ABSTRACT
@#The majority of incidentally found and screen-detected lung cancer is manifested as ground-glass nodule (GGN), which is more likely to be detected in the young people, women and non-smokers. An appropriate management strategy for GGN can not only reduce the mortality of lung cancer but also minimize overtreatment. Although most of persistent GGNs are finally diagnosed as adenocarcinoma or precursor glandular lesions, the GGN-featured lung cancer is characterized as indolent growth or even non-growth. Therefore, scheduled follow-up might be safe for the special radiologic type under a certain condition. We should design the individualized diagnosis and treatment strategy for each patient. The treatment decision-making depends on various factors, including invasion, dynamic change, efficacy and safety of the treatment, as well as physical and psychic condition of the patients. Different from other types of lung cancer, the indolent feature of GGN-featured lung cancer allows a long time to intervene. Therefore, the determination of proper timing for intervention should be made cautiously. Surgical resection is still the principal treatment for GGN-featured lung cancer. However, there is still no consensus on the optimal surgical approach for GGN-featured lung adenocarcinoma. Currently, sublobar resection without lymphadenectomy has been recommended to the patients with precursor glandular lesions. In light of the GGN-featured lung cancer which generally represents a local lesion, local ablation therapies have been used in those patients, especially in the ones who are inoperable or refuse to undergo surgery. The percutaneous local ablation includes different techniques: radiofrequency ablation, microwave ablation and argon-helium cryoablation. The local ablation is safe, minimally invasive and repeatable. In addition, it offers the advantage to biopsy and treatment synchronously. Percutaneous ablation has the potential to be an alternative of surgery to cure GGN-featured lung cancer based on emerging evidences. The efficacy of transbronchial ablation guided by ultrasound or electromagnetic navigational system in the treatment of GGN-featured lung cancer has been primarily validated. As a developing technology, it might be a promising approach but needs further exploration. With the advance in ablation technology, we do believe that the interventional therapy will play an equal role as surgery in curative treatment of GGN-featured lung cancer in the future. Personalized treatment considering the condition of patients and the features of the lesion will maximize the benefit of every patient. This article will explore the diagnosis and treatment strategies of GGN on the basis of further understanding of GGN, and introduce the application of ablation therapy in GGN from the perspective of respiratory intervention.
ABSTRACT
Objective To explore the efficacy and adverse reaction of nedaplatin (NDP)+gemcitabine (GEM)and cisplatin (DDP)+GEM for advanced lung squamous cell carcinoma.Methods A total of 1 01 cases advanced untreated patients from September 201 2 to December 201 3 were randomly divided into 2 groups using random number table method:69 patients in the observation group accepted NDP+GEM treatment and 32 patients in the control group received DDP +GEMtreatment.The objective response rate (RR),disease control rate (DCR ) and progression-free survival (PFS ) and adverse reaction were collected and evaluated. Results RR was 28.6%(1 8/63)in the observation group and 1 5.6%(5/32)in the control group,DCR was 81 .0%(51/63)in the observation group and 68.8%(22/32)in the control group (χ2 =1 .36,P=0.24;χ2 =1 .67,P=0.20).The median PFS was 4.52 months and 4.01 months in the observation group and control group (χ2 =0.09,P=0.73).The major adverse reaction was myelosuppression in both groups (33.3% vs.37.5%,χ2 =0.1 7,P=0.68).The incidence ofⅢ-Ⅳ grade nausea and vomiting was lower in the observation group, compared with the control group (1 4.5%vs.56.3%,χ2 =1 9.02,P=0.05).Conclusion NDP combined with GEM in advanced lung squamous cell carcinoma of the first-line treatment has equivalent efficacy to DDP+GEM, with lower incidence of adverse reaction,which is worthy of further dissemination of research.
ABSTRACT
ObjectiveTo evaluate the efficacy, feasibility and safety of CT guided percutaneous 125Ⅰ seeds implantation in elderly patients of stage Ⅰperipheral non-small cell lung cancer ( NSCLC ).MethodsClinical data of 16 elderly peripheral stage Ⅰ NSCLC patients ( 10 squamous carcinoma and 6adenocarcinoma;13 stage ⅠA and 3 stage ⅠB ) who received radioactive 125Ⅰ seeds implantation because of refusal or being unsuited to operation or external radiotherapy were retrospectively analyzed. Prescribed dose was 140 - 160 Gy. Under CT guidance, 125Ⅰ seeds were implanted percutaneously into tumors for interstitial radiotherapy according to treatment plan system. ResultsMean number of 125Ⅰ seeds each patient received was21.1. 12 complete response (CR) and 4 partial response (PR) were achieved. Total response rate ( CR + PR) was 100％. 100％ patients completed 10 to 56 months of follow-up, 15, 13, 8 and 6 patients completed 1-, 2-, 3-and 4-years'follow-up, respectively. The median local progression free time was 14months. The 1-,2-,3-and 4-year overall survival rate were 60％, 54％, 50％ and 33％, respectively (median:14 months). 7 cases died of non-tumor disease and 5 died of metastasis. No severe complications were observed. ConclusionsCT guided 125Ⅰ seeds implantation is a safe, reliable and effective radical treatment method for elderly stage Ⅰ peripheral NSCLC patients, who refuse to or are unsuitable to operation or external radiotherapy.