Luis Miguel Seijo Maceiras

Recomendaciones SEPAR de diagnóstico y tratamiento del cáncer de pulmón de células no pequeñas

Felipe Villar Álvareza,*,1, Ignacio Muguruza Truebab,1, José Belda Sanchisc, Laureano Molins López-Rodód, Pedro Miguel Rodríguez Suáreze, Julio Sánchez de Cos Escuínf, Esther Barreirog, M. Henar Borrego Pintadoh, Carlos Disdier Vicentei, Javier Flandes Aldeyturriagaj, Pablo Gámez Garcíak, Pilar Garrido Lópezl, Pablo León Atancem, José Miguel Izquierdo Elenan, Nuria M. Novoa Valentíno, Juan José Rivas de Andrésp, Íñigo Royo Crespop, Ángel Salvatierra Velázquezq, Luis M. Seijo Maceirasr, Segismundo Solano Reinas, David Aguiar Bujandat, Régulo J. Ávila Martínezk, José Ignacio de Granda Oriveu, Eva de Higes Martínezv, Vicente Díaz-Hellín Gudek, Raúl Embún Florp, Jorge L. Freixinet Gilarte, María Dolores García Jiménezm, Fátima Hermoso Alarzak, Samuel Hernández Sarmientot, Antonio Francisco Honguero Martínezm, Carlos A. Jiménez Ruizw, Iker López Sanzn, Andrea Mariscal de Albak, Primitivo Martínez Vallinap, Patricia Menal Muñozx, Laura Mezquita Pérezl, María Eugenia Olmedo Garcíal, Carlos A. Rombolám, Íñigo San Miguel Arreguiy, María del Valle Somiedo Gutiérrezj, Ana Isabel Triviño Ramírezm, Joan Carles Trujillo Reyesc, Carmen Vallejoz, Paz Vaquero Lozanos, Gonzalo Varela Simóo y Javier J. ZuluetaaaThe Thoracic Surgery and Thoracic Oncology groups of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) have backed the publication of a handbook on recommendations for the diagnosis and treatment of non-small cell lung cancer. Due to the high incidence and mortality of this disease, the best scientific evidence must be constantly updated and made available for consultation by healthcare professionals. To draw up these recommendations, we called on a wide-ranging group of experts from the different specialties, who have prepared a comprehensive review, divided into 4 main sections. The first addresses disease prevention and screening, including risk factors, the role of smoking cessation, and screening programs for early diagnosis. The second section analyzes clinical presentation, imaging studies, and surgical risk, including cardiological risk and the evaluation of respiratory function. The third section addresses cytohistological confirmation and staging studies, and scrutinizes the TNM and histological classifications, non-invasive and minimally invasive sampling methods, and surgical techniques for diagnosis and staging. The fourth and final section looks at different therapeutic aspects, such as the role of surgery, chemotherapy, radiation therapy, a multidisciplinary approach according to disease stage, and other specifically targeted treatments, concluding with recommendations on the follow-up of lung cancer patients and surgical and endoscopic palliative interventions in advanced stages.

Sumario ejecutivo de las recomendaciones SEPAR de diagnóstico y tratamiento del cáncer de pulmón de células no pequeñas

The Thoracic Surgery and Thoracic Oncology groups of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) have backed the publication of a handbook on recommendations for the diagnosis and treatment of non-small cell lung cancer. Due to the high incidence and mortality of this disease, the best scientific evidence must be constantly updated and made available for consultation by healthcare professionals. To draw up these recommendations, we called on a wide-ranging group of experts from the different specialties, who have prepared a comprehensive review, divided into 4 main sections. The first addresses disease prevention and screening, including risk factors, the role of smoking cessation, and screening programs for early diagnosis. The second section analyzes clinical presentation, imaging studies, and surgical risk, including cardiological risk and the evaluation of respiratory function. The third section addresses cytohistological confirmation and staging studies, and scrutinizes the TNM and histological classifications, non-invasive and minimally invasive sampling methods, and surgical techniques for diagnosis and staging. The fourth and final section looks at different therapeutic aspects, such as the role of surgery, chemotherapy, radiation therapy, a multidisciplinary approach according to disease stage, and other specifically targeted treatments, concluding with recommendations on the follow-up of lung cancer patients and surgical and endoscopic palliative interventions in advanced stages.

Prevalence of ALK translocations in a large cohort of non-small cell cancer patients and quality of hybridization by sampling method

Introduction: Molecular analysis is frequently performed in small tissue or cytologic samples obtained by minimally invasive techniques. Unlike EGFR mutations, which can be analyzed by PCR from stained slides, ALK translocations are commonly identified by a complex technique known as fluorescent in situ hybridization (FISH). Not all samples may be adequate for this type of analysis. Materials & Methods: We studied the prevalence of ALK translocations identified by FISH in a large University Hospital cohort of 1002 samples from non small cell lung carcinoma patients. The study aimed to determine the performance of FISH testing on different diagnostic samples. Results: FISH was attempted in 1002 samples, including 195 surgical biopsies, 518 conventional bronchoscopies, 239 EBUS procedures, and 50 percutaneous transthoracic biopsies. The overall prevalence of ALK translocations was 3.5%. Hybridization failure occurred in 7.7% of the samples. 86.7% of the samples were ALK-, and 2.1% of the samples were inadequate for FISH due to a paucity of tumor cells. The vast majority of tissue samples obtained by bronchoscopy (97%) and surgery (98%) were adequate for FISH. Succesful molecular analysis on samples obtained by EBUS and percutaneous CT guided biopsy was possible in 73% and 74% of those samples respectively. Failed ALK translocation analysis was due to either hybridization failure or paucity of tumor cells. Conclusions: Molecular analysis of ALK translocations is feasible in a variety of samples, although hybridization failure or a paucity of tumor cells can be a problem in samples obtained by minimally invasive methods.

Pros and Cons of Endoscopic Treatment of Emphysema

For a long time now, pulmonologists have been searching for a minimally-invasive alternative to lung volume reduction surgery, especially since the NETT study demonstrated that the surgical technique improves the functional capacity and quality of life of some patients with severe enfisema. 1 What is most striking of the NETT study is that a subgroup of patients with emphysema, predominantly in the upper lobes and with poor tolerance to effort, reached an unprecedented increase in survival. As strange as it may seem, it was that same assay that led to the demise of lung volume reduction surgery in the United States when evidence was given of the high price that some patients had to pay for improvement (5.5% mortality and morbidity higher than 50%), including a notable increase in mortality of some high-risk subgroups. 2 Currently, and despite the positive results of NETT, less than 200 surgical interventions are performed annually in the US. 3 The paradoxical