Lung cancer is a systemic disease, and only patients with early stage I (T≤2 cm, no lymph node metastasis) have the possibility of cure. If patients are T≥4 or 5 cm, their chances of local recurrence and distant metastasis will increase, so the five-year survival rate of stage I, IA patients can reach more than 95%, while stage IB ones drop to between 85%-95%, to 60%-70% for stage II, and only 25% for stage III lung cancer patients. Therefore, it is considered that lung cancer is not only a disease of thoracic surgery, but also a disease that requires the cooperation of thoracic surgery, medical oncology, respiratory medicine and radiotherapy to deal with. Lu Yanda, Department of Radiotherapy, Affiliated Hospital of Hainan Medical College
In recent years, clinical research on postoperative adjuvant therapy for early lung cancer is being carried out. What is the traditional treatment then? It is empirical treatment, picking a standard regimen and starting chemotherapy for the patient, one regimen for all patients. Now it is found that with the same regimen, many patients are actually accompanying the treatment, so how should the regimen be selected? The main thing is to apply genetic screening methods to select patients who can benefit from postoperative adjuvant therapy for treatment. For example, through this genetic screening, patients who are sensitive to platinum drugs or to paclitaxel-like drugs can be selected for chemotherapy. Due to the widespread use of minimally invasive surgery, patients recover quickly after surgery, ensuring that postoperative adjuvant therapy (especially adjuvant chemotherapy or radiotherapy) can be administered as scheduled and in adequate doses, whereas previously, those who wanted to have chemotherapy after conventional surgery often had to give up because of postoperative complications.
On the other hand, since post-surgical lung cancer specimens are routinely tested for lung cancer-related genes, post-surgical adjuvant chemotherapy and targeted therapy are more targeted and reflect more individualized treatment of lung cancer, thus minimizing or avoiding over-treatment of post-surgical lung cancer patients. This is currently one of the more important clinical studies worldwide, and the results show that the 5-year survival rate of patients can be increased by 4%-15% with post-operative adjuvant therapy, but at the same time more clinical studies are needed to do a good job of targeted and highly selective individualized therapy. There is a very famous 9633 study on platin plus testosterone regimen treatment. As mentioned above those with tumors smaller than 2 cm or 3 cm do not benefit from postoperative adjuvant therapy and should never be over treated. As long as the lesion is less than 3 cm, postoperative adjuvant therapy should not be done, and survival after surgery can be completely unimpeded. If the lesion is larger than 5 cm treated with a two-drug platinum-containing teso plus carboplatin regimen reduces mortality by 27%, although the difference is not significant at this point; however, when the lesion is larger than 7 cm, or T3, postoperative adjuvant therapy reduces mortality by 48%, and the difference is significant.
It is okay for thoracic surgeons not to do postoperative adjuvant chemotherapy, but they must send the resected tumor for examination and do relevant genetic testing before referring the patient to medical oncology for chemotherapy. With the abundance of postoperative adjuvant therapy, from chemotherapy to radiotherapy to targeted therapy, there are now many research projects studying postoperative adjuvant therapy, such as the study of Lipitor plus platinum-based treatment regimens. Currently, there are close to 130 studies in the clinical registry for adjuvant therapy for non-small cell lung cancer, as can be learned from specialized medical websites. We are looking forward to more insights from studies such as E1505, MAGRIT and SELECT. We hope that surgeons all establish the concept of comprehensive treatment and cooperate and help medical oncology to do a good job in postoperative adjuvant treatment, because the specimen is in our hands and the physician’s compliance is also in our hands. If a surgeon says, “Don’t worry, the surgery is clean, no need to do adjuvant therapy”, the patient will not listen to the surgeon no matter what he or she says.
Lung cancer is lung cancer, it is not a disease of thoracic surgery, radiotherapy or medical oncology. We now advocate an integrated multidisciplinary treatment system, and hope to establish a lung cancer treatment center, which includes both surgery and internal medicine and radiotherapy. Thoracic surgeons should participate in the multidisciplinary integrated treatment, and also participate in the clinical multicenter research. In particular, the Ministry of Health of China has now introduced the clinical pathway management of thoracic surgery, which includes the clinical pathway management of lung cancer and esophageal cancer; in 2011, the edition of the “Treatment Standards for Primary Lung Cancer of the Ministry of Health of the People’s Republic of China” was published and issued, requiring thoracic surgery, medical oncology and radiotherapy departments in each region to strictly comply with the treatment standards for lung cancer.