Advances in lung cancer?

Our plain-English summary of Advances in lung cancer?, by A.S. Teirstein (Environmental Research, 1992).

The study

• Author: A.S. Teirstein
• Journal: Environmental Research
• Published: 1992;59(1):145-9
• Read it: PubMed · Publisher

Abstract

Selikoff was among the first to emphasize the etiologic role of cigarette smoking and asbestos exposure in lung cancer. Recent reports suggest that aggressive chemotherapy and radiotherapy combined with surgery have improved the prognosis in lung cancer. The outcome of 100 patients with non-small-cell lung cancer (NSCLC) seen in 1979-1980 was compared with the outcome of 100 patients seen in 1989-1990. The two groups consisted of consecutive patients with proven NSCLC who were referred to a pulmonary consultant. In 28 of the earlier patients and 38 of the later group the cancers were completely resectable. Only 12 of the 1979-1980 group have been cured of their cancer, while 25 of the 1989-1990 are free of cancer during the less than 2-year follow-up period. It can be assumed that this number will diminish with time. Current treatment of NSCLC with surgical resection, chemotherapy, and radiotherapy has done little to improve the prognosis of lung cancer in the past 10 years. As stressed by Selikoff, the best available current method for control of lung cancer is prevention.

In plain English

This article compared two groups of 100 consecutive patients with non-small-cell lung cancer (NSCLC) from the author's private practice, seen in 1979-1980 and in 1989-1990. It did this by reviewing their records and was not a controlled study. Before surgery, 51 earlier and 59 later patients were thought to have fully removable cancers. At surgery, the cancer was completely removed in 28 and 38, respectively. Of these, 16 of 28 in the earlier group and 13 of 38 in the later group later showed spread or a second NSCLC. That left 12 earlier patients considered "cured" and 25 later patients free of cancer, though the later group had been followed for less than 2 years. In all, 87 earlier and 91 later patients were smokers or former smokers. Nine men in the earlier group and 8 in the later group had a history of occupational asbestos exposure, which the article did not analyze further. The author called the study scientifically flawed but concluded that the outlook for NSCLC remained poor and that prevention was the best treatment.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Uncontrolled review of records from the author's private practice, comparing two series of 100 consecutive patients seen about 10 years apart
• Who was studied: Two groups of 100 consecutive patients with tissue- or biopsy-confirmed non-small-cell lung cancer. The first group was seen over about 24 months including 1979 and 1980 (67 men; mean age 62). The second was seen over 14 months covering the last 2 months of 1989 and all of 1990 (53 women; mean age 57). Outcome data were available for 89 of the first group and 98 of the second.
• Exposure: The comparison was between treatment eras: surgery, radiotherapy and/or chemotherapy around 1979-1980 versus 1989-1990. Smoking history and occupational asbestos exposure were recorded. 87 of the first group and 91 of the second were smokers or former smokers. Nine men in the first group and 8 men in the second had occupational asbestos exposure. No fiber types or doses were given.
• Main results:
  • Before surgery, 51 patients in the 1979-1980 group and 59 in the 1989-1990 group were presumed resectable. At surgery the cancer had spread to mediastinal lymph nodes or pleura in 23 of the 51 and 21 of the 59.
  • The cancer was completely resected in 28 patients of the 1979-1980 group and 38 of the 1989-1990 group.
  • Among completely resected patients in the 1979-1980 group, 16 of 28 later showed spread or a second NSCLC.
  • Among the 38 completely resected patients in the 1989-1990 group, 11 had metastatic disease and 2 had a second NSCLC during the shorter follow-up.
  • 12 of the 1979-1980 group were considered cured. 25 of the 1989-1990 group were free of cancer after less than 2 years of follow-up.
  • In the earlier group, 72 patients had died, 11 from causes unrelated to NSCLC. In the recent group, 40 had died, all but one from metastatic NSCLC.
  • 87 of the 100 patients in the earlier group and 91 of the 100 in the recent group were smokers or former smokers.
• The authors' conclusion: The author concluded that the overall prognosis of NSCLC remained poor in both groups. The author also concluded that, given current treatment, the best treatment for NSCLC is prevention, pointing to Selikoff's studies of smoking and asbestos exposure.
• Limitations the authors state:
  • The author described the study as scientifically flawed: it was not controlled, and important data were missing or unreliable.
  • Patients were not compared by stage or cell type of NSCLC.
  • Postoperative follow-up was done by many different physicians.
  • 11 of the original 100 patients and 2 of the recent 100 were lost to follow-up.
  • Follow-up of the later group was less than 2 years, and the author expected its number of cancer-free patients to fall.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: Lung Cancer, Asbestos Exposure, Chemotherapy, Prognosis, Surgical Resection.

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