For stage III non-small cell lung cancer (NSCLC), approximately a third of patients survive up to 5 years, with decreasing 5-year survival rates for stage IIIB and stage IIIC disease. Although curable, stage III NSCLC encompasses a diverse range of disease presentation, with an equally complex range of multi-modal treatment options, including systemic and local therapies for distant and local disease control, respectively. This complexity results in a number of challenges for the multi-disciplinary team (MDT) in achieving optimal treatment outcomes for patients. As multi-modality treatment is the preferred treatment strategy for all stage III disease, the focus of this article is the key surgical, chemotherapy and radiotherapy clinical trials as well as guidelines that currently outline radical therapy options for patients with both potentially resectable and unresectable stage III NSCLC.

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The current treatment landscape in the UK for stage III NSCLC.

Pharmacological thromboprophylaxis in mechanically ventilated cancer patients in the intensive care unit: lower than expected

Aim-Background
During the staging process of lung cancer, accurate mediastinal lymph node staging is one of the more important factors to affect patient outcome. Accurate staging of the disease is important not only in determining prognosis but also in deciding the optimal treatment plan. The most significant treatment decision is establishing which patients can benefit from surgical resection and which should receive chemotherapy, radiation, or both. This paper reviews indications and current data regarding minimally invasive approaches for diagnosis and staging of lung cancer. In addition, current advances in diagnostic endoscopy for lung cancer will be reviewed.

Invasive techniques in diagnosis and staging of lung cancer

Cancer is a major public health problem worldwide and the second leading cause of death in the United States of America (USA), following heart disease. Male lung cancer death rates are decreasing in the western world and increasing in China and several other countries in Asia and Africa. Female lung cancer death rates are increasing worldwide, with the exception of the USA, Canada and Australia. Differences in lung cancer incidence patterns between men and women reflect historical differences in tobacco use. Staging of cancer at the time of diagnosis is the most important predictor of survival, and treatment options should be based on the stage. The aim of this overview is to discuss the changes in the 8th Edition of the TNM (Tumor, Nodes, Metastasis) Classification of lung cancer and its impact on predicting patient prognosis. Potential limitations of the classification system and future directions are discussed. A systematic literature search was performed to identify relevant reports. Studies and articles were identified using several online searches of the U.S. National Library of Medicine via www.pubmed.com. The article is based on the International Association for the Study of Lung Cancer (IASLC) Staging and Prognostic Factors Committee report. An international lung cancer database was developed from 35 sources in 16 countries around the globe, with staging and outcome data on 94,708 cases of lung cancer. This new edition of lung cancer TNM staging placed additional emphasis on tumor size, and size cut-off points have been added, which will now be a descriptor in all TNM categories. For the first time a new term was introduced, defined as minimally invasive adenocarcinoma. The additional cut-off point changes will definitely alter treatment recommendations in the future. The node classification remained unchanged in the new edition. Regarding metastasis, M1a refers to cases with intrathoracic metastases, M1b cases with a single metastasis outside the thoracic cavity. The situation involving multiple metastatic deposits, usually in more than one organ, is now classified as M1c. The new staging of lung cancer is based on analysis of survival in large databases, based on tumor size and disease proliferation, and is therefore expected to assess the prognosis of the individual patient more accurately. Based on the current edition of the TNM staging system many patients will be given a different staging category,. It is evident that improved survival may reflect the expected improvements in diagnosis and treatment, the net effect being a stage-for-stage survival increase at all stages. This 8th edition of the TNM classification for lung cancer has placed additional emphasis on tumor size.

Comments on the eighth edition of the TNM classification for lung cancer. Radical changes and limitations: Does size matter?

Aim-Background
The aim of this study was to evaluate the complications after major pulmonary resections for lung cancer and identify the risk factors associated with the occurrence of complications. We studied risk factors related to both clinical and laboratory characteristics of patients and those related to tumour stage, histology and type of surgery.

Complications after major pulmonary resections for lung cancer: A prospective study

Technical advances during the 20th century have drastically revolutionized surgical practice, as a result of which minimally invasive procedures have gained rapid diffusion. The term video-assisted thoracic surgery is used to describe a modern minimally invasive surgical technique that nowadays represents a valid alternative to open procedures for many chest diseases. This paper reviews indications and current data regarding minimally invasive surgical approaches for diagnosis, staging and treatment of lung cancer. A systematic literature search was performed to identify relevant reports. Studies and articles were identified using online searches of The U.S. National Library of Medicine via www.Pubmed.com
 . We limited the bibliographic search to include only articles from 2006 onward. The thoracoscopic approach is currently considered the gold standard for the evaluation and treatment of suspected or known pleural effusion and in the diagnosis of indeterminate pulmonary nodules, and it has a complementary role to cervical mediastinoscopy in the invasive staging of mediastinal lymph nodes. It has also become an accepted approach for resection of peripheral early-stage lung cancer (stage I). Its role continues to evolve in the management of lung cancer. Major lung resections should be considered as one of the most complex and challenging operations to be performed thoracoscopically. The impact of thoracoscopic lobectomy, however, remains unclear, and it is far from achieving widespread use. Mediastinoscopy has remained the ‘gold standard’ in invasive staging tests of the mediastinum. The classic way of invasively assessing the aortopulmonary window is a Chamberlain procedure, also known as an anterior mediastinotomy.

Minimally invasive surgical techniques in diagnosis and treatment of lung cancer

Aim-Background
Lung cancer is the most common cause of cancer death in both men and women in our country. It has been estimated that there will be 7,000 lung cancer deaths every year in Greece. However, many patients with bronchogenic carcinoma also have coexistent obstructive lung disease. In these patients, preoperative prediction of functional status after lung resection is mandatory. The aim of our study was to determine the effect of lobectomy on postoperative spirometric lung function.

K. N. Syrigos

Papers

Minimally invasive surgical techniques in diagnosis and treatment of lung cancer

Invasive techniques in diagnosis and staging of lung cancer

Comments on the eighth edition of the TNM classification for lung cancer. Radical changes and limitations: Does size matter?

Complications after major pulmonary resections for lung cancer: A prospective study

Prediction of pulmonary function after lobectomy