Seminars in thoracic and cardiovascular surgery
-
Semin. Thorac. Cardiovasc. Surg. · Jan 2011
The thoracic surgical intensivist: the best critical care doctor for our thoracic surgical patients.
The recognition of cardiothoracic critical care as a separate and integral component of the care of the thoracic surgical patient is emerging. We review the recent exciting emergence of this area of specialization and its important future.
-
Semin. Thorac. Cardiovasc. Surg. · Jan 2011
ReviewThe SYNTAX score and SYNTAX-based clinical risk scores.
Risk stratification is an important and essential component in appropriately informing patients electing to undergo coronary artery bypass graft or percutaneous coronary intervention. This process is an integral part of the SYNTAX pioneered Heart Team approach in selecting the most appropriate revascularization modality in patients with complex coronary artery disease. The SYNTAX score was pioneered as an anatomical-based risk score that aided in this decision-making process. The purpose of this review is to examine the SYNTAX score and subsequent risk models that have been developed on the basis of this landmark anatomical-based risk score.
-
Semin. Thorac. Cardiovasc. Surg. · Jan 2011
ReviewSex and gender differences in non-small cell lung cancer.
Historically, lung cancer has been viewed as a male disease, but during the past 50 years there has been a dramatic increase in the incidence of lung cancer in women. Lung cancer is currently the most common cause of cancer death in American women, accounting for more than one quarter of all cancer deaths. This has been attributed to a significant increase in tobacco consumption by women; however, approximately 1 in 5 women with lung cancer never smoked. As the incidence of lung cancer in women has increased, significant gender-based differences in epidemiology, biology, and treatment responses have become evident and warrant further investigation to advance the treatment of lung cancer in all patients.
-
Semin. Thorac. Cardiovasc. Surg. · Jan 2011
ReviewPersonalized therapy for non-small cell lung cancer: which drug for which patient?
The elucidation of the molecular alterations in non-small cell lung cancer (NSCLC) and the development of molecularly targeted agents have permanently shifted NSCLC therapy to a personalized approach. In the metastatic setting, the addition of the anti-vascular endothelial growth factor monoclonal antibody, bevacizumab, to chemotherapy improves overall survival. The oral epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors, gefitinib and erlotinib, prolong progression-free survival in patients selected for the presence of an EGFR activating mutation. ⋯ The realm of personalized lung cancer therapy also includes the study of chemotherapy selected on the basis of the pharmacogenetic profile of a patient's tumor. Several ongoing clinical trials in both the metastatic and adjuvant settings are studying the excision repair cross-complementing group 1 (ERCC1) protein, the ribonucleotide reductase subunit 1 (RRM1) protein, thymidylate synthase, and BRCA1 as predictors of chemotherapy response. This review will outline the current state of the art of personalized NSCLC therapy.
-
Semin. Thorac. Cardiovasc. Surg. · Jan 2011
ReviewCurrent surgical therapy for stage IIIA (N2) non-small cell lung cancer.
Local therapy alone (surgery or radiation) leads to poor overall survival in patients with stage III non-small cell lung cancer because most of these patients die of distant metastases. During the past 20 years, studies have focused on developing effective chemotherapy regimens that can be combined with local therapies (surgery and/or radiation). The role of surgery has been evaluated, and the selection criteria for resection have been defined.