CHEST Guidelines-American-College-of-Chest-Physicians-and-Society-o

American-College-of-Chest-Physicians-and-Society-o

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The executive summary of the report from the American College of Chest Physicians and the Society of Thoracic Surgeons addresses the treatment and evaluation of high-risk patients with stage I non-small cell lung cancer (NSCLC). The standard treatment for this condition is lobectomy with systematic mediastinal lymph node evaluation. However, up to 25% of these patients are not suitable candidates for lobectomy due to severe medical comorbidities.<br /><br />The consensus statement was developed by an expert panel using an evidence-based approach, resulting in 13 suggestions for evaluating and managing high-risk patients. This involves focusing on cardiopulmonary physiology, given the substantial risk of respiratory failure. Alternative treatments to lobectomy include sublobar resection (possibly with brachytherapy), stereotactic body radiation therapy (SBRT), and radiofrequency ablation (RFA). These options carry lower procedural morbidity and mortality but have heightened risks of recurrence in the originally affected lobe compared to lobectomy.<br /><br />The document emphasizes that treatment options for high-risk patients are evolving, particularly with advancements in radiographic staging and early detection of tumors. This prompts a shift towards parenchymal-sparing or nonoperative therapies in such patients. The publication stresses the need for unbiased assessment of therapies through uniform reporting of treatment populations and outcomes in clinical studies, which has been lacking.<br /><br />Key measures for medical assessment include FEV1, diffusing capacity of the lung for carbon monoxide (D LCO), and peak oxygen consumption, which help predict morbidity and mortality risks. Recommendations also include quality-of-life assessments and detailed documentation in clinical trials to improve treatment evaluations for high-risk populations with stage I NSCLC. The overarching goal is to provide an evolving, multidisciplinary approach to treatment for those not eligible for standard lobectomy.

Keywords

NSCLC

lobectomy

high-risk patients

sublobar resection

SBRT

radiofrequency ablation

cardiopulmonary physiology

treatment evaluation

clinical trials

quality of life