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![Investigation pathway for mediastinal diagnosis and staging. EBUS, endobronchial ultrasound; EUS, endoscopic ultrasound; FDG, [ 18 F]-2-fluoro-deoxy-D-glucose; MDT, multidisciplinary team; PET, positron emission tomography; TBNA, transbronchial needle aspiration.](profile/David-Baldwin-15/publication/47508412/figure/fig2/AS:670528209711128@1536877791903/nvestigation-pathway-for-mediastinal-diagnosis-and-staging-EBUS-endobronchial.png)
Investigation pathway for mediastinal diagnosis and staging. EBUS, endobronchial ultrasound; EUS, endoscopic ultrasound; FDG, [ 18 F]-2-fluoro-deoxy-D-glucose; MDT, multidisciplinary team; PET, positron emission tomography; TBNA, transbronchial needle aspiration.
Source publication
A joint initiative by the British Thoracic Society and the Society for Cardiothoracic Surgery in Great Britain and Ireland was undertaken to update the 2001 guidelines for the selection and assessment of patients with lung cancer who can potentially be managed by radical treatment.
Citations
... Patients with pathologically involved mediastinal lymph nodes (TanyN2) are commonly deemed unresectable and discussed in the section below. A subset of these patients, though, with nonbulky (<2-3 cm) mediastinal lymph node involvement and a limited number of involved lymph node stations, may also be considered surgically resectable [11]. ...
Background:
Stage III nonsmall cell lung cancer (NSCLC) represents a heterogeneous group of patients. Many patients are treated with curative intent multimodality therapy, either surgical resection plus systemic therapy or chemoradiation plus immunotherapy. However, many patients are not suitable for curative intent therapy and are treated with palliative systemic therapy or best supportive care.
Methods:
This paper is a review of recent advances in the management of patients with curative intent disease.
Results:
There have been significant advances in curative intent therapy for patients with stage III NSCLC in recent years. These include both adjuvant and neoadjuvant systemic therapies. For patients with resectable NSCLC, two trials have demonstrated that adjuvant atezolizumab or pembrolizumab, following chemotherapy, significantly improved disease-free survival (DFS). In patients with tumours harbouring a common mutation of the EGFR gene, adjuvant osimertinib therapy was associated with a large improvement in both DFS and overall survival (OS). Five randomized trials have evaluated chemotherapy plus nivolumab, pembrolizumab, durvalumab, or toripalimab, either as neoadjuvant or perioperative (neoadjuvant plus adjuvant) therapy. All five trials show significant improvements in the rate of pathologic complete response (pCR) and event-free survival (EFS). OS data are currently immature. This would now be considered the standard of care for resectable stage III NSCLC. The addition of durvalumab to chemoradiation has also become the standard of care in unresectable stage III NSCLC. One year of consolidation durvalumab following concurrent chemoradiation has demonstrated significant improvements in both progression-free and overall survival.
Conclusions:
Immune checkpoint inhibitor (ICI) therapy has become a standard recommendation in curative intent therapy for stage III NSCLC.
... 1. Preoperative risk assessment [13]; 2. Obstruction reversibility [8]; 3. Operability and resectability criteria [14]; 4. Disease classification [15] [7,9,20,21]. ...
... Of the various existing tests to assess respiratory mechanics, the most studied to determine the appearance of PPC after lung resection is the Postoperative Forced Expiratory Volume in 1 second (FEV 1 pop) [42]. The most commonly used formula is based on the lung segments resected and the percentage of FEV 1 provided by each lung [14,43]. Calculating the percentage of pop FEV 1 is radically important because, according to the percentage obtained, our patient can be extubated without problems in the operating room or will have to undergo rehabilitation therapy or even be transferred to intubated intensity therapy to condition the patient's of relating any data with that of the population from which it comes, especially in those that are absolute values and not a percentage with respect to the theoretical, and specifically in the FEV 1 / FVC ratio, although it has also been used with FVC, FEV 1 , and total lung capacity [54]. ...
Spirometry is a lung function test, whose main objective is to evaluate lung mechanics. It is a test that is currently easily accessible, but little used by anesthesiologists. One cause may be that they are not familiar with the analysis and understanding of said test or the lack of a pulmonary physiology laboratory in their hospitals. The proper analysis and understanding of this test by the general and thoracic anesthetist offers a range of possibilities both for the perioperative evaluation of the patient with pulmonary pathology or the one who will undergo thoracic surgery. Having a great impact by influencing the prognosis and management of these patients.
... Thus, patient selection is an essential consideration, and sequential radiochemotherapy might be suitable for patients whose performance status and comorbidities limit the tolerability of concurrent radiochemotherapy. It is worth pointing out that concomitant radiochemotherapy is broadly employed in the UK, Ireland and other European countries as the standard treatment procedure for unresectable stage III NSCLC [58][59][60][61][62][63]. ...
... In agreement with the previous findings, a single-institution retrospective investigation suggested that intensity-modulated radiotherapy (IMRT) can improve overall survival and reduce treatment-related pneumonitis [70]. Within this context, Liu et al. [58] compared 3D-CRT plans with VMAT plans for which mean lung dose and V20 were diminished for all patients, with median reductions of 2 Gy and 8%, respectively. Yom et al. [71] revealed that the rate of grade 3 radiation pneumonitis was 32% for 3D-CRT patients, compared with 8% for VMAT patients (p = 0.002). ...
The focus of this paper was to review and summarise the current issues and recent trends within the framework of locally advanced (LA) non-small cell lung cancer (NSCLC). The recently proposed 8th tumour-node-metastases (TNM) staging system exhibited significant amendments in the distribution of the T and M descriptors. Every revision to the TNM classification should contribute to clinical improvement. This is particularly necessary regarding LA NSCLC stratification, therapy and outcomes. While several studies reported the superiority of the 8th TNM edition in comparison to the previous 7th TNM edition, in terms of both the discrimination ability among the various T subgroups and clinical outcomes, others argued against this interpretation. Synergistic cytotoxic chemotherapy with radiotherapy is most prevalent in treating LA NSCLC. Clinical trial experience from multiple references has reported that the risk of locoregional relapse and distant metastasis was less evident for patients treated with concomitant radiochemotherapy than radiotherapy alone. Nevertheless, concern persists as to whether major incidences of toxicity may occur due to the addition of chemotherapy. Cutting-edge technologies such as four-dimensional computed tomography (4D-CT) and volumetric modulated arc therapy (VMAT) should yield therapeutic gains due to their capability to conform radiation doses to tumours. On the basis of the preceding notion, the optimum radiotherapy technique for LA NSCLC has been a controversial and much-disputed subject within the field of radiation oncology. Notably, no single-perspective research has been undertaken to determine the optimum radiotherapy modality for LA NSCLC. The landscape of immunotherapy in lung cancer is rapidly expanding. Currently, the standard of care for patients with inoperable LA NSCLC is concurrent chemoradiotherapy followed by maintenance durvalumab according to clinical outcomes from the PACIFIC trial. An estimated 42.9% of patients randomly assigned to durvalumab remained alive at five years, and free of disease progression, thereby establishing a new benchmark for the standard of care in this setting.
... The British Thoracic Society and the Society for Cardiothoracic Surgery in Great Britain and Ireland published Guidelines on the Radical Management of Patients with Lung Cancer (Warner and Weiskopf, 2000). According to this guide, patients should be given a 400-meter walking test and cardiopulmonary exercise tests before the surgery, and pulmonary functions should be evaluated (Lim et al., 2010). In the preoperative period, the FEV should be >1.5 L for lobectomy patients and >2.0 L for pneumonectomy patients. ...
... In the preoperative period, the FEV should be >1.5 L for lobectomy patients and >2.0 L for pneumonectomy patients. Also, a sputum sample should be taken from these patients, and arterial blood gases should be examined (Lim et al., 2010;Warner and Weiskopf, 2000). The Turkish Thoracic Society also recommends that before chest surgeries, lung function tests, blood gas analyses and exercise tests should be carried out on patients (Ozkan, 2014). ...
Changes in the pathophysiology of the chest after thoracic surgery cause respiratory and heart-related complications. These complications arise in connection with the patient's physiological characteristics and with the type of surgical intervention. Complications which occur and which cannot be brought under control extend the length of hospital stay and cause an increase in the rates of morbidity and mortality. To reduce and prevent complications, holistic nursing care is important throughout the surgical process. In this way, the patient's functional life can recover more quickly. Therefore, we will discuss the pathophysiological changes, complications and evidence-based practices for nursing care after thoracic surgery.
... Patients with higher perioperative risks such as COPD and older age are at higher risk for postoperative complications and mortality after resection 5 . The assessment of perioperative risk is essential because surgery is an invasive treatment, and it affects postoperative lung function 6,7 . Since postoperative lung function is related to the quality of life and mortality, treatment modalities are determined according to the predicted postoperative lung function. ...
Background:
: Surgical resection is the standard treatment for early-stage lung cancer. Since postoperative lung function is related to mortality, predicted postoperative lung function is used to determine the treatment modality. The aim of this study was to evaluate the predictive performance of linear regression and machine learning models.
Methods:
We extracted data from the Clinical Data Warehouse (CDW) and developed 3 sets: set Ⅰ, the linear regression model; set Ⅱ, machine learning models omitting the missing data: and set Ⅲ, machine learning models imputing the missing data. Six machine learning models, the least absolute shrinkage and selection operator (LASSO), ridge regression, ElasticNet, Random Forest, eXtreme gradient boosting (XGBoost), and the light gradient boosting machine (LightGBM) were implemented. The forced expiratory volume in one second (FEV1) measured 6 months after surgery was defined as the outcome. Five-fold cross-validation was performed for hyperparameter tuning of the machine learning models. The dataset was split into training and test datasets at a 70:30 ratio. Implementation was done after dataset splitting in set Ⅲ. Predictive performance was evaluated by R2 and mean squared error (MSE) in the 3 sets.
Results:
A total of 1,487 patients were included in sets Ⅰ and Ⅲ and 896 patients were included in set Ⅱ. In set Ⅰ, the R2 value was 0.27 and in set Ⅱ, LightGBM was the best model with the highest R2 value of 0.5 and the lowest MSE of 154.95. In set Ⅲ, LightGBM was the best model with the highest R2 value of 0.56 and the lowest MSE of 174.07.
Conclusion:
The LightGBM model showed the best performance in predicting postoperative lung function.
... Compensatory swelling of the residual lung, displacement of the mediastinum, lifting of the diaphragm, and collapse of the thorax all complicate the assessment of postoperative pulmonary function [3]. Current guidelines hold that postoperative pulmonary function is most commonly predicted by a simple calculation using the lung segment counting (SC) method [2,4], which may be inaccurate for predictions of residual pulmonary function, as it is based solely on the number of remaining pulmonary segments without considering that the volume and function of each lung segment are different [5,6]. There are interindividual differences or variations in the volume or function of each segment, and underlying lung diseases such as atelectasis, pulmonary emphysema, and fibrosis sometimes distribute heterogeneously [7,8]. ...
Background
Functional lung volume (FLV) obtained from computed tomography images was a breakthrough for lung imaging and functional assessment. We compared the accuracy of the FLV measurement method and the segment-counting (SC) method in predicting postoperative pulmonary function.
Methods
A total of 113 patients who underwent two thoracoscopic surgeries were enrolled in our study. We predicted postoperative pulmonary function by the FLV measurement method and the SC method. Novel formulas based on the FLV measurement method were established using linear regression equations between the factors affecting pulmonary function and the measured values.
Results
The predicted postoperative forced vital capacity (ppoFVC) and forced expiratory volume in 1 s (ppoFEV1) measured by the 2 methods showed high concordance between the actual postoperative forced vital capacity (postFVC) and the forced expiratory volume in 1 s (postFEV1) [r = 0.762, P < 0.001 (FLV method) and r = 0.759, P < 0.001 (SC method) for FVC; r = 0.790, P < 0.001 (FLV method) and r = 0.795, P < 0.001 (SC method) for FEV1]. Regression analysis showed that the measured preoperative pulmonary function parameters (FVC, FEV1) and the ratio of reduced FLV to preoperative FLV were significantly associated with the actual postoperative values and could predict these parameters (all P < 0.001). The feasibility of using these equations [postFVC = 0.8 × FVC − 0.784 × ΔFLV/FLV + 0.283 (R² = 0.677, RSD = 0.338), postFEV1 = 0.766 × FEV1 − 0.694 × ΔFLV/FLV + 0.22 (R² = 0.743, RSD = 0.265)] to predict the pulmonary function parameters after wedge resection was also verified.
Conclusions
The new FLV measurement method is valuable for predicting postoperative pulmonary function in patients undergoing lung resection surgery, with accuracy and consistency similar to those of the conventional SC method.
... Algorithms for pretreatment evaluation of surgical candidates in early stage NSCLC have been developed, 28,29 including a respiratory and cardiac assessment. The respiratory assessment consists of forced expiratory volume in 1 second and diffusing capacity of the lung for carbon monoxide. ...
... In order to appropriately risk stratify patients being considered for surgical resection, both the British Thoracic Society and the National Institute for Clinical Excellence advocate the use of a global risk score to predict shortterm mortality (3,4). Whilst many models have been developed for this purpose (5), formal external validation using contemporary patient cohorts has demonstrated that none are adequate for predicting short-term outcomes in contemporary practice (6). ...
... Regarding metastatic lung malignancies, breast, colorectal, prostate, kidney, and bladder cancers, as well as sarcomas, are common primary malignancies. Although surgical resection is of great significance in the treatment of primary and metastatic lung cancer, many patients do not have the opportunity to undergo surgery due to advanced age, comorbidities, poor cardiopulmonary function, or refusal to undergo surgery (2). In addition, chemotherapy and radiotherapy are commonly used to treat lung malignancies, and stereotactic body radiotherapy is an effective treatment for inoperable early-stage NSCLC, but these treatments have their limitations (3). ...
Image-guided percutaneous lung ablation has proven to be an alternative and effective strategy in the treatment of lung cancer and other lung malignancies. Radiofrequency ablation, microwave ablation, and cryoablation are widely used ablation modalities in clinical practice that can be performed along or combined with other treatment modalities. In this context, this article will review the application of different ablation strategies in lung malignancies.
... Patients with lung cancer often have concomitant comorbidities associated with smoking, in particular poor lung function due to chronic obstructive pulmonary disease (1). Although tumour resection is the gold standard treatment for early (stage I-II) non-small cell lung cancer (2)(3)(4), inevitably a portion of uninvolved lung is removed by the surgical procedure. This can be problematic in those with limited lung function and can result in a reduction in exercise tolerance and quality of life (5), or even oxygen dependence (6). ...
... No attempt was made to include any of the other abilities possible with DCR such as lung volume calculation or ventilation assessment, which might have provided further information to incorporate into predictive models of postoperative lung function-most likely to limit radiation dose, since these would require additional manoeuvres over a longer exposure time. Although PPS has been regarded as the traditional gold standard for prediction of postoperative lung function, dynamic perfusion MRI (18) and volumetric CT (19) have enviable test performance characteristics and are recommended in the British Thoracic Society lung cancer guideline (2), yet no comparison is made to these other techniques in the work of Hanaoka et al.; similarly, although the correlation between DPDR and PPS was high, PPS itself may underestimate lung function (20), hence need for comparison between DCR and other reference techniques. In this work, although correlation between predicted and measured postoperative spirometry is reported, mean differences are not. ...
