Clinical lung cancer最新文献

{"title":"Impact of First-Line Maintenance Immunotherapy With or Without Pemetrexed for Non-Squamous Advanced/Metastatic Non-Small Cell Lung Cancer Lacking Targetable Mutations: A Real-World Analysis in England","authors":"Fabio Gomes ,&nbsp;Niall Gilding ,&nbsp;Vivian Tan ,&nbsp;Katerina Christoforou ,&nbsp;Joanne Rule ,&nbsp;Amine Aziez ,&nbsp;Adam Januszewski ,&nbsp;Anna Minchom","doi":"10.1016/j.cllc.2025.12.007","DOIUrl":"10.1016/j.cllc.2025.12.007","url":null,"abstract":"<div><h3>Objectives</h3><div>Real-world analyses of first-line maintenance (1LM) immuno-oncology (IO) treatment with or without pemetrexed for patients with non-squamous (NSQ) advanced/metastatic non-small cell cancer (a/mNSCLC), including the relative impact of 1LM pemetrexed, are lacking. This retrospective analysis describes 1LM treatment patterns and their outcomes in England.</div></div><div><h3>Methods</h3><div>Data from the National Disease Registration Service were collated to identify 2 cohorts of patients with NSQ a/mNSCLC completing ≥ 4 cycles of first-line (1L) platinum-based chemotherapy with IO plus pemetrexed, diagnosed from 1 March to 31 December 2019 (Cohort 1), or during a period where interim coronavirus disease 2019 (COVID-19) guidelines were in effect (1 March to 31 December 2020; Cohort 2). Baseline characteristics, 1LM treatment, overall survival (OS) and time to next treatment or death in both cohorts, and in a combined cohort of patients receiving 1LM stratified by the presence/absence of 1LM pemetrexed, were analyzed.</div></div><div><h3>Results</h3><div>Overall, 595 and 516 NSQ a/mNSCLC patients were included in Cohorts 1 and 2, respectively. Median OS (95% confidence interval [CI], months) from start of 1L was numerically longer in Cohort 1 (19.5 [17.6-22.2] months) versus Cohort 2 (15.7 [14.2-18.0] months). Combined (Cohort 1 and Cohort 2) median OS from 1L was broadly similar irrespective of pemetrexed presence (19.5 [17.5-21.6] months) or absence (18.6 [15.6-23.0] months) in 1LM.</div></div><div><h3>Conclusions</h3><div>Survival was numerically shorter for patients diagnosed during the COVID-19 pandemic (Cohort 2; interim guidance) versus Cohort 1 (pre-COVID-19). In a combined cohort, survival was broadly similar regardless of 1LM pemetrexed use.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"27 3","pages":"Pages 224-234.e8"},"PeriodicalIF":3.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146194251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High Sustained Nocturnal Hypoxemic Burden Identifies Patients With High Risk for Prolonged Hospital Stay After Anatomical Lung Surgery, a Brief Report","authors":"Clemens Wiest ,&nbsp;Svenja Schroeder ,&nbsp;Hans-Stefan Hofmann ,&nbsp;Maximilian Valentin Malfertheiner ,&nbsp;Christopher Larisch ,&nbsp;Julia Riedel ,&nbsp;Martin Schauer ,&nbsp;Christian Schulz ,&nbsp;Michael Ried ,&nbsp;Michael Arzt","doi":"10.1016/j.cllc.2026.01.001","DOIUrl":"10.1016/j.cllc.2026.01.001","url":null,"abstract":"<div><div><ul><li><span>•</span><span><div>High nocturnal hypoxemic burden defined as T90 &gt; 12% of total recording time in polygraphy was found in 24.3% of the included patients. The hypoxemic burden is easy to assess with polygraphy. Patients with high hypoxemic burden have a risk for a longer hospital stay after anatomical lung resection. Therefore, information about nocturnal hypoxemic burden before anatomical lung surgery identifies patients at risk for longer LOS. Multiple underlying pathologies as COPD, heart failure, sleep apnea or pulmonary fibrosis can cause nocturnal hypoxemic burden. Some of them can be treated specifically. In the future, this could be used in the sense of individualized precision medicine to specifically identify and prehabilitate patients with high nocturnal hypoxemic burden preoperatively to reduce their length of hospital stay and thus reduce costs and potential complications associated with prolonged length of hospital stay.</div></span></li></ul></div></div><div><ul><li><span>•</span><span><div>High nocturnal hypoxemic burden defined as T90 &gt; 12% of total recording time in polygraphy was found in 24.3% of the included patients. The hypoxemic burden is easy to assess with polygraphy. Patients with high hypoxemic burden have a risk for a longer hospital stay after anatomical lung resection. Therefore, information about nocturnal hypoxemic burden before anatomical lung surgery identifies patients at risk for longer LOS. Multiple underlying pathologies as COPD, heart failure, sleep apnea or pulmonary fibrosis can cause nocturnal hypoxemic burden. Some of them can be treated specifically. In the future, this could be used in the sense of individualized precision medicine to specifically identify and prehabilitate patients with high nocturnal hypoxemic burden preoperatively to reduce their length of hospital stay and thus reduce costs and potential complications associated with prolonged length of hospital stay.</div></span></li></ul></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"27 3","pages":"Pages 235-239.e3"},"PeriodicalIF":3.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147602361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Phase II Study of Durvalumab, Doxorubicin, and Ifosfamide in Recurrent and/or Metastatic Pulmonary Sarcomatoid Carcinoma (KCSG LU-19-24)","authors":"Miso Kim ,&nbsp;Jeonghwan Youk ,&nbsp;Tae Min Kim ,&nbsp;Gyeong-Won Lee ,&nbsp;Dong-Wan Kim ,&nbsp;Bhumsuk Keam","doi":"10.1016/j.cllc.2025.10.003","DOIUrl":"10.1016/j.cllc.2025.10.003","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary sarcomatoid carcinomas (PSCs) are rare, aggressive tumors with a poor prognosis. Conventional chemotherapy shows limited efficacy, whereas immune checkpoint inhibitors and doxorubicin have shown potential. This study evaluated the efficacy and safety of durvalumab, doxorubicin, and ifosfamide in recurrent and/or metastatic PSC.</div></div><div><h3>Patients and Methods</h3><div>Patients with recurrent or metastatic PSC received durvalumab (1500 mg, day 1), doxorubicin (20 mg/m² intravenously, days 1-3), and ifosfamide (1.5 g/m² intravenously with mesna, days 2-4) every 3 weeks for up to four cycles, followed by durvalumab monotherapy until disease progression or unacceptable toxicity, for up to 12 months. The primary endpoint was objective response rate (ORR). Secondary endpoints included progression-free survival (PFS), overall survival (OS), duration of response (DOR), and toxicity.</div></div><div><h3>Results</h3><div>The study was prematurely terminated due to low recruitment rates, with 20 patients enrolled (15 male, 5 female; median age: 63.5 years). Among 18 evaluable cases, 16 (88.9%) were programmed death-ligand 1 positive. Six patients (30.0%) had prior palliative chemotherapy. ORR was 35.0% (95% CI, 17.7%-55.8%). The median DOR was 5.3 months (95% CI, 1.7-not estimated). After a median follow-up of 7.0 months (1.2-37.6), the median PFS and OS were 4.8 months (95% CI, 2.0-6.5) and 9.4 months (95% CI, 5.5-26.8), respectively. Adverse events (AEs) occurred in 19 patients, with serious AEs in 10 patients.</div></div><div><h3>Conclusion</h3><div>Durvalumab combined with doxorubicin and ifosfamide suggested clinical activity in recurrent and/or metastatic PSC. Larger studies are warranted to confirm benefits and refine treatment strategies.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"27 3","pages":"Pages 58-64"},"PeriodicalIF":3.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145444126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subcutaneous Delivery of Amivantamab in Patients With Advanced Solid Malignancies: The Phase Ib PALOMA Study","authors":"Anna Minchom ,&nbsp;Byoung Chul Cho ,&nbsp;Natasha B. Leighl ,&nbsp;Melissa L. Johnson ,&nbsp;Joshua Sabari ,&nbsp;Se-Hoon Lee ,&nbsp;Ki Hyeong Lee ,&nbsp;Yu Jung Kim ,&nbsp;Rachel E. Sanborn ,&nbsp;Bert O’Neil ,&nbsp;Kamya Sankar ,&nbsp;Anna Mitselos ,&nbsp;Donna Zemlickis ,&nbsp;Carmel Collins ,&nbsp;Ali Alhadab ,&nbsp;Pamela L. Clemens ,&nbsp;Busola Sanusi ,&nbsp;Eileen Berkay ,&nbsp;Mahadi Baig ,&nbsp;Roland E. Knoblauch ,&nbsp;Matthew G. Krebs","doi":"10.1016/j.cllc.2026.02.001","DOIUrl":"10.1016/j.cllc.2026.02.001","url":null,"abstract":"<div><h3>Purpose</h3><div>Amivantamab is an EGFR-MET bispecific antibody approved as an intravenous formulation for <em>EGFR</em>-mutated advanced non–small cell lung cancer (NSCLC). Intravenous delivery is frequently associated with infusion-related reaction (IRRs), which require adopting slow infusion rates and splitting the first dose over 2 days. The PALOMA study assessed the safety and feasibility of subcutaneous amivantamab administration and identified the formulation and recommended phase II doses (RP2Ds) for multiple dosing schedules.</div></div><div><h3>Patients and Methods</h3><div>PALOMA is a phase Ib dose-escalation study in 158 participants with advanced solid malignancies. Primary objectives included pharmacokinetics, safety, and determining RP2Ds for every-2-week (Q2W), every-3-week (Q3W), and every-4-week (Q4W) administration.</div></div><div><h3>Results</h3><div>The safety profile of subcutaneous amivantamab was largely consistent with intravenous monotherapy; most common toxicities reflected on-target EGFR/MET inhibition. Subcutaneous amivantamab resulted in meaningfully shorter administration time (≤ 10 minutes vs. 2.3 hours for intravenous beyond cycle 3) and lower incidence and severity of IRRs versus historical intravenous data, which eliminates the need for split-dose administration. Pharmacokinetic analyses and population pharmacokinetic modeling/simulation were used to estimate subcutaneous amivantamab RP2Ds of 1600 mg (2240 mg, ≥ 80 kg), 2400 mg (3360 mg, ≥ 80 kg), and 3520 mg (4640 mg, ≥ 80 kg) for Q2W, Q3W, and Q4W schedules, respectively. The observed efficacy was consistent with intravenous amivantamab monotherapy.</div></div><div><h3>Conclusion</h3><div>Subcutaneous amivantamab administration substantially reduced IRRs, obviating the need for prolonged infusions and 2-day split-dosing at first administration. The identified RP2Ds for subcutaneous amivantamab are implemented in ongoing studies evaluating amivantamab regimens in NSCLC, colorectal cancer, and head and neck squamous cell carcinoma.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"27 3","pages":"Pages 259-272.e7"},"PeriodicalIF":3.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147431279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First Frameshift Mutation of ALK in Non-Small Cell Lung Cancer Remaining Sensitive to Alectinib: Case Report","authors":"Xiaoqian Zhai ,&nbsp;Zuoyu Liang ,&nbsp;Cheng Zhen ,&nbsp;Ni Zhai ,&nbsp;Guowei Che ,&nbsp;Qinghua Zhou ,&nbsp;Weiya Wang","doi":"10.1016/j.cllc.2026.01.004","DOIUrl":"10.1016/j.cllc.2026.01.004","url":null,"abstract":"<div><div><ul><li><span>•</span><span><div>Nonrearrangement ALK alterations are rare in NSCLC. As most guidelines focuses on ALK fusions, these variants are often underestimated in routine practice.</div></span></li><li><span>•</span><span><div>Frameshift mutations alone can activate the ALK kinase domain without a canonical fusion. In this case, an exon 19 deletion caused strong Ventana ALK immunoreactivity and a durable response to alectinib.</div></span></li><li><span>•</span><span><div>Comprehensive genomic profiling (NGS-based DNA or RNA) should be considered in any NSCLC patient—especially mixed histology or rapidly progressing disease—when standard fusion assays are negative.</div></span></li><li><span>•</span><span><div>Strong, diffuse Ventana ALK staining predicted alectinib benefit even without an EML4-ALK fusion, supporting its use when sequencing is limited.</div></span></li><li><span>•</span><span><div>The optimal dosing for uncommon ALK variants is undefined. This patient’s tolerance of standard-dose alectinib for over 19 months suggests conventional dosing is appropriate pending further data.</div></span></li><li><span>•</span><span><div>Multidisciplinary discussion is critical. Pathologists, molecular biologists, and oncologists should jointly review discordant results (eg, ALK-IHC+ / FISH-) to avoid missing rare targetable mutations.</div></span></li></ul></div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"27 3","pages":"Pages 240-243.e2"},"PeriodicalIF":3.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147282564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between PD-L1 Expression and Outcomes of Salvage Treatment Following Durvalumab Consolidation","authors":"Tawee Tanvetyanon,&nbsp;Dung-Tsa Chen,&nbsp;Jhanelle E. Gray","doi":"10.1016/j.cllc.2025.10.011","DOIUrl":"10.1016/j.cllc.2025.10.011","url":null,"abstract":"<div><h3>Background</h3><div>Disease progression during or after consolidation treatment with durvalumab, an immune-oncology agent (IO) for non-small cell lung cancer, confers a poor prognosis. Systemic therapy is the mainstay. Currently, standard first-line systemic therapy includes IO; however, in the post-durvalumab setting, it remains unclear if IO should be used again.</div></div><div><h3>Methods</h3><div>We performed an analysis of a nationwide, deidentified database of patients with stage III non-small cell lung cancer who received concurrent chemoradiation, durvalumab consolidation, and salvage systemic therapy. Overall survival, measured from salvage treatment, was compared between salvage IO or IO-based regimens (ie IO regimens) and non-IO regimens. Predictive factor of PD-L1 level was demonstrated by effect modification.</div></div><div><h3>Results</h3><div>Analyses included 104 patients: 49 patients (47%) received salvage IO regimens and 55 (53%) received non-IO regimens. The median overall survival was 12.7 months: 13.4 months with IO regimens versus 9.5 months with non-IO regimens, <em>P</em> = .27. Among patients with PD-L1 &lt; 1% (<em>n</em> = 41), survival was numerically worse with IO regimens than with non-IO regimens: hazard ratio (HR) 1.88 (95% CI, 0.81-4.39, <em>P</em> = .14). However, among those with PD-L1 ≥ 1% (<em>n</em> = 63), survival was better with IO regimens than non-IO regimens: HR 0.48 (95% CI, 0.25-0.93, <em>P</em> = .03). The association between regimens and survival differed by PD-L1 level, <em>P</em>-interaction =.007. Poor performance status and lower socioeconomic index were significant adverse prognostic factors.</div></div><div><h3>Conclusion</h3><div>In post-durvalumab setting, this analysis suggests that salvage IO regimens are superior to non-IO regimens, but only among patients with PD-L1 ≥ 1%.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"27 3","pages":"Pages 135-143"},"PeriodicalIF":3.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145523086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biological Aging and Survival Outcomes in Patients With Advanced Non–Small Cell Lung Cancer Receiving Systemic Therapy","authors":"Suguru Kojima ,&nbsp;Yusuke Inoue ,&nbsp;Masato Karayama ,&nbsp;Dai Hashimoto ,&nbsp;Kazuhiro Asada ,&nbsp;Shun Matsuura ,&nbsp;Shiro Imokawa ,&nbsp;Takashi Matsui ,&nbsp;Hiroyuki Matsuda ,&nbsp;Nao Inami ,&nbsp;Yusuke Kaida ,&nbsp;Jun Sato ,&nbsp;Yasuhiro Ito ,&nbsp;Masato Fujii ,&nbsp;Mikio Toyoshima ,&nbsp;Hideki Yasui ,&nbsp;Yuzo Suzuki ,&nbsp;Hironao Hozumi ,&nbsp;Kazuki Furuhashi ,&nbsp;Noriyuki Enomoto ,&nbsp;Takafumi Suda","doi":"10.1016/j.cllc.2025.10.009","DOIUrl":"10.1016/j.cllc.2025.10.009","url":null,"abstract":"<div><h3>Background</h3><div>Chronological age alone does not adequately capture inter-individual variability in the health status and treatment outcomes of patients with advanced non–small cell lung cancer (NSCLC). Biological age, calculated using routine clinical biomarkers (BioAge), may offer superior prognostic value.</div></div><div><h3>Patients and Methods</h3><div>A retrospective analysis was conducted on 138 patients treated with immune checkpoint inhibitors (ICIs; ICI cohort) and 154 ICI-naïve patients treated with chemotherapy (chemotherapy cohort). BioAge was calculated using chronological age and seven clinical biomarkers. BioAge acceleration (BioAgeAccel) was defined as the residual derived from the linear regression of BioAge on chronological age. The Kaplan–Meier method and Cox proportional hazards model were used for survival analyses. In the ICI cohort, associations with immune-related adverse events (irAEs) development were evaluated using competing risk regression.</div></div><div><h3>Results</h3><div>Higher BioAge (≥79.1 years) was independently associated with shorter overall survival (OS) in both cohorts, whereas chronological age (≥75 years) was not. In the ICI cohort, biologically older patients demonstrated significantly worse OS than biologically younger patients, and BioAgeAccel was an independent prognostic factor. However, the BioAgeAccel was not associated with OS in the chemotherapy cohort. No significant associations were observed between BioAge, BioAgeAccel, or chronological age and the risk of irAEs.</div></div><div><h3>Conclusion</h3><div>Biological age is a robust prognostic factor for advanced NSCLC. BioAgeAccel has additional prognostic value, particularly in the context of immunotherapy. Incorporating biological age metrics into clinical practice may improve patient stratification and support individualized treatment decisions.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"27 3","pages":"Pages 115-126.e5"},"PeriodicalIF":3.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145437467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stereotactic Body Radiotherapy for Early-Stage Non-Small Cell Lung Cancer in Patients Aged 80 Years and Older: A Single-Center Retrospective Cohort Study of Octogenarians and Nonagenarians","authors":"Atsuto Katano,&nbsp;Yosuke Miki,&nbsp;Masanari Minamitani,&nbsp;Subaru Sawayanagi,&nbsp;Hideomi Yamashita","doi":"10.1016/j.cllc.2025.10.010","DOIUrl":"10.1016/j.cllc.2025.10.010","url":null,"abstract":"<div><h3>Background</h3><div>As the global population continues to age, the management of early stage non-small cell lung cancer (NSCLC) in patients aged ≥ 80 years has become increasingly relevant. Stereotactic body radiotherapy (SBRT) is a noninvasive alternative; however, evidence regarding its safety and efficacy in octogenarians and nonagenarians remains limited.</div></div><div><h3>Methods</h3><div>Data of 205 consecutive patients aged ≥ 80 years (median age, 84 years; range, 80-93 years) with early stage NSCLC (clinical T1–2bN0M0, AJCC 8th edition) treated with SBRT between January 2003 and November 2024 were retrospectively analyzed. The patients were stratified into younger (80-85 years) and older (&gt; 85 years) subgroups.</div></div><div><h3>Results</h3><div>With a median follow-up of 32.0 months, the median OS was 74.9 months, and the 1- and 3-year OS rates were 93.9% and 70.7%, respectively. The median PFS was 45.2 months, with 1- and 3-year PFS rates of 83.3% and 55.0%, respectively. The 3-year OS was 69.4% in patients aged 80 to 85 years and 73.5% in those &gt; 85 years. Similarly, the 3-year PFS was 51.7% and 62.1% (<em>P</em> = .289). Multivariate analysis revealed that sex, performance status, pathological confirmation, and biologically effective dose were independent predictors of OS and/or PFS, whereas chronological age was not. Grade ≥ 3 treatment-related toxicity was low (4.4%), with 3.4% experiencing grade ≥ 3 pneumonitis and no fatal adverse events.</div></div><div><h3>Conclusion</h3><div>SBRT proved to be a safe and effective treatment option for early stage NSCLC in patients aged ≥ 80 years, including those aged &gt; 85 years. These findings support the consideration of SBRT in appropriately selected older patients.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"27 3","pages":"Pages 127-134"},"PeriodicalIF":3.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145430564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Performance of Tumor-to-Lymph Node SUVmax Ratio in PET/CT-Guided EBUS-TBNA for NSCLC","authors":"Yasemin Söyler,&nbsp;Ayperi Öztürk,&nbsp;Melahat Uzel Şener,&nbsp;Figen Öztürk Ergür,&nbsp;Arzu Yenilmez,&nbsp;Zeynep Yeşilöz,&nbsp;Aydın Yilmaz","doi":"10.1016/j.cllc.2025.10.005","DOIUrl":"10.1016/j.cllc.2025.10.005","url":null,"abstract":"<div><h3>Background</h3><div>Accurate evaluation of mediastinal and hilar lymph node (LN) is essential in non–small cell lung cancer (NSCLC) management. While PET/CT plays a central role, SUV_max alone is limited by false positives and false negatives. The tumor-to-lymph node SUV_max (T/LN SUV_max) ratio may improve diagnostic accuracy by contextualizing nodal uptake relative to the primary tumor.</div></div><div><h3>Methods</h3><div>This retrospective single-center study analyzed 2469 LNs from 1408 NSCLC patients who underwent both PET/CT and EBUS-TBNA between 2010 and 2021. Sonographic features, including LN size, presence of coagulative necrosis sign (CNS), absence of central hilar structure (CHS), PET/CT findings and cytology results were recorded. Multivariate logistic regression identified independent predictors of malignancy. ROC analysis determined the optimal cut-off value for T/LN SUV_max ratio.</div></div><div><h3>Results</h3><div>Malignant LNs (n = 980, 39.7%) were more likely to be larger size, round in shape, with homogeneous texture, distinct margins, CNS, and lacking CHS (all <em>P</em> &lt; .001). Malignant LNs had significantly lower T/LN SUV_max ratios than benign LNs (1.74 ± 1.45 vs. 4.12 ± 2.46; <em>P</em> &lt; .001). Lower T/LN SUV_max ratio, higher SUV_max, larger size, and absence of CHS were independent predictors of malignancy. A cut-off of 2.10 yielded 79.1% sensitivity, 78.9% specificity, 79% diagnostic accuracy (AUC: 0.838).</div></div><div><h3>Conclusions</h3><div>The T/LN SUV_max ratio is a simple, and reproducible parameter with high diagnostic performance for predicting LN malignancy in PET/CT-guided EBUS-TBNA for NSCLC. Although this was a single-center retrospective study, the large cohort strengthens the reliability of our findings, and a cut-off value ≤ 2.10 may help clinicians prioritize LN sampling.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"27 3","pages":"Pages 76-87.e1"},"PeriodicalIF":3.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145470858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Inter-Fraction Volume Changes and Patient Outcomes from Stereotactic Ablative Radiotherapy for Early-Stage Lung Cancer","authors":"Wilson X. Mai ,&nbsp;Melissa A. Frick ,&nbsp;Scott Jackson ,&nbsp;Sara A. Richter ,&nbsp;Mohammad Hasan ,&nbsp;Tia Cheunkarndee ,&nbsp;Billy W. Loo ,&nbsp;Maximilian Diehn ,&nbsp;Lucas Vitzthum ,&nbsp;Alex Chin ,&nbsp;Noah Kastelowitz ,&nbsp;Michael F. Gensheimer","doi":"10.1016/j.cllc.2025.10.019","DOIUrl":"10.1016/j.cllc.2025.10.019","url":null,"abstract":"<div><h3>Introduction</h3><div>The aim of this study was to investigate the clinical significance of inter-fraction volume changes during stereotactic ablative body radiotherapy (SABR) for early-stage NSCLC. The prevalence and impact on disease control remain poorly studied. This is the largest study examining the association between inter-fraction volume changes during lung SABR and clinical outcomes.</div></div><div><h3>Patients and Methods</h3><div>121 NSCLC patients treated between April 2009 and July 2019 were included. Gross tumor volume (GTV) was calculated from planning-CT, and inter-fraction volumes from cone-beam CT images taken before treatment. Univariable and multivariable linear regression analyzed relationships between volumetric changes and baseline characteristics. Fine–Gray models assessed volume change associations with local, regional, and distant recurrence, considering death as a competing risk.</div></div><div><h3>Results</h3><div>61.9% and 11.1% of tumors demonstrated a &gt; 10% increase and decrease, respectively, in volume from the start to end of treatment. There was a negative correlation between initial tumor volume and inter-fraction volume increase on univariable analysis. Fine–Gray models showed no significant correlation between volume increase and local recurrence but found a negative association between volume increase and regional as well as distant recurrence.</div></div><div><h3>Conclusions</h3><div>Notable radiographic volume changes occurred in over half of lung SABR patients. This phenomenon did not appear to adversely affect local control. Increased radiographic volume correlated with reduced regional and distant recurrence, possibly representing an immune effect. Our findings suggest volume changes are likely a consequence of acute inflammatory reactions rather than tumor growth, and modest PTV expansions may be sufficient for tumor coverage.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"27 3","pages":"Pages 162-169.e3"},"PeriodicalIF":3.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145530427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}