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Role of Radiation Therapy for Non-small Cell Lung Cancer: Focused on Stereotactic Ablative Radiation Therapy in Stage I.

Yong Chan AHN

Hanyang Medical Reviews.2014;34(1):45-50. doi:10.7599/hmr.2014.34.1.45

Radiation therapy has played a key role, together with surgery and systemic chemotherapy, in treating in all stages of non-small cell lung cancer. We have witnessed remarkable improvements in radiation therapy techniques, with the innovations in hardware and software. Stereotactic ablative radiation therapy, which can deliver high radiation dose focused to small target volume, represents one of the state-of-the-art radiation therapy techniques. The technical development of radiation therapy and the role of stereotactic ablative radiation therapy in treating inoperable stage I non-small cell lung cancer are briefly reviewed.
Carcinoma, Non-Small-Cell Lung* ; Drug Therapy ; Radiotherapy ; Stereotaxic Techniques

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Molecular Targeted Therapy in Lung Cancer.

Myung Ju AHN

Hanyang Medical Reviews.2014;34(1):37-44. doi:10.7599/hmr.2014.34.1.37

Lung cancer is the most common cause of cancer death worldwide. With advances in understanding of lung cancer biology and technology, there has been significant improvement in the treatment of non-small-cell lung cancer (NSCLC) during the last decades through the development of targeted agents for molecular subgroups harboring specific genomic abnormalities. So far, agents targeting Epidermal growth factor receptor (EGFR) and Anaplastic Lymphoma Kinase (ALK) have led to high and durable response rates in patients with EGFR mutation or ALK translocation. Also agents targeting VEGF improved overall survival even though a specific biomarker has not been defined yet. As more and more genomic alterations, such as ROS1, RET, MET, HER2, BRAF, FGFR1, DDR2, PI3KCA and K-ras, are being identified in NSCLC, new targeted agents for patients with specific genomic alterations have been developed and have showed promising results. Furthermore, promising results with immune checkpoint inhibitors such as CTLA4 inhibitors, PD-1 or PDL-1 antibody will shed light on further improvement of treatment of lung cancer in the near future. However, the evolving nature of cancer through the appearance of resistance to targeted agents and tumor heterogeneity would provide much challenge to conquer lung cancer. Unfortunately, since no significant progress has been achieved in targeted agents in small cell lung cancer, this review will focus on NSCLC and provides an overview of growing new targeted agents in the treatment of NSCLC.
Biology ; Carcinoma, Non-Small-Cell Lung ; Humans ; Lung Neoplasms* ; Lung* ; Lymphoma ; Molecular Targeted Therapy* ; Phosphotransferases ; Population Characteristics ; Receptor, Epidermal Growth Factor ; Small Cell Lung Carcinoma ; Vascular Endothelial Growth Factor A

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Cytotoxic Chemotherapy for Non-small Cell Lung Cancer.

Byeong Bae PARK

Hanyang Medical Reviews.2014;34(1):31-36. doi:10.7599/hmr.2014.34.1.31

Non-small-cell lung cancer is one of the leading causes of deaths from cancer worldwide. There have been remarkable advances in the targeted treatment of advanced non-small cell lung cancer (NSCLC) over the past several years. Survival outcomes are steadily improving as management paradigms shift in the diagnosis and treatment of advanced NSCLC. Customizing treatment based on histology and molecular typing has become a standard of care in this era of targeted therapy. Even as new chemotherapeutic agents are proving effective, a pivotal role for platinum-based chemotherapy doublets has been confirmed. Maintenance chemotherapy has become an option, but determining which patients will most benefit from it remains controversial in the real-world setting. Ongoing efforts to overcome resistance to targeted agents utilizing combination regimens of chemotherapy plus targeted agents, are currently being explored and optimized. This review highlights recent developments in novel chemotherapeutics. Despite advances in molecular medicine, there remains an essential role for chemotherapy in advanced NSCLC, even in the recent targeted therapy era.
Antineoplastic Agents ; Carcinoma, Non-Small-Cell Lung* ; Cause of Death ; Chemotherapy, Adjuvant ; Diagnosis ; Drug Therapy* ; Humans ; Lung Neoplasms ; Maintenance Chemotherapy ; Molecular Medicine ; Molecular Typing ; Standard of Care

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Minimally Invasive Thoracic Surgery in Lung Cancer Operation.

Jong Ho CHO ; Yong Soo CHOI

Hanyang Medical Reviews.2014;34(1):26-30. doi:10.7599/hmr.2014.34.1.26

The progression to minimally invasive techniques has been almost a natural evolution of the use of video-assisted thoracic surgery (VATS) from the investigation of pleural diseases, such as pneumothorax, and pleural effusion. Surgical resection is the primary treatment for early-stage non-small cell lung cancer (NSCLC). Minimally invasive thoracic surgery has been extensively used in the field of lung cancer. As the procedure has evolved and been studied, thoracoscopic lobectomy has been demonstrated to be a safe and oncologically effective strategy in the surgical management of patients with early stage NSCLC. VATS is a minimally invasive technique that has many advantages in postoperative pain and recovery time. Most surgeons perform VATS for lung cancer with three or more incisions. As the technique of VATS has evolved, single- or double-port VATS for lung cancer has been recently attempted and its advantages have been reported.
Carcinoma, Non-Small-Cell Lung ; Humans ; Lung Neoplasms* ; Lung* ; Pain, Postoperative ; Pleural Diseases ; Pleural Effusion ; Pneumothorax ; Thoracic Surgery* ; Thoracic Surgery, Video-Assisted

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The Role of EBUS-TBNA in the Diagnosis and Staging of Lung Cancer.

Sang Won UM

Hanyang Medical Reviews.2014;34(1):20-25. doi:10.7599/hmr.2014.34.1.20

Convex-probe endobronchial ultrasound-guided transbronchial needle aspiration (CP-EBUS-TBNA) has emerged as a new diagnostic modality that allows ultrasound-guided, real-time needle aspiration of mediastinal and hilar lymph nodes. Mediastinoscopy has been the reference standard for neoplastic staging in the mediastinum, but it is invasive and requires general anesthesia. Considering recent prospective studies and clinical guidelines, a needle technique such as EBUS-TBNA and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) should be performed first for the mediastinal nodal staging of non-small lung cancer. Combining EBUS-TBNA and EUS-FNA will replace more invasive methods such as mediastinoscopy. CP-EBUS-TBNA can also be used for the restaging after neoadjuvant therapy, the diagnosis of recurrent lung cancer and central lung parenchymal lesion which abuts trachea or bronchi. In the era of personalized medicine, good-quality and sufficient tissues need to be obtained for the molecular testing and treatment guidance. EBUS-TBNA has the ability to obtain satisfactory material for the detection of EGFR mutation, KRAS mutation, and EML-ALK fusion gene.
Anesthesia, General ; Bronchi ; Diagnosis* ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Lung Neoplasms* ; Lung* ; Lymph Nodes ; Mediastinoscopy ; Mediastinum ; Methods ; Needles ; Neoadjuvant Therapy ; Neoplasm Metastasis ; Trachea ; Precision Medicine

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Lung Cancer Screening.

Young Woong WON

Hanyang Medical Reviews.2014;34(1):15-19. doi:10.7599/hmr.2014.34.1.15

Lung cancer is the leading cause of cancer-related mortality worldwide, including in Korea. Although various treatment modalities have been developed, the prognosis of patients with lung cancer is still very unfavorable. Most patients with lung cancer are diagnosed at an advanced stage, and palliative care remains the only therapeutic option for these patients. Accordingly, early detection of lung cancer may lead to a decrease in lung cancer-related mortality. Therefore, considerable interest has been generated in the development of screening tools to detect lung cancer at an early stage. Although chest radiography and sputum cytological evaluation have been used to screen patients for lung cancer, the sensitivity and specificity of these procedures are not adequate. Recently, low-dose computed tomography (LDCT) has emerged as a promising screening technique, and several trials have demonstrated its benefit in the high-risk population. One such well-designed and well-conducted trial, the National Lung Screening Trial (NLST), showed a 20% reduction in lung cancer-related mortality. Based on the results of NLST and other trials, screening for lung cancer using LDCT is recommended in asymptomatic patients who are at a high risk for lung cancer, with regard to age and smoking history. The present report is a comprehensive review of available evidence on the benefits and risks of lung cancer screening and summarizes some recommendations.
Early Detection of Cancer ; Humans ; Korea ; Lung Neoplasms* ; Lung* ; Mass Screening* ; Mortality ; Palliative Care ; Prognosis ; Radiography ; Risk Assessment ; Sensitivity and Specificity ; Smoke ; Smoking ; Sputum ; Thorax ; Tomography, X-Ray Computed

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Current Issues in Lung Cancer Pathology.

Jin Haeng CHUNG

Hanyang Medical Reviews.2014;34(1):10-14. doi:10.7599/hmr.2014.34.1.10

Lung cancer is characterized by accumulation of oncogene activation, inactivation of tumor suppressor genes and alteration of epigenetic changes. Fortunately, the past decade has seen remarkable development in molecular pathogenesis and management of lung cancer, especially adenocarcinoma. The discovery of the biologic and therapeutic importance of acquired genetic alterations in 2 genes that encode pharmacologically targetable tyrosine kinases involved in growth factor receptor signaling, epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK), has raised hope that targeted therapy will improve survival and quality of life of patients with lung cancer. Therefore, molecular testing to detect these 2 mutated genes is more important than ever and has changed the management of the patients with lung cancer and the role of pathologists. Furthermore, as most lung cancer patients present with advanced-stage disease at the time of diagnosis, it is important to detect targetable mutations using small tissue samples or cytology specimens. Here, the author summarizes the practical impact of the molecular testing of lung cancer and introduces the current knowledge of lung cancer pathology.
Adenocarcinoma ; Diagnosis ; Epigenomics ; Genes, Tumor Suppressor ; Hope ; Humans ; Lung Neoplasms* ; Lung* ; Lymphoma ; Molecular Diagnostic Techniques ; Oncogenes ; Pathology* ; Phosphotransferases ; Quality of Life ; Receptor, Epidermal Growth Factor ; Tyrosine

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Molecular Biology of Non-small-cell Lung Cancer.

Jung Hye CHOI

Hanyang Medical Reviews.2014;34(1):4-9. doi:10.7599/hmr.2014.34.1.4

In the past decades, substantial developments in the understanding of molecular biology in non-small-cell lung cancer (NSCLC) have improved diagnosis and treatment of NSCLC based on the genotype of each patient's tumor. For example, gain-of function mutations of epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) rearrangement are sensitive biomarkers in predicting tumor response and survival to EGFR tyrosine kinase inhibitor and ALK inhibitor, respectively. However, since NSCLC is one of the most complex and heterogenous cancers and the leading cause of cancer-related death in the world, there are still many challenges for prevention, diagnosis, and treatment of NSCLC. This review summarizes the molecular biology of NSCLC including activation of oncogenes, suppression of tumor suppressor genes, angiogenesis, epigenetic alteration, microRNA, telomerase, cancer stem cell, and cancer genomics using next generation sequencing methods.
Carcinoma, Non-Small-Cell Lung ; Diagnosis ; Epigenomics ; Genes, Tumor Suppressor ; Genomics ; Genotype ; High-Throughput Nucleotide Sequencing ; Lung Neoplasms* ; Lung* ; Lymphoma ; Methods ; MicroRNAs ; Molecular Biology* ; Neoplastic Stem Cells ; Oncogenes ; Phosphotransferases ; Protein-Tyrosine Kinases ; Receptor, Epidermal Growth Factor ; Telomerase ; Biomarkers

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Ocular Inflammation Associated with Systemic Infection.

Byung Gil MOON ; Joo Yong LEE

Hanyang Medical Reviews.2016;36(3):192-202. doi:10.7599/hmr.2016.36.3.192

Systemic infections that are caused by various types of pathogenic organisms can be spread to the eyes as well as to other solid organs. Bacteria, parasites, and viruses can invade the eyes via the bloodstream. Despite advances in the diagnosis and treatment of systemic infections, many patients still suffer from endogenous ocular infections; this is particularly due to an increase in the number of immunosuppressed patients such as those with human immunodeficiency virus infection, those who have had organ transplantations, and those being administered systemic chemotherapeutic and immunomodulating agents, which may increase the chance of ocular involvement. In this review, we clinically evaluated posterior segment manifestations in the eye caused by hematogenous penetration of systemic infections. We focused on the conditions that ophthalmologists encounter most often and that require cooperation with other medical specialists. Posterior segment manifestations and clinical characteristics of cytomegalovirus retinitis, endogenous endophthalmitis, toxoplasmosis, toxocariasis, and ocular syphilis are included in this brief review.
Bacteria ; Cytomegalovirus Retinitis ; Diagnosis ; Endophthalmitis ; Eye Infections ; HIV ; Humans ; Inflammation* ; Organ Transplantation ; Parasites ; Specialization ; Syphilis ; Toxocariasis ; Toxoplasmosis ; Toxoplasmosis, Ocular ; Transplants

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Current Trends in the Management of Thyroid Ophthalmopathy.

Sunah KANG ; Ho Seok SA

Hanyang Medical Reviews.2016;36(3):186-191. doi:10.7599/hmr.2016.36.3.186

Thyroid ophthalmopathy (TO) is an autoimmune inflammatory disorder involving the orbit characterized by inflammation and swelling of the extraocular muscles and an increase in orbital fat and connective tissue. Despite extensive research, TO continues to be a difficult condition for the patient to cope with and for the clinician to treat. Current treatments consist of systemic immunosuppression, orbital irradiation, and surgery. It is promising for patient refractory to conventional therapy that pathogenesis of TO at molecular level which advance development of new therapies targeting cellular immunity are now better understood. Future therapies targeting immune system or specific molecules are under investigation and show promise for the future. This review will describe current trends in the management of TO, from well-established therapies such as glucocorticoids, orbital irradiation and orbital decompression to more innovative therapies targeting immune system or specific molecules involved in TO pathogenesis.
Adrenal Cortex Hormones ; Connective Tissue ; Decompression ; Glucocorticoids ; Humans ; Immune System ; Immunity, Cellular ; Immunosuppression ; Inflammation ; Muscles ; Orbit ; Therapies, Investigational ; Thyroid Gland*

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