung cancers, with microwave ablation being the most promising based on early to midterm results. Adjuncts to improve transbronchial ablation efficiency and accuracy include mobile C-arm platforms, software to correct for the CT-to-body divergence, metal-containing nanoparticles, and robotic bronchoscopy. Other forms of energy including steam vapor therapy and pulse electric field are under intensive investigation. Full article

(This article belongs to the Special Issue Novel Strategy and Technologies in Local and Locoregional Treatment for Lung Cancer)

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