Translational Health Reports

Abstract Background: Older patients undergoing thoracoscopic radical resection for lung cancer face considerable risks of postoperative pain, weakened immunity, and malnutrition, which can slow recovery. Multimodal approaches are needed to enhance results. This review explores the combined benefits of preoperative nutritional support and analgesia based on esketamine.
Methods: A narrative literature review was performed using databases including PubMed, Embase, and the Cochrane Library up to 2025. The search targeted clinical trials, randomized controlled trials (RCTs), and meta-analyses on esketamine, preoperative nutrition, and outcomes in thoracic or cancer surgery. Information was combined to assess impacts on pain relief, immune and nutritional indicators, and recovery measures.
Results: Research consistently shows that esketamine notably decreases postoperative pain scores and opioid use while reducing opioid-related side effects. Preoperative immunonutrition lessens the surgery-related drop in immune markers (IgG, IgM, IgA) and nutritional proteins (Alb, TRF, PAB). Together, these approaches work synergistically to speed gastrointestinal recovery, reduce hospital stay, and improve health-related quality of life scores in older surgical patients.
Conclusion: Incorporating preoperative nutritional support and esketamine into Enhanced Recovery After Surgery (ERAS) protocols offers a promising multimodal method to improve perioperative care. This approach effectively manages pain, supports immune and nutritional health, and encourages quicker recovery, supporting broader clinical use and additional large-scale RCTs.

Abstract Background: The optimal radiation dose for stage III non-small cell lung cancer (NSCLC) remains unclear. This study aimed to investigate the radiation dose-response relationship in patients with stage III NSCLC treated with definitive radiation therapy.

Methods: This retrospective cohort study analyzed 376 patients with stage III NSCLC treated with definitive radiation therapy between 2010 and 2019. The study population had a median age of 68 years, with 64.9% being male and 89.4% having a performance status of ECOG 0-1. The median radiation dose was 66 Gy, with 74.5% of patients receiving conventional fractionation and 25.5% receiving hypofractionated radiation.

Results: The median overall survival (OS) was 24.5 months, with a 95% confidence interval (CI) of 13.1-32.9 months. For every 1 Gy increase in radiation dose, the hazard of death decreases by 6% (HR = 0.94, p < 0.001). Older age is associated with a higher hazard of death (HR = 1.02, p = 0.002). Poorer performance status (ECOG 2-3) is associated with a higher hazard of death compared to good performance status (ECOG 0-1) (HR = 1.63, p = 0.009). Histology other than adenocarcinoma is associated with a higher hazard of death (HR = 1.55, p = 0.02). The results of the PCA suggest that the 15 dosimetric variables can be reduced to 5 components that explain 88.4% of the variance in the data suggesting that higher doses to smaller tumor volumes may be associated with better treatment outcomes.

Conclusion: Higher radiation doses may be associated with improved OS, but in patients with smaller tumor size. Further studies are needed to confirm these findings and to determine the optimal radiation dose for this patient population.