Emerging treatment options in the management of non-small cell lung cancer

Pier Luigi Filosso1, Alberto Sandri1, Alberto Oliaro1, Andrea Riccardo Filippi2, Maria Carla Cassinis3, Umberto Ricardi2, Paolo Olivo Lausi1, Sofia Asioli4, Enrico Ruffini11Department of Thoracic Surgery, 2Department of Medical and Surgical Disciplines, Radiation Therapy Division, 3Department of Medical and Surgical Disciplines, Diagnostic-Imaging Division, 4Department of Oncology and Biomedical Sciences, University of Torino, Torino, ItalyAbstract: Lung cancer (LC) has become the leading cancer-related cause of death in the US and in developed European countries in the last decade. Its incidence is still growing in females and in smokers. Surgery remains the treatment of choice whenever feasible, but unfortunately, many patients have an advanced LC at presentation and one-third of potentially operable patients do not receive a tumor resection because of their low compliance for intervention due to their compromised cardiopulmonary functions and other comorbidities. For these patients the alternative therapeutic options are stereotactic radiotherapy or percutaneous radiofrequency. When surgery is planned, an anatomical resection (segmentectomy, lobectomy, bilobectomy, pneumonectomy, sleeve lobectomy) is usually performed; wedge resection (considered as a nonanatomical one) is generally the accepted option for unfit patients. The recent increase in discovering small and peripheral LCs and/or ground-glass opacities with screening programs has dramatically increased surgeons' interest in limited resections. The role of these resections is discussed. Also, recent improvements in molecular biology techniques have increased the chemotherapic options for neoadjuvant LC treatment. The role and the importance of targeted chemotherapy is also discussed.Keywords: lung cancer, adenocarcinoma, surgery, radiofrequency, radiotherapy, chemotherapy