Lung Cancer

The current issue of Seminars in Respiratory and Critical Care Medicine reviews a broad spectrum of topics in lung cancer. Lung cancer is one of the most lethal illnesses known to humankind, not only because of its high incidence rate, but more importantly, because of its high mortality rate. For years screening for lung cancer was highly controversial, but that changed with the results of the National Lung Screening Trial. Dr. Arenberg excellently reviews the evidence for screening and addresses harms and benefits to help providers and patients make informed decisions about lung cancer screening. Although screening for lung cancer has been shown to reduce mortality for lung cancer by 20%, there are concerns regarding potential risks associated with screening, including the risk of radiation exposure. In this issue, Dr. Frank and colleagues summarize why the concerns about radiation exposure form low-dose computed tomography (LDCT) should not be an obstacle to the adoption of lung cancer screening. While screening detects early-stage lung cancers, the majority of nodules detected on computed tomographic (CT) scans are benign, and their management may be complex. The paper by Dr. Lazarus and Ost reviews the fundamental concepts derived from decision analysis that can be used to help clinicians optimize the workup of pulmonary nodules, whereas the paper by Skouras et al provides an excellent review of the diagnostic management options available when evaluating pulmonary nodules. In the last several years we have come to appreciate the importance of accurate histological and molecular characterization of non–small cell lung cancer (NSCLC) as these distinctions are important because of the differences in tumor biology, response to therapy, and prognosis, and because of the impact they have on treatment decisions. Dr. Rezaei and colleagues present us with an excellent review on the surgical pathology of lung cancer and highlight the vital role all clinicians, including pathologists, play in the multidisciplinary care of the lung cancer patient. Over the past few years we have benefited from the development of newer technologies such as endobronchial ultrasonographically guided transbronchial needle aspiration (EBUS-TBNA), which allows clinicians to obtain tissue for both diagnosis and staging of lung cancer with less invasive procedures. Because samples collected via these newer technologies are smaller than historical surgical specimens, it is paramount that good communication between the various specialists involved in collecting and processing specimens take place to ensure specimens are optimally used. To that end, Dr. Akulian and colleagues review the importance of tissue acquisition and preparation of collected specimens to ensure accurate histological and molecular characterization of lung cancer specimens. A comprehensive review on the epidemiology and treatment outcomes of lung cancer in women is included in this issue as well as an excellent review by Drs. Weiss and Langer on the treatment of lung cancer in patients older than 70 years of age, a dominant subgroup of patients with lung cancer who are often excluded from treatment such as surgery and chemotherapy based on age alone. Dr. Antonia provides us with an insightful review of the immunotherapy of lung cancer, whereas Dr. Villaruz and colleagues eloquently describe that NSCLC is not a single disease entity, but rather a collection of distinct molecularly driven tumors, and that identifying actionable mutations in NSCLC has permanently shifted the treatment of NSCLC to a personalized approach. However, whereas targeted therapy in NSCLC has evolved rapidly, acquired tumor resistance to targeted agents is a major challenge. In his paper, Dr. Ho and colleagues provide a superb summary of evolving treatment approaches that may help to overcome the problem of acquired resistance. We wrap up this issue of Seminars with Dr. Timmerman's thoughtful review of the role of stereotactic radiotherapy in the treatment of lung cancer and with an excellent update by Drs. Kim and Detterbeck on the advances in surgical techniques, including minimally invasive surgery and robotic surgery, in NSCLC.

In summary, this issue of Seminars will hopefully illustrate the tremendous advances that have been made in screening, diagnosing and staging, and treatment of lung cancer. I would like to thank all the contributors to the lung cancer issues of the Seminars for their time and for sharing their extraordinary expertise, which I hope will enhance your understanding and interest in the field of lung cancer.