Early Detection, Resection Key to Lung Cancer Survival in Patients With Lymphoma History

Patients with a history of lymphoma who are diagnosed with lung cancer are good candidates for resection surgery, and have higher survival rates when their lung cancer is identified early, according to a new retrospective study.

The research, published in Translational Lung Cancer Research, sheds light on an important issue within the lymphoma community. Advances in chemotherapy and radiotherapy have increased survival rates in patients with lymphoma. Unfortunately, survivors of lymphoma face an increased risk of secondary cancer. In fact, second cancer is the leading cause of death of lymphoma survivors, and the most common solid tumor diagnosis among lymphoma survivors is lung cancer.

While the risk of lung cancer is a known problem among patients with lymphoma, investigators don’t have a firm grasp of the treatment and prognosis of these patients. In an effort to better understand the path forward for such patients, corresponding author Alfonso Fiorelli, MD, PhD, of the University of Campania Luigi Vanvitelli, and colleagues put together a retrospective multi-center study looking at patients who were treated for lymphoma but later were diagnosed with non-small cell lung cancer. The study included 164 patients, of whom 145 underwent lung resection.

Fiorelli told The American Journal of Managed Care^® that the study confirms earlier evidence that survivors of lymphoma should not automatically be excluded from consideration for surgical resection of lung cancer, noting that the surgery is the only curative option for patients with lung cancer.

“Obviously, there are other factors (ie, nutritional status, performance status etc….) not investigated in our study that could affect the survival,” he said in an email. “However, the main concept is that physicians should not avoid resection of lung cancer based only on the previous history of lymphoma.”

Moreover, he said early detection and radical resection of lung cancer were significant survival factors among the patients in his study. Fiorelli said survivors of lymphoma ought to be regularly screened for lung cancer in order to facilitate early treatment and lower the risk of mortality. He said doctors should consider lymphoma survivors to be “high risk” for lung cancer, particularly if a patient has other risk factors like a history of smoking or an age above 55.

“Thus, it is important that physicians promote for these patients close and prolonged follow-up, keeping in mind that latency time between the diagnosis of lymphoma and lung cancer may be more than 10 years, as observed in our study,” he said. “This strategy allows them to diagnose lung cancer at an early stage and to significantly improve survival.”

Fiorelli said he was surprised to find that the presence of active lymphoma was not a significant factor in terms of a patient’s likelihood of surviving lung cancer, though it was a significant factor in overall survival.

“It means that patients with active lymphoma had a higher probability of death from other diseases rather than from lung cancer recurrence,” he said. “Thus, also patients with active lymphoma could achieve reasonable survival after lung resection, but they should be carefully selected for surgery.”

He said factors to be considered when selecting such patients for surgery include the stage of the lung cancer, whether the lymphoma is treatable, and cardio-respiratory function.

Reference

Fiorelli A, D’Andrilli A, Carlucci A, et al. The LuCiLyS study group. Prognostic factors of lung cancer in lymphoma survivors (the LuCiLyS study). Transl Lung Cancer Res 2020;9(1):90-102. doi: 10.21037/tlcr.2019.12.28.