Lung Cancer—Where Are We Today?
- 1 November 2002
- journal article
- review article
- Published by American Thoracic Society in American Journal of Respiratory and Critical Care Medicine
- Vol. 166 (9) , 1166-1196
- https://doi.org/10.1164/rccm.200202-070so
Abstract
Lung cancer remains the commonest cause of cancer death in both men and women in the developed world, although mortality rates for men are dropping. Spiral computed tomography (CT) of the chest in middle-aged, smoking subjects may identify two to four times more lung cancers than a chest X-ray, with more than 70% of tumors being Stage I. The incidence of benign nodules is high, making interpretation difficult. Randomized controlled trials are required to determine whether spiral CT detects lung cancer early enough to improve mortality. Preoperative staging has relied on CT scans, but positron emission tomography scanning has greater sensitivity, specificity, and accuracy than CT and is recommended as the final confirmatory investigation when the CT shows resectable disease. In locally advanced non-small cell lung cancer, there is a small advantage for the addition of chemotherapy to radiotherapy, but no advantage for postoperative radiotherapy. Chemotherapy gives no benefit when given as neoadjuvant or adjuvant treatment around surgery. In advanced disease, newer cytotoxic agents confer a small survival advantage over older combinations, but the advantage in median survival over best supportive care remains a few months with modest improvements in quality of life. Survival with small cell lung cancer has shown little increase over the last 15 years despite multiple attempts to manipulate the timing, dose intensity of chemotherapy, and the potential of radiotherapy. Novel therapies are urgently needed for all cell types of lung cancer.Keywords
This publication has 98 references indexed in Scilit:
- Investigating extrathoracic metastatic disease in patients with apparently operable lung cancer∗∗The authors, including their roles in the project, are listed in the Appendix.The Annals of Thoracic Surgery, 2001
- Vascular Endothelial Growth Factor Expression in Stage I Non-Small Cell Lung Cancer Correlates With Neoangiogenesis and a Poor PrognosisAnnals of Surgical Oncology, 2001
- Early Lung Cancer Action Project: overall design and findings from baseline screeningThe Lancet, 1999
- Prophylactic cranial irradiation is indicated following complete response to induction therapy in small cell lung cancer: Results of a multicentre randomised trialEuropean Journal Of Cancer, 1997
- Accuracy of computed tomography and magnetic resonance imaging in staging bronchogenic carcinomaMagnetic Resonance Materials in Physics, Biology and Medicine, 1996
- Activity of gemcitabine in patients with non-small cell lung cancer: A multicentre, extended phase II studyEuropean Journal Of Cancer, 1996
- Radiation therapy for Stage I–III epidermoid carcinoma of the lungLung Cancer, 1992
- Inoperable non-small cell lung cancer: Radiation with or without chemotherapyEuropean Journal of Cancer and Clinical Oncology, 1988
- The superiority of combination chemotherapy over single agent chemotherapy in small cell lung carcinomaCancer, 1979
- The natural history of lung cancer: A review based on rates of tumour growthRespiratory Medicine, 1979