[Treatment of non-small cell lung cancer]

In this review article we discuss the diagnostic workup and current treatment strategies for non-small cell lung cancer (NSCLC). Anatomical resection and systematic lymph node dissection is the recommended treatment for early-stage NSCLC. Stereotactic body radiotherapy (SBRT) is an alternative for non-operable patients. Locally advanced NSCLC could be treated with a combination of chemotherapy, radiotherapy and immunotherapy, and in select cases followed by surgical resection. Treatment for patients with metastasized NSCLC depends on molecular tumor characteristics, PD-L1 expression and could consist of chemotherapy, immunotherapy, targeted therapy or a combination of these modalities. In all stages, best supportive care is an option to consider. Because of the success of immunotherapy and targeted therapy for stage IV NSCLC, numerous trials have started to investigate the efficacy of these modalities in early-stage NSCLC as well, further optimizing treatment strategies for this patient group.

Current treatment options for local residual nasopharyngeal carcinoma

OPINION STATEMENT

Local residual disease occurs in 7-13 % after primary treatment for nasopharyngeal carcinoma (NPC). To prevent tumor progression and/or distant metastasis, treatment is indicated. Biopsy is the "gold standard" for diagnosing residual disease. Because late histological regression frequently is seen after primary treatment for NPC, biopsy should be performed when imaging or endoscopy is suspicious at 10 weeks. Different modalities can be used in the treatment of local residual disease. Interestingly, the treatment of residual disease has better outcomes than treatment of recurrent disease. For early-stage disease (rT1-2), treatment results and survival rates are very good and comparable to patients who had a complete response after the first treatment. Surgery (endoscopic or open), brachytherapy (interstitial or intracavitary), external or stereotactic beam radiotherapy, or photodynamic therapy all have very good and comparable response rates. Choice should depend on the extension of disease, feasibility of the treatment, and doctor's and patient's preferences and experience, as well as the risks of the adverse events. For the more extended tumors, choice of treatment is more difficult, because complete response rates are poorer and severe side effects are not uncommon. The results of external beam reirradiation and stereotactic radiotherapy are better than brachytherapy for T3-4 tumors. Photodynamic therapy resulted in good palliative responses in a few patients with extensive disease. Also, chemotherapeutics or the Epstein-Barr virus targeted therapies can be used when curative intent treatment is not feasible anymore. However, their advantage in isolated local failure has not been well described yet. Because residual disease often is a problem in countries with a high incidence of NPC and limited radiotherapeutic and surgical facilities, it should be understood that most of the above mentioned therapeutic modalities (radiotherapy and surgery) will not be readily available. More research with controlled, randomized trials are needed to find realistic treatment options for residual disease.