Lung cancer is the most common cause of cancer death in the world, with most patients having a dismal prognosis. As many as 40 % of lung cancers are diagnosed in stage IV, with current 5-year ...survival rates well below 20 %. Conventional chest radiography has been historically derided as a valid screening tool for this dreaded disease. A recent National Cancer Institute-sponsored study known as the Prostate, Lung, Colorectal, and Ovarian cancer screening trial found no benefit from such screening in patients at risk. In recent years, low-dose computed tomography (LDCT) of the chest has emerged as a promising screening tool. Recent evidence from the National Lung Screening Trial (NLST) demonstrated a 20 % reduction in mortality from lung cancer in patients undergoing three rounds of LDCT screening. Opponents of lung cancer screening favor its limited use in the setting of well-designed trials claiming excessive false-positive findings, overdiagnosis, and morbidity and mortality associated with invasive testing. That notwithstanding, leading medical societies such as ASCO and ATS have positioned themselves recently in favor of screening subjects meeting the NLST criteria.
The Thoracic Surgery and Thoracic Oncology groups of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) have backed the publication of a handbook on recommendations for the diagnosis and ...treatment of non-small cell lung cancer. Due to the high incidence and mortality of this disease, the best scientific evidence must be constantly updated and made available for consultation by healthcare professionals. To draw up these recommendations, we called on a wide-ranging group of experts from the different specialties, who have prepared a comprehensive review, divided into 4 main sections. The first addresses disease prevention and screening, including risk factors, the role of smoking cessation, and screening programs for early diagnosis. The second section analyzes clinical presentation, imaging studies, and surgical risk, including cardiological risk and the evaluation of respiratory function. The third section addresses cytohistological confirmation and staging studies, and scrutinizes the TNM and histological classifications, non-invasive and minimally invasive sampling methods, and surgical techniques for diagnosis and staging. The fourth and final section looks at different therapeutic aspects, such as the role of surgery, chemotherapy, radiation therapy, a multidisciplinary approach according to disease stage, and other specifically targeted treatments, concluding with recommendations on the follow-up of lung cancer patients and surgical and endoscopic palliative interventions in advanced stages.
Resumen La Sociedad Española de Neumología y Cirugía Torácica (SEPAR), a través de las áreas de Cirugía Torácica y de Oncología Torácica, ha promovido la realización de un manual de recomendaciones ...para el diagnóstico y el tratamiento del cáncer de pulmón de células no pequeñas. Las elevadas incidencia y mortalidad de esta patología hacen necesaria una constante actualización de las mejores evidencias científicas para su consulta por parte de los profesionales de la salud. Para su confección se ha contado con un amplio grupo de profesionales de distintas especialidades que han elaborado una revisión integral, que se ha concretado en 4 apartados principales. En el primero se ha estudiado la prevención y el cribado de la enfermedad, incluyendo los factores de riesgo, el papel de la deshabituación tabáquica y el diagnóstico precoz mediante programas de cribado. En un segundo apartado se ha analizado la presentación clínica, los estudios de imagen y el riesgo quirúrgico, incluyendo el cardiológico y la evaluación funcional respiratoria. Un tercero trata sobre los estudios de confirmación cito-histológica y de estadificación, con un análisis de las clasificaciones TNM e histológica, métodos no invasivos y mínimamente invasivos, así como las técnicas quirúrgicas para el diagnóstico y estadificación. En un cuarto y último capítulo se han abordado aspectos del tratamiento, como el papel de las técnicas quirúrgicas, la quimioterapia, la radioterapia, el abordaje multidisciplinar por estadios y otros tratamientos dirigidos frente a dianas específicas, terminando con recomendaciones acerca del seguimiento del cáncer de pulmón y los tratamientos paliativos quirúrgicos y endoscópicos en estadios avanzados.
Abstract The Thoracic Surgery and Thoracic Oncology groups of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) have backed the publication of a handbook on recommendations for the ...diagnosis and treatment of non-small cell lung cancer. Due to the high incidence and mortality of this disease, the best scientific evidence must be constantly updated and made available for consultation by healthcare professionals. To draw up these recommendations, we called on a wide-ranging group of experts from the different specialties, who have prepared a comprehensive review, divided into 4 main sections. The first addresses disease prevention and screening, including risk factors, the role of smoking cessation, and screening programs for early diagnosis. The second section analyzes clinical presentation, imaging studies, and surgical risk, including cardiological risk and the evaluation of respiratory function. The third section addresses cytohistological confirmation and staging studies, and scrutinizes the TNM and histological classifications, non-invasive and minimally invasive sampling methods, and surgical techniques for diagnosis and staging. The fourth and final section looks at different therapeutic aspects, such as the role of surgery, chemotherapy, radiation therapy, a multidisciplinary approach according to disease stage, and other specifically targeted treatments, concluding with recommendations on the follow-up of lung cancer patients and surgical and endoscopic palliative interventions in advanced stages.
Pulmonary emphysema is a chronic, debilitating, often fatal disease, characterized by progressive destruction of the lung parenchyma, hyperinflation, and impaired gas exchange. Medical treatment for ...emphysema offers limited symptomatic relief, and with the exception of smoking cessation has failed to improve survival.
Surgical lung volume reduction, however, proved to be an alternative to medical therapies capable of prolonging survival in a selected group of patients with emphysema.
Endoscopic methods of lung volume reduction (ELVR) have been developed in order to provide a minimally invasive alternative to the surgical procedure. Some procedures rely on device insertion, including endobronchial valves, coils, and bypass stents, while others instill bioactive substances such as a polymer or water vapor with identical therapeutic intentions. The methods are diverse, but are usually applied using the flexible bronchoscope, and may target one or both lungs.
Complications are few but include COPD exacerbations and occasionally pneumothoraces among the most feared. Thus far, ELVR has proven successful in improving quality of life of a minority of patients with severe emphysema and continues to be the object of intense scientific scrutiny.
Results from recent studies confirm the overall safety of various procedures and offer a glimpse of potential benefits, although surgical outcomes thus far have not been matched.
Transplante pulmonar Espinosa Hernández, M; Seijo Maceiras, Luis Miguel; Goikoetxea, M. J ...
Anales del sistema sanitario de Navarra,
2006, Letnik:
29, Številka:
2
Journal Article
Odprti dostop
El transplante pulmonar suele ser la última opción terapéutica para pacientes con insuficiencia respiratoria. A pesar de los muchos avances en inmunología y el manejo de las complicaciones, la ...mortalidad y morbilidad asociadas a este trasplante son muy superiores a los demás. El rechazo agudo es casi un problema universal en el primer año, mientras que la bronquiolitis obliterante limita la supervivencia a largo plazo. Las infecciones respiratorias también cumplen un papel importante en las complicaciones asociadas al trasplante pulmonar por la constante exposición del injerto al medio exterior. No obstante, los éxitos de esta opción terapéutica que depende fundamentalmente de una correcta selección de donante y receptor, son evidentes, sobre todo en cuanto a calidad de vida se refiere.
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