Based on new clinical evidence, the National Comprehensive Cancer Network (NCCN) annually updates and releases the "NCCN Guidelines for the Clinical Diagnosis and Treatment of Non-Small Cell Lung Cancer" which has become the reference for clinical diagnosis and treatment approved and complied by clinicians worldwide. On November 25, 2020, the latest 2021 V1 version of "NCCN Clinical Diagnosis and Treatment Guidelines for Non-Small Cell Lung Cancer" (hereinafter referred to as "Guidelines") was released. Compared with the 8th edition of the "Guidelines" in 2020, many updates focused on the progress of targeted and immunotherapy. This article will provide the interpretations of the updated therapy content of this edition of the guidelines.
In recent years, immune checkpoint inhibitor therapy has changed the treatment of various malignant tumors. Immunotherapy for specific targets currently plays an important role in melanoma, lung cancer and other tumors. Malignant pleural mesothelioma (MPM) is an aggressive malignant tumor. Although the treatments include surgery, chemotherapy and radiotherapy, the clinical efficacy is limited, and the prognosis of advanced patients is poor. With the application of monoclonal antibodies such as programmed death 1/programmed death ligand 1 and cytotoxic T-lymphocyte antigen 4, MPM patients have more treatment options. And compared with traditional chemotherapy, immunotherapy may have the effect of improving survival and shrinking tumors. This article will summarize the current clinical trials of immunotherapy in MPM, and explain the current application and progress of immunotherapy in MPM from both single-agent immunotherapy and combined immunotherapy.
Intrathyroid thymic carcinoma (ITTC) is a rare type of malignent tumor. Two cases of ITTC were reported. Both patients underwent surgical treatment and recovered well after surgery, with no surgery-related complications and no recurrence during follow-up. In order to discuss the clinical features, diagnosis and treatment of ITTC, the literature review was conducted.
The National Comprehensive Cancer Network (NCCN) updates the "NCCN clinical practice guidelines in oncology: Lung cancer screening" annually, and the second edition of 2024 was released in October 2023. The 2024 edition of the guidelines builds on the 2023 edition with some updates on description and assessment of risk factors for lung cancer, evaluation and follow-up of lung nodules found during initial and subsequent screening, and low-dose CT screening protocols and imaging modalities. In this article, we will introduce the above updates and provide reference for lung cancer screening in China by combining the relevant guidelines and consensus in China.
Surgery is the preferred treatment for early esophageal cancer. Minimally invasive esophagectomy (MIE) can significantly reduce the incidence of postoperative complications and mortality, but due to the complex esophageal anatomy, intraoperative esophageal exposure, separation, anastomosis and lymph node dissection are difficult. The da Vinci surgical system provides a 3D vision and a more flexible as well as stable robotic arm, which is very helpful in completing fine surgical procedures. Robot-assisted minimally invasive esophagectomy(RAMIE) has been carried out in a number of countries, including China. Robot-assisted Ivor-Lewis esophagectomy (RAILE) is a transthoracic approach of robots developed in recent years. This paper summarizes the current researches on RAILE.
The National Comprehensive Cancer Network (NCCN) released the latest version 1, 2022 of "NCCN guidelines for the clinical diagnosis and treatment of small cell lung cancer" (hereinafter referred to as "guideline"). Based on high-quality evidence-based medicine, this guideline provides references of clinical diagnosis and treatment for clinicians around the world. Compared with the version 3, 2021 of the "guideline", updates and revisions mainly focused on the progress of radiotherapy and systemic treatment. This article will interpret the updated therapy content in this new version of the "guideline".
The National Comprehensive Cancer Network (NCCN) has updated and released the latest content of the NCCN guidelines for the clinical diagnosis and treatment of non-small cell lung cancer (NSCLC) in the version 1, 2022. Based on high-quality clinical evidence and the latest research progress of the diagnosis and treatment of NSCLC, the guidelines have been widely recognized and welcomed by clinicians around the world. Compared with the version 7, 2021, the new version has been updated and revised in some parts of chapters and sections, mainly focusing on targeted therapies and molecular testing. This article will interpret the updated therapy content of the new version.
ObjectiveTo investigate the clinical efficacy of preoperative location of pulmonary nodules guided by electromagnetic navigation bronchoscopy (ENB). MethodsPatients who received preoperative ENB localization and then underwent surgery from March 2021 to November 2022 in the Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine were collected. The clinical efficacy and safety of ENB localization and the related factors that may affect the success of ENB localization were analyzed. ResultsInitially 200 patients were included, among whom 17 undergoing preoperative localization and biopsy were excluded and a total of 183 patients and 230 nodules were finally included. There were 62 males and 121 females with a mean age of 49.16±12.50 years. The success rate of navigation was 88.7%, and the success rate of ENB localization was 67.4%. The rate of complications related to ENB localization were 2.7%, and the median localization time was 10 (7, 15) min. Multi-variable analysis showed that factors related to successful localization included distance from localization site (OR=0.27, 95%CI 0.13-0.59, P=0.001), staining material (OR=0.40, 95%CI 0.17-0.95, P=0.038), and staining dose (OR=60.39, 95%CI 2.31-1 578.47, P=0.014). Conclusion ENB-guided preoperative localization of pulmonary nodules is safe and effective, and the incidence of complications is low, which can be used to effectively assist the diagnosis and treatment of early lung cancer.
Chinese Medical Association Guidelines for Clinical Diagnosis and Treatment of Lung Cancer (2023 Edition) has been released in July 2023. Based on the 2022 edition, the 2023 edition of the guideline has been updated in the aspects of lung cancer screening, pathology, surgical standards, neoadjuvant therapy, targeted therapy and treatment of advanced lung cancer. This article will give a brief introduction to these updated parts.
Recently, anatomical segmentectomy emerges as a hot spot in clinical research for surgical treatment of early-stage lung cancer. The techniques of segmentectomy are more elaborate and complicated than lobectomy, because of the considerable anatomic variations of segment blood vessels and bronchus. In a long term, video-assisted thoracic surgery is the mainly minimally invasive approach. As a new approach of minimally invasive surgery, da Vinci robot system possesses three-dimensional and high definition view, better dexterity mechanical wrist and tremor filtering system, which are the main advantages over video-assisted thoracic surgery. All the superiorities of robot system provide good supports for performing segmentectomy. Robot-assisted segmentectomy has been carried out in many medical centers in China and abroad until now. However, most surgery cases often lack adequate controls on quality.