Cleveland Clinic journal of medicine
-
The goal of screening is to detect disease at a stage when cure or control is possible, thereby decreasing disease-specific deaths in the population. Many studies have attempted to demonstrate that lung cancer screening using chest radiography or computed tomography (CT) identifies patients with lung cancer and reduces cancer-related mortality. Until recently, there was no evidence confirming a reduction in disease-specific mortality with screening. ⋯ Lead-time, length-time, and overdiagnosis biases may each have an impact on screening studies reporting survival as an outcome. In this past year, the National Lung Screening Trial reported a significant reduction in cancer-related mortality as a result of screening with chest CT imaging. This will shape the direction of future screening programs.
-
Review Case Reports
Video-assisted thoracoscopic surgery for the treatment of lung cancer.
A growing proportion of lung resections is being performed by video-assisted thoracoscopic surgery (VATS). VATS lobectomy is indicated for clinical stage I suspected lung cancer with pulmonary function sufficient to tolerate resection. ⋯ A potential oncologic benefit of VATS lobectomy (over thoracotomy) has been proposed through attenuation of postoperative cytokine release. Regardless of whether VATS or an open approach is utilized, thorough lymphadenectomy is important and may confer an additional survival benefit.
-
Personalized targeted therapy for advanced non-small cell lung cancer (NSCLC) primarily relies on the concept of "oncogene addiction," in which multiple genetic abnormalities are addicted to one or a few genes for tumor cell maintenance and survival. Several molecular aberrations have been identified in NSCLC, with subsequent development of drugs targeted to these aberrations; gefitinib, erlotinib, and cetuximab for the treatment of NSCLC harboring epidermal growth factor receptor mutation or overexpression, and crizotinib for the treatment of NSCLC with the EML4-ALK fusion translocation oncogene being some examples. ⋯ Cellular heterogeneity within an oncogene-addicted tumor can cause resistance to targeted therapy after an initial response. As our understanding of tumor heterogeneity and tumor resistance mechanisms evolves, more rational therapies and combinations of therapies can be expected.
-
Surgical resection for patients with stage I non-small cell lung cancer (NSCLC) produces high long-term survival rates, but many patients are ineligible for surgery because of medical comorbidity or other factors. Stereotactic body radiotherapy (SBRT) is the standard of care for patients with medically inoperable stage I NSCLC. Studies have reported local control rates with SBRT of about 95% when an adequate radiation dose is used. ⋯ On average, lung function tests reveal little or no change from baseline, although individual patients may exhibit changes in pulmonary function after treatment. Most studies report pneumonitis rates of 0% to 5%. Ongoing clinical trials are investigating single-fraction SBRT and evaluating the maximal tolerated dose for centrally located tumors.
-
Various techniques, including standard bronchoscopy, transthoracic needle aspiration and mediastinoscopy, are used for diagnosis and staging of lung cancer. Minimizing the number of invasive procedures for lung cancer diagnosis and staging is preferred, however, and a growing number of bronchoscopic techniques are being used. Currently available techniques for the initial diagnosis of lung cancer include electromagnetic navigation bronchoscopy with computed tomography mapping and sample collection, endobronchial ultrasound (EBUS) using radial or convex probe tips, and the combination of the two approaches. ⋯ Several studies have demonstrated the utility of this approach for less invasive lung cancer mediastinal staging. EBUS-TBNA has also been used in the collection of tissue samples for the analysis of tumor biomarkers that significantly influence the selection of cancer treatment strategies. Evidence suggests that EBUS-TBNA may be less useful for restaging patients with lung cancer after cytotoxic therapy.