Lung cancer, as one of the malignant tumors with the highest incidence worldwide, has attracted much attention due to its increasing number of patients year by year. How to formulate reasonable treatment plans for the best treatment outcome in a more scientific and standardized way, how to maximize the disease-free survival time of patients, and how to ensure the best post-operative quality of life of patients is currently an urgent issue that every lung cancer doctor must address, and it is also an important issue that lung cancer patients and their families should recognize and understand.
Standardized treatment is an important issue in the world, and it is also a difficult problem in China. In clinical practice, the same film and the same patient are treated differently by three or four or five authoritative experts, and the treatment methods are different or even opposite. Patients are often confused when seeking medical treatment, and inevitably, they have to turn to doctors for treatment, while doctors in different hospitals have different knowledge about lung cancer disease, which also causes irregular treatment of lung cancer to a certain extent. In order to prolong patients’ lives and improve their quality of life as much as possible, it is necessary to combine the latest and most effective proven treatment methods and customize them for each patient so that each lung cancer patient can receive the best treatment, therefore, it is very important for our team to propose and promote comprehensive multidisciplinary treatment with surgery as the main treatment, i.e. standardized treatment of lung cancer.
I. What are the benefits of standardized lung cancer treatment for patients
1. Standardized surgical treatment is the most important and critical treatment for lung cancer patients;
2.Significantly improve the survival rate of patients;
3.Prolong the time without disease progression and reduce the local recurrence rate;
4.Minimize the situation of tumor micrometastasis and jump metastasis and other complicated situations;
5.Provide more accurate clinical staging for doctors and patients, and provide accurate information for later treatment.
What is the standardized treatment of lung cancer?
According to the Guidelines for Standardized Diagnosis and Treatment of Lung Cancer formulated by the Ministry of Health of China in 2011, it is required that
(A) Principles of surgical treatment for lung cancer
Before any non-emergency surgical treatment, necessary imaging and auxiliary examinations such as cardiopulmonary, hepatic and renal functions should be completed according to the diagnostic requirements, and c-TNM staging of lung cancer should be performed to facilitate the formulation of a comprehensive, reasonable and individualized treatment plan.
a. A surgeon with thoracic surgery as the main specialty should decide the possibility of surgical resection and develop the surgical plan. Complete resection of tumor and regional lymph nodes should be achieved as much as possible; meanwhile, functional lung tissues should be preserved as much as possible.
b. Complete resection of lung cancer should be performed routinely by removing all groups of lymph nodes in the hilum and mediastinum and marking their locations for pathological examination, and at least three lymph nodes in the mediastinal drainage area should be sampled or lymph node dissection.
c. For patients with recurrence or isolated lung metastases 6 months after complete resection of lung cancer, residual lung resection or resection of diseased lung is feasible if distant metastases are excluded.
Patients with stage I and II who are evaluated by the thoracic surgeon as inoperable may be treated with radical radiotherapy and/or systemic chemotherapy instead.
(ii) Surgical treatment (indication for surgery) is feasible in the following cases.
a, Stage I, II and some Stage IIIa non-small cell lung cancer and some small cell lung cancer.
b, N2 non-small cell lung cancer that is effective after neoadjuvant therapy.
c, some stage IIIb non-small cell lung cancer if the tumor can be completely removed locally.
d.Some stage IV non-small cell lung cancer with single brain or adrenal metastasis.
e. Those who have high clinical suspicion of lung cancer and cannot be diagnosed qualitatively by various examinations and are recommended to be referred to a higher level hospital for further consultation and treatment.
(c) Surgical treatment should not be performed in the following cases.
a, the vast majority of stage IV, most stage IIIB and some stage IIIA non-small cell lung cancer with clear diagnosis.
b. Those with poor cardiopulmonary function or combined with serious diseases of other important organ systems that cannot tolerate surgery.
Simply put, what is standardized treatment of lung cancer? It is to let patients receive standardized diagnosis and standardized treatment, which requires unified standardized standards for lung cancer staging and treatment plan. It requires unified standardized criteria for lung cancer staging and treatment plan, and unified criteria for judging what kind of patients can have surgery and what kind of patients cannot have surgery.
III. Irregular lung cancer treatment phenomenon that cannot be ignored
Although the implementation of standardized treatment for lung cancer is so important, the following phenomena of non-standardized treatment and its consequences still exist in some medical units due to the awareness or conditions.
1. According to the standardized treatment criteria, patients who should receive surgical treatment do not undergo surgery, but instead undergo radiotherapy and chemotherapy, which makes patients miss the best time for surgery and adds extra burden;
2.In accordance with the standardized treatment criteria, patients with advanced disease who should not have received surgical treatment instead underwent surgery;
3.Patients who are eligible for surgical treatment, but the resection of lung cancer lesions cannot reach the standard of complete cure, which leads to residual lesions and increases the risk of intraoperative dissemination, postoperative recurrence and metastasis;
4. Incomplete lymph node dissection in surgical treatment leads to recurrence and metastasis of lung cancer after surgery.
5. Patients with lung cancer who have received surgical treatment are not standardized to assess whether they need appropriate adjuvant therapy such as radiotherapy or targeted therapy after surgery, resulting in increased risk of tumor spread due to the lack of consolidation therapy after surgery;
The whole process of standardized lung cancer treatment
1. Clear clinical lung cancer stage before treatment.
Patients should undergo whole-body examination (avoid repeating the examinations recently completed by patients in outside hospitals), including chest X-ray and chest CT, head MRI, ultrasound (or CT) of abdominal organs, whole-body bone scan to exclude distant metastases. EBUS or CT percutaneous lung puncture), and finally complete the cell type diagnosis and clinical staging of lung cancer to guide the next step of treatment. Those who have difficulty in diagnosis will be consulted by a multidisciplinary lung cancer diagnosis and treatment team.
2.Implementation of standardized treatment.
(1) Standardized surgical treatment of lung cancer: It requires resection of the primary tumor and the lung lobe where it is located and systematic clearance of the hilar and mediastinal lymph nodes, (generally including the lymph nodes in three areas of the hilar region and three adjacent mediastinal regions). For example, intraoperative rapid pathological examination must be done if there is any suspicion of residual tissue, and the chest cavity and wound must be soaked and flushed with distilled water to highlight the professionalism of tumor surgery.
②Patients eligible for surgery for non-small cell lung cancer undergo standardized surgery, and postoperative decision on whether reasonable and effective postoperative adjuvant chemotherapy, radiotherapy or targeted therapy regimen is needed and formulated based on pathology and lymph node metastasis. Appropriate drugs are selected based on the genetic test results of the pathological specimens of this patient. For preoperative clearly diagnosed mediastinal lymph node metastasis or locally advanced lung cancer, preoperative neoadjuvant chemotherapy and radiotherapy can be administered, and those with reduced tumor size will continue to undergo standardized surgery.
3. Multidisciplinary cooperation to further improve standardization.
The multiple stages of diagnosis, evaluation, treatment and rehabilitation of lung cancer patients are cooperated with multiple authoritative departments such as respiratory medicine, medical oncology, radiology, pathology and laboratory to discuss and collaborate regularly, share and improve the standardized treatment plan, and formulate individualized treatment measures for each patient, so that the treatment plan of patients can be more comprehensively standardized.
4. Long-term post-operative follow-up review follow up.
All surgical patients will establish a complete database of their condition, and after surgery, patients or their families will be contacted regularly through various ways (outpatient, QQ or telephone) to understand the recovery situation and guide post-operative rehabilitation and treatment, so that patients can receive standardized treatment throughout.
Post-operative patients will have their chest CT, abdominal ultrasound and tumor markers reviewed once every 3 months within 2 years, and once every 6 months from 2 years to 5 years after surgery, and after 5 years, it can be changed to annual comprehensive examination.
For detailed steps and instructions of post-operative review for lung cancer patients, please refer to the article “How to Review Lung Cancer Patients After Surgery” on our website.
With the gradual advancement of the current international medical level and the improvement of people’s demand for quality of life, the standardization of lung cancer surgical treatment has become imperative, and the standardized treatment of lung cancer has been paid more and more attention to. Although each hospital has its own characteristics in some small details, the general principle is the same, so that lung cancer patients can receive the best treatment, prolong their lives and improve their quality of life.
Our team has taken the lead in minimally invasive surgery for lung cancer in China, especially in Hubei Province, not only removing the primary tumor but also performing standardized and systematic lymph node dissection, with minimally invasive surgery accounting for more than 68% of all our surgeries. The standardized treatment of lung cancer has become the regular treatment guideline of our team, and after long-term statistics, the 3-year and 5-year survival rates of lung cancer patients treated by our team are among the leading international standards, which is also a very convincing reflection of the benefits of standardized treatment for patients.