Seminars in respiratory and critical care medicine
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Semin Respir Crit Care Med · Dec 2013
ReviewAdvances in surgical techniques in non-small cell lung cancer.
Thoracic surgery is a dynamic field, and many scientific, technological, technical, and organizational changes are occurring. A prominent example is the use of less invasive approaches to major resection of non-small cell lung cancer (NSCLC), both thoracoscopic and robotic. Sophisticated technology corroborated by clinical data has led to these approaches becoming accepted additions to the armamentarium. ⋯ Lung cancer is being detected more often at an early stage. At the same time, advances in techniques, patient care, clinical science, and multidisciplinary treatment support an increased role for aggressive resection in the face of larger locally advanced tumors or for those with limited metastatic disease. These advances, conducted in the setting of multidisciplinary decision making, have resulted in real and palpable advancements for patients with lung cancer.
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Semin Respir Crit Care Med · Dec 2013
ReviewPersonalizing therapy in advanced non-small cell lung cancer.
The recognition that non-small cell lung cancer (NSCLC) is not a single disease entity, but rather a collection of distinct molecularly driven neoplasms, has permanently shifted the therapeutic landscape of NSCLC to a personalized approach. This personalization of NSCLC therapy is typified by the dramatic response rates seen in EGFR mutant NSCLC when treated with targeted tyrosine kinase inhibitor therapy and in ALK translocation-driven NSCLC when treated with ALK inhibitors. ⋯ The identification of these oncogenic drivers and the triage of patients to clinical trials evaluating novel targeted therapeutic approaches will increasingly mold a landscape of personalized lung cancer therapy where each genotype has an associated targeted therapy. This review outlines the state of personalized lung cancer therapy as it pertains to individual NSCLC genotypes.
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The number of solitary pulmonary nodules (SPNs) detected each year is expected to increase dramatically with the implementation of lung cancer screening. Although some will have radiographic features highly specific for benignity, the rest are considered indeterminate and require further investigation. The management options include continued surveillance or immediate diagnostic sampling. ⋯ Surgical methods are preferred in SPNs with high probability of malignancy because they provide both a definitive diagnosis and treatment in a single procedure. In contrast, when the probability of malignancy is low to moderate nonsurgical sampling is preferred. The following is a review of the diagnostic management options available when approaching an SPN.
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Semin Respir Crit Care Med · Dec 2013
ReviewStereotactic Ablative Radiotherapy (SABR) for Non-Small Cell Lung Cancer.
Stereotactic ablative radiotherapy (SABR), otherwise known as stereotactic body radiation therapy (SBRT), is an external beam treatment modality that offers the ability to deliver with high precision large doses of radiation over a limited number of fractions. SABR is currently a standard of care in the treatment of early-stage primary non-small cell lung cancers (NSCLCs) that are medically inoperable and for metastases in many anatomical locations. ⋯ However, randomized comparisons have not been completed to assess survival in operable patients. This review summarizes the advanced technology and radiation concepts that have helped clinicians optimize the use of stereotactic ablative therapies for lung cancer, with an emphasis on the rationale for future continued use of this advanced treatment modality.
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Semin Respir Crit Care Med · Dec 2013
ReviewImmunotherapy in lung cancer: "b7-bombers" and other new developments.
Several recent immunotherapy agents have exhibited exceptional activity, and their eventual approval for use in lung cancer appears plausible. The immune checkpoint proteins, such as the B7 superfamily, are becoming increasingly relevant targets for therapeutic inhibition. ⋯ Several vaccine trials are accruing more patients than any previous lung cancer trials and are designed to select a specific population based on a predefined, scientifically justified biomarker. These emerging immune treatments may hold great potential for the systemic treatment of lung cancers.