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Lung Cancer: Symptoms, Treatment, and Early Diagnosis
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Lung Cancer: Symptoms, Treatment, and Early Diagnosis

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Oncology".

Deadline for manuscript submissions: closed (15 January 2022) | Viewed by 19347

Special Issue Editor

Prof. Dr. Giulia Veronesi

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Guest Editor
1. Division of Thoracic Surgery, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Manzoni 56, 20089 Rozzano, MI, Italy
2. School of Medicine, Vita-Salute San Raffaele University, 20132 Milano, MI, Italy
Interests: robotic and minimally invasive surgery; lung cancer limited resection; lung cancer screening; mediastinal disease
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Thoracic oncology represents one of the fields of greatest interest and innovation in oncology. Lung cancer remains the leading cause of death due to cancer in Western countries. The high lethality rate is due to the fact that, in most cases, the diagnosis is obtained when the disease is advanced and inoperable.

Lung cancer is strongly related to environmental exposure and cigarette smoking is its primary cause, which has important implications for the field of public health since prevention and early diagnosis campaigns can clearly change the natural history of this pathology. 

Recently, four important innovations have emerged in the field of lung cancer diagnosis and treatment. The first is the validation of the critical role that low-radiation-dose CT screening plays in high-risk subjects, which allows us to change the stage of diagnosis in an incisive way with repercussions for the possibility of curative treatments. The second consists of technological innovations that have allowed us to achieve important goals in molecular diagnosis, circulating and volatile markers with implications for screening, noninvasive diagnosis, prognosis and prediction of early recurrence, and response to therapy. The third consists of the technological progress and evolution of micromechanics that have allowed us to introduce and diffuse robotic surgical tools, which allow us to perform high-quality, minimally invasive treatments in complex and locally advanced disease, with the centering of patients’ quality of life and body integrity. The fourth consists of our improved knowledge and the new applications of immunotherapy and precision treatments, which represent game changers in systemic therapies for both advanced and localized tumors. 

I invite you to submit to this Special Issue an original research paper or a review article on one or more of these four important topics. 

Prof. Giulia Veronesi
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • lung cancer
  • screening
  • robotic surgery
  • minimally invasive surgery
  • immunotherapy
  • target therapy
  • liquid biopsy
  • molecular markers
  • computed tomography

Published Papers (8 papers)

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Research

17 pages, 2439 KiB  
Article
Chest Drainage Therapy: What Comes out of Pandora’s Box Can Affect Patient Outcomes
by Alberto Antonicelli, Fabrizio Monaco, Angelo Carretta, Bryan M. Burt, Joshua R. Sonett and Giulia Veronesi
J. Clin. Med. 2022, 11(18), 5311; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11185311 - 9 Sep 2022
Cited by 1 | Viewed by 3111
Abstract
Background: Over the last 100 years, the original three-bottle chest drainage system has been variously engineered into compact disposables and electronic units. Clinicians are now surrounded by a plethora of different types of systems, but little is known about the way that they [...] Read more.
Background: Over the last 100 years, the original three-bottle chest drainage system has been variously engineered into compact disposables and electronic units. Clinicians are now surrounded by a plethora of different types of systems, but little is known about the way that they work and perform. Thus, we sought to test the performance of the most commonly used chest drainage units under conditions that are relevant to clinical practice. Methods: A pleural space environment simulator was built. Thirty-two units were tested under four clinical scenarios: air leak interpretation during quiet breathing and after obstructed inspiration (−5 to −150 cmH2O), a buildup of negative pressure (−100 cmH2O), a bronchopleural fistula (10 L/min) and the need for effective external suction in the presence of air leakage. Twenty-five units were “traditional” thoracic drainages, five were “digital” low-flow/low-vacuum pumps and two were hybrids (a combination of the two). According to the design of the seal and of the suction control, the units were classified as wet-wet, wet-dry and dry-dry. Results: All wet units showed reverse air flow, with the potential to mimic an air leak when there was none. Ten wet units showed no automatic negative pressure relief features, while five dry-dry did but were slow to react. Ten wet and five dry-dry units showed no capability to handle a 10 L/min leak, as they were restrictive to flow (peak pressure up to 55 cmH2O). Only seven dry-suction units were able to maintain the set suction at high airflow rates (>20 L/min). Conclusions: Different chest drainage unit designs lead to different performances, some of which may negatively impact patient outcomes. This sounds the call to tailor our clinical practice for the individual patient. A paradigm shift to better understand all components of pleural physiology post-surgical intervention on this relatively neglected topic is needed to improve our daily practice. Full article
(This article belongs to the Special Issue Lung Cancer: Symptoms, Treatment, and Early Diagnosis)
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11 pages, 1955 KiB  
Article
Occult Non-Small Cell Lung Cancer: An Underappreciated Disease
by Jingsheng Cai, Fan Yang and Xun Wang
J. Clin. Med. 2022, 11(5), 1399; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11051399 - 3 Mar 2022
Viewed by 1411
Abstract
Background: The number of researches on occult non-small cell lung cancer (NSCLC) is modest. Herein, we defined the clinicopathological features, prognosis and survival outcome of this underappreciated tumor, with purpose of obtaining a clearer picture on this disease. Methods: The entire cohort was [...] Read more.
Background: The number of researches on occult non-small cell lung cancer (NSCLC) is modest. Herein, we defined the clinicopathological features, prognosis and survival outcome of this underappreciated tumor, with purpose of obtaining a clearer picture on this disease. Methods: The entire cohort was categorized into two groups (occult NSCLC and other NSCLC) and further into five groups (occult, T1, T2, T3 and T4). A least absolute shrinkage and selection operator (LASSO) penalized Cox regression model was performed to identify the prognostic indicators. A nomogram and a risk-classifying system were formulated. Kaplan–Meier with Log-rank method was carried out to compare overall survival (OS) and cancer specific survival (CSS) differences between groups. Results: 59,046 eligible NSCLC cases (occult NSCLC: 1158 cases; other NSCLC: 57,888 cases) were included. Occult NSCLC accounted for 2.0% of the included cases. Multivariate analysis revealed that age, sex, tumor location, histology, grade and surgery were prognostic factors for OS. The corresponding prognostic nomogram classified occult NSCLC patients into low-risk and high-risk group, and its performance was acceptable. Survival curves demonstrated that occult NSCLC patients exhibited worse survivals than other NSCLC. In further analyses, the survival of low-risk occult NSCLC and stage T3 NSCLC were comparable, and the high-risk occult NSCLC patients still owned the worst survival rate. Conclusions: Occult NSCLC was an aggressive tumor with poor prognosis, and surgery was the preferred treatment. More attention should be paid to this overlooked disease due to no evidence of tumor imaging. Full article
(This article belongs to the Special Issue Lung Cancer: Symptoms, Treatment, and Early Diagnosis)
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17 pages, 4365 KiB  
Article
Model Calibration of Pharmacokinetic-Pharmacodynamic Lung Tumour Dynamics for Anticancer Therapies
by Maria Ghita, Charlotte Billiet, Dana Copot, Dirk Verellen and Clara Mihaela Ionescu
J. Clin. Med. 2022, 11(4), 1006; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11041006 - 15 Feb 2022
Cited by 7 | Viewed by 1694
Abstract
Individual curves for tumor growth can be expressed as mathematical models. Herein we exploited a pharmacokinetic-pharmacodynamic (PKPD) model to accurately predict the lung growth curves when using data from a clinical study. Our analysis included 19 patients with non-small cell lung cancer treated [...] Read more.
Individual curves for tumor growth can be expressed as mathematical models. Herein we exploited a pharmacokinetic-pharmacodynamic (PKPD) model to accurately predict the lung growth curves when using data from a clinical study. Our analysis included 19 patients with non-small cell lung cancer treated with specific hypofractionated regimens, defined as stereotactic body radiation therapy (SBRT). The results exhibited the utility of the PKPD model for testing growth hypotheses of the lung tumor against clinical data. The model fitted the observed progression behavior of the lung tumors expressed by measuring the tumor volume of the patients before and after treatment from CT screening. The changes in dynamics were best captured by the parameter identified as the patients’ response to treatment. Median follow-up times for the tumor volume after SBRT were 126 days. These results have proven the use of mathematical modeling in preclinical anticancer investigations as a potential prognostic tool. Full article
(This article belongs to the Special Issue Lung Cancer: Symptoms, Treatment, and Early Diagnosis)
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10 pages, 776 KiB  
Article
The Surgical Management of Brain Metastases in Non-Small Cell Lung Cancer (NSCLC): Identification of the Early Laboratory and Clinical Determinants of Survival
by Matthias Schneider, Niklas Schäfer, Christian Bode, Lars Eichhorn, Frank A. Giordano, Erdem Güresir, Muriel Heimann, Yon-Dschun Ko, Jennifer Landsberg, Felix Lehmann, Alexander Radbruch, Christina Schaub, Katjana S. Schwab, Johannes Weller, Ulrich Herrlinger, Hartmut Vatter and Patrick Schuss
J. Clin. Med. 2021, 10(17), 4013; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10174013 - 5 Sep 2021
Cited by 1 | Viewed by 2479
Abstract
Background: Brain metastases (BM) indicate advanced states of cancer disease and cranial surgery represents a common treatment modality. In the present study, we aimed to identify the risk factors for a reduced survival in patients receiving a surgical treatment of BM derived from [...] Read more.
Background: Brain metastases (BM) indicate advanced states of cancer disease and cranial surgery represents a common treatment modality. In the present study, we aimed to identify the risk factors for a reduced survival in patients receiving a surgical treatment of BM derived from non-small cell lung cancer (NSCLC). Methods: A total of 154 patients with NSCLC that had been surgically treated for BM at the authors’ institution between 2013 and 2018 were included for a further analysis. A multivariate analysis was performed to identify the predictors of a poor overall survival (OS). Results: The median overall survival (mOS) was 11 months (95% CI 8.2–13.8). An age > 65 years, the infratentorial location of BM, elevated preoperative C-reactive protein levels, a perioperative red blood cell transfusion, postoperative prolonged mechanical ventilation (>48 h) and the occurrence of postoperative adverse events were identified as independent factors of a poor OS. Conclusions: The present study identified several predictors for a worsened OS in patients that underwent surgery for BM of NSCLC. These findings might guide a better risk/benefit assessment in the course of metastatic NSCLC therapy and might help to more sufficiently cope with the challenges of cancer therapy in these advanced stages of disease. Full article
(This article belongs to the Special Issue Lung Cancer: Symptoms, Treatment, and Early Diagnosis)
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12 pages, 897 KiB  
Article
Short-Term Changes in Quality of Life in Patients with Advanced Lung Cancer during In-Hospital Exercise Training and Chemotherapy Treatment: A Randomized Controlled Trial
by Anna Rutkowska, Sebastian Rutkowski, Adam Wrzeciono, Oliver Czech, Jan Szczegielniak and Dariusz Jastrzębski
J. Clin. Med. 2021, 10(8), 1761; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10081761 - 18 Apr 2021
Cited by 11 | Viewed by 2827
Abstract
The aim of this study was to assess the impact of exercise training on the quality of life (QoL) of patients diagnosed with stage IIIB and stage IV non–small cell lung cancer (NSCLC) compared to a passive control group (CG). The exercise-trained group [...] Read more.
The aim of this study was to assess the impact of exercise training on the quality of life (QoL) of patients diagnosed with stage IIIB and stage IV non–small cell lung cancer (NSCLC) compared to a passive control group (CG). The exercise-trained group (ETG) consisted of 18 patients, and the CG consisted of 8 patients. The training program in the ETG consisted of two 2-week running cycles interspersed with consecutive rounds of chemotherapy with cytostatic drugs. A comparison of the changes in the Short Form (36) Health Survey (SF-36), St. George’s Respiratory Questionnaire (SGRQ), and the Functional Assessment of Cancer Therapy-Lung (FACT-L) was the primary outcome. Analysis of the results of the SGRQ and the SF-36 questionnaire did not reveal any statistically significant differences in the assessment of QoL between the examined groups. The analysis of FACT-L questionnaires showed statistically significant changes, indicating deterioration of QoL in domains describing physical well-being in the CG. Therefore, the analysis of the results of the QoL assessment did not show any significant improvements in the group of patients undergoing comprehensive exercise training, although deterioration of QoL was noted in the CG. Full article
(This article belongs to the Special Issue Lung Cancer: Symptoms, Treatment, and Early Diagnosis)
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12 pages, 606 KiB  
Article
Quality of Life, Postoperative Pain, and Lymph Node Dissection in a Robotic Approach Compared to VATS and OPEN for Early Stage Lung Cancer
by Pierluigi Novellis, Patrick Maisonneuve, Elisa Dieci, Emanuele Voulaz, Edoardo Bottoni, Sara Di Stefano, Michela Solinas, Alberto Testori, Umberto Cariboni, Marco Alloisio and Giulia Veronesi
J. Clin. Med. 2021, 10(8), 1687; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10081687 - 14 Apr 2021
Cited by 20 | Viewed by 2052
Abstract
We compare the perioperative course, postoperative pain, and quality-of-life (QOL) in patients undergoing anatomic resections of early-stage lung cancer by means of robotic surgery (RATS), video-assisted thoracic surgery (VATS), or muscle-sparing thoracotomy (OPEN); 169 consecutive patients with known/suspected lung cancer, candidates to anatomic [...] Read more.
We compare the perioperative course, postoperative pain, and quality-of-life (QOL) in patients undergoing anatomic resections of early-stage lung cancer by means of robotic surgery (RATS), video-assisted thoracic surgery (VATS), or muscle-sparing thoracotomy (OPEN); 169 consecutive patients with known/suspected lung cancer, candidates to anatomic resection, were enrolled in a single-center prospective study from April 2016 to December 2018. EORTC QLQ-C30 and QLQ-LC13 scores were obtained preoperatively and, at three time points, postoperatively. RATS and VATS groups were matched for ASA scores, while RATS and open surgery were matched for gender, ASA score, cancer stage, and tumor size; 58 patients underwent open surgery, 58 had VATS, and 53 had RATS. Hospital stay was shorter after RATS than OPEN (median 4.5 versus 5; p = 0.047). Comparing matched RATS and VATS groups, the number of hilar lymph nodes and nodal stations removed was significantly higher in the former approach (p = 0.01 vs. p < 0.0001); conversely, pain at 2 weeks was slightly lower after VATS (p = 0.004). No significant difference was observed in conversions, complications, duration of surgery, and postoperative hospitalization. The robotic approach was superior to OPEN in terms of QOL, pain, and length of postoperative stay and showed improved lymph node dissection compared to VATS. Full article
(This article belongs to the Special Issue Lung Cancer: Symptoms, Treatment, and Early Diagnosis)
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9 pages, 445 KiB  
Article
500 Meters Is a Result of 6-Minute Walk Test Which Differentiates Patients with High and Low Risk of Postoperative Complications after Lobectomy—A Validation Study
by Tomasz Marjanski, Damian Wnuk, Robert Dziedzic, Marcin Ostrowski, Wioletta Sawicka and Witold Rzyman
J. Clin. Med. 2021, 10(8), 1686; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10081686 - 14 Apr 2021
Cited by 5 | Viewed by 2047
Abstract
The 6-min walk test (6MWT) is a simple method of identifying patients with a high risk of postoperative complications. In this study, we internally validated the previously obtained threshold value of 500 m in the 6MWT as differentiating populations with a high and [...] Read more.
The 6-min walk test (6MWT) is a simple method of identifying patients with a high risk of postoperative complications. In this study, we internally validated the previously obtained threshold value of 500 m in the 6MWT as differentiating populations with a high and a low risk of postoperative complications after a lobectomy. Between November 2011 and November 2016, 624 patients who underwent a lobectomy and performed the 6MWT preoperatively entered this study. We compared the complication rates of two groups of patients—those who walked more than and those who walked less than 500 m. The patients who did not reach the distance of 500 m in the 6MWT were older (70 vs. 63 years p < 0.001), had worse pulmonary function tests (FEV1% 84 vs. 88 p = 0.041) and had a higher Charlson Comorbidity Index (p < 0.001). The patients who had a worse result in the 6MWT had a higher complication rate (52% vs. 42% p = 0.019; OR: 1.501 95% CI: 1.066–2.114) and a longer median postoperative hospital stay (7 vs. 6 days p = 0.010). In a multivariate analysis, the result of the 6MWT and pack-years proved to independently influence the risk of postoperative complications. This internal validation study confirms that 500 m is a result of the 6MWT which differentiates patients with a higher risk of postoperative complications and a prolonged hospital stay after a lobectomy. Full article
(This article belongs to the Special Issue Lung Cancer: Symptoms, Treatment, and Early Diagnosis)
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9 pages, 1307 KiB  
Article
Incidence Lung Cancer after a Negative CT Screening in the National Lung Screening Trial: Deep Learning-Based Detection of Missed Lung Cancers
by Jungheum Cho, Jihang Kim, Kyong Joon Lee, Chang Mo Nam, Sung Hyun Yoon, Hwayoung Song, Junghoon Kim, Ye Ra Choi, Kyung Hee Lee and Kyung Won Lee
J. Clin. Med. 2020, 9(12), 3908; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9123908 - 2 Dec 2020
Cited by 5 | Viewed by 2520
Abstract
We aimed to analyse the CT examinations of the previous screening round (CTprev) in NLST participants with incidence lung cancer and evaluate the value of DL-CAD in detection of missed lung cancers. Thoracic radiologists reviewed CTprev in participants with incidence [...] Read more.
We aimed to analyse the CT examinations of the previous screening round (CTprev) in NLST participants with incidence lung cancer and evaluate the value of DL-CAD in detection of missed lung cancers. Thoracic radiologists reviewed CTprev in participants with incidence lung cancer, and a DL-CAD analysed CTprev according to NLST criteria and the lung CT screening reporting & data system (Lung-RADS) classification. We calculated patient-wise and lesion-wise sensitivities of the DL-CAD in detection of missed lung cancers. As per the NLST criteria, 88% (100/113) of CTprev were positive and 74 of them had missed lung cancers. The DL-CAD reported 98% (98/100) of the positive screens as positive and detected 95% (70/74) of the missed lung cancers. As per the Lung-RADS classification, 82% (93/113) of CTprev were positive and 60 of them had missed lung cancers. The DL-CAD reported 97% (90/93) of the positive screens as positive and detected 98% (59/60) of the missed lung cancers. The DL-CAD made false positive calls in 10.3% (27/263) of controls, with 0.16 false positive nodules per scan (41/263). In conclusion, the majority of CTprev in participants with incidence lung cancers had missed lung cancers, and the DL-CAD detected them with high sensitivity and a limited false positive rate. Full article
(This article belongs to the Special Issue Lung Cancer: Symptoms, Treatment, and Early Diagnosis)
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