Lung Cancer Frank V. Fossella, MD Ritsuko Komaki, MD Joe B. Putnam, Jr., MD, Editors Springer Fossella_00_FM 8/7/02 09:27 Page i M. D. ANDERSON CANCER CARE S E R I E S Series Editors Aman U. Buzdar, MD Ralph S. Freedman, MD, PhD This page intentionally left blank Fossella_00_FM 8/7/02 09:27 Page iii Frank V. Fossella, MD, Ritsuko Komaki, MD, and Joe B. Putnam, Jr., MD Editors The University of Texas M. D. Anderson Cancer Center, Houston, Texas Lung Cancer Foreword by James D. Cox, MD, Waun Ki Hong, MD, and Jack A. Roth, MD With 34 Illustrations Fossella_00_FM 8/7/02 09:27 Page iv Frank V. Fossella, MD Ritsuko Komaki, MD Joe B. Putnam, Jr., MD Department of Department of Department of Thoracic Thoracic/Head and Radiation Oncology and Cardiovascular Neck Medical Oncology The University of Texas Surgery The University of Texas M. D. Anderson The University of Texas M. D. Anderson Cancer Center M. D. Anderson Cancer Center Houston, TX 77030-4009 Cancer Center Houston, TX 77030-4009 USA Houston, TX 77030-4009 USA USA Series Editors: Aman U. Buzdar, MD Ralph S. Freedman, MD, PhD Department of Breast Medical Immunology/Molecular Biology Oncology Laboratory The University of Texas Department of Gynecologic Oncology M. D. Anderson Cancer Center The University of Texas Houston, TX 77030-4009 M. D. Anderson Cancer Center USA Houston, TX 77030-4009 USA Cover illustration: © Fiona King/Images.com Library of Congress Cataloging-in-Publication Data Lung cancer / editors, Frank V. Fossella, Ritsuko Komaki, Joe B. Putnam. p. ; cm. — (M.D. Anderson cancer care series) Includes bibliographical references and index. ISBN 0-387-95507-0 (s/c :alk. paper) 1. Lungs—Cancer. I. Fossella, Frank V. II. Komaki, Ritsuko III. Putnam, J. B. (Joe Billy), 1953– IV. Series. [DNLM: 1. Lung Neoplasms—therapy. WF 658 L96063 2002] RC280.L8 L76533 2002 616.99(cid:1)424—dc21 2002070465 ISBN 0-387-95507-0 Printed on acid-free paper. ©2003 Springer-Verlag New York, Inc. All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer-Verlag New York, Inc., 175 Fifth Avenue, New York, NY 10010, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or here- after developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no war- ranty, express or implied, with respect to the material contained herein. Printed in the United States of America. 9 8 7 6 5 4 3 2 1 SPIN 10879972 www.springer-ny.com Springer-Verlag New York Berlin Heidelberg Amember of BertelsmannSpringer Science+Business Media GmbH Fossella_00_FM 8/7/02 09:27 Page v F OREWORD The care of patients with cancer has been a multidisciplinary effort throughout the 60-year history of M.D. Anderson Cancer Center. In the early years, cancer care at M.D. Anderson involved primarily the disci- plines of diagnostic imaging, pathology, and a treatment modality. The complexity of these interrelationships has increased at a seemingly expo- nential rate, especially in the last decade. Technological advances, intro- duction of new drugs, improvements in supportive care, and exciting findings in basic and translational research have placed demands on the entire medical team for constant education and coordination. Lung cancer is a leading cause of death from cancer throughout the world. It is by far the leading cause of death in all urbanized countries, and it has rapidly risen in importance in developing countries. An intensely committed group of physicians and laboratory investigators has been gath- ered at M.D. Anderson to treat lung cancer. Their understanding of the dis- eases involved and their commitment to thoughtful, carefully coordinated collaborations in the care of patients with lung cancer are reflected in this monograph, the second volume in the M.D. Anderson Cancer Care Series. The subjects in this book are presented in much the order a patient might perceive events: symptoms and signs, diagnostic imaging, and biopsy and pathologic diagnosis, followed by differing sequences of treat- ment depending upon the particular disease. Surgical resection is the most successful treatment for early cancer of the lung, but efforts to enhance the benefit of surgery with chemotherapy and radiation therapy are also ex- plored. Treatment of advanced cancer of the lung involves, at least, inter- actions between the medical oncologist and the radiation oncologist and often, in the case of non–small cell cancer of the lung, the thoracic surgeon. The distinction was made years ago between small cell carcinoma of the lung, a tumor strikingly responsive to chemotherapy and radiation ther- apy, and non–small cell carcinomas (including squamous cell carcinoma, adenocarcinoma, and large cell carcinoma), which are not very responsive to these treatments. Although the terms “small cell lung cancer”and “non–small cell lung cancer”are preserved for simplicity of expression, important differences in subcategories within these categories are recog- nized and play a role in treatment decisions. The commitment to patient care occurring in the setting of clinical in- vestigations is implied throughout the chapters in this book. With every patient seen, the goal is definitive treatment with curative intent if at all Fossella_00_FM 8/7/02 09:27 Page vi vi Foreword possible. Since the results of current standard treatments are not as suc- cessful as they could be, developments from the laboratory, new ap- proaches to focusing radiations, new drugs, and therapeutic agents de- rived from research in molecular cell biology are an important part of therapeutic considerations for individual patients. Clinical research is es- sential if progress is to be made. By agreeing to enrollment in a protocol, a patient may become a collaborator in this enterprise as well as a recipient of the best available care. The final chapters of Lung Cancerreflect important new initiatives. The first is prevention and early detection. The final chapter suggests the bases for future translations into clinical practice. The interplay and coordination among all of the physicians and labora- tory investigators contributing to this monograph cannot be overempha- sized. There are few, if any, other types of cancer that call for such broad understanding and technological expertise among the many physicians involved as does lung cancer. The expertise and commitment the con- tributing physicians and scientists bring to this treatise reflect only a part of the commitment they bring to the care of their patients. James D. Cox,MD Waun Ki Hong,MD Jack A. Roth,MD Fossella_00_FM 8/7/02 09:27 Page vii P REFACE It is estimated that 450,000 people in the United States will die of lung can- cer and other tobacco-related disorders this year. The relationship be- tween smoking and lung cancer is inarguable. It is strongly believed that changes in population behavior could in time almost eliminate this di- sease, and efforts to bring about such changes remain a challenge for those involved with public policy. In contrast to efforts in breast cancer prevention, which have demon- strated that antiestrogens are effective in reducing the risk of disease de- velopment in high-risk women, attempts to identify pharmacologic inter- ventions effective in secondary prevention of lung cancer have thus far met with little success. There remains, however, a strong interest in this area, and anumber of novel agents are currently being tested in clinical trials. The combined-modality treatment approach has resulted in modest gains in the survival of lung cancer patients. Specifically in locally ad- vanced disease, neoadjuvant systemic therapy followed by local thera- pies, including surgery and radiation therapy, has had a favorable impact on disease-free and overall survival. The availability of novel cytotoxic agents and drugs with substantial antitumor activity as well as target- specific biologics has the potential to further favorably alter the prognosis of lung cancer patients. This volume reflects M. D. Anderson Cancer Center’s commitment to the multidisciplinary disease-oriented approach—an approach that has evolved here over a number of years and is contributing to the progress in patient outcomes. We would like to thank the volume editors—Dr. Frank V. Fossella, Dr. Ritsuko Komaki, and Dr. Joe B. Putnam, Jr.—for their sig- nificant efforts in putting this book together. This volume is a tribute to their continued dedication, as well as that of the faculty in their depart- ments, to a resolution of the lung cancer problem. We would also like to thank the Department of Scientific Publications for their assistance with this volume, especially Walter Pagel for helping develop the series, Stephanie Deming for editing the manuscript, and Leigh Fink for editorial assistance, including help with permissions and illustrations. Aman U. Buzdar, MD Ralph S. Freedman,MD, PhD This page intentionally left blank Fossella_00_FM 8/7/02 09:27 Page ix C ONTENTS Foreword v James D. Cox, Waun Ki Hong, and Jack A. Roth Preface vii Contributors xi Chapter 1 Implementation of Multidisciplinary Care in the Treatment of Patients with Lung Cancer 1 Joe B. Putnam, Jr., Frank V. Fossella, and Ritsuko Komaki Chapter 2 Clinical Examination of Patients with Suspected Lung Cancer 25 Frank V. Fossella Chapter 3 Thoracic Imaging Techniques for Non–Small Cell and Small Cell Lung Cancer 35 Reginald F. Munden and Jeremy J. Erasmus Chapter 4 Pathologic Evaluation of Lung Cancer 57 Pheroze Tamboli and Jae Y. Ro Chapter 5 Role of Clinical Practice Guidelines and Clinical Pathways in the Treatment of Patients with Lung Cancer 81 Yvette De Jesus and Garrett L. Walsh Chapter 6 Treatment of Early-Stage Non–Small Cell Carcinoma of the Lung 101 W. Roy Smythe