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Pulmonary Literature Review and Complex Case Prese ...
Update on Lung Cancer Treatment and Screening Silv ...
Update on Lung Cancer Treatment and Screening Silvestri
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The document provides an update on lung cancer treatment and screening, focusing on recent advancements and challenges. <br /><br />**Treatment for Stage 1B and 2 Lung Cancer:** <br />The treatment paradigm has evolved, with surgery followed by Osimertinib for EGFR-positive tumors, Alectinib for ALK-positive tumors, and preoperative chemo/immunotherapy followed by surgery, lacking benefit for perioperative immunotherapy with a PDL1 score of 1%. Proper testing for EGFR, ALK, and PDL1 expression is crucial for treatment decisions.<br /><br />**Screening and Diagnosis:** <br />Lung cancer screening often results in a higher rate of downstream procedures and complications, requiring better diagnostic management to enhance benefits. The presence of pulmonary nodules (PNs) often indicates early-stage lung cancer, sometimes more prevalent than findings from low-dose CT scans. Diagnostic techniques like electromagnetic navigation have varying yield rates, with complication risks prompting careful consideration of their routine use.<br /><br />**Guided Bronchoscopy Diagnostic Yield:** <br />Yield is approximately 69.4%, varying based on technology used, with robotic-assisted procedures showing higher yields.<br /><br />**Importance of Biomarker Testing:** <br />Adequate biomarker testing, particularly through EBUS (Endobronchial Ultrasound), requires a sufficient number of needle passes (six for 90% adequacy for NGS testing).<br /><br />**Late-Stage Treatment with SBRT:** <br />Stereotactic body radiotherapy (SBRT) has shown promise in managing oligoprogressive metastatic lung cancer, offering improved progression-free survival but requiring further validation through phase 3 trials.<br /><br />Key takeaways include the importance of accurate screening workups to differentiate benign from malignant disease, the changing landscape of lung cancer treatment including neo/adjuvant therapies based on molecular markers, and potential benefits of SBRT for specific advanced cancer cases. Pulmonologists play a vital role in biomarker testing and care coordination. <br /><br />Overall, while advancements in treatment and screening offer new hope, careful application and ongoing research are essential to maximize patient outcomes.
Keywords
lung cancer treatment
screening advancements
EGFR-positive tumors
ALK-positive tumors
pulmonary nodules
biomarker testing
guided bronchoscopy
SBRT
molecular markers
pulmonologists
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American College of Chest Physicians
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