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Dated lung cancer protocol revised


Thousands more lung cancer patients each year could be offered surgery or other aggressive therapy under a new system that classifies many tumors as more treatable than in the past.

It is the first major overhaul of a decades-old method used to predict survival and help determine whether a lung cancer patient will have surgery, chemotherapy or be treated at all.

The new guidance is to be presented at a conference of lung cancer specialists in Seoul, South Korea, that starts today. It is expected to be adopted by policy-making groups in the next year.

Lung cancer is the world’s top cancer killer, claiming 1.3 million lives each year. In the United States, 213,380 new cases and 160,390 deaths from the disease are expected this year.

Nearly 60 percent of people die within one year of diagnosis, and nearly 75 percent die within two years, American Cancer Society statistics show.

In treating it, doctors use a formula called tumor staging. It is based on a tumor’s size, how far it has spread and other factors to predict survival odds and to guide treatment.

The current system was developed decades ago before improved scanning technology was available to evaluate a cancer’s spread.

The new plan keeps four broad groupings but sorts people more precisely based on refined understanding of tumors.

“There will clearly be shifting of patients from categories not operable to operable” – as many as 10,000 a year in the United States, said Dr. David Johnson, a lung cancer specialist at Vanderbilt University in Nashville, Tenn.

The stage of the tumor at diagnosis is the best predictor of survival. Only 20 percent of cases are diagnosed in Stages 1 or 2, when tumors are small and confined to a lung, Johnson said.

Among the changes: creating sub-stages for tumor size, reassigning some large tumors to a more advanced stage, reclassifying tumors that have spread into fluid around the lung, and recognizing that spread to certain lymph nodes is more dangerous than its spread to others.

“By changing some of these groupings, some patients will get moved to an earlier stage of disease for which we tend to be more aggressive” in treatment, said Dr. Joan Schiller, a lung cancer specialist at the University of Texas Southwestern Medical Center in Dallas.

Conversely, some people thought to have earlier-stage tumors now will be grouped with those whose tumors have widely spread, and discouraged from undergoing therapies that have little chance of helping them.

“In some cases, patients were getting inappropriately aggressive treatment,” Schiller said.


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