Stage classification provides a nomenclature about the anatomic extent of a cancer; a consistent language provides the ability to communicate about a specific patient and about cohorts of patients in ...clinical studies. This paper summarizes the eighth edition of lung cancer stage classification, which is the worldwide standard as of January 1, 2017. This revision is based on a large global database, a sophisticated analysis, extensive internal validation as well as multiple assessments confirming generalizability. Practicing clinicians must be familiar with the stage classification system when managing contemporary patients with lung cancer.
The New Lung Cancer Staging System DETTERBECK, Frank C; BOFFA, Daniel J; TANOUE, Lynn T
Chest,
07/2009, Letnik:
136, Številka:
1
Journal Article
Recenzirano
The International Association for the Study of Lung Cancer (IASLC) has conducted an extensive initiative to inform the revision
of the lung cancer staging system. This involved development of an ...international database along with extensive analysis of
a large population of patients and their prognoses. This article reviews the recommendations of the IASLC International Staging
Committee for the definitions for the TNM descriptors and the stage grouping in the new non-small cell lung cancer staging
system.
Management of carcinoid tumors Detterbeck, Frank C
The Annals of thoracic surgery,
03/2010, Letnik:
89, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Primary bronchopulmonary carcinoids comprise a significant proportion of carcinoid tumors. The clinical presentation allows prediction of the diagnosis and cell type and directs evaluation and ...treatment. Young age, central tumor, and no nodal enlargement are highly suggestive of typical carcinoid. These patients require no further diagnostic or staging tests beyond chest computed tomography and bronchoscopy before resection using parenchyma-sparing techniques. All bronchopulmonary carcinoids are malignant (though indolent), and surgical intervention is the mainstay of treatment. Mediastinoscopy is suggested when there is moderate suspicion of atypical carcinoid (central cN1 or peripheral cN0), with lobectomy and lymphadenectomy if the mediastinal nodes are benign. For a high suspicion of atypical carcinoid (central cN2, peripheral cN1, 2), imaging for distant metastases and mediastinoscopy is suggested, with multimodality treatment for an atypical carcinoid with N2 involvement.
Low-dose chest CT screening for lung cancer has become a standard of care in the United States in the past few years, in large part due to the results of the National Lung Screening Trial. The ...benefit and harms of low-dose chest CT screening differ in both frequency and magnitude. The translation of a favorable balance of benefit and harms into practice can be difficult. Here, we update the evidence base for the benefit, harms, and implementation of low radiation dose chest CT screening. We use the updated evidence base to provide recommendations where the evidence allows, and statements based on experience and expert consensus where it does not.
Approved panelists developed key questions using the PICO (population, intervention, comparator, and outcome) format to address the benefit and harms of low-dose CT screening, as well as key areas of program implementation. A systematic literature review was conducted by using MEDLINE via PubMed, Embase, and the Cochrane Library. Reference lists from relevant retrievals were searched, and additional papers were added. The quality of the evidence was assessed for each critical or important outcome of interest using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Important clinical questions were addressed based on the evidence developed from the systematic literature review. Graded recommendations and ungraded statements were drafted, voted on, and revised until consensus was reached.
The systematic literature review identified 59 studies that informed the response to the 12 PICO questions that were developed. Key clinical questions were addressed resulting in six graded recommendations and nine ungraded consensus based statements.
Evidence suggests that low-dose CT screening for lung cancer results in a favorable but tenuous balance of benefit and harms. The selection of screen-eligible patients, the quality of imaging and image interpretation, the management of screen-detected findings, and the effectiveness of smoking cessation interventions can affect this balance. Additional research is needed to optimize the approach to low-dose CT screening.
Lung cancer is by far the major cause of cancer deaths largely because in the majority of patients it is at an advanced stage at the time it is discovered, when curative treatment is no longer ...feasible. This article examines the data regarding the ability of screening to decrease the number of lung cancer deaths.
A systematic review was conducted of controlled studies that address the effectiveness of methods of screening for lung cancer.
Several large randomized controlled trials (RCTs), including a recent one, have demonstrated that screening for lung cancer using a chest radiograph does not reduce the number of deaths from lung cancer. One large RCT involving low-dose CT (LDCT) screening demonstrated a significant reduction in lung cancer deaths, with few harms to individuals at elevated risk when done in the context of a structured program of selection, screening, evaluation, and management of the relatively high number of benign abnormalities. Whether other RCTs involving LDCT screening are consistent is unclear because data are limited or not yet mature.
Screening is a complex interplay of selection (a population with sufficient risk and few serious comorbidities), the value of the screening test, the interval between screening tests, the availability of effective treatment, the risk of complications or harms as a result of screening, and the degree with which the screened individuals comply with screening and treatment recommendations. Screening with LDCT of appropriate individuals in the context of a structured process is associated with a significant reduction in the number of lung cancer deaths in the screened population. Given the complex interplay of factors inherent in screening, many questions remain on how to effectively implement screening on a broader scale.
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