Oncology Frontier: What is the optimal management strategy for the malignant solitary pulmonary nodule (SPN)？

　　《肿瘤瞭望》：请谈一谈恶性孤立性肺结节（SPN）的最佳管理策略？

　　Dr. Veronesi: So far the surgical reaction with patients fit to receive the surgery is the standard. We know that minimally invasive approaches are nowadays more diffused， compared to the past in which thoracotomy was performed. Now we always perform video-thoracoscopic approach or robotic approach， and the objective is to reduce the invasiveness of surgery and increase the quality of life of patients. There is another trend， which is the reduction of the extension of resection. In the past， the standard approach was a lobectomy with radical lymph node dissection， and we could see in our research that as the cancers have very small nodule sizes in very early stages， in most of them it’s possible to perform a lung sparing sublobar resection， and in most cases an anatomic segmentectomy is the good adequate oncological procedure. So， most of our work cases are treated with minimally-invasive， so mainly robotic， segmentectomy. For those cases that are larger than 2 centimeters， or very aggressive tumors， the standard anatomical lobectomy is performed， mainly with minimally invasive access. The new point for the future is to evaluate the potential of stereotactic radiotherapy for various small nodules， both in the case of primary lesions， but in particular for lesions that are multifocal， second primary， or that have already received a lobectomy. So far， radiotherapy has been proposed as a good alternative to surgery for patients that are unfit for surgery. Now we are going to evaluate it for patients who can be treated with surgery， but in which surgery is correlated with higher mortality compared to radiotherapy. So， in the future our objective will be to screen cancer， to have a noninvasive diagnosis and a noninvasive treatment.

　　Veronesi:博士：对于适合手术的患者来说标准治疗是手术治疗。肺癌微创手术的应用越来越普遍，电视胸腔镜手术或机器人手术的方法可减少手术创伤，提高患者的生活质量。肺癌手术的另一种发展趋势是切除范围减少。过去标准术式是肺叶切除术及彻底淋巴结清扫。而在我们研究中，结节很小的早期肺癌患者大多行亚肺叶切除术，采取微创技术（主要是机器人手术），大多数情况肺段切除术（anatomic segmentectomy）的效果已经很好。而大于2厘米或侵袭性强的肿瘤行标准肺叶切除术（微创手术）。

　　未来研究者将评估立体定向放射治疗各种肺小结节患者（原发肺癌、多灶性肺癌、第二原发肺癌，或已行肺叶切除术的患者）的效果。对于不适宜手术的肺小结节患者，放疗是很好的替代治疗方式。目前，我们对放疗与手术（针对适用手术的患者）的疗效进行比较，但手术与较多并发症相关。未来研究方向是改进肺癌筛查，进行无创性诊断和无创性治疗。