A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation-part 1: a guide to decision-making.

Autor:	Detterbeck FC; Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA., Blasberg JD; Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA., Woodard GA; Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA., Decker RH; Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA., Kumbasar U; Thoracic Surgery, Hacettepe University School of Medicine, Ankara, Turkey., Park HS; Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA., Mase VJ Jr; Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA., Bade BC; Pulmonary Medicine, Yale University School of Medicine, New Haven, CT, USA., Li AX; General Surgery, Yale University School of Medicine, New Haven, CT, USA., Brandt WS; Cardiothoracic Surgery, Washington University School of Medicine, St louis, MO, USA., Madoff DC; Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA.
Jazyk:	angličtina
Zdroj:	Journal of thoracic disease [J Thorac Dis] 2022 Jun; Vol. 14 (6), pp. 2340-2356.
DOI:	10.21037/jtd-21-1823
Abstrakt:	Background: Clinical decision-making for patients with stage I lung cancer is complex. It involves multiple options (lobectomy, segmentectomy, wedge, Stereotactic Body Radiotherapy, thermal ablation), weighing multiple outcomes (e.g., short-, intermediate-, long-term) and multiple aspects of each (e.g., magnitude of a difference, the degree of confidence in the evidence, and the applicability to the patient and setting at hand). A structure is needed to summarize the relevant evidence for an individual patient and to identify which outcomes have the greatest impact on the decision-making. Methods: Based on a systematic review from 2000-2021, evidence regarding relevant outcomes was assembled, with attention to aspects of applicability, uncertainty and effect modifiers. A framework was developed to present this information a format that enhances decision-making at the point of care for individual patients. Results: While patients often cross over several boundaries, the evidence fits into categories of healthy patients, compromised patients, and favorable tumors. In healthy patients with typical (i.e., solid spiculated) lung cancers, the impact on long-term outcomes is the major driver of treatment selection. This is only slightly ameliorated in older patients. In compromised patients increasing frailty accentuates short-term differences and diminishes long-term differences especially when considering non-surgical vs. surgical approaches; nuances of patient selection (technical treatment feasibility, anticipated risk of acute toxicity, delayed toxicity, and long-term outcomes) as well as patient values are increasingly influential. Favorable (less-aggressive) tumors generally have good long-term outcomes regardless of the treatment approach. Discussion: A framework is provided that organizes the evidence and identifies the major drivers of decision-making for an individual patient. This facilitates blending available evidence and clinical judgment in a flexible, nuanced manner that enhances individualized clinical care. Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-21-1823/coif). The series “A Guide for Managing Patients with Stage I NSCLC: Deciding between Lobectomy, Segmentectomy, Wedge, SBRT and Ablation” was commissioned by the editorial office without any funding or sponsorship. FCD served as the unpaid Guest Editor of the series. HSP serves as an unpaid editorial board member of Journal of Thoracic Disease. HSP reports research funding from RefleXion Medical; consulting fees from AstraZeneca; honoraria and speaking fees from Bristol Myers Squibb; and advisory board fees from Galera Therapeutics; all unrelated to current work. BCB reports in the past 36 months, he receives grants from Veterans Affairs Central Office, American Cancer Society, Yale SPORE in Lung Cancer. DCM reports that he is the lead for an early career educational course on microwave ablation that is sponsored by Johnson & Johnson. The authors have no other conflicts of interest to declare. (2022 Journal of Thoracic Disease. All rights reserved.)
Databáze:	MEDLINE
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