Early lung cancer detection by low-dose CT screening: therapeutic implications

Abstract

Lung cancer screening by low-dose chest computed tomography is currently implemented in the U.S. After implementation of screening, a stage shift may be observed from around 15% stage I non-small cell lung cancers (NSCLCs) in routine clinical practice to up to 70% in screening patients. This indicates a move in treatment options from advanced to early lung cancers, especially in those with small suspected intrapulmonary nodules. Areas covered: We have reviewed the current status of lung cancer screening from the different randomized controlled lung cancer screening studies and the clinical evidence so far for both surgical and non-surgical treatment options for (screen-detected) stage I NSCLC. Furthermore, we provide a step-wise approach for the treatment of stage I NSCLC. Expert Commentary: Recommended treatment for stage I NSCLC remains (VATS) lobectomy in case of a medically operable patient, VATS sublobar resection for subcentimeter nodules, and SBRT otherwise. Currently, there is too limited evidence for the value of ablative techniques in curative treatment of early stage NSCLC. Therefore, these therapies should only be used in expert centers for selected patients in clinical studies.

Long-Term and Latent Side Effects of Specific Cancer Types

“…1 However, with increased screening for high-risk individuals, it is anticipated that there may be a stage shift so that the majority of LC will be diagnosed at early stage. 93 The 5-year survival rate for those diagnosed at early-stage is 55%. Most early-stage LC is treated with surgical resection and adjuvant chemotherapy +/− RT.…”

Early death in Danish stage I lung cancer patients: a population-based case study

“…In addition to stage, several other factors affect the prognosis and available treatment options, such as tumor histology, age, gender, comorbidity, life style factors, socioeconomic factors and treatment complications [6][7][8][9]. However, effective treatment alternatives to surgery exist for stage I lung cancer [10,11], thus providing treatment options with curative intent also for patients who are not candidates for surgery.…”

An Evolving Role for Cancer Rehabilitation in the Era of Low‐Dose Lung Computed Tomography Screening

“…Furthermore, the stage at diagnosis is closely associated with survival, with a 5‐year survival of only 6% for patients with metastases present on initial diagnosis, compared with 85% for patients with stage IA disease [8]. Only about 15% of patients are diagnosed with stage I disease [9,10].…”

“…The use of alternative and more aggressive screening criteria using LDCT are being investigated, potentially preventing another 16,000 additional deaths because of improved identification of at‐risk patients [15,16]. Multiple studies continue to evaluate the efficacy of LDCT screening in an effort to improve specificity, to improve detection, to save costs, and reduce mortality [9].…”

“…Earlier detection through LDCT has the potential to increase the cure rate of lung cancer through earlier detection and to reduce treatment‐associated morbidity due to a smaller tumor burden at the time of diagnosis [9]. It also may change the approach to rehabilitation of lung cancer patients.…”