Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
Cet article présente les recommandations de l'ESMO pour le diagnostic et le traitement d'un cancer du poumon non à petites cellules de stade précoce ou de stade localement avancé et pour le suivi des patients
incidence/epidemiology : Lung cancer is the leading cause of cancer mortality worldwide, accounting for ∼1.3 million deaths each year. Overall incidence and epidemiology data are summarised in the ESMO Clinical Practice Guidelines (CPG) on ‘metastatic non-small-cell lung cancer (NSCLC).
screening for lung cancer : A high proportion of NSCLC patients present with symptoms in advanced disease stage. The aim of lung cancer screening is to reduce lung cancer-related mortality by detecting more patients in earlier—potentially curable—stages. Historical randomised, controlled trials (RCTs) on the use of periodical chest X-ray and/or sputum cytology were negative, and screening based on these techniques is therefore not recommended [I, C]. Low-dose computed tomography (LDCT)—more sensitive for the detection of small nodules—was studied in more recent RCTs. The National Lung Screening Trial (NLST) compared LDCT with chest X-ray in 53 454 current or former heavy smokers (≥30 pack-years or ≤15 years since smoking cessation) aged between 55 and 74 years. In this high-risk group, a 20% reduction in lung cancer related deaths, from 425 to 326 (P = 0.004), was reported. All-cause mortality was reduced by 6.7% [2]. LDCT screening thus reduces lung cancer-related mortality [I, A]. It is, however, not ready for large-scale population-based implementation because of remaining questions surrounding the definition of the at-risk population, timing, interval and method of computed tomography (CT) (particularly 2D versus 3D nodule interpretation [3]), how to handle (false) positive findings and, especially, cost-effectiveness when compared with, e.g. smoking cessation alone [4]. Further analyses and results of several ongoing European trials are eagerly awaited.
Other potential methods of screening, such as exhaled breath or blood biomarkers lack validation and are therefore not recommended in clinical practice...
Annals of Oncology , article en libre accès, 2013