Special Treatment Issues in Non-small Cell Lung Cancer: Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
TL;DR: This guideline updates the second edition and addresses patients with particular forms of non-small cell lung cancer that require special considerations, including Pancoast tumors, T4 N0,1 M0 tumors, additional nodules in the same lobe, ipsilateral different lobe, synchronous and metachronous second primary lung cancers, solitary brain and adrenal metastases, and chest wall involvement.
About: This article is published in Chest.The article was published on 2013-05-01. It has received 277 citations till now. The article focuses on the topics: Pneumonectomy & Lung cancer.
Citations
More filters
University of Turin1, Aix-Marseille University2, University Hospital of South Manchester NHS Foundation Trust3, National Health Service4, University of Ljubljana5, Karolinska University Hospital6, Centre Hospitalier Universitaire de Grenoble7, University of Aberdeen8, The Royal Marsden NHS Foundation Trust9, VU University Medical Center10, University of Salamanca11, Katholieke Universiteit Leuven12, University Hospital of Lausanne13
TL;DR: The ESMO Guidelines Committee concluded that current state-of-the-art oncology practices in France, Belgium, and the Netherlands are suitable for frontline use and recommend further research into these practices.
2,349 citations
University of Alabama at Birmingham1, University of South Florida2, Vanderbilt University3, City of Hope National Medical Center4, Fox Chase Cancer Center5, University Of Tennessee System6, Brigham and Women's Hospital7, Seattle Cancer Care Alliance8, Case Western Reserve University9, Roswell Park Cancer Institute10, Northwestern University11, Harvard University12, University of Nebraska Medical Center13, University of Utah14, Memorial Sloan Kettering Cancer Center15
TL;DR: This manuscript focuses on the NCCN Guidelines Panel recommendations for the workup, primary treatment, risk reduction strategies, and surveillance specific to DCIS.
Abstract: Ductal carcinoma in situ (DCIS) of the breast represents a heterogeneous group of neoplastic lesions in the breast ducts. The goal for management of DCIS is to prevent the development of invasive breast cancer. This manuscript focuses on the NCCN Guidelines Panel recommendations for the workup, primary treatment, risk reduction strategies, and surveillance specific to DCIS.
1,545 citations
TL;DR: Surgical resection remains the primary and preferred approach to the treatment of stage I and II NSCLC, and mediastinal lymph node sampling at the time of curative intent surgical resection can be performed without increased morbidity.
1,180 citations
TL;DR: Recommendations for evaluation and management of individuals with solid pulmonary nodules and those with nonsolid nodules are formulated by using the methods described in the "Methodology for Development of Guidelines for Lung Cancer" in the American College of Chest Physicians Lung Cancer Guidelines, 3rd ed.
927 citations
University of Washington1, University of Michigan2, University of Tennessee Health Science Center3, University of Texas MD Anderson Cancer Center4, Johns Hopkins University5, Northwestern University6, Brigham and Women's Hospital7, University of South Florida8, Fox Chase Cancer Center9, University of California, San Francisco10, Harvard University11, Stanford University12, University of California, San Diego13, Vanderbilt University14, Case Western Reserve University15, Ohio State University16, Washington University in St. Louis17, Mayo Clinic18, University of Utah19, Roswell Park Cancer Institute20, City of Hope National Medical Center21, University of Colorado Boulder22, University of Wisconsin-Madison23, Duke University24, Memorial Sloan Kettering Cancer Center25, University of Alabama at Birmingham26
TL;DR: This manuscript focuses on identifying patients at high risk for lung cancer who are candidates for low-dose computed tomography of the chest and on evaluating initial screening findings.
Abstract: Lung cancer is the leading cause of cancer-related mortality in the United States and worldwide. Early detection of lung cancer is an important opportunity for decreasing mortality. Data support using low-dose computed tomography (LDCT) of the chest to screen select patients who are at high risk for lung cancer. Lung screening is covered under the Affordable Care Act for individuals with high-risk factors. The Centers for Medicare & Medicaid Services (CMS) covers annual screening LDCT for appropriate Medicare beneficiaries at high risk for lung cancer if they also receive counseling and participate in shared decision-making before screening. The complete version of the NCCN Guidelines for Lung Cancer Screening provides recommendations for initial and subsequent LDCT screening and provides more detail about LDCT screening. This manuscript focuses on identifying patients at high risk for lung cancer who are candidates for LDCT of the chest and on evaluating initial screening findings.
380 citations
References
More filters
TL;DR: This new adenocarcinoma classification is needed to provide uniform terminology and diagnostic criteria, especially for bronchioloalveolar carcinoma (BAC), the overall approach to small nonresection cancer specimens, and for multidisciplinary strategic management of tissue for molecular and immunohistochemical studies.
3,850 citations
TL;DR: Suggestions include additional cutoffs for tumor size, with tumors >7 cm moving from T2 to T3; reassigning the category given to additional pulmonary nodules in some locations; and reclassifying pleural effusion as an M descriptor.
3,466 citations
TL;DR: The invasion-metastasis cascade is a multistep cell-biological process that involves dissemination of cancer cells to anatomically distant organ sites and their subsequent adaptation to foreign tissue microenvironments as mentioned in this paper.
3,150 citations
TL;DR: Detailed genetic and histological analysis of 37 patients with drug-resistant non–small cell lung cancers carrying EGFR mutations provides new insights into the shifting sands of drug resistance evolution in lung cancers and suggests that serial biopsies may be essential in the quest to reverse or even prevent the development ofdrug resistance.
Abstract: Lung cancers harboring mutations in the epidermal growth factor receptor (EGFR) respond to EGFR tyrosine kinase inhibitors, but drug resistance invariably emerges. To elucidate mechanisms of acquired drug resistance, we performed systematic genetic and histological analyses of tumor biopsies from 37 patients with drug-resistant non–small cell lung cancers (NSCLCs) carrying EGFR mutations. All drug-resistant tumors retained their original activating EGFR mutations, and some acquired known mechanisms of resistance including the EGFR T790M mutation or MET gene amplification. Some resistant cancers showed unexpected genetic changes including EGFR amplification and mutations in the PIK3CA gene, whereas others underwent a pronounced epithelial-to-mesenchymal transition. Surprisingly, five resistant tumors (14%) transformed from NSCLC into small cell lung cancer (SCLC) and were sensitive to standard SCLC treatments. In three patients, serial biopsies revealed that genetic mechanisms of resistance were lost in the absence of the continued selective pressure of EGFR inhibitor treatment, and such cancers were sensitive to a second round of treatment with EGFR inhibitors. Collectively, these results deepen our understanding of resistance to EGFR inhibitors and underscore the importance of repeatedly assessing cancers throughout the course of the disease.
2,972 citations
TL;DR: Patients with cancer and single metastases to the brain who receive treatment with surgical resection and postoperative radiotherapy have fewer recurrences of cancer in the brain and are less likely to die of neurologic causes than similar patients treated withurgical resection alone.
Abstract: Context.—For the treatment of a single metastasis to the brain, surgical resection
combined with postoperative radiotherapy is more effective than treatment
with radiotherapy alone. However, the efficacy of postoperative radiotherapy
after complete surgical resection has not been established.Objective.—To determine if postoperative radiotherapy resulted in improved neurologic
control of disease and increased survival.Design.—Multicenter, randomized, parallel group trial.Setting.—University-affiliated cancer treatment facilities.Patients.—Ninety-five patients who had single metastases to the brain that were
treated with complete surgical resections (as verified by postoperative magnetic
resonance imaging) between September 1989 and November 1997 were entered into
the study.Interventions.—Patients were randomly assigned to treatment with postoperative whole-brain
radiotherapy (radiotherapy group, 49 patients) or no further treatment (observation
group, 46 patients) for the brain metastasis, with median follow-up of 48
weeks and 43 weeks, respectively.Main Outcome Measures.—The primary end point was recurrence of tumor in the brain; secondary
end points were length of survival, cause of death, and preservation of ability
to function independently.Results.—Recurrence of tumor anywhere in the brain was less frequent in the radiotherapy
group than in the observation group (9 [18%] of 49 vs 32 [70%] of 46; P<.001). Postoperative radiotherapy prevented brain
recurrence at the site of the original metastasis (5 [10%] of 49 vs 21 [46%]
of 46; P<.001) and at other sites in the brain
(7 [14%] of 49 vs 17 [37%] of 46; P <.01). Patients
in the radiotherapy group were less likely to die of neurologic causes than
patients in the observation group (6 [14%] of 43 who died vs 17 [44%] of 39; P =.003). There was no significant difference between the
2 groups in overall length of survival or the length of time that patients
remained functionally independent.Conclusions.—Patients with cancer and single metastases to the brain who receive
treatment with surgical resection and postoperative radiotherapy have fewer
recurrences of cancer in the brain and are less likely to die of neurologic
causes than similar patients treated with surgical resection alone.
1,705 citations