Dr. Landreneau discusses the changing trends in surgical treatment following removal of a patient's lung cancer and  Dr. Schuchert reviews the role of surgery in patients with clinical stage IIIA lung cancer.

Educational objectives:

Upon completing this clinical brief the physician should be able to:

• Identify changing trends in surgical treatment of the small peripheral potentially malignant lung nodule potentially leading to preservation in pulmonary functional reserve following removal of a patient’s lung cancer.
• Appreciate the clinical utility of surgical resection for the peripheral lung cancer over image guided ablation procedures related to improved pathologic staging, assurance of clear surgical margins, and adequate tissue for pharmacogenomic study of the tumor tissue in this era of adjuvant chemotherapy for lung cancer.
• Gain a better understanding of the clinical presentation and management strategies for patients with Stage IIIA non-small cell lung cancer.
• Review the role of surgery in patients that present with clinical stage IIIA lung cancer.

Reading Resources:

1. Landreneau RJ, Sugarbaker DJ, Mack MJ, Hazelrigg SR, Luketich JD, Fetterman L, et al. Wedge resection versus lobectomy for stage 1 (T1N0M0) non-small cell lung cancer. J Thorac Cardiovasc Surg 1997; 113: 691-700.
2. Schuchert MJ, Pettiford BL, Keeley S, D’Amato TA, Kilic A, Close J, et al. Anatomic Segmentectomy in the Treatment of Stage 1 non-small cell lung cancer. Ann Thorac Surg 2007; 84(3): 926-32.
3. Fernando HC, Santos R, Benfield JR, et al. Lobar and Sublobar resection with and without brachytherapy for small stage IA non-small cell lung cancer. J Thorac Cardiovasc Surg 2005; 129: 261-7.
4. Schuchert MJ, Pettiford BL, Luketich JD, Landreneau RJ. Parenchymal-sparing resections: why, when, and how. Thoracic Surgery Clinics 2008; 18(1):93-105.
5. Okada M, Koike T, Higashiyama M, et al. Radical sublobar resection for small-sized non-small cell lung cancer: A multicenter study. J Thorac Cardiovasc Surg 2006; 132: 769-75.
6. Roth JA, Atkinson EN, Fossella F, Komaki R, Bernadette Ryan M, Putnam JB Jr., Lee JS, Dhingra H, DeCaro L, Chasen M, Hong WK. Long-term follow-up of patients enrolled in a randomized trial comparing perioperative chemotherapy and surgery with surgery alone in resectable stage IIIA non-small cell lung cancer. Lung Cancer 1998; 21(1): 1-6.
7. Rosell R, Gomez-Codina J, Camps C, Javier Sanchez J, Maestre J, Padilla J, Canto A, Abad A, Roig J. Preresectional chemotherapy in stage IIIA non-small cell lung cancer: A seven-year assessment of a randomized-controlled trial. Lung Cancer 1999; 26(1): 7-14.
8. Depierre A, Milleron B, Moro-Sibilot D, Chevret S, Quoix E, Lebeau B, Braun D, Breton JL, Lemarie E, Gouva S, Paillot N, Brechot JM, Janicot H, Lebas FX, Terrioux P, Clavier J, Foucher P, Monchatre M, Coetmeur D, Level MC, Leclerc P, Blanchon F, Rodier JM, Thiberville L, Villanueve A, Westeel V, Chastang C, French Thoracic Co-Operative Group. Preoperative chemotherapy followed by surgery compared with primary surgery in resectable stage I (except T1N0), II and IIIA non-small cell lung cancer. J Clin Oncol 2002; 20(1): 247-53.
9. Van Meerbeeck JP, Kramer GW, Van Schil PE, Legrand C, Smit EF, Schramel F, Tjan-Heijnan VC, Biesma B, Debruyne C, van Zandwijk N, Splinter TA, Giaccone G, European Organisation for Research and Treatment of Cancer – Lung Cancer Group. Randomized controlled trial of resection versus radiotherapy after induction chemotherapy in stage IIIA-N2 non-small cell lung cancer. J Natl Cancer Inst 2007; 99(6): 442-50.
10. Albain KS, Swann RS, Rusch VW, Turrisi AT 3rd, Shepherd FA, Smith C, Chen Y, Livingston RB, Feins RH, Gandara DR, Fry WA, Darling G, Johnson DH, Green MR, Miller RC, Ley J, Sause WT, Cox JD. Radiotherapy plus chemotherapy with or without surgical resection for stage III non-small-cell lung cancer: a phase III randomised controlled trial. Lancet 2009; 374(9687):379-86.

Disclosures:

Doctors Landreneau and Schuchert have no relationships with proprietary entities producing healthcare goods or services.

Accreditation Statement:

The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Pittsburgh School of Medicine designates this enduring material for a maximum of .5 AMA PRA Category 1 Credits^TM. Each physician should only claim credit commensurate with the extent of their participation in the activity. Other health care professionals are awarded (0.05) continuing education units (CEU) which are equivalent to .5 contact hour.

For your credit transcript, please access our website 4 weeks post-completion at http://ccehs.upmc.edu and follow the link to the Credit Transcript page. If you do not provide the last 5 digits of your SSN on the next page you will not be able to access a CME credit transcript. Providing your SSN is voluntary.

Release Date: 11/14/2012 | Last Modified On: 11/14/2012 | Expires: 11/14/2013