Pub Date : 2024-10-01DOI: 10.1016/S1877-1203(24)00082-X
F. Le Tinier , C. Durdux , D. Lerouge , L. Kaoutar
Surgery remains the reference treatment for primary non-small cell lung cancer (NSCLC) T1-T2 N0. However, 20-30 % of patients present a surgical contraindication. For these patients who cannot be operated on, stereotactic radiotherapy (SBRT) has been validated as the alternative of choice by learned medical societies. These two treatments are aimed at different populations, with a recognized role for these tumours local control. Radiotherapy remains less risky for fragile patients, but maybe at the cost of a higher risk of lymph node recurrence. The role of systemic treatment in association with stereotactic radiotherapy remains to be determined, particularly for non-operable T3NO tumours.
Several complex clinical situations can be identified depending on the location and size of the tumour, the patient’s history of irradiation and co-morbidities. The treatment of central tumours, re-irradiation, which is becoming increasingly frequent with advances in systemic treatments, and treatment of patients with pulmonary fibrosis represent a real technical challenge, requiring a specialized multi-disciplinary assessment to evaluate the benefit-risk ratio.
Pub Date : 2024-10-01DOI: 10.1016/S1877-1203(24)00075-2
A. Agrafiotis , B. Grigoriu , P. Van Schil
The 9th TNM edition for lung cancer is based on a database of 124,581 cases, of which 18.9% were entered prospectively. Regarding the T component no changes are implemented as the 8th edition descriptors performed well in the new database. Concerning the N component, N2 is subdivided into N2a and N2b representing single station and multiple stations N2 involvement, respectively. Individual lymph nodes in each station are not counted. With regard to the M component, M1c is subdivided into M1c1 and M1c2 when multiple extrathoracic metastases are present in a single organ system or multiple organ systems, respectively. Bone and muscle are counted as a single organ system. Especially the new N descriptors have an impact on the overall stage groupings, whereby e.g. T1N1 belongs to stage IIA and T1N2a to stage IIB. M1c1 and M1c2 both belong to stage IVB. For staging of thymic epithelial tumours comprising thymoma and thymic carcinoma, the 9th edition is based on analysis of 9,147 cases. Changes are only proposed in the T component: T1a characterizes tumors until 5 cm and T1b tumors larger than 5 cm in greatest dimension. T2 denotes partial or full-thickness pericardial invasion but also direct invasion into lung parenchyma or phrenic nerve. Invasion of mediastinal pleura is now separately considered as additional histologic descriptor. There are no changes in the stage groupings with both T1a and T1b belonging to stage I.
Pub Date : 2024-10-01DOI: 10.1016/S1877-1203(24)00097-1
A.-P. Meert , M. Ilzkovitz
Around 40 % of patients with lung cancer are required to consult the emergency room during their follow-up. These are often patients at an advanced stage of their disease. These consultations lead in about 2/3 of cases to hospitalization, some of which in intensive care. Respiratory problems, fever, pain and digestive complaints are the classic reasons for emergency room visits. The advent of targeted therapies and immunotherapy has greatly diversified the reasons for presenting to emergency departments. If cancer or its treatment can be the cause of the emergency room consultation, around 30 % of these consultations have no link with the cancer.
Pub Date : 2024-10-01DOI: 10.1016/S1877-1203(24)00092-2
M. Cani , A. Lefevre , J. Remon
New treatment strategies have been developed in the treatment landscape of patients with advanced lung cancer. These agents include antibody drug conjugates, bi-specific antibodies, and a subtype of bi-specific agent also called the bi-specific T-cell engagers or BiTe. All these drugs have reported promising clinical activity at the time of progression in patients previously treated either with chemotherapy and immunotherapy, but also after failure of personalized treatment approaches and chemotherapy in patients with some oncogenic addicted tumors. In this review, we summarize the clinical data of these treatments and potential challenges with this approach in daily practice.
在晚期肺癌患者的治疗领域，已经开发出了新的治疗策略。这些药物包括抗体药物共轭物、双特异性抗体，以及双特异性药物的一种亚型，也称为双特异性 T 细胞诱导剂或 BiTe。据报道，所有这些药物都具有良好的临床活性，不仅适用于之前接受过化疗和免疫疗法的进展期患者，也适用于一些致癌成瘾肿瘤患者的个性化治疗方法和化疗失败后的治疗。在这篇综述中，我们总结了这些治疗方法的临床数据以及这种方法在日常实践中可能面临的挑战。由 Elsevier Masson SAS 出版。保留所有权利。
Pub Date : 2024-10-01DOI: 10.1016/S1877-1203(24)00079-X
A. Mavrikios , P.-A. Thomas , J. Remon , A. Botticella , L. Tselikas , C. Le Péchoux , A. Levy
The development of immunotherapy and targeted therapies in the management of non-small cell lung cancer has led to the emergence of the concept of oligometastatic disease, characterized by a limited number of metastases and a more favorable prognosis compared to multimetastatic disease. Local radical treatments (LRT, including radiotherapy, surgery and interventional radiology) of oligometastases could strengthen the response to systemic treatment while minimizing the emergence of resistant clones responsible for disseminated systemic progression. There is no trial comparing the different LRT modalities and the different techniques must be discussed in a multi-disciplinary tumor board. The use of LRT is supported by international consensuses and guidelines based on encouraging data from several randomized phase 2 trials, although strict assessment is needed beforehand in order to avoid unnecessary treatment at risk of toxicity. Supplementary ongoing phase 3 trials will soon strengthen the limited available level of evidence. The future integration of biomarkers should also contribute to a better understanding of the biological reality of oligometastatic disease and thus to an optimized selection of patients who can benefit from a combined therapeutic approach.
Pub Date : 2024-10-01DOI: 10.1016/S1877-1203(24)00081-8
P.-E. Falcoz , T. Berghmans , M. Brandao , B. Grigoriu , A. Charloux
Surgery is the cornerstone treatment for limited stage non-small cell lung cancer and car-cinoid tumours, and may be considered for some cases of small-cell lung cancer. Before considering a patient for surgical resection, two points must be taken into account: the resectability – the surgeon’s ability for taking out all the cancer tissue – and the operability – the patient’s ability to tolerate the surgical intervention with adequate recovery and quality of life. Resectability depends on disease extent, while operability’s consequences are measured by the operative risk (mortality and morbidity), taking into account patient’s characteristics: comorbidities, cardiac and respiratory function, and general condition. This article will assess operability, with a particular attention to the cardiorespiratory work-up and decisional algorithms.
手术是治疗局限期非小细胞肺癌和类癌的基础方法，某些小细胞肺癌病例也可考虑手术治疗。在考虑对患者进行手术切除之前，必须考虑两点：可切除性--外科医生切除所有癌组织的能力；可操作性--患者能否耐受手术治疗，并获得足够的康复和生活质量。可切除性取决于疾病的程度，而可操作性的后果则由手术风险（死亡率和发病率）来衡量，同时考虑到患者的特征：合并症、心脏和呼吸功能以及全身状况。本文将对可手术性进行评估，尤其关注心肺功能检查和决策算法。由 Elsevier Masson SAS 出版。保留所有权利。
Pub Date : 2024-10-01DOI: 10.1016/S1877-1203(24)00069-7
P. Andujar , B. Fervers , F. Delva , B. Clin , J.-C. Pairon
In France, Belgium and Schwizerland, respectively, lung cancer is the 3rd most common cancer and the 1st cause of cancer-related death. While incidence and mortality rates in men have stabilized, they are demonstrating an alarming growth in women, linked to the increase in female tobacco consumption. Combined, close to 90% of lung cancer cases are attributable to modifiable factors, offering numerous levers for prevention policies. While tobacco smoking is indeed the main risk factor for lung cancer, responsible for 80% of cases, the risk factors and exposures are numerous, such as a diet low in fruit (10% of cases), occupational exposures (15% of cases), and environmental exposures, such as radon (almost 10% of cases) and outdoor air pollution (3.6% of cases). The proportion of environmental exposures are probably underestimated. In 2024, the International Agency for Research on Cancer identified more than 30 definite carcinogen agents (and carcinogenic exposure situations from all sources) for which there is an excess of lung cancer in occupational settings. In the clinical management of pneumology patients, it is important to identify any exposure to carcinogenic agents. Recognition of lung cancer as an occupational disease is a major medical and social issue for patients. Several approaches can be used to identify exposure to occupational carcinogens: occupational interview (with specific questionnaires or self-questionnaires), biometrological analysis for certain agents, or imaging. Once an occupational exposure has been identified, the clinician may or may not advise the patient to file an occupational disease claim.
在法国、比利时和瑞士，肺癌分别是第三大常见癌症和第一大癌症致死原因。虽然男性的发病率和死亡率已趋于稳定，但女性的发病率和死亡率却出现了惊人的增长，这与女性烟草消费的增加有关。总之，近 90% 的肺癌病例可归因于可改变的因素，这为预防政策提供了许多杠杆。虽然吸烟确实是肺癌的主要风险因素，占肺癌病例的 80%，但风险因素和暴露也很多，如饮食中水果含量低（占病例的 10%）、职业暴露（占病例的 15%）以及环境暴露，如氡（占病例的近 10%）和室外空气污染（占病例的 3.6%）。环境暴露的比例可能被低估了。2024 年，国际癌症研究机构（International Agency for Research on Cancer）确定了 30 多种明确的致癌物质（以及各种来源的致癌接触情况），这些致癌物质在职业环境中导致肺癌发病率过高。在对肺病患者进行临床治疗时，必须查明是否接触过致癌物质。将肺癌认定为职业病对患者来说是一个重大的医疗和社会问题。有几种方法可用于确定是否接触过职业致癌物：职业访谈（特定问卷或自我问卷）、针对某些致癌物的生物计量学分析或成像。一旦确定职业接触，临床医生可以建议病人提出职业病索赔，也可以不建议病人提出职业病索赔。
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