Lung cancer is the highest morbidity of malignant tumor in China, and bone metastasis is one of the common sites. With the development of imaging and nuclear medicine technology, the level of early diagnosis of bone metastasis has been improved. There are also many evidence-based evidences and advances in systemic therapy (chemotherapy, targeted therapy, immunotherapy) and bone modification drugs for treatment of bone metastases from lung cancer. The comprehensive treatment model under the guidance of multiple disciplines (including medical oncology, surgery, radiotherapy, interventional medicine, nuclear medicine, psychological rehabilitation, etc.) has been widely implemented in clinical practice. Therefore, Lung Cancer Medical Education Committee of China Medicine Education Association, Youth Specialists Committee of Lung Cancer, Beijing Medical Award Foundation and Lung Cancer Specialty Committee of Chinese Elderly Health Care Association have written the "Chinese Clinical Guidelines on Diagnosis and Treatment of Lung Cancer Bone Metastasis (Version 2024)", based on the "Expert Consensus on Diagnosis and Treatment of Lung Cancer Bone Metastasis (Version 2019)". The aim is to enhance the comprehensive treatment level of lung cancer bone metastasis in China.

With the increasing application of low-dose computed tomography and the rising public health awareness, the early detection of pulmonary nodules has become more prevalent. Pulmonary nodules, especially those with a diameter≤2 cm, pose a critical challenge in clinical practice due to the potential risk of progressing into malignant lung lesions. Guided by the principles of "avoiding both over-treatment and mistreatment", the goal is to standardize the clinical management of pulmonary nodules. The "Chinese thoracic surgery expert consensus on rational diagnosis and treatment of pulmonary nodules with a diameter≤2 cm (2024)" was developed after extensive consultation with nearly one hundred thoracic surgery experts in China, relying on large-scale clinical study data and referencing national and international guidelines and consensus. The consensus includes 29 recommendations, focusing on specific attributes such as the size, composition, and anatomical positioning of the nodules. It proposes targeted guidelines for screening, follow-up, diagnostic criteria, and recommendations for personalized treatment, surgical approaches, and protocols for rapid postoperative recovery.

BACKGROUND: With the extensive application of segmental lung resection in the treatment of early-stage lung cancer, how to complete segmentectomy more accurately and minimally invasively has become a research hotspot. The aim of this study is to explore the application of three-dimensional computed tomography bronchography and angiography (3D-CTBA) combined with perfusion area recognition technique in single-hole thoracoscopic complex segmentectomy. METHODS: From January 2021 to January 2022, the clinical data of 112 consecutive patients undergoing single-port thoracoscopic complex segmentectomy in the Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University were retrospectively analyzed. The three-dimensional reconstruction combined with perfusion area identification technique was used to perform the operation and the clinical data were analyzed. RESULTS: The average operation time was (141.1±35.4) min; the initial time of intersegmental plane display was (12.5±1.7) s; the maintenance time of intersegmental plane was (114.3±10.9) s; the intersegmental plane was clearly displayed (100%); the amount of bleeding was [10 (10, 20)] mL; the total postoperative drainage volume was (380.5±139.7) mL; the postoperative extubation time was (3.9±1.2) d; and the postoperative hospitalization time was (5.2±1.6) d. Postoperative complications occurred in 8 cases. CONCLUSIONS The advantages of 3D-CTBA combined with perfusion area recognition technique are fast, accurate and safe in identifying intersegmental boundary in single-port thoracoscopic complex segmentectomy, which could provide guidances for accuratding resection of tumors, shortening operation time and reducing surgical complications.
Humans ; Lung Neoplasms/pathology* ; Bronchography ; Pneumonectomy/methods* ; Retrospective Studies ; Thoracic Surgery, Video-Assisted/methods* ; Tomography, X-Ray Computed ; Angiography/methods* ; Perfusion

Objective:Immune checkpoint inhibitors have a high remission rate in the preoperative application of resectable and potentially resectable non-small cell lung cancer when combined with chemotherapy. For the unresectable stage Ⅲ non-small cell lung cancer, whether the transformation can be achieved through this regimen to provide opportunities for surgical resection is controversial. In this study, we evaluated the pattern of transformation therapy by reviewing the efficacy and safety of preoperative therapy and surgery of this group.Methods:A review of 23 patients undergoing surgical resection after transformation therapy by preoperative immunotherapy combined chemotherapy between November 2019 and November 2021 was performed. All patients must clarify the pathological diagnosis of non-small cell lung cancer by biopsy. After the multi-disciplinary treatment team and preoperative imaging assessment, the diagnosis should be consistent with unresectable stage III as described in the Expert Consensus on Multidisciplinary Management of Stage Ⅲ Non-Small Cell Lung Cancer, 2019 Edition. After 2 to 4 cycles of preoperative anti-PD-1 monoclonal antibody combined with chemotherapy, the surgical team assessed the chance of resection and performed surgery. Important indicators such as surgical resection rate, R0 resection rate, MPR, pCR, incidence of grade 3-5 adverse reactions and various other perioperative data were counted.Results:In the whole group, initial imaging evaluation was 10 of stage cⅢA and 13 of stage cⅢB.15 cases had multiple stations N2 lymph nodes metastasis, 9 had enlarged fused N2 lymph nodes metastasis, 6 had large vessel invasion(T4), and 1 had contralateral mediastinal lymph node metastasis(N3). After preoperative neoadjuvant therapy, 17 cases achieved PR, 3 achieved SD and 3 achieved PD. The surgical resection rate of the whole group was 91.3%(21/23, 1 lobectomy combined with superior vena cava reconstruction, 2 sleeve lobectomy, 5 pneumonectomy, 12 lobectomy/combined lobectomy, 1 wedge resection and 2 unresectable cases), R0 resection rate was 95.2%(20/21). MPR was achieved in 13 cases, 8 of them reached pCR. There were no perioperative deaths, median surgical time was 260(190-460) min, median bleeding volume was 100(50-750) ml, median drainage time was 5(3-9) days, and median hospitalization was 7(5-11) days. Two cases got immunotherapy-related grade 3 adverse reactions, one was interstitial pneumonia and the other was immune-related injury involving the eye, oral and genital mucosa. Two cases got surgical complications and one was persistent lung leakage, which stopped after 46 days of conservative treatment; The other was pleural effusion, which was relieved after drainage.Conclusion:For the unresectable stage Ⅲ NSCLC, immunotherapy combined chemotherapy is an effective preoperative downstage method. It can convert 91.3% cases to resectable ones while achieving a good degree of pathological remission. Its side reactions are generally controllable and safety.

With the widespread application of high-resolution and low-dose computed tomography (CT), especially the increasing number of people participating in lung cancer screening projects or health examinations, the detection of pulmonary nodules is increasing. At present, the relevant guidelines for pulmonary nodules focus on how to follow up and diagnose, but the treatment is vague. And the guidelines of European and American countries are not suitable for East Asia. In order to standardize the diagnosis and treatment of pulmonary nodules and address the issue of disconnection between existing guidelines and clinical practice, the Lung Cancer Medical Education Committee of the Chinese Medicine Education Association has organized domestic multidisciplinary experts, based on literature published by experts from East Asia, and referring to international guidelines or consensus, the "Chinese expert consensus on multi-disciplinary minimally invasive diagnosis and treatment of plmonary nodules" has been formed through repeated consultations and thorough discussions. The main content includes epidemiology, natural course, malignancy probability, follow-up strategies, imaging diagnosis, pathological biopsy, surgical resection, thermal ablation, and postoperative management of pulmonary nodules.

Recently, sponsored by the Science Popularization Department of the China Anti Cancer Association, jointly organized by the Rehabilitation Branch of the China Anti Cancer Association and the Mijian Digital Cancer Patient Course Management Platform, and co-organized by the Science Popularization Special Committee of the China Anti Cancer Association, The "2022 White Paper on the Quality of Life of Chinese Lung Cancer Patients" has been officially released (herein after referred to as the "White Paper"), which mainly elaborates on the basic situation of Chinese lung cancer patients and the medical, social, and economic impacts caused by the disease. This article interprets the White Paper in order to help the public understand the real situation of lung cancer patients and provide important empirical evidence and valuable insights for the diagnosis, treatment, and rehabilitation of lung cancer in China.

Objective    To explore and analyze the related influencing factors for common intraoperative complications during CT-guided percutaneous radiofrequency ablation of pulmonary tumor. Methods    We retrospectively analyzed the clinical data of the patients who underwent CT-guided percutaneous radiofrequency ablation of pulmonary tumor in our hospital from December 2018 to December 2019, and analyzed the influencing factors for complications. Results    A total of 106 patients were enrolled. There were 58 (54.7%) males and 48 (45.3%) females aged 46-81 (68.05±8.05) years. All patients successfully completed the operation. The operation time was 47.67±16.47 min, and the hospital stay time was 2.45±1.35 d. The main intraoperative complications were pneumothorax (16.0%, 17/106) and intrapulmonary hemorrhage (22.6%, 24/106). Univariate analysis showed that the number of pleural punctures had an impact on the occurrence of pneumothorax (P=0.00). The length of the puncture path (P=0.00), ablation range (P=0.03) and ablation time (P=0.00) had an impact on the occurrence of intrapulmonary hemorrhage. Multivariate logistic regression analysis showed that the size of the lesion (OR=17.85, 95%CI 3.41-93.28, P=0.00) and the number of pleural punctures (OR=0.02, 95%CI 0.00-0.11, P=0.00) were independent influencing factors for the occurrence of pneumothorax. The length of the puncture path (OR=15.76, 95%CI 5.34-46.57, P=0.00) was the independent influencing factor for the occurrence of intrapulmonary hemorrhage. Conclusion    Percutaneous radiofrequency ablation of pulmonary tumor is safe and with a high success rate, but intraoperative complications are affected by many factors, so the surgeons should be proficient in operating skills to avoid complications.

Objective     To compare the safety and efficacy of thulium laser wedge resection of the lung under uniportal thoracoscopy with the other two traditional surgical methods (mechanical cutting stapler wedge resection and segmentectomy) in the treatment of small pulmonary nodules. Methods    Clinical data of 125 patients with small pulmonary nodules receiving uniportal video-assisted thoracoscopic surgery from December 2017 to December 2018 in our hospital were retrospectively analyzed. Among them, 33 patients had thulium laser wedge resection (a thulium laser group), including 10 males and 23 females, with an average age of 59.21±11.31 years; 48 patients had mechanical stapling pulmonary wedge resection (a mechanical stapling pulmonary wedge resection group), including 17 males and 31 females, with an average age of 57.27±11.30 years; and 44 patients had pulmonary segmentectomy (a pulmonary segmentectomy group), including 21 males and 23 females, with an average age of 63.00±9.68 years. The surgical margin air leakage, operation time, intraoperative blood loss, postoperative hospital stay, drainage days, average daily drainage volume, fever, pain and hospitalization expenses were compared among the three groups. Results    The body mass index, gender, smoking history, benign and malignant pathological results, average maximum diameter of lesions and lesion location distribution were not statistically different among the three groups (P>0.05). The average age and the proportion of pleural adhesions in the thulium laser group were not statistically different from those of the other two groups (P>0.05). In the distribution of the number of lesions, the proportion of multiple lesions in the mechanical stapling pulmonary wedge resection group was higher than that of the other two groups, and there was no statistical difference between the other two groups. The intraoperative blood loss in the thulium laser group was less than that of the other two groups (P≤0.05). There was no statistical difference in the classification of surgical margin air leakage or the operation time among the three groups (P>0.05). The proportion of postoperative fever and hospitalization expenses in the thulium laser group were lower or less than those of the other two groups (P<0.05). The length of hospitalization stay and postoperative chest tube placement in the thulium laser group was significantly shorter than that of the pulmonary segmentectomy group (P<0.05), which was not statistically different from the mechanical stapling pulmonary wedge resection group (P>0.05). There was no statistical difference in the average daily drainage volume or the proportion of pain among the three groups (P>0.05). Conclusion     The thulium laser wedge resection under uniportal thoracoscopy is a safe, effective and economical method for the treatment of small pulmonary nodules.

Objective:To investigate the feasibility of positron apoptosis radioactive tracer 18F-labeled 5-fluoropentyl-2-methyl-malonic acid ( 18F-ML-10) in the detection of cisplatin inducing apoptosis of lung adenocarcinoma A549 cells. Methods:Lung adenocarcinoma A549 cells were divided into the control group, cisplatin time groups and cisplatin dose groups. Cisplatin was not added to the control group. Cisplatin time groups with added 50 μg/ml cisplatin were used for 12, 18, 24, 30, 36, 42 and 48 h, respectively, and the cells of the control group were cultured for 48 h; cisplatin dose groups were treated with 10, 20, 30, 40, 50, 60, 70, 80, 90 and 100 μg/ml cisplatin, respectively for 30 h. The apoptosis was detected by using flow cytometry, and the 18F-ML-10 uptake rate of apoptotic cells in each group was calculated. Results:With the prolongation of the action time of 50 μg/ml cisplatin, the apoptosis rate of A549 cells was increased gradually ( F = 66.87, P < 0.01), and the standavd uptate value of 18F-ML-10 was also increased gradually ( F = 86.47, P < 0.01). When cisplatin was treated for 48 h, the apoptosis rate [(63.10±14.00)%] and 18F-ML-10 standard uptake value (4.97±1.03) reached the highest (all P < 0.01). After cisplatin treatment for 30 h, with the increase of cisplatin dose, the apoptosis rate and 18F-ML-10 standavd uptate value were gradually increased (all P < 0.01), and the apoptosis rate of cisplatin 100 μg/ml group was the highest [(37.31±2.48)%], and the 18F-ML-10 standavd uptate value was the highest (3.08±0.20). Conclusions:18F-ML-10 is feasible in the detection of cisplatin inducing the apoptosis of A549 cells.

In recent years, with the improvement of CT resolution, the reduction of radiation dose, the popularization of lung cancer screening and the enhancement of people's health awareness, the detection rate of lung nodules is higher and higher. Due to the close relationship between lung nodules and lung cancer, more and more attention has been paid to them. Although patients with early and middle stage lung cancer receive complete resection, all postoperative patients are at risk of recurrence and metastasis. Adjuvant or neoadjuvant therapy can improve the survival and reduce the recurrence and metastasis. Therefore, the multidisciplinary team, as the best model, provides a standardized and individualized plan for the diagnosis and treatment of lung nodules and lung cancer patients. However, in the clinical practice, the work efficiency of the multidisciplinary team is not high, and the participation rate of patients is low; therefore the multidisciplinary doctor model with thoracic surgeons as the mainstay is a reasonable alternative.