RESUMO
The most effective treatment for lung cancer is complete lung resection, although recurrences reach up to 10% and the appearance of second neoplasms, up to 6%. Therefore, the follow-up of these patients will be essential for the early detection and treatment of these events; however there is no definition of the form, time and cadence of these follow-ups. In this consensus document, we try to define them based on the available scientific evidence. A critical review of the literature is carried out (meta-analysis, systematic reviews, reviews, consensus recommendations of scientific societies, randomized controlled studies, non-randomized controlled studies, observational studies and case series studies) and communications to the main congresses on oncology and thoracic surgery in Spanish, English and French. The evidences found are classified following the GRADE system. It is defined according to the existing evidence that the patient resected for lung cancer should be followed up, as well as that this follow-up should be close during the first years and with CT (not being necessary to follow up with PET-CT, biomarkers or bronchoscopy). Cessation of smoking is also recommended in this follow-up.
Assuntos
Neoplasias Pulmonares , Cirurgia Torácica , Consenso , Seguimentos , Humanos , Neoplasias Pulmonares/cirurgia , Tomografia por Emissão de Pósitrons combinada à Tomografia ComputadorizadaRESUMO
The most effective treatment for lung cancer is complete lung resection, although recurrences reach up to 10% and the appearance of second neoplasms, up to 6%. Therefore, the follow-up of these patients will be essential for the early detection and treatment of these events; however, there is no definition of the form, time and cadence of these follow-ups. In this consensus document, we try to define them based on the available scientific evidence. A critical review of the literature is carried out (meta-analysis, systematic reviews, reviews, consensus recommendations of scientific societies, randomized controlled studies, non-randomized controlled studies, observational studies and case series studies) and communications to the main congresses on oncology and thoracic surgery in Spanish, English and French. The evidences found are classified following the GRADE system. It is defined according to the existing evidence that the patient resected for lung cancer should be followed up, as well as that this follow-up should be close during the first years and with CT (not being necessary to follow up with PET-CT, biomarkers or bronchoscopy). Cessation of smoking is also recommended in this follow-up.
RESUMO
After publication of the PACIFIC trial results, immune checkpoint inhibitor-based immunotherapy was included in the treatment algorithm of locally advanced non-small cell lung cancer (NSCLC). The PACIFIC trial demonstrated that 12 mo of durvalumab consolidation therapy after radical-intent platinum doublet chemotherapy with concomitant radiotherapy improved both progression-free survival and overall survival in patients with unresectable stage III NSCLC. This is the first treatment in decades to successfully improve survival in this clinical setting, with manageable toxicity and without deterioration in quality of life. The integration of durvalumab in the management of locally advanced NSCLC accentuates the need for multidisciplinary, coordinated decision-making among lung cancer specialists, bringing new challenges and controversies as well as important changes in clinical work routines. The aim of the present article is to review-from a practical, multidisciplinary perspective-the findings and implications of the PACIFIC trial. We evaluate the immunobiological basis of durvalumab as well as practical aspects related to programmed cell death ligand 1 determination. In addition, we comprehensively assess the efficacy and toxicity data from the PACIFIC trial and discuss the controversies and practical aspects of incorporating durvalumab into routine clinical practice. Finally, we discuss unresolved questions and future challenges. In short, the present document aims to provide clinicians with a practical guide for the application of the PACIFIC regimen in routine clinical practice.
RESUMO
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.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/terapia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/terapia , Biomarcadores Tumorais/sangue , Broncoscopia , Carcinoma Pulmonar de Células não Pequenas/prevenção & controle , Quimiorradioterapia , Técnicas de Diagnóstico do Sistema Respiratório/normas , Detecção Precoce de Câncer , Humanos , Neoplasias Pulmonares/prevenção & controle , Estadiamento de Neoplasias , Cuidados Paliativos , Pneumonectomia/normas , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Pneumologia/organização & administração , Terapia de Salvação , Abandono do Hábito de Fumar , Sociedades Médicas , Espanha , Tomografia Computadorizada por Raios XAssuntos
Adenocarcinoma/secundário , Coma/etiologia , Disartria/etiologia , Receptores ErbB/genética , Genes erbB-1 , Neoplasias Pulmonares/complicações , Carcinomatose Meníngea/secundário , Transtornos Mentais/etiologia , Proteínas de Neoplasias/genética , Adenocarcinoma/complicações , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/genética , Receptores ErbB/análise , Receptores ErbB/antagonistas & inibidores , Cloridrato de Erlotinib/uso terapêutico , Evolução Fatal , Feminino , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/genética , Carcinomatose Meníngea/complicações , Carcinomatose Meníngea/diagnóstico , Pessoa de Meia-Idade , Proteínas de Neoplasias/análise , Proteínas de Neoplasias/antagonistas & inibidores , Inibidores de Proteínas Quinases/uso terapêutico , Deleção de SequênciaRESUMO
No disponible
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias Pulmonares/complicações , Neoplasias Meníngeas/complicações , Carcinomatose Meníngea/patologia , Doenças do Sistema Nervoso/etiologia , Autopsia , Genes erbB-1Assuntos
Adenocarcinoma/secundário , Neoplasias Ósseas/secundário , Falanges dos Dedos da Mão/patologia , Neoplasias Pulmonares/patologia , Adenocarcinoma/complicações , Adenocarcinoma/diagnóstico , Adulto , Neoplasias Ósseas/complicações , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico , Osteólise/etiologiaRESUMO
No disponible
Assuntos
Humanos , Feminino , Adulto Jovem , Adenocarcinoma/complicações , Adenocarcinoma/diagnóstico , Radiografia Torácica/instrumentação , Radiografia Torácica/normas , Radiografia Torácica , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares , Falanges dos Dedos da Mão/patologia , Falanges dos Dedos da Mão , Adenocarcinoma/patologia , Adenocarcinoma , Articulações dos Dedos/patologia , Articulações dos Dedos , Mãos/patologia , Mãos , Metástase Neoplásica/patologia , Metástase NeoplásicaAssuntos
Fístula Artério-Arterial/congênito , Artéria Braquial/anormalidades , Carcinoma de Células Escamosas/complicações , Neoplasias Pulmonares/complicações , Artéria Pulmonar/anormalidades , Idoso , Angiografia , Fístula Artério-Arterial/complicações , Fístula Artério-Arterial/diagnóstico , Biópsia , Artéria Braquial/diagnóstico por imagem , Carcinoma de Células Escamosas/diagnóstico , Humanos , Neoplasias Pulmonares/diagnóstico , Masculino , Artéria Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
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
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
Assuntos
Humanos , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/terapia , Padrões de Prática Médica , Prática Clínica Baseada em Evidências , Abandono do Hábito de FumarRESUMO
No disponible