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Ann Thorac Surg 2004;77:1503-1504
© 2004 The Society of Thoracic Surgeons

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Correspondence

Limited resection of non–small cell lung cancer: should brachytherapy be indicated in all cases?

Division of Surgery, Toneyama National Hospital, 5-1-1, Toneyama, Toyonaka, Osaka 560-8552, Japan

e-mail: nsawabata{at}m5.dion.ne.jp

To the Editor:

Lee and colleagues [1] discussed the impact of implanting iodine-125 seeds along the resection margin in patients who had undergone limited resection for lung cancer. They concluded that this combined treatment achieved acceptable survival and local control in the majority of compromised patients with stage IA disease.

We believe that radiotherapy can control local recurrence at the surgical margin. However, surgical margin relapses occur only at malignant cell–positive surgical margins [2, 3]. Because there was no information on the ratio of positive to negative surgical margins in the study of Lee and associates, it is difficult to gauge the potential to reduce the number of recurrences at the margins. This point arises because in a small series of patients, 2 patients had surgical margin relapses even though they underwent brachytherapy.

It is very easy to evaluate the malignant status of the surgical margin. Only two slides are required when using our run-across method. Tissue is collected from the margin with one slide and then spread over the other [4]. We recommend that the run-across method be used in a prospective, randomized multicenter clinical trial to accurately validate the results of radiotherapy and to find out how many patients truly benefit from this treatment.

References

1. Lee W., Daly B.D.T., DiPetrillo T.A., et al. Limited resection for non–small cell lung cancer: observed local control with implantation of I-125 brachytherapy seeds. Ann Thorac Surg 2003;75:237-243.[Abstract/Free Full Text]
2. Sawabata N., Matsumura A., Ohota M., et al. Cytologically malignant margins of wedge resected stage I non-small cell lung cancer. Ann Thorac Surg 2002;74:1953-1957.[Abstract/Free Full Text]
3. Higashiyama M., Kodama K., Takami K., Higaki N., Nakayama T., Yokouchi H. Intraoperative lavage cytologic analysis of surgical margins in patients undergoing limited surgery for lung cancer. J Thorac Cardiovasc Surg 2003;125:101-107.[Abstract/Free Full Text]
4. Sawabata N., Mori T., Iuchi K., Maeda H., Ohta M., Kuwahara O. Cytologic examination of surgical margin of excised malignant pulmonary tumor: methods and early results. J Thorac Cardiovasc Surg 1999;117:618-619.[Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Noriyoshi Sawabata Masayoshi Inoue Shin-ichi Takeda Hajime Maeda Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Sawabata, N. Articles by Maeda, H. Search for Related Content PubMed Articles by Sawabata, N. Articles by Maeda, H. Related Collections Lung - cancer