Leventakos Konstantinos, Peikert Tobias, Midthun David E, Molina Julian R, Blackmon Shanda, Nichols Francis C, Garces Yolanda I, Hallemeier Christopher L, Murphy Stephen J, Vasmatzis George, Kratz Sarah L, Holland William P, Thomas Charles F, Mullon John J, Shen K Robert, Cassivi Stephen D, Marks Randolph S, Aubry Marie Christine, Adjei Alex A, Yang Ping, Allen Mark S, Edell Eric S, Wigle Dennis, Mansfield Aaron S
Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota.
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota.
J Thorac Oncol. 2017 Sep;12(9):1398-1402. doi: 10.1016/j.jtho.2017.05.013. Epub 2017 Jun 3.
Multifocal lung cancer is an increasingly common clinical scenario, but there is lack of high-level evidence for its optimal treatment. Thus, we surveyed members of the interdisciplinary International Association for the Study of Lung Cancer on their therapeutic approaches and analyzed the resultant practice patterns.
We described the clinical scenario of an otherwise healthy 60-year-old man with bilateral pulmonary nodules and asked the 6373 members of the International Association for the Study of Lung Cancer whether they would recommend surgery, and if so, the extent of surgery. We also asked what other measures would be recommended to complete the staging and whether radiation therapy or chemotherapy would be suggested.
We received 221 responses (response rate 3.5%) from multiple specialists. Most respondents (140 [63%]) recommended surgery for this scenario. Surgeons were significantly more likely to recommend surgery than were those in other specialties. Of those who recommended surgery, most would obtain a PET/CT scan to rule out distant metastases and a magnetic resonance imaging scan to rule out brain metastases; but in the absence of radiographic lymph node involvement, most would not stage the mediastinum by bronchoscopy or mediastinoscopy before resection. When surgery was not recommended or declined, respondents commonly recommended radiation.
This survey suggests that therapeutic recommendations for multifocal lung cancer are influenced to a large extent by physicians' specialty training, probably because of the lack of high-level evidence for its standard treatment. Ongoing systematic and multidisciplinary approaches with robust short-term and long-term patient outcomes may improve the quality of evidence for the optimal management of this clinical entity.
多灶性肺癌是一种日益常见的临床情况，但对于其最佳治疗方法缺乏高级别证据。因此，我们对跨学科的国际肺癌研究协会成员的治疗方法进行了调查，并分析了由此产生的实践模式。
我们描述了一名60岁健康男性双侧肺结节的临床情况，并询问国际肺癌研究协会的6373名成员是否会推荐手术治疗，若推荐，手术范围如何。我们还询问了完成分期还会推荐哪些其他措施，以及是否会建议进行放疗或化疗。
我们收到了来自多个专科医生的221份回复（回复率3.5%）。大多数受访者（140人[63%]）建议针对这种情况进行手术。外科医生比其他专科医生更有可能推荐手术。在那些推荐手术的人中，大多数会进行PET/CT扫描以排除远处转移，并进行磁共振成像扫描以排除脑转移；但在没有影像学显示淋巴结受累的情况下，大多数人在切除术前不会通过支气管镜检查或纵隔镜检查对纵隔进行分期。当不建议或患者拒绝手术时，受访者通常会推荐放疗。
这项调查表明，多灶性肺癌的治疗建议在很大程度上受到医生专科培训的影响，这可能是因为缺乏其标准治疗的高级别证据。采用持续的系统和多学科方法，并取得可靠的短期和长期患者预后，可能会提高这一临床实体最佳管理的证据质量。
