The Sixth International Conference on Screening for Lung Cancer
Hosted by: The American Hospital of Paris International Affiliate of
Weill Cornell Medical College and New York-Presbyterian Hospital
55 Boulevard du Chateau,Neuilly sur Seine, France
Friday, April 5, 2002 to Sunday, April 7, 2002
Summary of Workshop
Data Registry and Intervention Workshop
I-ELCAP is a collaborative group whose mission is to learn about screening for lung cancer using spiral CT scans. Essential to the I-ELCAP approach is the understanding that this requires two important, but separate sets of information. The first being the diagnostic question as this provides information in regards to the distribution of cancers detected under a specified screening regimen. The second question relates to the curability of the lesions detected under screening following early intervention. Up until this time, I-ELCAP has focused on issues primarily relating to the first of these questions. In this workshop we now for the first time, after having made significant progress in addressing the diagnositic issues, now start to address issues relating to intervention.
The first concern of the group was to define and prioritize the interventive issues that we currently encounter. The foremost among these related to intervention regarding sub-solid nodules, notably the non-solid ones. Principally, the issue was one of necessity for any intervention at all in this category of lesions. Thus, the concern was to quantitate the extent to which overdiagnosis may exist, if it exists at all, in this category of abnormalities. Once this can be learned, the subsequent question related to the remainder of the cancers with this radiologic profile, and their curability given early intervention. These same questions were also raised in regards to small solid cancers.
It was decided that a useful way to learn about these issues was through the development of a data registry. We would include those cases with specified radiologic findings in which we had information about their natural history. In particular, those cases with cytologic documentation who did not undergo surgery. We would also include those patients who did not have cytologic confirmation of their abnormality, but met certain radiologic criteria that would have led to intervention yet chose not to have it performed. Additionally, we would also include those patients who actually underwent the interventions and thereby would have information regarding the curability of these lesions as well.
The next clinical issue of concern related to extent to which traditional lobectomy was necessary in regards to documented early lung cancer, as compared to a less invasive procedure such as segmentectomy. The motivation for using the traditional approach relates primarily to the results of the Lung Cancer Study Group, and it was felt that it would be useful to carefully review the basis for this conclusion and determine its applicability to the type of lesions currently being detected with spiral CT. To further our understanding of this issue it was felt that we should pool our information in regards to patients with early lung cancer who have undergone limited resection versus traditional resection to determine if perhaps we would have enough data available to make a more conclusive statement about the efficacy of the less aggressive procedure. It was the general opinion that an RCT comparing traditional lobectomy with segmentectomy was not warranted at this time.
Another issue was concerned with the usefulness of needle biopsy in those patients that had growth documented on CT scan. If it could be determined that radiologic characterization was sufficiently accurate to predict malignancy, then the performance of the biopsy would no longer be necessary. It was also felt that much information could be gained through the registry to answer this question.
A discussion took place regarding the extent to which delay in surgery would effect the curability of early cancer.
The final set of questions raised was in regards to newer treatment options. This included the use of focused radiation therapy, microwaves, radio-frequency and cryotherapy. It was generally considered that it was too early to start pursuing further information about these techniques through any formal mechanism.
No attempt was made to define the various elements of the registry. It was decided that a group would form to discuss the various issues that would be relevant such as data elements, pathologic and radiologic findings, results of follow up and perhaps funding.
Encourage clinical studies addressing these and other questions. The availability of the I-ELCAP network provides a vehicle to enlist interested participants in these studies and the I-ELCAP web page provides a prompt means to enlist both additional collaborators and accrual of subjects for study.
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