Search Results (611)

Introduction: Intracranial stereotactic radiosurgery (SRS) is a specialised radiotherapy technique that plays an essential role in achieving local control of brain metastases and therefore optimising quality of life for many cancer patients. It also confers a survival benefit in selected patients. Rural and regional Australians may face significant challenges in accessing this treatment, as it is predominantly delivered at metropolitan institutions. We sought to assess the cost-effectiveness of a brain SRS service implemented using local resources at a North Queensland regional hospital from a societal perspective. Methods: We prospectively collected treatment costs and clinical outcomes for a consecutive cohort of patients who received SRS for intracranial metastatic lesions at a regional cancer centre since the implementation of the brain SRS program in September 2022. We compared the healthcare and non-healthcare costs (e.g., travel and informal care) with the costs that would have otherwise been incurred if patients were referred to metropolitan centres in the state capital. Clinical outcomes incorporated overall survival, intracranial disease control rates, and incidence of radiation necrosis. Clinical outcome data of the metropolitan centres were derived from the published literature. Results: A total of 34 patients received treatment during the study period. Their median age was 65 years (range: 49–78 years). Around 47% received adjuvant SRS following surgical resection, and the remaining 53% were treated for intact brain metastases. The predominant primary malignancy was non-small cell lung cancer. The mean total cost per course of brain SRS at a regional hospital was AUD 6690, including AUD 5754 for healthcare and AUD 1682 for non-healthcare costs, across 34 patients recruited between September 2022 and August 2024. This was AUD 760 less than that of a course of treatment delivered at a metropolitan hospital. Median survival among the cohort was 15.7 months, and eight patients (24%) developed radionecrosis; these were comparable to published data reported by Australian urban and international institutions. Conclusions: The implementation of a brain SRS service at regional cancer centres utilising existing infrastructure and local expertise has the potential to offer cost-effective treatment to rural and regional cancer patients. This approach improves access for patients who might otherwise face logistics barriers and competing life priorities when seeking treatment in metropolitan centres. Full article

The management strategies in resectable non-small cell lung cancer (NSCLC) have changed over the last few years. Despite advancements in surgical techniques and conventional chemotherapy, patients with resectable NSCLC remained at high risk of future recurrence. Clinical trials have demonstrated improvements in response rates, pathological outcomes, and survival with the perioperative approach. Considering the findings of these landmark trials, there is a pressing need to contextualize and incorporate these global developments into the national practice framework. This review outlines key developments from recent clinical trials, with a focus on perioperative strategies in early-stage operable NSCLC from a Canadian perspective. We discuss the integration of checkpoint inhibitors in the perioperative setting for patients without actionable genomic alterations, adjuvant targeted therapies for EGFR and ALK mutant disease, and emerging tools such as ctDNA based minimal residual disease monitoring. The article also addresses the practical challenges of implementing these advances within the Canadian healthcare system, including systemic therapy approvals, barriers, and importance of multidisciplinary care to guide clinicians in optimizing patient outcomes. Full article

Background/Objectives: This study aimed to evaluate the prognostic effects of tumor spread through air spaces (STAS) and other clinical and pathological risk factors on disease-free survival (DFS) in patients with non-small cell lung cancer (NSCLC) who underwent curative lobectomy and had tumors measuring 4 cm or less. Methods: NSCLC patients who underwent surgery between March 2015 and May 2024 and had at least 12 months of follow-up were retrospectively analyzed. Patients with tumors measuring 4 cm or less who underwent R0 resection, lobectomy, and STAS assessment on intraoperative frozen sections were included in the study. Clinicopathological features of all patients were restaged according to the 9th edition of the TNM staging system. The Kaplan–Meier method, log-rank test, and univariate Cox regression analysis were used to determine the factors affecting DFS. Results: 88 patients were included in the study. The median age of the patients was 61 years, 77.3% were male, and 72.7% had adenocarcinoma histology. According to TNM 9, 23.9% of the cases were staged T1b, 18.2% T1c, and 58.0% T2a. STAS positivity was detected in 45 patients (51.1%). The rates of lymphovascular invasion (LVI) (40.0% vs. 18.6%; p = 0.028) and visceral pleural invasion (VPI) (57.8% vs. 27.9%; p = 0.005) were significantly higher in the STAS-positive group than in the STAS-negative group. Recurrence was observed in a total of 31 patients (35.2%) during a median follow-up period of 68.1 months. In Kaplan–Meier analysis, the median DFS was not reached for the entire cohort. The estimated median DFS in STAS-positive patients was 52.7 months, while the median was not reached in the STAS-negative group (p = 0.001). The median DFS was 52.3 months in those with lymph node positivity, while the median was not reached in those with lymph node negativity (p = 0.031). According to TNM 9, the difference in DFS between stage IA/IB and stage IIAB groups was not statistically significant (p = 0.080). In univariate Cox analysis, STAS positivity (HR = 3.79; 95% CI: 1.69–8.51; p = 0.001), lymph node positivity (HR = 2.58; 95% CI: 1.05–6.31; p = 0.038) and VPI (HR = 2.28; 95% CI: 1.07–4.86; p = 0.032) were found to be significant prognostic factors adversely affecting DFS. Age, gender, histological type, tumor location, T stage, LVI, perineural invasion (PNI), and adjuvant chemotherapy had no significant effect on DFS. Conclusions: STAS is a strong negative prognostic indicator for recurrence in patients with operated NSCLC with tumor size ≤ 4 cm. It is believed that STAS should be integrated into risk-based staging and adjuvant treatment decision-making processes in early-stage NSCLC, particularly when evaluated in conjunction with VPI and lymph node positivity. Full article

Background: Conventional absorption-based computed tomography has a limited ability to resolve lung microarchitectures that are critical for histological subtype discrimination. This study evaluated the potential of X-ray Dark-Field Imaging Computed Tomography (XDFI CT) using synchrotron radiation for non-destructive, three-dimensional visualization of human lung cancer microstructures. Methods: Surgically resected human lung cancer specimens (n = 4) were examined, including acinar-predominant adenocarcinoma (n = 1), adenocarcinoma after concurrent chemoradiation therapy (n = 1), keratinizing squamous cell carcinoma (n = 1), and metastatic hepatocellular carcinoma in the lung (n = 1). Image acquisition was performed at beamline BL-14B of the Photon Factory (Tsukuba, Japan), using a monochromatic 19.8 keV synchrotron X-ray beam and a crystal analyzer-based refraction-contrast optical system. Imaging findings were qualitatively correlated with corresponding histopathological sections. Results: Synchrotron radiation XDFI CT enabled clear visualization of normal distal lung microanatomy, including alveolar walls and associated vascular structures, which served as internal references adjacent to tumor regions. Distinct microstructural features—such as invasive growth patterns, fibrotic or keratinized stroma, necrosis, and treatment-related remodeling—were identifiable and varied according to histological subtype. Tumor–normal tissue transitional zones were consistently delineated in all specimens. Conclusions: Synchrotron radiation XDFI CT provides high-resolution, non-destructive volumetric imaging of lung cancer tissues and reveals subtype-associated microarchitectural features. This technique may complement conventional histopathology by enabling three-dimensional virtual histologic assessment of lung cancer specimens. Full article

Background/Objectives: Surgical resection of non-small-cell lung cancer (NSCLC) often results in temporary suppression of natural killer cell activity (NKA), potentially increasing the risk of recurrence. This study aimed to evaluate whether multivitamin and mineral complexes containing Agaricus blazei could support postoperative immune recovery. Methods: In this randomized, double-blind, placebo-controlled multicenter pilot trial, 66 patients with stage I–III NSCLC received either a supplement or a placebo for 28 days post-surgery. NKA was assessed using an interferon-γ release assay preoperatively, on postoperative days (POD) 1–4, and on POD 30. Immune cell subsets, cytokine levels, clinical parameters, and quality of life were evaluated. Results: Both groups showed a postoperative decline in NKA, with recovery observed by POD 30. Although the increase in NKA was not statistically significant, the treatment group showed a greater relative recovery (17.8% vs. 9.9%, p = 0.104). Immune profiling demonstrated significantly better preservation of T cells (p = 0.026) and B cells (p = 0.001) as well as a greater reduction in monocytes (p = 0.031) in the treatment group. No significant differences were observed in cytokine levels, body mass index, Eastern Cooperative Oncology Group Performance Status, or patient-reported outcomes. Conclusions: Supplementation with a multivitamin and mineral complex containing Agaricus blazei may contribute to favorable immune modulation in patients undergoing curative surgery for NSCLC. Larger long-term trials are warranted to confirm these findings and facilitate clinical application. Full article

Background: Uterine malignancies frequently metastasize to the lungs. Pulmonary metastasectomy has demonstrated survival benefits in some malignancies; however, its efficacy for uterine malignancies remains unclear. Methods: We retrospectively analyzed 38 patients who underwent pulmonary metastasectomy for uterine malignancies at the Kanagawa Cancer Center between 2010 and 2020. The primary endpoint was recurrence-free survival (RFS) after pulmonary resection. Results: The median patient age was 63 years. The primary sites were the cervical uteri (n = 22) and corpus uteri (n = 16). The FIGO stages at the time of treatment for the primary tumor were I, II, III, IV, and unknown in 20, 7, 9, 1, and 1 patient, respectively. The median disease-free interval (DFI), defined as the interval between primary treatment and first recurrence, was 26.5 months. Most patients had single metastasis (n = 32). The procedures for metastasectomy included lobectomy, segmentectomy, and wedge resection (n = 15, 8, and 15, respectively), and two cases resulted in microscopically incomplete resection. The median follow-up period after pulmonary metastasectomy was 57 months, with 16 patients experiencing recurrence after pulmonary metastasectomy (5-year RFS rate: 55.6%). Univariate analysis identified FIGO stage ≥ III, DFI < 12 months, presence of synchronous extrapulmonary recurrence, and uterine sarcoma as poor prognostic factors. No prognostic differences were found between cervical and corpus uteri cancers. Conclusions: Pulmonary metastasectomy may confer prognostic benefits in patients with uterine malignancies. Careful consideration is warranted for patients with advanced-stage primary tumors, early recurrence after primary treatment, synchronous extrapulmonary recurrence, and uterine sarcoma. Full article

Surgical resection is recommended for operable stage I non-small-cell lung cancer (NSCLC), while radiotherapy reserved for inoperable patients. Very comorbid patients may receive no treatment at all. Social determinants of health (SDOHs) may influence access to these treatments. We examined how SDOHs affect treatment modality among these patients using a population-based retrospective cohort study using ICES data including adults with stage I NSCLC diagnosed between 2007 and 2023. Multivariable logistic regression assessed associations between SDOH and treatment received. Of 19,179 patients, 54.4% received only surgery, 15.8% received only radiotherapy, 27.5% received no treatment, and 2.3% received surgery and radiotherapy. Surgery was less likely in patients aged >80 versus <50 (OR 0.07, p < 0.001), patients with frailty (OR 0.38, p < 0.001), patients with ≥5 comorbidities (OR 0.21, p < 0.001), or those who were not rostered with a family physician (OR 0.59, p < 0.001). Recent immigrants were more likely to undergo surgery (OR 1.23, p = 0.035), as well as those in the highest neighbourhood income quintile (OR 1.45, p < 0.001). Surgery was less likely for those living 50–100 km from a cancer centre (OR 0.85, p = 0.004). Radiotherapy was more likely in patients aged >80 (OR 9.86, p < 0.001), those with ≥5 comorbidities (OR 2.23, p < 0.001), or those in the lowest household income quintile (OR 1.27, p = 0.009). Recent immigrants were less likely to receive radiotherapy (OR 0.69, p = 0.005). SDOHs independently influence treatment type for stage I NSCLC. Full article

Background: Recent trials, including JCOG0802/WJOG4607L and CALGB140503, have confirmed the oncological adequacy of segmentectomy for early-stage non-small-cell lung cancer (NSCLC). This shift emphasizes the preservation of pulmonary function and minimal invasiveness. Robot-assisted thoracic surgery (RATS) offers enhanced anatomical precision and potentially improves segmentectomy outcomes. Methods: We reviewed the current evidence comparing sublobar resection and lobectomy for early-stage NSCLC, focusing on RATS segmentectomy. Clinical trials, perioperative and long-term outcomes, technical innovations, and patient selection criteria were analyzed. Comparative data among RATS, video-assisted thoracoscopic surgery (VATS), and open approaches were synthesized, including the emerging roles of AI and 3D imaging. Results: Segmentectomy yields survival outcomes equivalent or superior to lobectomy for stage IA peripheral NSCLC ≤2 cm, with better pulmonary function despite higher locoregional recurrence. RATS enhances visualization, dexterity, and ergonomics, thereby enabling precise dissection and lymph node assessment. Compared to VATS and open surgery, RATS shows lower conversion rates, reduced pain, and comparable oncological control. Innovations, such as indocyanine green imaging, 3D modeling, and AI-guided navigation, support margin accuracy and personalized care. Conclusions: Segmentectomy has redefined the surgical standards for early-stage NSCLC. RATS maximizes the minimally invasive benefits by combining oncological safety and functional preservation. Its technical precision facilitates complex resections and integration with digital planning tools to advance personalized thoracic surgery. RATS represents the next evolution of minimally invasive thoracic surgery, redefining the balance between oncological safety and functional preservation in early-stage NSCLC. Full article

Background: Triple primary malignant tumors (TPMTs) are extremely rare and represent a major diagnostic and therapeutic challenge. Their frequency has increased with advances in cancer detection and longer patient survival. Case presentation: We report the case of a 76-year-old male diagnosed with three synchronous primary malignancies involving the liver, left kidney, and right lung. Imaging revealed a hepatic mass with arterial enhancement and portal washout, a large left renal mass, and a cavitated pulmonary nodule. Histopathological and immunohistochemical evaluation confirmed three distinct tumors: well-differentiated hepatocellular carcinoma, chromophobe renal cell carcinoma, and invasive non-mucinous lung adenocarcinoma. A multidisciplinary oncology board recommended surgical resection of the liver and kidney lesions and stereotactic body radiotherapy for the lung tumor. The patient underwent hepatectomy and nephrectomy but experienced severe postoperative complications leading to multi-organ failure and death. Results of the systematic review: A systematic search identified 83 relevant cases of triple primary malignancies after full-text eligibility assessment. None of the 159 articles included after primary screening described a synchronous association of primary liver, kidney, and lung cancers. Conclusions: This case highlights the importance of thorough diagnostic assessment and individualized, multidisciplinary management in patients with multiple synchronous malignancies. To our knowledge, this is the first reported case of synchronous hepatocellular carcinoma, chromophobe renal cell carcinoma, and lung adenocarcinoma. Full article

Objective: The optimal extent of segmentectomy for clinical T1N0 non-small cell lung cancer (NSCLC) remains unclear. This study compared perioperative and oncological outcomes of video-assisted thoracoscopic surgery (VATS) single segmentectomy (SS) versus multiple segmentectomy (MS) for tumors ≤ 3 cm. Methods: This single center study retrospectively analyzed all consecutive patients who underwent VATS anatomic segmentectomy for cT1N0 NSCLC between 2017 and 2022. Patient demographics, perioperative outcomes, and survival were compared between SS and MS groups. Results: In total, 334 patients underwent pulmonary segmentectomy: single in 211 (63%) and multiple in 123 patients (37%). In the SS group, 83 (39%) were simple and 128 (61%) complex segmentectomies; while in the MS group, 67 (54%) were simple and 56 (46%) were complex. Baseline characteristics were similar between groups. SS was associated with shorter operative time (117 vs. 132 min; p = 0.007), reduced length of drainage (1 vs. 3 days; p < 0.001), reduced hospital stay (5 vs. 6 days; p < 0.001), and lower atrial fibrillation (1.4% vs. 5.7%; p = 0.042). Total mean tumor size was 14.3 mm, with no statistical difference between groups (14.3 vs. 15.5 mm; p = 0.115). Surgical margins were larger in SS (median 13 vs. 11 mm; p = 0.038), while the number of lymph nodes dissected was similar. After a median follow-up of 30 months, no significant differences were observed in overall survival (OS) (94.5% vs. 90.7%) and disease-free survival (DFS) (83.2% vs. 79.1%). Conclusions: SS and MS provide equivalent short-term oncological outcomes in cT1N0 NSCLC ≤ 3 cm. SS may be preferred when adequate margins are achievable, offering equivalent oncologic outcomes with better perioperative recovery. Full article

Background: Pulmonary metastases occur in approximately 20–40% of patients with solid malignancies, with colorectal cancer representing the most frequent primary source. Surgical resection remains a potentially curative strategy for selected patients, and wedge metastasectomy has long been considered the standard of care. However, increasing attention has been paid to the role of anatomical resections such as segmentectomy and lobectomy, particularly for centrally located or technically challenging metastases. Methods: We performed a narrative literature review across PubMed, Embase, and Scopus databases covering the period 2010–2025, using the keywords “pulmonary metastasectomy”, “anatomical resection”, “segmentectomy”, “lobectomy”, and “pneumonectomy”. Articles included original series, comparative studies, meta-analyses, and systematic reviews. Special attention was given to technical indications, oncological outcomes, minimally invasive techniques, histological differences, and postoperative functional results. Results: Evidence suggests that anatomical resections are most often indicated not purely on oncological grounds, but due to technical considerations such as central localization, size greater than 2 cm, involvement of segmental or lobar bronchi or vessels, or the presence of multiple metastases confined to one lobe. Comparative studies indicate that segmentectomy provides superior local control compared to wedge resection, while lobectomy ensures complete clearance in complex cases, with five-year overall survival approaching 50% in carefully selected colorectal cancer patients. Conclusions: While wedge resection and metastasectomies remain the gold standard for small, peripheral metastases, anatomical resections represent a valuable extension of the surgical armamentarium in secondary lung cancer. Their role should be understood primarily as a technical necessity to ensure radical clearance while minimizing loss of lung parenchyma. The integration of minimally invasive approaches and emerging adjuncts, such as 3D reconstruction and fluorescence-guided surgery, is likely to further refine patient selection and optimize outcomes. Full article

Background: Multiple primary lung cancer (MPLC) presents clinical challenges due to its biological complexity. While lobectomy remains standard, limited resection and localized ablation offer comparable efficacy. This systematic review evaluates the safety and efficacy of combining surgical and ablative therapies for MPLC. Methods: A comprehensive search of PubMed, Embase, and Web of Science (January 2000–2025) identified studies involving MPLC patients treated with both surgery and ablation, either concurrently or sequentially. Data on ablation efficacy, adverse events, and prognosis were extracted. A meta-analysis was performed when data pooling was appropriate. The methodological quality and risk of bias of the included studies were assessed using the MINORS and ROBINS-I tools. Publication bias was evaluated through funnel plots and Egger’s linear regression test. Furthermore, one case report on combination therapy was also included. Results: A total of nine studies met the inclusion criteria and were included in the final analysis. All reported a 100% technical success rate for ablation, efficacy rates exceeding 70%, and adverse event rates ranging from 5.0% to 26.7%. Due to significant heterogeneity among studies, a random-effects model was applied. The meta-analysis yielded a pooled ablation efficacy rate of 97.11% (95% CI: 85.81–100.00%) and a pooled adverse event rate of 14.23% (95% CI: 8.07–20.38%), indicating favorable safety and efficacy of the combined therapy. Conclusions: The integration of surgical and ablative therapies offers a safe and effective strategy for managing MPLC and supports a potential paradigm shift from single-modality treatment toward a more personalized, organ-preserving, and patient-centered approach. Full article

Objectives: Lung neuroendocrine tumors (LNETs) are rare, comprising 1–2% of lung cancers. This study aimed to compare overall survival (OS) and recurrence-free survival (RFS) after lobar resection versus sublobar resection for LNETs and to identify factors associated with prognosis and resection extent. Methods: We retrospectively analyzed patients with clinical stage I (T ≤ 4 cm, N0M0) typical or atypical carcinoid who underwent curative resection at Hadassah Medical Center and Kaplan medical Center between 2010 and 2024. Results: Seventy patients (mean age 56.8 ± 16 years; 63% female) were included. Lobar resection was performed in 40 (57%) and sublobar resection in 30 (43%; 15 segmentectomies, 15 wedge resections). Pathology revealed 50 typical carcinoid (71.43%) and 20 atypical carcinoid (28.57%). Final pathological stage was I in 57 patients (81.42%), II in 9 (12.86%), and III in 4 (5.71%), reflecting surgical upstaging in 13 patients (18.57%), all due to nodal involvement. Atypical carcinoid was associated with worse RFS, nodal upstaging, and adjuvant therapy (all p < 0.01). Patients undergoing sublobar resection were older, had higher comorbidity scores, more frequently presented with peripheral tumors, and underwent less frequent lymph node assessment (all p < 0.01). At a median follow-up of 3.8 years for OS and 2.0 years for RFS, survival rates were 95.7% for both. Neither OS, RFS, nor postoperative normalization of plasma pro-gastrin-releasing peptide (ProGRPp) levels differed significantly between lobar resection and sublobar resection (p = 0.94, p = 0.42, and p = 0.205, respectively). Conclusions: Sublobar resection may represent an acceptable surgical option for selected patients with clinical stage I LNETs, particularly for peripheral tumors ≤ 2 cm in older or comorbid patients. The high rate of nodal upstaging underscores the need for lymph node assessment, irrespective of resection extent. Full article

Background: Recent landmark clinical trials have introduced the role of targeted therapy with surgery for resectable non-small cell lung cancers (NSCLCs). Methods: This narrative review summarizes data from recent clinical trials and retrospective studies to highlight the evolving interplay between targeted therapy and resectable NSCLC. Results: For patients with epidermal growth factor receptor (EGFR) mutations, the ADAURA trial demonstrated significant improvements in disease-free and overall survival with adjuvant osimertinib after complete resection. The NeoADAURA trial expanded the role of osimertinib to neoadjuvant treatment as it showed benefit in major pathologic response rates when compared to chemotherapy alone. Neoadjuvant osimertinib may facilitate surgical resection, especially for patients with lymph node involvement. Furthermore, the ALINA trial established the role of adjuvant alectinib, another targeted therapy, for patients with anaplastic lymphoma kinase (ALK) positive resectable NSCLC. Given the evidence for use of these novel targeted therapies in patients with resectable lung cancer, early molecular profiling is critical for patients with NSCLC to help guide pre- and postoperative treatment. The use of targeted therapies may even expand to stage IV NSCLC as clinical trials are ongoing and could possibly redefine the role of surgery in advanced disease. Conclusions: While there are ongoing trials to clarify the optimal timing of targeted therapies and surgical resection, current data supports the use of targeted therapies as part of multimodality care in surgically resectable NSCLC. Full article