Field Of Thoracic Oncology Research Articles

Disparities in thoracic surgical oncology.

Disparities in access and outcomes of thoracic surgical oncology are long standing. This article examines the patient, population, and systems-level factors that contribute to these disparities and inequities. The need for research and policy to identify and solve these problems is apparent. As leaders in the field of thoracic oncology, surgeons will be instrumental in narrowing these gaps and moving the discipline forward.

Machine learning to refine prognostic and predictive nodal burden thresholds for post-operative radiotherapy in completely resected stage III-N2 non-small cell lung cancer

BackgroundThe role of post-operative radiotherapy (PORT) for completely resected N2 non-small-cell lung cancer (NSCLC) is controversial in light of recent randomized data. We sought to utilize machine learning to identify a subset of patients who may still benefit from PORT based on extent of nodal involvement. Materials/MethodsPatients with completely resected N2 NSCLC were identified in the National Cancer Database. We trained a machine-learning based model of overall survival (OS). SHapley Additive exPlanation (SHAP) values were used to identify prognostic and predictive thresholds of number of positive lymph nodes (LNs) involved and lymph node ratio (LNR). Cox proportional hazards regression was used for confirmatory analysis. ResultsA total of 16,789 patients with completely resected N2 NSCLC were identified. Using the SHAP values, we identified thresholds of 3+ positive LNs and a LNR of 0.34+. On multivariate analysis, PORT was not significantly associated with OS (p = 0.111). However, on subset analysis of patients with 3+ positive LNs, PORT improved OS (HR: 0.91; 95% CI: 0.86–0.97; p = 0.002). On a separate subset analysis in patients with a LNR of 0.34+, PORT improved OS (HR: 0.90; 95% CI: 0.85–0.96; p = 0.001). Patients with 3+ positive lymph nodes had a 5-year OS of 38% with PORT compared to 31% without PORT. Patient with positive lymph node ratio 0.34+ had a 5-year OS of 38% with PORT compared to 29% without PORT. ConclusionsPatients with a high lymph node burden or lymph node ratio may present a subpopulation of patients who could benefit from PORT. To our knowledge, this is the first study to use machine learning algorithms to address this question with a large national dataset. These findings address an important question in the field of thoracic oncology and warrant further investigation in prospective studies.

Current Surgical Indications for Non-Small-Cell Lung Cancer.

Simple SummaryThe management strategy for the treatment of non-small-cell lung cancer (NSCLC) has been transformed by our improved understanding of the cancer biology and concomitant development of novel systemic therapies. Complete surgical resection of NSCLC continues to offer the best chance for cure or local and regional disease control, and with improvements in minimally invasive techniques and enhanced recovery, the morbidity associated with surgical resection has been reduced. Patient-centered multi-disciplinary discussions that consider surgical therapy are associated with improved outcomes. Provided with promising novel therapeutic modalities including immune checkpoint inhibitors with or without chemotherapy, stereotactic radiotherapy, and targeted systemic therapies, indications for surgery continue to evolve and have expanded to include selected patients with advanced and metastatic disease.With recent strides made within the field of thoracic oncology, the management of NSCLC is evolving rapidly. Careful patient selection and timing of multi-modality therapy to permit the optimization of therapeutic benefit must be pursued. While chemotherapy and radiotherapy continue to have a role in the management of lung cancer, surgical therapy remains an essential component of lung cancer treatment in early, locally and regionally advanced, as well as in selected, cases of metastatic disease. Recent and most impactful advances in the treatment of lung cancer relate to the advent of immunotherapy and targeted therapy, molecular profiling, and predictive biomarker discovery. Many of these systemic therapies are a part of the standard of care in metastatic NSCLC, and their indications are expanding towards surgically operable lung cancer to improve survival outcomes. Numerous completed and ongoing clinical trials in the surgically operable NSCLC speak to the interest and importance of the multi-modality therapy even in earlier stages of NSCLC. In this review, we focus on the current standard of care indications for surgical therapy in stage I-IV NSCLC as well as on the anticipated future direction of multi-disciplinary lung cancer therapy.

Application of Dual-Energy Spectral Computed Tomography to Thoracic Oncology Imaging.

Computed tomography (CT) is an important imaging modality in evaluating thoracic malignancies. The clinical utility of dual-energy spectral computed tomography (DESCT) has recently been realized. DESCT allows for virtual monoenergetic or monochromatic imaging, virtual non-contrast or unenhanced imaging, iodine concentration measurement, and effective atomic number (Zeff map). The application of information gained using this technique in the field of thoracic oncology is important, and therefore many studies have been conducted to explore the use of DESCT in the evaluation and management of thoracic malignancies. Here we summarize and review recent DESCT studies on clinical applications related to thoracic oncology.

Dépistage des expositions professionnelles à l’amiante et à la silice par matrice emplois-expositions auprès de patients atteints de cancer bronchopulmonaire et de mésothéliome

In the context of underreporting of occupational diseases, the aim was to study the validity of silica and asbestos job-exposure matrices in screening occupational exposure in the field of thoracic oncology. Fifty patients hospitalized with primitive lung cancer or mesothelioma in a university hospital center in the Hauts-de-Seine department of France were included between November 2016 and September 2017. For each patient 1/the job history was collected, from which data was entered single-blindly into the job-exposure matrices by a resident in occupational medicine, 2/a questionnaire (Q-SPLF) was completed similarly, and 3/the patients also had a consultation with a chief resident in occupational medicine, considered the gold standard. The main outcome was the diagnostic performance of the matrices. The Q-SPLF diagnostic performance was also studied. The asbestos and silica matrices had sensitivities of 100%, specificities of respectively 76.1% and 87.8%, the positive likelihood ratios were at 4.19 [2.5-6] and 8.17 [3.8-10], and the negative likelihood ratios were at 0. The Q-SPLF diagnostic performance was comparable to that of the matrices. The matrices and the questionnaire have a great diagnostic performance which seems interesting for a use as a screening tool for occupational exposures. These results have yet to be confirmed by large-scale studies.

YI01.02 Why to Become a Member of the IASLC

Since the 1970s, the International Association for the Study of Lung Cancer (IASLC) has promoted research and education into all aspects of lung cancer and other thoracic malignancies, as well as encouraged worldwide cancer prevention efforts. According to its mission statement the International Association for the Study of Lung Cancer (IASLC) must embrace the study of the etiology, epidemiology, prevention, diagnosis, treatment and all other aspects of lung cancer and other thoracic malignancies; provide education and information about lung cancer and other thoracic malignancies to IASLC members, to the medical community at large, and to the public; use all available means to eliminate lung cancer and other thoracic malignancies as a health threat for the individual patient and throughout the world. In the last ten years those goals have been embraced by a growing number of members worldwide and now the association counts on approximately 7.000 members with a large portfolio of scientific and educational activities, being now IASLC the premiere society in the field of thoracic oncology. Beyond this bold statement the really question here is why me? While IASLC in the context of many other offers coming from other scientific organizations? The answer comes from one of our members “Being a member helped me in many, many ways. First coming to the IASLC World Conference on Lung Cancer. I was a resident and presenting in front of 100 people [….] that helped me secure my fellowship position. The IASLC helped me with great networking opportunities to interact with many members of the lung cancer community”. That is really the key message. Inclusivity and multidisciplinary. The composition of our Board and committees reflect this sense of inclusivity. We want all the players in the thoracic oncology arena to have the appropriate voice, and the younger generation at the foremost. IASLC mentors and support younger people in the context of several activities within the organization. IASLC has a wide range of fellowships that support people to travel and present at meetings, to get involved in research, and more importantly to get a research grant to make your ideas a reality, and to meet people who can help you further in boosting your career. Our annual meeting is a reference meeting and every year the most relevant scientific research results have been constantly presented. The targeted therapy meeting held every year at the end of February in Santa Monica remains a unique forum of scientific exchange between researchers and pharma not paired by any other type of meeting throughout the world. Equally relevant are the regional meetings that are mainly educational but are also offering the opportunity to report about your own research. One of the main duties of a membership association is to provide value to its members, through high quality and relevant offerings and deeper, more efficient mechanisms for engagement. Creating a robust experience for IASLC members and honoring our commitment to geographic and discipline diversity is our goal The most challenging part for any scientific society is to understand the differences in generational needs. We need to identify the best new talents, the rising stars in our field, who will not only disrupt conventional thinking; they will lead the IASLC in the future. Specific actions will be considered and others are already in place to convince younger generations to see themselves in the IASLC mission. We want you joining us in the fight against tobacco, we want you to be the ambassadors of our organization for the present and, more importantly, the future of our patients with the ultimate goal to be part of a dream: the eradication of thoracic malignancies thoracic malignancies, fellowship, membership

Publication rate of registered clinical trials in lung cancer.

e18211 Background: Clinical trials play a crucial role in shaping oncology practice. Publishing results of clinical trials is key to reducing publication bias. Lung cancer is the leading cause of cancer-related mortality in the U.S. We assessed the publication rate of registered lung cancer clinical trials. Methods: ClinicalTrials.gov was searched to identify registered lung cancer clinical trials with study completion date between 1/1/2000 and 8/7/2016. Interventional phase II and III clinical trials involving patients ³ 18 years old with a recruitment status of completed or terminated were included. Using National Clinical Trial identifier and keywords including the clinical trial name, three databases (PubMed, Google Scholar, EMBASE) were queried to assess the publication status of each trial. We analyzed the publication rate among the identified clinical trials and predictors of publication. Results: A total of 1293 clinical trials were identified. Among 1037 completed clinical trials, 690 (66.5%; 193,587 patients) were published in peer-reviewed journal, while 347 (33.5%; 51,505 patients) were unpublished. Industry sponsored, non-randomized, and single-center studies were less likely to be published with odds ratio 0.52 (95% CI: 0.28-0.97), 0.67 (0.45-1.00), and 0.36 (0.25-0.51), respectively. Among the 347 unpublished completed trials, 75 (21.6%) trials reported the results as meeting presentation and 63 (18.2%) trials posted the results only on ClinicalTrials.gov. Among 256 terminated clinical trials, 72 (28.1%; 19,858 patients) were published in peer-reviewed journal, while 184 (71.9%; 10,259 patients) were unpublished. Among the 184 unpublished terminated trials, 19 (10.3%) trials reported the results as meeting presentation and 70 (38.0%) trials posted the study results only on ClinicalTrials.gov; reporting of primary outcome was incomplete in 50 (71.4%) of 70 studies whose results were only available on ClinicalTrials.gov. Conclusions: A significant proportion of registered lung cancer clinical trials remain unpublished, raising the concern of publication bias in the field of thoracic oncology.

Liquid Biopsy for Advanced Non-Small Cell LungCancer (NSCLC): A Statement Paper from theIASLC.

The isolation and analysis of circulating cell-free tumor DNA in plasma is a powerful tool with considerable potential to improve clinical outcomes across multiple cancer types, including NSCLC. Assays of this nature that use blood as opposed to tumor samples are frequently referred to as liquid biopsies. An increasing number of innovative platforms have been recently developed that improve not only the fidelity of the molecular analysis but also the number of tests performed on a single specimen. Circulating tumor DNA assays for detection of both EGFR sensitizing and resistance mutations have already entered clinical practice and many other molecular tests - such as detection of resistance mutations for Anaplastic Lymphoma Kinase (ALK) receptor tyrosine kinase rearrangements - are likely to do so in the near future. Due to an abundance of new evidence, an appraisal was warranted to review strengths and weaknesses, to describe what is already in clinical practice and what has yet to be implemented, and to highlight areas in need of further investigation. A multidisciplinary panel of experts in the field of thoracic oncology with interest and expertise in liquid biopsy and molecular pathology was convened by the International Association for the Study of Lung Cancer to evaluate current available evidence with the aim of producing a set of recommendations for the use of liquid biopsy for molecular analysis in guiding the clinical management of advanced NSCLC patients as well as identifying unmet needs. In summary, the panel concluded that liquid biopsy approaches have significant potential to improve patient care, and immediate implementation in the clinic is justified in a number of therapeutic settings relevant to NSCLC.

Progress in the Management of Advanced Thoracic Malignancies in 2017.

The treatment paradigm of NSCLC underwent a major revolution during the course of 2017. Immune checkpoint inhibitors (ICIs) brought remarkable improvements in response and overall survival both in unselected pretreated patients and in untreated patients with programmed deathligand 1 expression of 50% or more. Furthermore, compelling preliminary results were reported for new combinations of anti-programmed cell death 1/programmed death ligand 1 agents with chemotherapy or anti-cytotoxic T-lymphocyte associated protein 4 inhibitors. The success of the ICIs appeared to extend to patients with SCLC, mesothelioma, or thymic tumors. Furthermore, in SCLC, encouraging activity was reported for an experimental target therapy (rovalpituzumab teserine) and a new chemotherapeutic agent (lurbinectedin). For oncogene-addicted NSCLC, next-generation tyrosine kinase inhibitors (TKIs) (such as osimertinib or alectinib) have demonstrated increased response rates and progression-free survival compared with first-generation TKIs in patients with both EGFR-mutated and ALK receptor tyrosine kinase gene (ALK)-rearranged NSCLC. However, because of the lack of mature overall survival data and considering the high efficacy of these drugs in patients with NSCLC previously exposed to first- or second-generation TKIs, definitive conclusions concerning the best treatment sequence cannot yet be drawn. In addition, new oncogenes such as mutant BRAF, tyrosine-protein kinase met gene (MET) and erb-b2 receptor tyrosine kinase 2 gene (HER2), and ret proto-oncogene (RET) rearrangements have joined the list of potential targetable drivers. In conclusion, the field of thoracic oncology is on the verge of a breakthrough that will open up many promising new therapeutic options for physicians and patients. The characterization of biomarkers predictive of sensitivity or resistance to immunotherapy and the identification of the optimal therapeutic combinations (for ICIs) and treatment sequence (for oncogene-addicted NSCLC) represent the toughest upcoming challenges in the domain of thoracic oncology.

Multidisciplinary teams in thoracic oncology-from tragic to strategic.

The Journal has been constantly re-inventing itself since inception as is evidenced by randomly browsing at issues every successive year. Specific priority fields have changed over the years in parallel with novel developments emerging in the field of thoracic oncology and in several instances the subjects covered in the journal have even set the trend. Very clearly, methodology of the published papers has improved from mainly explorative retrospective work to more hypothesis-driven prospective approaches. Revolutionary new areas have been integrated such as the present article on Multidisciplinary Teams.

Pulmonary artery sarcoma: a rare thoracic tumor frequently misdiagnosed at presentation.

This case illustrates a rare but important differential diagnosis of pulmonary emboli in the field of thoracic oncology, that of pulmonary artery sarcoma. It describes particular clinical features that may raise suspicion of this tumor in cases of suspected pulmonary emboli, and highlights novel radiological modalities and tissue sampling techniques in such cases. Surgical resection, as part of multi-modality therapy, is the cornerstone of treatment that has seen survival dramatically improve in recent years for patients with this rare cancer.

Detection of circulating tumor cells from lung cancer patients in the era of targeted therapy: promises, drawbacks and pitfalls.

Interest in biomarkers in the field of thoracic oncology is focused on the search for new robust tests for diagnosis (in particular for screening), prognosis and theragnosis. These biomarkers can be detected in tissues and/or cells, but also in biological fluids, mainly the blood. In this context, there is growing interest in the detection of circulating tumor cells (CTCs) in the blood of lung cancer patients since CTC identification, enumeration and characterization may have a direct impact on diagnosis, prognosis and theragnosis in the daily clinical practice. Many direct and indirect methods have been developed to detect and characterize CTCs in lung cancer patients. However, these different approaches still hold limitations and many of them have demonstrated unequal sensitivity and specificity. Indeed, these methods hold advantages but also certain disadvantages. Therefore, despite the promises, it is currently difficult and premature to apply this methodology to the routine care of lung cancer patients. This situation is the consequence of the analysis of the methodological approaches for the detection and characterization of CTCs and of the results published to date. Finally, the advent of targeted cancer therapies in thoracic oncology has stimulated considerable interest in non-invasive detection of genomic alterations in tumors over time through the analysis of CTCs, an approach that may help clinicians to optimize therapeutic strategies for lung cancer patients. We describe here the main methods for CTC detection, the advantages and limitations of these different approaches and the potential usefulness and value of CTC characterization in the field of thoracic oncology.

Updates in oncology

The objective of this review is to report the Clinical Year in Review proceedings in the field of thoracic oncology that were presented at the 2013 European Respiratory Society Annual Congress in Barcelona, Spain. Various topics were reviewed, including: epidemiology, screening, histology, and treatment of nonsmall cell lung cancer and small cell lung cancer.

From the Desk of Guest Editor

The field of Thoracic Oncology has evolved over the past many years. The advances in understanding of biology of thoracic malignancies coupled with, new staging methods, development of newer technologies for diagnosis (high resolution CT scans and PET scans) and treatment (voltage gated radiotherapy machines) has revolutionized this field. Surgical tools such as Robotic and minimally invasive surgical techniques have given new dimensions to surgical outcomes of thoracic oncological solid tumor malignancies. In India the first esophagectomy was performed by Dr. D.J Jussawalla in 1944 at the Tata Memorial Hospital. Since then few anecdotal centres did surgery for esophageal and lung cancer, but with high mortality and morbidity. The formal thoracic oncology unit was formed at the Tata Memorial Hospital in mid-80’s, where formal training of surgical oncologist in the subject and better management of thoracic oncological cases were done. The radical surgical approaches were aided by better anesthesia and improved intensive care for good outcome. Recently there are about six exclusive trained thoracic oncological units in different parts of India with dedicated team work giving better results. The special issue of Journal on Thoracic Malignancies highlights the latest trends in surgical management of thoracic cancers especially lung and esophageal cancers. The issue throws light on the role of recent changes in management of these cancer due to emerging molecular science and subtle changes in management. I believe that progress in molecular biology and development of target treatment with advanced surgical tools will lead to improved survival and better quality of life of thoracic malignancy cases.

Advances in Fine Needle Aspiration Cytology for the Diagnosis of Pulmonary Carcinoma

New developments in the field of thoracic oncology have challenged the way pathologists approach the diagnosis of pulmonary carcinoma. Nonsmall cell carcinoma is no longer an adequate diagnostic category. Pathologists are required to further classify tumors into adenocarcinoma and squamous cell carcinoma since specific therapies are now recommended depending on the histological tumor type. This change occurred following the discovery of specific molecular alterations that predict response to certain drugs and now molecular testing of tumor cells is often requested to direct therapy. The vast majority of lung cancer is diagnosed in advanced clinical stages, where cytologic or small biopsy material is the only form of tissue diagnosis, thus placing cytology, especially fine needle aspiration biopsy in the front line for management of patients with lung cancer. In this paper we will review the current concepts in the suitability and accuracy of fine needle aspiration biopsy, including diagnosis, classification, prognostic markers, and use of ancillary techniques.

Thoracic oncology in Europe: the ERS action plan by the Thoracic Oncology Assembly

Lung cancer is the leading cause of cancer mortality in Europe and its incidence is rapidly increasing in females 1, 2. In addition, malignant mesothelioma is an emerging neoplasm that is expected to become a frequent disease in the forthcoming decade. Based on these considerations, the European Respiratory Society (ERS), which is the only European medical organisation dealing with respiratory diseases, has founded a new assembly to set up an action plan called “Thoracic Oncology in Europe”. The decision to create a new assembly dedicated to thoracic oncology was made in 2009. The Thoracic Oncology Assembly (assembly 11) was issued from the thoracic oncology group of the Clinical Assembly and consists of two groups: group 11.1, dealing with lung cancer, and group 11.2, dealing with pleural and thoracic malignancies. The motivation of the ERS to establish a new assembly is that thoracic oncology has become a strong pillar of the society. Indeed, thoracic malignancies are a menacing health problem, not only on our continent. To meet this challenge, an action plan was designed by the assembly officers during a memorable meeting in Brussels in March 2010 and approved immediately, and was strongly welcomed by the ERS executive committee in April. The action plan intends that the ERS becomes the leading European society in the field, as its members already deal with all aspects of thoracic malignancies, from basic science to patient care. To fulfil this objective, various activities will be developed. European guidelines in the field of thoracic oncology are an important part of the plan, not only to keep up with an accelerating development …

General thoracic surgery in the year 2010

Education and clinical practice in general thoracic surgery will be considerably different in the year 2010. The individual surgeon will most likely see a decline in patient volume and net income. Teaching hospitals with declining profit margins will place monetary constraints on patient programs that do not generate income, and capital budgets will be curtailed. To remain competitive. the general thoracic surgeon will have to keep pace with technologic advances and maintain a current knowledge in the field of thoracic oncology. General thoracic surgical training will profit by a core curriculum with a defined general thoracic surgical faculty dedicated to education in this field.