Lung%20cancer Treatment

Treatment

Surgical Intervention

Surgery for Non-Small Cell Lung Cancer (NSCLC)

Resectability of tumor, surgical staging and pulmonary resection should be fully assessed
May offer the best chance of survival and possible cure in NSCLC patients with stage I-II disease
- May be considered in patients with N2 disease responsive to induction chemotherapy
Surgery is recommended for patients with the following:
- ≥8 mm solid nodule on LDCT screening that has high probability of cancer as shown on PET/CT scan
- ≥8 mm solid nodule that increased in size in chest CT with contrast and/or PET/CT scan with high probability for cancer
- ≥15 mm solid nodule with the same measurements in PET/CT scan with high probability for cancer
- ≥6 mm part-solid nodule with ≥6-<8 mm solid component in follow-up LDCT with high probability for cancer in PET/CT scan
- New or growing part-solid nodule with ≥4 mm solid component in LDCT with high probability for cancer in chest CT scan with contrast and/or PET/CT scan
- Growing NS nodule ≥20 mm in size during follow-up or annual LDCT
Treatment of choice for stage I and II NSCLC
- In the absence of medical contraindications to surgery, complete resection (ie lobectomy) with clear surgical margins should be achieved as much as possible
- In patients with comorbidities who are not able to tolerate lobectomy, sublobar resection (segmentectomy or wedge resection) is recommended
  - Parenchymal resection margins ≥2 cm or more than the nodule's size is preferred
- Contraindications to lobectomy/indications for sublobar resection include:
  - Impaired pulmonary function
  - Peripheral nodule ≤2 cm with at least 1 of the following: Pure adenocarcinoma in situ, nodule with ≥50% ground-glass appearance on CT scan, long doubling time of ≥400 days on imaging
- Nodal dissection is preferred over simple intraoperative sampling for mediastinal lymph node
- Sleeve lobectomy is recommended for total resection of centrally or locally advanced NSCLC

Surgery in stage IIIA N2 lung cancer is controversial
- Surgery is considered in resectable stage IIIA N0-1 tumors, followed by adjuvant chemotherapy
- Usually not recommended if with involvement of N2; patient may undergo chemotherapy prior to surgery to decrease the tumor size, eliminate micrometastases and to improve patient’s tolerance to procedure
- Formal ipsilateral mediastinal LN dissection is indicated for patients undergoing planned resection
- For patients undergoing video-assisted thoracic surgery (VATS) with N2 disease, procedure may be halted to start induction therapy or may opt to continue with the surgery

En-bloc resection of the involved structure with negative margins is required for patients with T3 and T4 local extension tumors
VATS is a less invasive and reasonable approach for patients with no anatomic or surgical contraindication
For highly selected patients with recurrent NSCLC, stereotactic radiation surgery and surgical resection of isolated cerebral metastasis are recommended

Surgery for Small Cell Lung Cancer (SCLC)

Considered only for patients with clinical stage I-IIA and in limited disease (LD) patients with sufficient pulmonary function and no evidence of metastases to mediastinal or supraclavicular lymph nodes
Lobectomy or pneumonectomy should be done followed by detailed dissection of the mediastinal lymph nodes
Platinum-based adjuvant chemotherapy is recommended after complete resection

Long COVID: What we have learned so far

Prof. Ghassan Dbaibo, 27 Apr 2023

The WHO defines long COVID as a condition that occurs 3 months from COVID-19 onset, whose symptoms last ≥2 months and cannot be attributed to an alternative diagnosis. In an interview with MIMS Doctor, Professor Ghassan Dbaibo of the Center for Infectious Diseases, American University of Beirut, Beirut, Lebanon, describes the evolving attitudes towards long COVID among healthcare professionals (HCPs), some unexpected predisposing factors, potential biological mechanisms behind prolonged symptom duration and shares data on vaccination’s protective effects against long COVID.

Antigen rapid test vs RT-PCR for COVID-19: What you need to know

Pearl Toh, 29 Jul 2021

While RT-PCR is the current gold standard to confirm a SARS-CoV-2 infection, antigen rapid test (ART) for COVID-19 allows for quick detection of SARS-CoV-2 and thus fast triaging of infected patients requiring isolation at the population level, according to studies presented at ECCMID 2021.

Tackling multidrug-resistant gram-negative bacterial infections in critically ill patients: Challenging the standard approach

Dr. Asok Kurup, Dr. Kenneth Chan, 07 Dec 2020

The rising incidence of infections caused by multidrug-resistant (MDR) gram-negative bacteria has become a serious health threat and a major challenge for intensivists. Against a backdrop of high patient mortality and risk factors for infection in intensive care units (ICU), early adequate therapy is of paramount importance. At a recent Pfizer-sponsored symposium, Dr Asok Kurup, Infectious Disease Physician, Singapore presented the implications of MDR gram-negative infections in critically ill patients in Asia, while Dr Kenneth Chan, Respiratory Physician and Intensivist, Singapore highlighted the role of ceftazidime-avibactam (Zavicefta) and shared published real-world data on ceftazidime-avibactam.