Special treatment issues in lung. cancer - ACCP evidence-based clinical practice guidelines (2nd edition)
Special treatment issues in lung. cancer - ACCP evidence-based clinical practice guidelines (2nd edition)
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DOI：
10.1378/chest.07-1382
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发表时间：
2007-09-01
期刊：
影响因子：
9.6
通讯作者：
Jones, David R.
中科院分区：
文献类型：
--
作者：
Shen, K. Robert;Meyers, Bryan F.;Jones, David R.
背景：该指南的本章介绍了具有特殊形式的非小细胞肺癌的患者，需要特殊考虑。这包括患有胰腺肿瘤，T4N0,1M0肿瘤的患者，同一叶中的卫星结节，同步和多个原发性肺癌（MPLC），孤立的大脑和肾上腺转移酶以及胸壁累及。为了确保这些准则得到了最新数据的支持，可以通过对MEDLINE计算机化数据库的文献搜索获得适合本章涵盖的主题的出版物。如果可能的话，我们还引用了其他共识陈述。建议是由写作委员会制定的，该建议是通过标准化方法进行评分的（请参阅“肺癌证据审查和指南的方法论”一章），并在肺癌小组的所有成员审查胸部肿瘤学网络，健康和科学政策委员会，卫生与科学政策委员会的批准之前，以及美国胸部的摄政委员会的摄影委员会。和手术切除，但已进行了适当的分期。没有纵隔节点受累的中央T4肿瘤患者并不常见。然而，这样的患者在仔细上演和选择时，与单独进行化学疗法相比，这是治疗方法的一部分，似乎从切除术中受益。与原发性肿瘤的卫星病变患者的卫星病变患者具有良好的预后，并且不需要对评估和治疗方法进行修改，而不是仅原发性肿瘤所决定的。但是，很难知道如何最好地治疗不同叶片中相同类型癌症的患者。尽管确实发生了MPLC，但切除后的同步表现或肿瘤间间隔<4年间隔的生存结果是可变且通常很差的，这表明其中许多患者可能患有肺转移，而不是第二个原发性肺癌。有必要对这些患者进行彻底的仔细评估，以尝试区分转移患者和第二个原发性肺癌，尽管尚未定义区分他们的标准。选定的大脑或肾上腺转移性疾病孤立焦点的患者似乎从切除中受益匪浅。在无病间隔长的患者中尤其如此。最后，在胸壁受累的患者中，只要可以完全切除肿瘤并且缺乏N2淋巴结受累，应考虑原发性手术治疗。结论：精心挑选的患者可能会从积极的手术方法中受益。
Background: This chapter of the guidelines addresses patients who have particular forms of non-small cell lung cancer that require special considerations. This includes patients with Pancoast tumors, T4N0,1M0 tumors, satellite nodules in the same lobe, synchronous and metachronous multiple primary lung cancers (MPLCs), solitary brain and adrenal metastases, and chest wall involvement.Methods: The nature of these special clinical cases is such that in most cases, metaanalyses or large prospective studies of patients are not available. For ensuring that these guidelines were supported by the most current data available, publications that were appropriate to the topics covered in this chapter were obtained by performance of a literature search of the MEDLINE computerized database. When possible, we also referenced other consensus opinion statements. Recommendations were developed by the writing committee, graded by a standardized method (see "Methodology for Lung Cancer Evidence Review and Guideline Development" chapter), and reviewed by all members of the lung cancer panel before approval by the Thoracic Oncology NetWork, Health and Science Policy Committee, and the Board of Regents of the American College of Chest Physicians.Results: In patients with a Pancoast tumor, a multimodality approach seems to be optimal, involving chemoradiotherapy and surgical resection, provided appropriate staging has been conducted. Patients with central T4 tumors that do not have mediastinal node involvement are uncommon. Such patients, however, seem to benefit from resection as part of the treatment as opposed to chemoradiotherapy alone when carefully staged and selected. Patients with a satellite lesion in the same lobe as the primary tumor have a good prognosis and require no modification of the approach to evaluation and treatment than what would be dictated by the primary tumor alone. However, it is difficult to know how best to treat patients with a focus of the same type of cancer in a different lobe. Although MPLCs do occur, the survival results after resection for either a synchronous presentation or a metachronous presentation with an interval of < 4 years between tumors are variable and generally poor, suggesting that many of these patients may have had a pulmonary metastasis rather than a second primary lung cancer. A thorough and careful evaluation of these patients is warranted to try to differentiate between patients with a metastasis and a second primary lung cancer, although criteria to distinguish them have not been defined. Selected patients with a solitary focus of metastatic disease in the brain or adrenal gland seem to benefit substantially from resection. This is particularly true in patients with a long disease-free interval. Finally, in patients with chest wall involvement, as long as tumors can be completely resected and there is absence of N2 nodal involvement, primary surgical treatment should be considered.Conclusions: Carefully selected patients may benefit from an aggressive surgical approach.