intervention, and psychological support had fewer medical complications and better recovery postsurgery than those who did not participate in such programs (363). Other approaches to reducing the complications during and after surgery and improving quality of life postprocedure are to perform less extensive and minimally invasive surgeries, such as robotic surgeries or to identify a subset of patients who could skip surgery altogether. As one example, data from a recent clinical trial showed that for certain patients with early-stage non–small cell lung cancer (NSCLC), surgical removal of only part of the affected lobe of lung is an effective treatment option (364). The study, which compared the outcomes of patients who had their entire lobes removed to those who had only the tumor-affected regions removed, showed that the 5-year overall survival was similar in the two groups. While the study participants represent only a select subgroup of patients with lung cancer, these data are important considering that removal of less lung tissue can preserve lung function, especially for older adults and those with compromised lung capacity, such as patients with a prior lung cancer. Studies have shown that less invasive surgeries may benefit patients since they can minimize postprocedural complications without compromising and sometimes improving long-term outcomes (365-367). As one example, in a recent clinical trial, patients with locally advanced stomach cancer who underwent a minimally invasive procedure had significantly lower longterm complications after surgery, but similar 5-year overall and relapse-free survival rates compared to those who had The Pillars of Cancer Treatment The cancer treatment paradigm is built upon what physicians often refer to as the “pillars” of cancer treatment. For centuries, surgery was the only treatment for cancer (347). In 1896, treatment of a breast cancer patient with X-rays added radiotherapy as the second pillar (348). The foundations for the third treatment pillar—cytotoxic chemotherapy— were established in the early 1940s, with the use of a derivative of nitrogen mustard to treat lymphoma (349). These three pillars—surgery, radiotherapy, and cytotoxic chemotherapy—continue to be critical components of cancer treatment. Introduction of the first molecularly targeted therapeutics in the late 1990s led to the establishment of a fourth pillar, molecularly targeted therapy (350). Also, in the late 1990s, decades of discovery science laid the groundwork for the fifth treatment pillar, immunotherapy (351). Continued evolution of new approaches, such as analysis of tumors aided by artificial intelligence, enhanced molecular imaging, and validation of new biomarkers, plays a critical role in advances in each of these therapeutic areas. FIGURE 15 Surgery Radiotherapy Cytotoxic Chemotherapy Immunotherapy Molecularly Targeted Therapy CANCER TREATMENT Molecularly Targeted Therapy Ancient Times– Present 1890s– Present 1940s– Present 1990s– Present 1990s– Present AACR Cancer Progress Report 2023 Advancing the Frontiers of Cancer Science and Medicine 76
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