Lung Cancer: A Comprehensive Guide for the Clinician (Respiratory Medicine)

Preface
Contents
Contributors
Chapter 1: US and Global Epidemiology and Incidence Rates of Lung Cancer
	Introduction
	Influential Factors of Lung Cancer Incidence
		Age
		Sex
		Tobacco Use
		Socioeconomic Factors
	Smoking-Related Risk Factors
		Cigarette Smoking
		Secondhand Smoke
		Cigar Smoking
		Cannabis Smoking
		Electronic Cigarette Smoking
		Smoking Cessation
		Never-Smoking
	Nonsmoking-Related Risk Factors
		Sex
		Race
		Diet and Supplements
		Weight
		Underlying Lung Disease
		Radiation Therapy
		Familial Risk Factors
	Occupational and Environmental Factors
		Asbestos
		Radon
		Environmental Pollution
	Conclusion
	References
Chapter 2: Lung Cancer Screening
	The History of Lung Cancer Screening
		Sputum Cytology and Chest Radiography
		Chest Computed Tomography for Lung Cancer Screening
		Preventative Care Coverage Policy in the United States
	Evidence for Lung Cancer Screening
		The National Lung Screening Trial (NLST)
		Global Lung Cancer Screening Trials
		Limitations in LCS Evidence
	2021 USPSTF LCS Recommendations
	Lung Cancer Screening Methods
		Low-Dose CT Screening Exam Technique
		Interpretation
		Risks and Benefits
		Does Lung Cancer Screening Result in Stage Shift?
		Screening Strategy
	Implementation of Lung Cancer Screening
		State of Implementation
		System-Level Barriers
		Clinician-Level Barriers
		Shared Decision-Making Visit and Decision Aids
		LCS Program Structure
		Adherence to Screening
		Patient-Level Barriers
		Lung Cancer Screening and Smoking Cessation
	Emerging Issues in Lung Cancer Screening
		Future Directions for Lung Cancer Screening Tests
		Lung Cancer Screening for Other High-Risk individuals
		Lung Cancer Screening During the COVID-19 Pandemic
	Conclusions
	References
Chapter 3: Tobacco Prevalence and Treatment
	Introduction
	Disparities in Tobacco Use Patterns
	Carcinogenesis of Tobacco Smoke and the Development of Lung Cancer
	Lung Cancer Continuum: An Opportunity to Promote Smoking Cessation
		Lung Cancer Screening
		Lung Cancer Care
		Informed by Ongoing Research
	Understanding Nicotine Addiction
	Dismantling Stigma through Healthcare Provider Self-Awareness and Proactive Work
	Taking a Structured and Comprehensive Tobacco Use History
		Assessing Nicotine Dependency
		Motivational Interviewing for Behavior Change
		Leveraging the 5As Model for Behavior Change in Cessation Work
		Taking a Comprehensive Tobacco History and Examination for Success
	Counseling
	Pharmacotherapy
		Nicotine Replacement Therapy
		Varenicline
		Bupropion Sustained Release
		Extended Duration of Cessation Therapy
	Examining the Role of Electronic Cigarettes in Promoting Smoking Cessation
	Relapse Prevention
	Conclusion
	References
Chapter 4: Approach to Lung Nodules
	Introduction
	Etiology
	Evaluation
	Imaging
		Chest X-ray and Chest CT
		Classification of Pulmonary Nodules by Imaging
		Specific Morphologic Features
		Nodule Size: Solid Pulmonary Nodules
		Subsolid Pulmonary Nodules
		Pure Ground-Glass Nodules
		Semisolid Nodules (Part Solid, Part Ground-Glass)
		Pulmonary Nodule Number
		Unique Considerations for Screen-Detected Lung Nodules
	Risk Stratification Models
		Diagnostic Testing
		PET Imaging
		Biopsy
		Lymph Node Staging
	Pulmonary Biomarkers: Current and Future Directions
	Conclusions
	References
Chapter 5: Staging and Diagnosis of Lung Cancer
	Significance of Staging
	Staging Overview
	Clinical Versus Pathological Staging Prefixes
	TNM
		T Component
		N Component
		M Component and Stage Grouping
	Lung Cancers with Multiple Lesions
	Noninvasive Staging
	Invasive Staging
		Who Requires Invasive Staging
		Conventional TBNA
		EBUS/TBNA
		Endoscopic Ultrasound
		Combined EUS/EBUS
		Endobronchial Ultrasound Using the EBUS Scope (EUS-B)
		Sampling of Metastatic Disease
	Surgical Staging
		Mediastinoscopy
		Transcervical Lymphadenectomies
		Endosonography Versus Mediastinoscopy
		VATS
		Prediction Models
		Pathologic Staging
		Pathologic Staging of Adenocarcinoma
		Patients Without Nodal Metastases
	Conclusion
	References
Chapter 6: Treatment of Early-Stage (Stage I and II) Non-Small Cell Lung Cancer
	Introduction
	Presentation
	Staging Schema
	Treatment Options for Early-Stage Lung Cancer
		Adjuvant Chemotherapy in Resected Early-Stage NSCLC
		Radiotherapy in Resected Early-Stage NSCLC
		Radiotherapy in Unresected Early-Stage NSCLC
	Determination of Operability
	Determination of Extent of Resection
	Preoperative Workup
	Surgical Approach
	Surgical Techniques
		Lobectomy
			Anatomic and Positioning Considerations
		Operative Flow
		Segmentectomy
		Wedge Resection
		Pneumonectomy and Sleeve Lobectomy
		Mediastinal Lymph Sampling Versus Dissection
	Surgical Outcomes
		Quality of Life
		Disparities
	Radiotherapy Techniques
	Outcomes After SBRT
	Conclusion
	References
Chapter 7: Treatment of Stage III Non-small Cell Lung Cancer
	Introduction
	Current Treatment Strategies for Stage III NSCLC
	Treatment Modalities in the Pre-immunotherapy Era
		Surgery Plus Adjuvant Therapy
		Neoadjuvant Therapy Plus Surgery
		Nonsurgical Treatment
	Immunotherapy for Stage III NSCLC
		Immunotherapy in the Neoadjuvant Setting
		Combination Immunotherapy Chemoradiotherapy
	Molecular Targeting Agents
	Conclusion
	References
Chapter 8: Treatment of Stage IV Non-small Cell Lung Cancer
	Introduction
	Choosing First-Line Therapy
		Histology
			Adenocarcinoma Versus Squamous Cell Carcinoma
			Large Cell Neuroendocrine Carcinoma
			Sarcomatoid Carcinoma
		Actionable Mutations
			EGFR
			ALK
			ROS1
			KRAS G12C
			HER2
			MET Exon 14, RET, BRAF V600E, and NTRK
		Chemotherapy
		Bevacizumab
		Immunotherapy
			Single Agent Immunotherapy: Anti-PD1/PD-L1
			Chemoimmunotherapy
			Dual Immunotherapy: Anti-CTLA-4 with Anti-PD1/PD-L1
		Deciding on Treatment: PD-L1 ≥50% and No Actionable Mutations
		Deciding on Treatment: PD-L1 1–49% and No Actionable Mutations
		Deciding on Treatment: PD-L1 <1% and No Actionable Mutations
	Summary
	References
Chapter 9: Treatment of Small Cell Lung Cancer
	Staging and Diagnosis
	Treatment of Limited Stage Disease
		Systemic Treatment Considerations
		Surgical Considerations
		Thoracic Radiation Considerations
			Fractionation and Dose of Thoracic Radiation
			Radiation Target Volumes
		Normal Tissue Dose Objectives
		Timing of Systemic and Local Therapies
			Particle-Based Therapy
	Treatment of Extensive Stage Disease
		Systemic Therapy Considerations
			Initial Systemic Treatment
			Systemic Treatment for Relapsed Disease
		Topotecan
		Lurbinectedin
		Metronomic Chemotherapy
		Cyclophosphamide, Doxorubicin, and Vincristine (CAV)
		Temozolomide
		Pembrolizumab
		Other Systemic Regimens
			Thoracic Radiation Considerations
			Local Therapy for Oligometastatic SCLC
			Palliative, Attenuated Dose Radiotherapy in ED SCLC
			Prophylactic Cranial Irradiation (PCI)
			PCI in Limited Stage Disease
			PCI in Extensive Stage Disease
			Hippocampal Avoidance PCI
	Summary of Recommendations
	References
Chapter 10: Management of Malignant Pleural Effusion
	Introduction
	Epidemiology
		The Cause of Malignant Pleural Effusion by Cancer Type
	Clinical Presentation
	Pathophysiology
	Diagnosis
		Imaging
		Pleural Fluid Analysis
		Pleural Biopsy
	Management
	Therapeutic Thoracentesis
	Definitive Pleural Intervention
		Chemical Pleurodesis
		Indwelling Pleural Catheter
		Comparator Trials and Combination Approaches
		Surgical Management
	Special Situations
		Nonexpandable Lung
		Loculated or Septated MPE
	Conclusion
	References
Chapter 11: Pulmonary Complications of Lung Cancer Treatment
	Introduction
	Approach to the Patient with Lung Cancer and New Pulmonary Symptoms
		General Approach to Evaluation
	Pulmonary Complications of Radiation Therapy
		Epidemiology, Risk Factors, and Risk Reduction
		Phases of Radiation-Induced Lung Injury
		Evaluation of Suspected Radiation-Induced Lung Injury
		Management of Radiation-Related Pulmonary Toxicity
	General Approach to Evaluation of Suspected Drug-Induced Lung Disease
		Patient Assessment
		Diagnostic Testing
		Assessing Severity and Principles of Management
	Management of Pulmonary Complications of Systemic Therapies
		Traditional Chemotherapies
			Platinum Agents
			Taxanes
			Pemetrexed
			Gemcitabine
			Etoposide
			Topoisomerase I Inhibitors
			Vinorelbine
			Alkylating Agents
		Immunotherapy/Immune Checkpoint Inhibitors
			Pneumonitis Epidemiology and Risk Factors
			Clinical Presentation and Evaluation of ICI Pneumonitis
			Management of ICI Pneumonitis
			ICI-Related Sarcoidosis
		Molecularly Targeted Agents
			VEGF
			EGFR
			ALK and ROS1
			BRAF
			Other Newer Agents
	Summary
	References
Chapter 12: Multidisciplinary Approach to Lung Cancer Care
	Introduction
	A Framework for a Multidisciplinary Lung Cancer Program: The Front Desk Experience
		The Serial Referral Model
		The Joint Practice Model
		The Hub, Joint Decision-Making Model
		Challenges
	Multidisciplinary Lung Cancer Care: Are There Knowledge Gaps?
	Evidence Supporting Multidisciplinary Care Teams
		Reducing Delays in Diagnosis and Staging
		Treatment Utilization
		Patient-Reported Outcomes
		Improving Patient Survival
		Disparities in the Receipt of Multidisciplinary Care
	Conclusion
	References
Chapter 13: Physiologic and Patient-Centered Considerations in Lung Cancer Care
	Introduction
	Pulmonary Function Testing
	Exercise Testing
		Cardiopulmonary Exercise Testing
		Simple Field Exercise Tests
		Additional Physiologic and Other Measures
			Adjunct Physiologic Measures
			Other Measures
	Practical Challenges and Considerations
		Variations in Guideline Recommendations
		Defining Risk and Acceptable Thresholds
		Real-World Challenges
		Patient-Centered Care
	Additional Considerations
		Mitigating Risk
		Care Team Characteristics
	A Consolidated Approach
	References
Index