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Radiological Investigation III: Pulmonary Angiogram and PET Scan01:13

Radiological Investigation III: Pulmonary Angiogram and PET Scan

Radiological investigations are paramount in the diagnosis and management of various pulmonary diseases. Two essential investigations are the Pulmonary Angiogram and the Positron Emission Tomography (PET) Scan.
Pulmonary Angiogram
A Pulmonary Angiogram is an invasive procedure involving injecting a contrast medium through a catheter threaded into the pulmonary artery or the right side of the heart to visualize the pulmonary vasculature. Computed Tomography (CT) scans have mainly replaced this...

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Real-world Decision-making Process for Stereotactic Body Radiotherapy Versus Minimally Invasive Surgery in

Stijn Vanstraelen1, Kay See Tan2, Prasad S Adusumilli1

  • 1Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.

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A new model predicts treatment for early-stage non-small cell lung cancer (NSCLC), guiding selection between minimally invasive surgery (MIS) and stereotactic body radiotherapy (SBRT). This aids in categorizing patients into risk groups for optimal care.

Keywords:
early-stagelung cancerminimally invasive surgeryoutcomesrecurrencestereotactic body radiotherapy

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Area of Science:

  • Oncology
  • Thoracic Surgery
  • Radiation Oncology

Background:

  • Early-stage non-small cell lung cancer (NSCLC) treatment involves stereotactic body radiotherapy (SBRT) and minimally invasive surgery (MIS).
  • Patient selection for SBRT versus MIS in early-stage NSCLC is complex due to numerous influencing factors.

Purpose of the Study:

  • To develop a predictive model for selecting the optimal treatment modality (MIS or SBRT) for early-stage NSCLC.
  • To stratify patients into distinct risk categories based on predicted treatment outcomes.

Main Methods:

  • Analysis of 1291 patients with clinical stage I NSCLC treated with MIS or SBRT (January 2020 - July 2023).
  • Development of a prediction model using multivariable logistic regression, incorporating factors like age, performance status, and pulmonary function.
  • Receiver operating characteristic (ROC) curve analysis to stratify patients into risk categories and assess model performance.

Main Results:

  • The prediction model, including age, performance status, prior pulmonary resection, MSK-Frailty score, FEV1, and DLCO, achieved an area under the curve (AUC) of 0.908.
  • Patients were stratified into low-risk (970 MIS, 28 SBRT), intermediate-risk (96 MIS, 53 SBRT), and high-risk (10 MIS, 40 SBRT) groups.
  • No significant difference in overall survival (OS) was observed between MIS and SBRT (HR 1.67, P=0.20).

Conclusions:

  • Clinical expertise can be translated into a robust predictive model for guiding treatment selection in early-stage NSCLC.
  • The model effectively categorizes patients into low, intermediate, and high-risk groups for MIS versus SBRT.
  • Patients in the intermediate-risk category may particularly benefit from multidisciplinary team evaluation for treatment decisions.