The broadest mission of these Conferences is the collective pursuit of avant-garde understanding of the issues surrounding screening for lung cancer, the broadest subissues being early diagnosis and early intervention. Any given Conference focuses on issues that are particularly topical at the time.
As always, we provide an update on research and practice of screening for lung cancer. In the prior conferences, the diagnostic component of screening has been emphasized in order to gain further understanding of the relevant issues. This focused effort has resulted in the development of the I-ELCAP diagnostic protocol. The radiologic component of this protocol has had wide acceptance by a large number of institutions. The pathologic component has also been developed and according to its specifications, an Expert Pathology Panel has reviewed more than 100 screen-diagnosed and resected cases and these results will be reported.We then turn our focus on the prognosis of these screen-diagnosed cancers -- that is, their significance in terms of their course without and with treatment. Further topics include treatment alternatives and their future evaluation.
Given the continuing and rapid spread of experimental CT screening for lung cancer, this conference focused on small, early lung cancers which are diagnosed, their radiologic, cytologic, and histologic characteristics as well as their natural history and treatment options. The Expert Pathology Panel review of screen-diagnosed cancers stressed that these, including ones found on baseline screening, do indeed show local vascular, pleural and/or lymphatic invasion. On the other hand, an extensive Japanese surgical experience on a subtype of cancer quite unique to CT screening at baseline showed no detectable lymph node involvement, and excellent survival; therefore, relatively conservative treatment might well be considered for these. The conference also focused on community outreach in providing access to screening for people who have not traditionally participated in medical studies.
The I-ELCAP Advisory Board continued its efforts to ensure inclusive and productive collaborations of the I-ELCAP with all interested organizations, specifically the EU/US collaboration, the American College of Radiology Imaging Network (ACRIN) and the National Cancer Institute's National Lung Screening Trial (NLST).
Two workshops were held. One of them focused on treatment options for small early lung cancers. The consensus was that for cancers in solid and part-solid nodules there is no role for nonsurgical treatments at present. Clinical studies comparing lobectomy with limited resection are encouraged; some are already being done in Japan. In these studies, attention needs to be given to growth rates, lymph node involvement and other particulars of the cancer for better understanding of the relative merits of the surgical options.
As for cancer presenting in CT images as one or more non-solid nodules (no solid component) and diagnosed from biopsy specimen, it was felt that research on alternatives to surgery should be developed. The suggested alternatives included: 1) observation at regular intervals for growth or development of a solid component; 2) similar observation under chemotherapy/chemoprevention with well-tolerated agents; and 3) wedge resection.
Accordingly, two new subcommittees were formed. Each will be co-chaired and will develop a first draft protocol by January 31, 2003 and a second draft by March 31, 2003; both submitted to the I-ELCAP chair. The draft protocols will be discussed in the workshop at the next I-ELCAP conference.
The development of a registry of unresected cases of diagnosed early lung cancer had been discussed at the previous conference in April 2002, and a subcommittee had been formed. Individuals interested in the development of the registry had identified existing registries throughout the world. It was now decided to focus on a limited number of the larger 'registries' as the primary sources of these cases. Initial candidates included the Anti Lung Cancer Association (ALCA) in Japan, Surveillance , Epidemiology and End Results (SEER) registry in the US, Veterans Administration, the Florida Cancer Data System (FACS) located at the University of Miami, and Provincia of Latina Population Registry which is the regional registry of Rome. The goal is to accrue at least 100 cases of untreated Stage I cancer, less than 10 mm in diameter and diagnosed either by screening or incidentally. Additional, prospective collection of such cases from the participating I-ELCAP institutions is sought. Documentation will include symptoms (if any) at time of diagnosis, diagnostic work-up and subsequent course either to manifest metastatic spread or absence of this for at least 10 years. The registry will provide information on the frequency of overdiagnosis in various subcategories of diagnosed small, early lung cancer, as well as on the natural history of genuine cancers of this type.
The scientific presentations on Saturday stimulated much discussion and were felt to be an important part of the meeting.
Subcommittee on the treatment of cancer in a solid nodule:
Chairs: Nasser Altorki (thoracic surgery, New York, NY), Fred Grannis (thoracic surgery, Los Angeles, CA), Harubumi Kato (thoracic surgery, Tokyo, Japan)
Members: Hisao Asamura (thoracic surgery, Tokyo, Japan), Elizabeth Brambilla (pathology, Grenoble, France), Pierre Yves Brichon (thoracic surgery, Grenoble, France), Francesco Facciolo (thoracic surgery, Rome, Italy), Douglas Flieder (pathology, New York, NY), Fred Hirsch (oncology, Denver, CO), Daniel Libby (pulmonology, New York, NY), Harvey Pass (thoracic surgery, Detroit, MI), Roman Perez-Solar (oncology, New York, NY), Michael Smith (thoracic surgery, Atlanta, GA), Richard Thurer (thoracic surgery, Miami, FL)
Subcommittee on treatment of cancer in a non-solid nodule:
Chairs: Christian Brambilla (pulmonology, Grenoble, France), James Mulshine (oncology, Bethesda, MD), Mark Pasmantier (oncology, New York, NY)
Members: Andrew Dannenberg (oncology, New York, NY), Yoshihiro Matsuno (cytology, Tokyo, Japan), Dattatreyudu Nori (radiation oncology, New York, NY), James P. Smith (pulmonology, New York, NY), Melvyn S. Tockman (pulmonology, Tampa, FL), Michael Unger (pulmonology, Philadelphia, PA), Madeline Vazquez (cytology, New York, NY), David Yankelevitz (radiology, New York, NY), Junji Yoshida (thoracic surgery, Kashiwa City, Japan)
Subcommittee on registry of diagnosed small lung cancers:
Chairs: Hisao Asamura (thoracic surgery, National Cancer Center of Japan), David Yankelevitz (radiology, New York, NY), Junji Yoshida (thoracic surgery, Kashiwa City, Japan)
Members: Nathaniel Berlin (internal medicine, Miami, FL), Ettore Maria Conti (epidemiology, Rome, Italy), Kenji Eguchi (pulmonology, Tokyo, Japan), Salvatore Giunta (radiology, Rome, Italy), Olli S. Miettinen (epidemiology, Montreal, Canada), Melvyn S. Tockman (pulmonology, Tampa, FL), James P. Smith (pulmonology, New York, NY), Tomotaka Sobue (epidemiology, Tokyo, Japan), Shusuke Sone (radiology, Nagano, Japan).