Management of Multifocal Lung Cancer: Results of a Survey

Konstantinos Leventakos, Tobias D Peikert, David Eric Midthun, Julian R Molina, Shanda Blackmon, Francis C. Nichols, Yolanda Isabel Garces, Christopher Hallemeier, Stephen J. Murphy, George Vasmatzis, Sarah L. Kratz, William P. Holland, Charles F. Thomas, John J. Mullon, K. Robert Shen, Stephen D. Cassivi, Randolph Stuart Marks, Marie Christine Aubry, Alex Adjei, Ping YangMark S. Allen, Eric Edell, Dennis A Wigle, Aaron Mansfield

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Introduction: Multifocal lung cancer is an increasingly common clinical scenario, but there is lack of high-level evidence for its optimal treatment. Thus, we surveyed members of the interdisciplinary International Association for the Study of Lung Cancer on their therapeutic approaches and analyzed the resultant practice patterns. Methods: We described the clinical scenario of an otherwise healthy 60-year-old man with bilateral pulmonary nodules and asked the 6373 members of the International Association for the Study of Lung Cancer whether they would recommend surgery, and if so, the extent of surgery. We also asked what other measures would be recommended to complete the staging and whether radiation therapy or chemotherapy would be suggested. Results: We received 221 responses (response rate 3.5%) from multiple specialists. Most respondents (140 [63%]) recommended surgery for this scenario. Surgeons were significantly more likely to recommend surgery than were those in other specialties. Of those who recommended surgery, most would obtain a PET/CT scan to rule out distant metastases and a magnetic resonance imaging scan to rule out brain metastases; but in the absence of radiographic lymph node involvement, most would not stage the mediastinum by bronchoscopy or mediastinoscopy before resection. When surgery was not recommended or declined, respondents commonly recommended radiation. Conclusions: This survey suggests that therapeutic recommendations for multifocal lung cancer are influenced to a large extent by physicians' specialty training, probably because of the lack of high-level evidence for its standard treatment. Ongoing systematic and multidisciplinary approaches with robust short-term and long-term patient outcomes may improve the quality of evidence for the optimal management of this clinical entity.

Original languageEnglish (US)
JournalJournal of Thoracic Oncology
DOIs
StateAccepted/In press - 2017

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Lung Neoplasms
Neoplasm Metastasis
Mediastinoscopy
Mediastinum
Bronchoscopy
Therapeutics
Surveys and Questionnaires
Radiotherapy
Lymph Nodes
Magnetic Resonance Imaging
Radiation
Physicians
Drug Therapy
Lung
Brain

Keywords

  • Chemotherapy
  • Multifocal lung cancer
  • Radiation therapy
  • Staging
  • Surgery

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine

Cite this

Management of Multifocal Lung Cancer : Results of a Survey. / Leventakos, Konstantinos; Peikert, Tobias D; Midthun, David Eric; Molina, Julian R; Blackmon, Shanda; Nichols, Francis C.; Garces, Yolanda Isabel; Hallemeier, Christopher; Murphy, Stephen J.; Vasmatzis, George; Kratz, Sarah L.; Holland, William P.; Thomas, Charles F.; Mullon, John J.; Shen, K. Robert; Cassivi, Stephen D.; Marks, Randolph Stuart; Aubry, Marie Christine; Adjei, Alex; Yang, Ping; Allen, Mark S.; Edell, Eric; Wigle, Dennis A; Mansfield, Aaron.

In: Journal of Thoracic Oncology, 2017.

Research output: Contribution to journalArticle

Leventakos, Konstantinos ; Peikert, Tobias D ; Midthun, David Eric ; Molina, Julian R ; Blackmon, Shanda ; Nichols, Francis C. ; Garces, Yolanda Isabel ; Hallemeier, Christopher ; Murphy, Stephen J. ; Vasmatzis, George ; Kratz, Sarah L. ; Holland, William P. ; Thomas, Charles F. ; Mullon, John J. ; Shen, K. Robert ; Cassivi, Stephen D. ; Marks, Randolph Stuart ; Aubry, Marie Christine ; Adjei, Alex ; Yang, Ping ; Allen, Mark S. ; Edell, Eric ; Wigle, Dennis A ; Mansfield, Aaron. / Management of Multifocal Lung Cancer : Results of a Survey. In: Journal of Thoracic Oncology. 2017.
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abstract = "Introduction: Multifocal lung cancer is an increasingly common clinical scenario, but there is lack of high-level evidence for its optimal treatment. Thus, we surveyed members of the interdisciplinary International Association for the Study of Lung Cancer on their therapeutic approaches and analyzed the resultant practice patterns. Methods: We described the clinical scenario of an otherwise healthy 60-year-old man with bilateral pulmonary nodules and asked the 6373 members of the International Association for the Study of Lung Cancer whether they would recommend surgery, and if so, the extent of surgery. We also asked what other measures would be recommended to complete the staging and whether radiation therapy or chemotherapy would be suggested. Results: We received 221 responses (response rate 3.5{\%}) from multiple specialists. Most respondents (140 [63{\%}]) recommended surgery for this scenario. Surgeons were significantly more likely to recommend surgery than were those in other specialties. Of those who recommended surgery, most would obtain a PET/CT scan to rule out distant metastases and a magnetic resonance imaging scan to rule out brain metastases; but in the absence of radiographic lymph node involvement, most would not stage the mediastinum by bronchoscopy or mediastinoscopy before resection. When surgery was not recommended or declined, respondents commonly recommended radiation. Conclusions: This survey suggests that therapeutic recommendations for multifocal lung cancer are influenced to a large extent by physicians' specialty training, probably because of the lack of high-level evidence for its standard treatment. Ongoing systematic and multidisciplinary approaches with robust short-term and long-term patient outcomes may improve the quality of evidence for the optimal management of this clinical entity.",
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T1 - Management of Multifocal Lung Cancer

T2 - Results of a Survey

AU - Leventakos, Konstantinos

AU - Peikert, Tobias D

AU - Midthun, David Eric

AU - Molina, Julian R

AU - Blackmon, Shanda

AU - Nichols, Francis C.

AU - Garces, Yolanda Isabel

AU - Hallemeier, Christopher

AU - Murphy, Stephen J.

AU - Vasmatzis, George

AU - Kratz, Sarah L.

AU - Holland, William P.

AU - Thomas, Charles F.

AU - Mullon, John J.

AU - Shen, K. Robert

AU - Cassivi, Stephen D.

AU - Marks, Randolph Stuart

AU - Aubry, Marie Christine

AU - Adjei, Alex

AU - Yang, Ping

AU - Allen, Mark S.

AU - Edell, Eric

AU - Wigle, Dennis A

AU - Mansfield, Aaron

PY - 2017

Y1 - 2017

N2 - Introduction: Multifocal lung cancer is an increasingly common clinical scenario, but there is lack of high-level evidence for its optimal treatment. Thus, we surveyed members of the interdisciplinary International Association for the Study of Lung Cancer on their therapeutic approaches and analyzed the resultant practice patterns. Methods: We described the clinical scenario of an otherwise healthy 60-year-old man with bilateral pulmonary nodules and asked the 6373 members of the International Association for the Study of Lung Cancer whether they would recommend surgery, and if so, the extent of surgery. We also asked what other measures would be recommended to complete the staging and whether radiation therapy or chemotherapy would be suggested. Results: We received 221 responses (response rate 3.5%) from multiple specialists. Most respondents (140 [63%]) recommended surgery for this scenario. Surgeons were significantly more likely to recommend surgery than were those in other specialties. Of those who recommended surgery, most would obtain a PET/CT scan to rule out distant metastases and a magnetic resonance imaging scan to rule out brain metastases; but in the absence of radiographic lymph node involvement, most would not stage the mediastinum by bronchoscopy or mediastinoscopy before resection. When surgery was not recommended or declined, respondents commonly recommended radiation. Conclusions: This survey suggests that therapeutic recommendations for multifocal lung cancer are influenced to a large extent by physicians' specialty training, probably because of the lack of high-level evidence for its standard treatment. Ongoing systematic and multidisciplinary approaches with robust short-term and long-term patient outcomes may improve the quality of evidence for the optimal management of this clinical entity.

AB - Introduction: Multifocal lung cancer is an increasingly common clinical scenario, but there is lack of high-level evidence for its optimal treatment. Thus, we surveyed members of the interdisciplinary International Association for the Study of Lung Cancer on their therapeutic approaches and analyzed the resultant practice patterns. Methods: We described the clinical scenario of an otherwise healthy 60-year-old man with bilateral pulmonary nodules and asked the 6373 members of the International Association for the Study of Lung Cancer whether they would recommend surgery, and if so, the extent of surgery. We also asked what other measures would be recommended to complete the staging and whether radiation therapy or chemotherapy would be suggested. Results: We received 221 responses (response rate 3.5%) from multiple specialists. Most respondents (140 [63%]) recommended surgery for this scenario. Surgeons were significantly more likely to recommend surgery than were those in other specialties. Of those who recommended surgery, most would obtain a PET/CT scan to rule out distant metastases and a magnetic resonance imaging scan to rule out brain metastases; but in the absence of radiographic lymph node involvement, most would not stage the mediastinum by bronchoscopy or mediastinoscopy before resection. When surgery was not recommended or declined, respondents commonly recommended radiation. Conclusions: This survey suggests that therapeutic recommendations for multifocal lung cancer are influenced to a large extent by physicians' specialty training, probably because of the lack of high-level evidence for its standard treatment. Ongoing systematic and multidisciplinary approaches with robust short-term and long-term patient outcomes may improve the quality of evidence for the optimal management of this clinical entity.

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KW - Radiation therapy

KW - Staging

KW - Surgery

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