Treatment Decisions for Resectable Non-Small-Cell Lung Cancer: Balancing Less With More?

For patients with non-small-cell lung cancer (NSCLC), the outcomes for patients with resectable disease are historically poor compared with other solid organ malignancies. In recent years, there have been significant advances in multidisciplinary care, which have resulted in improved outcomes. Innovations in surgical oncology include the use of limited resection and minimally invasive techniques. Recent data in radiation oncology have suggested refinements in pre- and postoperative radiation therapy, resulting in optimization of techniques in the curative setting. Finally, the success of immune checkpoint inhibitors and targeted therapies in the advanced setting has paved the way for inclusion in the adjuvant and neoadjuvant settings, resulting in recent regulatory approvals for four regimens (CheckMate-816, IMpower010, PEARLS, ADAURA). In this review, we will provide an overview of the seminal studies informing advancements in optimal surgical resection, radiation treatment, and systemic therapy for resectable NSCLC. We will summarize the key data on survival outcomes, biomarker analyses, and future directions for perioperative studies.

Co-designing a recruitment strategy for lung cancer screening in high-risk individuals: protocol for a mixed-methods study.

Background: Lung cancer is a significant cause of cancer-related mortality globally, with early detection through screening critical to improving patient outcomes. However, recruiting high-risk individuals, particularly in deprived populations, for screening remains a considerable challenge. This study aims to co-design a targeted recruitment strategy for lung cancer screening, tailored to the specific needs and experiences of high-risk individuals, in collaboration with a Patient and Public Involvement (PPI) panel and expert stakeholders in Ireland. Methods: We will employ a mixed-methods design guided by the Medical Research Council (MRC) framework for developing complex interventions. Our approach will integrate systematic review findings on screening participation interventions, evaluation of the recruitment strategy's feasibility in an Irish context, and the application of behavioural science frameworks. The target population includes individuals over 55 years, either current smokers or those who quit within the last year, who reside in highly deprived areas. Conclusion: This co-designed recruitment strategy will combine evidence-based research, local context understanding, and stakeholder input to develop a solution that is both scientifically robust and tailored to the target population's needs. This patient-centred approach aims to increase the potential for successful implementation of lung cancer screening programs, thereby improving early detection and patient outcomes.

Parathormone response to thyroid surgery.

BACKGROUND: Confident determination of adequate residual parathyroid function early after thyroid surgery could facilitate the discharge of patients soon after their operation without the need for subsequent serum calcium monitoring and/or calcium and vitamin D supplementation. METHODS: Thirty-one patients who underwent 33 thyroid operations (22 unilateral lobectomies and 11 bilateral thyroid resections) were prospectively studied. Parathormone (PTH) levels were measured intraoperatively, and serum calcium was monitored before and after surgery to determine PTH and calcium homeostatic response to thyroid surgery. RESULTS: A significant decrease in circulating PTH occurred during 27 procedures, most markedly after specimen mobilization. Intraoperative PTH and postoperative calcium levels were lowest in those who underwent bilateral operations. Patients who underwent unilateral procedures experienced significant decreases in PTH but not postoperative calcium levels. A PTH level >50% of baseline predicted normocalcemia by postoperative day 3. However, PTH level did not accurately triage other patients' risk for postoperative hypocalcemia. CONCLUSIONS: A decrease in PTH levels intraoperatively is a common event during both unilateral and bilateral thyroid operations. Although normal PTH levels at the end of surgery ensure normocalcemia after surgery, patients with low final PTH measurements may not develop significant hypocalcemia after surgery.