Seminars in respiratory and critical care medicine
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Solitary pulmonary nodules (SPNs) are commonly encountered in pulmonary practice. Their management is complex, and multiple clinical factors must be considered. The three common management strategies applied to solitary pulmonary nodules are careful observation, diagnostic testing, and surgery. ⋯ Patients who have a high pretest probability of cancer merit surgical diagnosis. Patients with an intermediate pretest probability of cancer go on to further diagnostic testing, primarily with CT-guided fine needle aspiration or positron-emission tomography. Patient preferences are considered throughout the process because the absolute difference in outcome between some strategies may be small.
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Semin Respir Crit Care Med · Dec 2013
ReviewSalvage Therapy beyond Targeted Therapy in Lung Adenocarcinoma.
Targeted therapy in lung adenocarcinoma has evolved rapidly over the last few years, especially in the application of epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors (TKIs). Although many patients with advanced EGFR-mutated or ALK-rearranged lung adenocarcinoma do benefit from treatment with a specific TKI, the duration of disease control is notoriously short. Different patterns of disease progression have been recognized that may require distinct treatment approaches. ⋯ It is now known that EGFR TKI-acquired resistance is mostly (50-60%) due to a single resistance mutation in exon 20 (T790M) and occasionally (5-10%) due to c-MET amplification. On the contrary, the acquired resistance mechanisms to ALK TKI appear more diverse. Specific therapeutic strategies are being developed to overcome various acquired resistance mechanisms and may further improve the overall prognosis of advanced lung adenocarcinoma with actionable driver mutations.
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Semin Respir Crit Care Med · Dec 2013
ReviewStereotactic Ablative Radiotherapy (SABR) for Non-Small Cell Lung Cancer.
Stereotactic ablative radiotherapy (SABR), otherwise known as stereotactic body radiation therapy (SBRT), is an external beam treatment modality that offers the ability to deliver with high precision large doses of radiation over a limited number of fractions. SABR is currently a standard of care in the treatment of early-stage primary non-small cell lung cancers (NSCLCs) that are medically inoperable and for metastases in many anatomical locations. ⋯ However, randomized comparisons have not been completed to assess survival in operable patients. This review summarizes the advanced technology and radiation concepts that have helped clinicians optimize the use of stereotactic ablative therapies for lung cancer, with an emphasis on the rationale for future continued use of this advanced treatment modality.
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The National Lung Screening Trial demonstrated that lung cancer screening with three annual low-dose computed tomographic scans has the potential to reduce lung cancer-specific mortality by 20% in an older population of heavy smokers. This was a great achievement by the National Lung Screening Trial (NLST) investigators, but this should be viewed as an important first step in an unfinished process. ⋯ Screening for lung cancer will be most effective if it is accompanied by continued research into risk modeling, patient communication strategies, and biomarkers. For clinicians establishing a program of lung cancer screening, we encourage this to be done in a responsible fashion, adhering to practices specified in the design of the NLST, and with careful attention given to proper management of screen-detected abnormalities and maintenance of screening registries.