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Mark J. Krasna
Carolyn E. Reed
William C. Nugent
Jemi Olak
David J. Sugarbaker
Leslie J. Kohman
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Ann Thorac Surg 1999;68:201-207
© 1999 The Society of Thoracic Surgeons

Original Articles

Lung cancer staging and treatment in multidisciplinary trials: cancer and leukemia group B cooperative group approach1

Mark J. Krasna, MDa, Carolyn E. Reed, MDa,b,c,d,e,f,g, William C. Nugent, MDa,b,c,d,e,f,g, Jemi Olak, MDa,b,c,d,e,f,g, David J. Sugarbaker, MDa,b,c,d,e,f,g, Mark R. Green, MDa,b,c,d,e,f,g, Leslie J. Kohman, MDa,b,c,d,e,f,g, for the Thoracic Surgeons of CALGB

a Division of Thoracic Surgery, University of Maryland Medical School, Baltimore, Maryland, USA
b Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
c Division of Cardiothoracic Surgery, Dartmouth University, Hanover, New Hampshire, USA
d Lutheran General Hospital, Park Ridge, Illinois, USA
e Division of Thoracic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
f Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
g Division of Cardiothoracic Surgery, State University of New York, Syracuse, New York, USA

Address reprint requests to Dr Krasna, Division of Thoracic Surgery, N4W94, University of Maryland Hospital, 22 South Greene St, Baltimore, MD 21201
e-mail: mkrasna{at}surgery1.ab.umd.edu

Background. Aggressive routine surgical staging is necessary to evaluate patients to be treated on cooperative oncology protocols. Less than 1% of lung cancer patients in the United States are currently being treated in a clinical trial. Only with results from large, prospective trials can the questions of neoadjuvant and adjuvant therapy be answered.

Methods. An outline describing the schema of preoperative patient evaluation, surgical staging, and the definition of surgical staging and resection procedures appropriate for patients considered for cooperative group protocol is presented. Current Cancer and Leukemia Group B (CALGB) protocols are used in the discussion as examples of this systematic approach.

Conclusions. Over the next few years, it will be important to enter the maximum number of patients into combined modality studies to identify the role of neoadjuvant treatment in lung cancer. Entry of patients into protocols will also make their pathological specimens and clinical information available for basic science research related to treatment results. Adherence to a logical sequence of patient evaluation as outlined above will optimize patient care, as well as accrual to cooperative group studies.




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