Arjun Pennathur, Michael Lanuti, Robert E Merritt, Andrea Wolf, Homa Keshavarz, Billy W Loo, Robert D Suh, Raymond H Mak, Alessandro Brunelli, Gerard J Criner, Peter J Mazzone, Garrett Walsh, Michael Liptay, Q Eileen Wafford, Sudish Murthy, M Blair Marshall, Betty Tong, Brian Pettiford, Gaetano Rocco, James Luketich, Matthew J Schuchert, Thomas K Varghese, Thomas A D'Amico, Scott J Swanson
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The current objective was to evaluate treatment options and important factors to consider during treatment selection for these high-risk patients.</p><p><strong>Methods: </strong>The AATS Clinical Practice Standards Committee assembled an expert panel to review treatment options for high-risk patients with stage I NSCLC. After a systematic search of the literature identification of lung-nodule-related factors to consider in treatment selection, the panel developed expert consensus statements and vignettes using a modified Delphi method. A 75% consensus was required for approval.</p><p><strong>Results: </strong>The expert panel identified sublobar resection, image-guided thermal ablation (IGTA), and stereotactic ablative radiotherapy (SABR), which is also known as stereotactic body radiation therapy (SBRT) or stereotactic radiosurgery (SRS), as modalities applicable in the treatment of high-risk patients with stage I NSCLC. 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引用次数: 0
摘要
目的：相当一部分 I 期非小细胞肺癌 (NSCLC) 患者被认为是肺叶切除术后并发症或死亡率的高危人群。美国胸外科协会（AATS）曾公布了确定哪些患者被认为是高风险患者的重要考虑因素。目前的目标是评估这些高风险患者的治疗方案以及在选择治疗时应考虑的重要因素：AATS临床实践标准委员会组建了一个专家小组，对I期NSCLC高危患者的治疗方案进行审查。在对文献进行系统检索，确定治疗选择中应考虑的肺结节相关因素后，专家组采用改良德尔菲法制定了专家共识声明和小故事。结果：专家小组认为，肺叶下切除术、图像引导热消融术（IGTA）和立体定向消融放疗（SABR）（又称立体定向体放射治疗（SBRT）或立体定向放射外科（SRS））是适用于治疗 I 期 NSCLC 高危患者的方法。我们制定、修订并最终批准了 14 项声明和 5 个说明临床情况的小故事：结论：对于 I 期 NSCLC 高危患者来说，选择哪种治疗方式（球下切除术、SABR 或 IGTA）最为理想是一个复杂的问题，但在认为安全的情况下，手术方式通常更受青睐。SABR 和 IGTA 是部分患者的合理选择，对于非手术患者，SABR 可能是下一个选择。如果可能，在非手术治疗前进行活检非常重要。对患者和肿瘤特征进行多学科审查对于做出最佳决定至关重要。临床治疗决策还应考虑患者的观点、偏好和生活质量。
Treatment of High-Risk Patients with Stage I Non-Small Cell Lung Cancer.
Objective: A significant proportion of patients with stage I non-small cell lung cancer (NSCLC) are considered at high risk for complications or mortality after lobectomy. The American Association for Thoracic Surgery (AATS) previously published important considerations in determining which patients are considered high risk. The current objective was to evaluate treatment options and important factors to consider during treatment selection for these high-risk patients.
Methods: The AATS Clinical Practice Standards Committee assembled an expert panel to review treatment options for high-risk patients with stage I NSCLC. After a systematic search of the literature identification of lung-nodule-related factors to consider in treatment selection, the panel developed expert consensus statements and vignettes using a modified Delphi method. A 75% consensus was required for approval.
Results: The expert panel identified sublobar resection, image-guided thermal ablation (IGTA), and stereotactic ablative radiotherapy (SABR), which is also known as stereotactic body radiation therapy (SBRT) or stereotactic radiosurgery (SRS), as modalities applicable in the treatment of high-risk patients with stage I NSCLC. Fourteen statements and 5 vignettes illustrating clinical scenarios were formulated, revised, and ultimately approved.
Conclusions: The choice of which modality (sublobar resection, SABR, or IGTA) is optimal in high-risk patients with stage I NSCLC is complex, but a surgical approach is generally favored when deemed safe. SABR and IGTA are reasonable options in select patients, with SABR being the likely next choice in nonsurgical patients. If possible, obtaining a biopsy is very important prior non-surgical treatment. A multi-disciplinary review of patient and tumor characteristics is essential for achieving an optimal decision. The clinical treatment decision should also take patient perspectives, preferences, and quality of life into consideration.
期刊介绍：
Seminars in Thoracic and Cardiovascular Surgery is devoted to providing a forum for cardiothoracic surgeons to disseminate and discuss important new information and to gain insight into unresolved areas of question in the specialty. Each issue presents readers with a selection of original peer-reviewed articles accompanied by editorial commentary from specialists in the field. In addition, readers are offered valuable invited articles: State of Views editorials and Current Readings highlighting the latest contributions on central or controversial issues. Another prized feature is expert roundtable discussions in which experts debate critical questions for cardiothoracic treatment and care. Seminars is an invitation-only publication that receives original submissions transferred ONLY from its sister publication, The Journal of Thoracic and Cardiovascular Surgery. As we continue to expand the reach of the Journal, we will explore the possibility of accepting unsolicited manuscripts in the future.
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