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Lung Cancer Screening: The Last 10 Years

Douglas E. Wood

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VATS Versus Open Surgery for Lung Cancer Resection: Moving Beyond the Incision

Aaron M. Cheng and Douglas E. Wood

Surgery remains the primary therapy in the treatment of early-stage lung cancer. Traditionally, anatomic resection via open thoracotomy has been the conventional approach, but as experience with minimally invasive lung surgery has increased, video-assisted thoracoscopic surgical (VATS) lobectomy is being performed more commonly for treatment of lung cancer. Proponents of VATS have argued that thoracoscopic resection for lung cancer is not only safe but is also superior to the open approach. VATS enthusiasts even have proposed that this approach should be the standard of care and a metric for quality in lung cancer surgery. Such zeal for promoting a “preferred” technique, however, obscures focus from other time-proven, but perhaps less fashionable, factors that have a tremendous impact on quality and lung cancer outcomes, namely cancer staging and quality of cancer surgery. Rather than debate incisions, thoracic surgeons should advocate for specialty care and surgical quality that assures the best short- and long-term outcomes for patients, regardless of the surgical approach.

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Screening for Lung Cancer: An Expert Review

Presented by: Ella A. Kazerooni, Jacob Sands, and Douglas E. Wood

The NCCN Guidelines for Lung Cancer Screening have evolved over time to reflect the latest evidence and expert consensus. These NCCN Guidelines have played a significant role in shaping clinical practice and policy, leading to increased payer coverage for lung cancer screening and decreasing lung cancer mortality. Continued research and advancements in early detection methods, along with the implementation of effective screening programs, will be crucial in the ongoing effort to reduce lung cancer mortality and improve the overall quality of life for patients affected by this disease.

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The Management of Patients With Stage IIIA Non–Small Cell Lung Cancer With N2 Mediastinal Node Involvement

Renato G. Martins, Thomas A. D’Amico, Billy W. Loo Jr, Mary Pinder-Schenck, Hossein Borghaei, Jamie E. Chaft, Apar Kishor P. Ganti, Feng-Ming (Spring) Kong, Mark G. Kris, Inga T. Lennes, and Douglas E. Wood

Patients with stage IIIA non–small cell lung cancer, determined based on involvement of ipsilateral mediastinal lymph nodes, represent the most challenging management problem in this disease. Patients with this stage disease may have very different degrees of lymph node involvement. The pathologic confirmation of this involvement is a key step in the therapeutic decision. The difference in the degree of lymph node compromise has prognostic and treatment implications. Based on multiple considerations, patients can be treated with induction chemotherapy, chemoradiotherapy followed by surgery, or definitive chemoradiotherapy without surgery. Data derived from clinical trials have provided incomplete guidance for physicians and their patients. The best therapeutic plan is achieved through the multidisciplinary cooperation of a team specialized in lung cancer.

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Smoking Cessation, Version 1.2016, NCCN Clinical Practice Guidelines in Oncology

Peter G. Shields, Roy S. Herbst, Douglas Arenberg, Neal L. Benowitz, Laura Bierut, Julie Bylund Luckart, Paul Cinciripini, Bradley Collins, Sean David, James Davis, Brian Hitsman, Andrew Hyland, Margaret Lang, Scott Leischow, Elyse R. Park, W. Thomas Purcell, Jill Selzle, Andrea Silber, Sharon Spencer, Tawee Tanvetyanon, Brian Tiep, Hilary A. Tindle, Reginald Tucker-Seeley, James Urbanic, Monica Webb Hooper, Benny Weksler, C. Will Whitlock, Douglas E. Wood, Jennifer Burns, and Jillian Scavone

Cigarette smoking has been implicated in causing many cancers and cancer deaths. There is mounting evidence indicating that smoking negatively impacts cancer treatment efficacy and overall survival. The NCCN Guidelines for Smoking Cessation have been created to emphasize the importance of smoking cessation and establish an evidence-based standard of care in all patients with cancer. These guidelines provide recommendations to address smoking in patients and outlines behavioral and pharmacologic interventions for smoking cessation throughout the continuum of oncology care.

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Lung Cancer Screening, Version 3.2018, NCCN Clinical Practice Guidelines in Oncology

Douglas E. Wood, Ella A. Kazerooni, Scott L. Baum, George A. Eapen, David S. Ettinger, Lifang Hou, David M. Jackman, Donald Klippenstein, Rohit Kumar, Rudy P. Lackner, Lorriana E. Leard, Inga T. Lennes, Ann N.C. Leung, Samir S. Makani, Pierre P. Massion, Peter Mazzone, Robert E. Merritt, Bryan F. Meyers, David E. Midthun, Sudhakar Pipavath, Christie Pratt, Chakravarthy Reddy, Mary E. Reid, Arnold J. Rotter, Peter B. Sachs, Matthew B. Schabath, Mark L. Schiebler, Betty C. Tong, William D. Travis, Benjamin Wei, Stephen C. Yang, Kristina M. Gregory, and Miranda Hughes

Lung cancer is the leading cause of cancer-related mortality in the United States and worldwide. Early detection of lung cancer is an important opportunity for decreasing mortality. Data support using low-dose computed tomography (LDCT) of the chest to screen select patients who are at high risk for lung cancer. Lung screening is covered under the Affordable Care Act for individuals with high-risk factors. The Centers for Medicare & Medicaid Services (CMS) covers annual screening LDCT for appropriate Medicare beneficiaries at high risk for lung cancer if they also receive counseling and participate in shared decision-making before screening. The complete version of the NCCN Guidelines for Lung Cancer Screening provides recommendations for initial and subsequent LDCT screening and provides more detail about LDCT screening. This manuscript focuses on identifying patients at high risk for lung cancer who are candidates for LDCT of the chest and on evaluating initial screening findings.

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Lung Cancer Screening

Douglas E. Wood, George A. Eapen, David S. Ettinger, Lifang Hou, David Jackman, Ella Kazerooni, Donald Klippenstein, Rudy P. Lackner, Lorriana Leard, Ann N. C. Leung, Pierre P. Massion, Bryan F. Meyers, Reginald F. Munden, Gregory A. Otterson, Kimberly Peairs, Sudhakar Pipavath, Christie Pratt-Pozo, Chakravarthy Reddy, Mary E. Reid, Arnold J. Rotter, Matthew B. Schabath, Lecia V. Sequist, Betty C. Tong, William D. Travis, Michael Unger, and Stephen C. Yang

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Gastric Cancer

Jaffer A. Ajani, James S. Barthel, Tanios Bekaii-Saab, David J. Bentrem, Thomas A. D'Amico, Prajnan Das, Crystal Denlinger, Charles S. Fuchs, Hans Gerdes, James A. Hayman, Lisa Hazard, Wayne L. Hofstetter, David H. Ilson, Rajesh N. Keswani, Lawrence R. Kleinberg, Michael Korn, Kenneth Meredith, Mary F. Mulcahy, Mark B. Orringer, Raymond U. Osarogiagbon, James A. Posey, Aaron R. Sasson, Walter J. Scott, Stephen Shibata, Vivian E. M. Strong, Mary Kay Washington, Christopher Willett, Douglas E. Wood, Cameron D. Wright, and Gary Yang

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Lung Cancer Screening, Version 1.2015

Douglas E. Wood, Ella Kazerooni, Scott L. Baum, Mark T. Dransfield, George A. Eapen, David S. Ettinger, Lifang Hou, David M. Jackman, Donald Klippenstein, Rohit Kumar, Rudy P. Lackner, Lorriana E. Leard, Ann N.C. Leung, Samir S. Makani, Pierre P. Massion, Bryan F. Meyers, Gregory A. Otterson, Kimberly Peairs, Sudhakar Pipavath, Christie Pratt-Pozo, Chakravarthy Reddy, Mary E. Reid, Arnold J. Rotter, Peter B. Sachs, Matthew B. Schabath, Lecia V. Sequist, Betty C. Tong, William D. Travis, Stephen C. Yang, Kristina M. Gregory, and Miranda Hughes

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Lung Cancer Screening provide recommendations for selecting individuals for lung cancer screening, and for evaluation and follow-up of nodules found during screening, and are intended to assist with clinical and shared decision-making. These NCCN Guidelines Insights focus on the major updates to the 2015 NCCN Guidelines for Lung Cancer Screening, which include a revision to the recommendation from category 2B to 2A for one of the high-risk groups eligible for lung cancer screening. For low-dose CT of the lung, the recommended slice width was revised in the table on “Low-Dose Computed Tomography Acquisition, Storage, Interpretation, and Nodule Reporting.”

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NCCN Guidelines® Insights: Lung Cancer Screening, Version 1.2022

Featured Updates to the NCCN Guidelines

Douglas E. Wood, Ella A. Kazerooni, Denise Aberle, Abigail Berman, Lisa M. Brown, Georgie A. Eapen, David S. Ettinger, J. Scott Ferguson, Lifang Hou, Dipen Kadaria, Donald Klippenstein, Rohit Kumar, Rudy P. Lackner, Lorriana E. Leard, Inga T. Lennes, Ann N.C. Leung, Peter Mazzone, Robert E. Merritt, David E. Midthun, Mark Onaitis, Sudhakar Pipavath, Christie Pratt, Varun Puri, Dan Raz, Chakravarthy Reddy, Mary E. Reid, Kim L. Sandler, Jacob Sands, Matthew B. Schabath, Jamie L. Studts, Lynn Tanoue, Betty C. Tong, William D. Travis, Benjamin Wei, Kenneth Westover, Stephen C. Yang, Beth McCullough, and Miranda Hughes

The NCCN Guidelines for Lung Cancer Screening recommend criteria for selecting individuals for screening and provide recommendations for evaluation and follow-up of lung nodules found during initial and subsequent screening. These NCCN Guidelines Insights focus on recent updates to the NCCN Guidelines for Lung Cancer Screening.