Today we would like to present for you an overview article published in 2022 in The Journal of Thoracic and Cardivascular Surgery, on the topic of local treatment of pulmonary transferoma. The author of the article is Professor Mara B. Antonoff of the chest surgery at the MD Anderson Cancer Center in the United States.IntroductionPulmonary transferoma is a common complication of many malignant tumours. While full-body treatment is a standard treatment, partial treatment can also extend the life of specific patients, slow their relapse and even remove them from chemotherapy for the time being. However, the range, timing and manner of adaptation to local treatments vary, requiring a comprehensive diagnosis based on the tumour ‘ s histological characteristics, disease burden, whole-body treatment response, and complications of patients. The present paper explores the advantages and disadvantages of local treatment methods such as external surgery, radiotherapy and digestive therapy, with the aim of articulating the basic principles of local treatment for patients with pulmonary transferoma.II. The role of pulmonary transferoma treatmentSurgical surgery has been the most important local treatment for pulmonary tumours, although new methods have emerged in recent years. The literature supporting surgical treatment consists mainly of retrospective studies showing that properly screened patients can improve their survival through surgery. Different types of tumours have different pre-post-factors, such as the location of primary tumours, mutated state, number of pulmonary knots, no disease spacing (DFI) and lymphoma dysentery.Conectoral cancer (CRC) is one of the most common malignant tumours leading to lung transfer, with about 18 per cent of patients experiencing lung transfer. Retrospective studies and metastasis have shown that the survival rate is as high as 68 per cent for five years after the surgical removal. The best patients are those with longer DFIs, lower pulmonary knots, and no lymphomy ligature. The APC mutation can extend the patient ‘ s life while the KRAS mutation is associated with a poor postpregnancy. The location of the original CRC will also affect the lifetime, with a relatively short life span for persons with rectal tumours, while those with left colon tumours benefit more from pulmonary ectomy.
In addition to CRC, malignant tumours such as carcasses, kidney cell cancer, melanoma and tumours of reproductive cells can benefit from surgery. Among them, osteosamas showed the highest survival rates. Similar to CRC, the longer DFI and the lower number of knots are good predictors.
Figure 1: WedchesFor transferectomy, the substantive removal strategy is more common than the anatomy strategy, as it allows for more normal tissue and reduces post-operative complications. Wedge removal is the most commonly used method, and whole pulmonary mutilation only applies to very few patients. The opening of a chest is easier to detect and remove hidden knots than a pectroscopy, but the two methods do not differ from a five-year survival rate. lymph nodes sampling or cleaning has no significant impact on survival, but lymph nodes are known to reduce survival.There is also a lack of forward-looking clinical trials to support the role of pulmonary transfer excision. A trial against a patient in CRC was suspended due to recruitment difficulties. A follow-up analysis of the data sets found that the survival rate of the control group (non-surgery group) was higher than expected, but the experiment was limited to factors such as good prognosis and inconsistent use of the whole-body drug. In the author ‘ s view, partial treatment (including surgery, radiation or digestion) can provide an important benefit to patients: they are not treated for the time being with a full-body drug. Another multi-centre experiment is currently under way to manage the restricted CRC pulmonary transfer patients in a multi-modal manner after assessment of the risk hierarchy.The future may determine the treatment on the basis of genomics and biomarkers, not just on the basis of the patient and the disease itself. For example, mutation in the CRC may affect the post-transferal hysterectomy life period, so it is preferable for APC mutagenic patients to be excised. In addition, in the TSOG 103 experiment, changes in circulose cancer DNA levels following surgical removal or chemical drug treatment were explored in addition to assessing the impact of different treatments on survival outcomes. This information will help in the future to use biomarkers to guide individualized provision of the best timing and manner for each patient with a lung-transmitted malignant tumour.
III. The role of stereodirectional treatment in pulmonary transferoma treatment
Figure 2: StereotypingPulmonary tumours are commonly treated for surgically, but microcreative alternatives are also becoming more common. They can be used for treatment or post-operative consolidation, such as SABR and absconding. SABR is a convenient, ingenious and safe alternative to surgery.SABR is effective in the treatment of many pulmonary transfer patients in times when systematic treatment appears to prolong the survival of multiple transfer patients. For example:686 cases of circulatory cancer (CRC) were treated by SABR, with local control rates of 81 per cent, 66 per cent and 60 per cent for 1, 2 and 3 years, respectively. The local control rate for CRC pulmonary transfer patients is lower than for non-CRC pulmonary transfer patients, but the overall survival rate is higher.Pulmonary transfer patients with 134 different types of cancer (including CRC) received SABR treatment at doses of 30-60 Gy of 1-5 times, with local control rates of 97.6 per cent in one year and 90.6 per cent in two years.76 cases of renal cell cancer pulmonary transfer unfit for surgery received SABR treatment, with doses ranging from 24 Gy to 3 45 Gys, with local control rates of 98.1 per cent and 91.9 per cent for one and three years, respectively.107 cases of initial pulmonary transfer to the neck were treated by SABR, with a local control rate of 94 per cent for two years and a total survival rate of 62 per cent. The overall survival rate for oligo-transferees is higher than for oligo-transferees in 2 years (72 per cent versus 44 per cent). SABR has good tolerance and no toxicity incidents above level 3 have been reported.In addition, several more retrospective analyses and phase II tests have supported SABR effects.Several third-stage random trials are currently under way to assess the effectiveness of SABR for oligopathic patients and to explore the joint application of SABR with immunotherapy and/or target-oriented treatment, with a view to optimizing local and systematic responses and further improving patient pre- and survival rates.
IV. The role of skin digestion in pulmonary transferoma treatment
Fig. 3: Pneumocular ecstasyIn addition to surgery and treatment, pulmonary tumours are also subject to several emerging skin digestives. The National Comprehensive Cancer Network Guide (NCCN) believes that, as long as all visible stoves can be cleared, properly selected patients can either use digestive techniques alone or be combined with surgery. The benefits of ablution are both safe treatment of transfer stoves and the retention of normal lung tissue and function. Leather ecstasy has proved to be an effective and relatively safe treatment option for new and repeat pulmonary transfer patients, of which rectal transfer data are the most adequate.Absorption of the ecstasy applies to controllable extra-pulmonary diseases, to fewer than three knots per half chest, to a maximum tumour diameter of less than 2 cm, and to pneumatic lungs around. However, there are no absolute size limits, and larger tumours can also be assessed individually according to location and ability to form the edges. A number of factors have been found to influence the digestive effects of tumours greater than 2 cm, cancer antigen levels higher than 10 ng/mL, multiple transfers and short disease-free intervals associated with poor survival and local control.There are currently three main ways of decomposition: RFA, MWA and CRA. RFA is limited by the radiator phenomenon and is less effective for tumours that are larger or close to the blood vessels. MWA overcomes this limitation and shows better local control and survival rates, especially for small tumours on the edge of 5 mm. CRA is an emerging technology that has proved its safety and effectiveness in a multi-centre forward-looking II study (SOLSTICE).In short, ecstasy is a technically feasible and effective treatment that applies to both primary and transmissible pulmonary tumours. MWA and CRA show particular prospects. More patient data are needed in the future to support their wider application and to explore other possible treatment combinations.ConclusionsFor patients with tumours in their lungs, a variety of local treatments can be selected, such as surgery, medical treatment and skin digestion. These partial treatments can delay the development of conditions and reduce dependence on systematic treatment.The biological characteristics of the tumor determine the most appropriate local treatment. Based on the literature on the transfer of lung from colon cancer, surgical removal provides the best local control effect for patients eligible for surgery. For patients who are unfit for surgery, SBRT shows good local control and potential remote effects in various tumour types. Skin digestion is also applied to small tumours or re-emergence, provided that all visible can be eliminated.In order to determine the best individualisation options, a multidisciplinary assessment and discussion is required for each patient, taking into account the type of tumor, the degree of condition, the complications and other treatment options.With the emergence of new forms of whole-body medicine, more patients are likely to experience re-emergence of pulmonary problems, using combinations or combinations of treatments. Forward-looking trials and multidisciplinary collaboration can help us to set the best treatment sequence for each patient.The author’s perspectiveAfter partial treatment for lung transfer has been effective in improving the patient ‘ s prognosis, a programme of treatment appropriate to each patient should be developed on the basis of multidisciplinary advice. Pulmonary transfer tumor
