Oncology Perspective Research Articles

Otolaryngologist and pediatric oncologist perspectives on the role of fine needle aspiration in diagnosing pediatric head and neck masses

ObjectiveTo determine how otolaryngologists and pediatric oncologists differ in their initial approach to diagnosing head and neck masses in children and adolescents. MethodsWe designed an electronic 28-question survey consisting of 4 clinical cases and one referral case varying by patient age, history, and physical exam findings. The survey was sent anonymously to pediatric oncologists and otolaryngologists at institutions in the United States and Canada. ResultsTwo hundred and thirty one pediatric oncologists (29.4%) and 87 otolaryngologists (39.5%) completed the survey. Otolaryngologists were significantly more likely to recommend performing an FNA than oncologists in all four cases; less than 7% of pediatric oncologists recommended FNA for head and neck mass evaluation. Of providers who recommended FNA, otolaryngologists were more likely to do so because of diagnostic yield when compared to pediatric oncologists. However, when referred a patient with an FNA demonstrating non-Hodgkin lymphoma, the majority of pediatric oncologists (73.6%) and otolaryngologists (78.7%) would complete the staging work-up and begin treatment. If the same patient was referred with an FNA that demonstrated non-specific inflammation, most oncologists (91.0%) and otolaryngologists (94.4%) would biopsy the mass. ConclusionOtolaryngologists and pediatric oncologists differ in their initial approach to diagnosing head and neck masses in children, yet they both would recommend treating a patient with a positive FNA. This highlights important differences in the diagnostic process depending on which provider sees the patient first. Further studies assessing the sensitivity and specificity are needed to determine the true diagnostic yield of FNAs in the assessment of head and neck masses in children and adolescents, especially with increasing need for molecular and genomic profiling.

Utility of Molecular Imaging with 2-Deoxy-2-[Fluorine-18] Fluoro-DGlucose Positron Emission Tomography (18F-FDG PET) for Small Cell Lung Cancer (SCLC): A Radiation Oncology Perspective.

Although accounting for a relatively small proportion of all lung cancers, small cell lung cancer (SCLC) remains to be a global health concern with grim prognosis. Radiotherapy (RT) plays a central role in SCLC management either as a curative or palliative therapeutic strategy. There has been considerable progress in RT of SCLC, thanks to improved imaging techniques leading to accurate target localization for precise delivery of RT. Positron emission tomography (PET) is increasingly used in oncology practice as a non-invasive molecular imaging modality. Herein, we review the utility of molecular imaging with 2-deoxy-2-[fluorine-18] fluoro-Dglucose PET (18F-FDG PET) for SCLC from a radiation oncology perspective. There has been extensive research on the utility of PET for SCLC in terms of improved staging, restaging, treatment designation, patient selection for curative/palliative intent, target localization, response assessment, detection of residual/recurrent disease, and prediction of treatment outcomes. PET provides useful functional information as a non-invasive molecular imaging modality and may be exploited to improve the management of patients with SCLC. Incorporation of PET/CT in staging of patients with SCLC may aid in optimal treatment allocation for an improved therapeutic ratio. From a radiation oncology perspective, combination of functional and anatomical data provided by integrated PET/CT improves discrimination between atelectasis and tumor, and assists in the designation of RT portals with its high accuracy to detect intrathoracic tumor and nodal disease. Utility of molecular imaging for SCLC should be further investigated in prospective randomized trials to acquire a higher level of evidence for future potential applications of PET.

3313 “My research is their business, but I’m not their business”: Patient and Oncologist Perspectives on the Commercialization of Research Data

OBJECTIVES/SPECIFIC AIMS: Our objective was to assess and compare the attitudes of patients with head and neck cancer and their clinicians regarding the commercialization of genetic research data. We explored whether such opinions changed when profits from such transactions were used to fund 1) cancer research, 2) academic research generally, or 3) if patients were given personalized genetic information in return. METHODS/STUDY POPULATION: This qualitative analysis was nested within a prospective precision oncology genomic sequencing study in an NCI-designated cancer center. We conducted paired, semi-structured interviews with enrolled participants with head & neck cancer and with their doctors (medical oncologists, surgical oncologists, and radiation oncologists). Interviews were recorded, transcribed, and coded for analysis. Codes were developed through an iterative process until saturation was reached, and all transcripts were double-coded (and discrepancies reconciled) to ensure reliability. RESULTS/ANTICIPATED RESULTS: We identified three main themes from the patients and clinicians: (1) Both clinicians and their patients were unclear about how the study protocol and informed consent form authorized patients’ genetic data to be used and commercialized in the future. (2) Patients with cancer were generally more comfortable than their clinician thought they were regarding the ongoing research use of their genetic data and commercialization thereof. (3) There is a strong interest among patients and clinicians in focusing academic medical center profits from commercialization back into the research program from which the data was acquired, rather than being invested into academic research more broadly. DISCUSSION/SIGNIFICANCE OF IMPACT: Given patients’ strong feelings about the commercialization of their data, our results highlight the need for greater transparency—both with patients and with their clinicians—about potential future use of research data. Clinicians appear inclined to be particularly cautious regarding access to and commercialization of patients’ data, however patients generally hope that their data may be used to help future cancer patients. Explicit discussions with patients about specific future uses of profits derived from commercialization of research data can ensure both transparency and participation in future primary and secondary precision health research programs.

The effects of testosterone replacement therapy on the prostate: a clinical perspective.

Male hypogonadism is a clinical syndrome characterized by low testosterone and symptoms of androgen deficiency. Prostate cancer remains a significant health burden and cause of male mortality worldwide. The use of testosterone replacement therapy drugs is rising year-on-year for the treatment of androgen deficiency and has reached global proportions. As clinicians, we must be well versed and provide appropriate counseling for men prior to the commencement of testosterone replacement therapy. This review summarizes the current clinical and basic science evidence in relation to this commonly encountered clinical scenario. There is gathering evidence that suggests, from an oncological perspective, that it is safe to commence testosterone replacement therapy for men who have a combination of biochemically confirmed androgen deficiency and who have either had definitive treatment of their prostate cancer or no previous history of this disease. However, patients must be made aware and cautioned that there is a distinct lack of level 1 evidence. Calls for such studies have been made throughout the urological and andrological community to provide a definitive answer. For those with a diagnosis of prostate cancer that remains untreated, there is a sparsity of evidence and therefore clinicians are “pushing the limits” of safety when considering the commencement of testosterone replacement therapy.

Abstract P1-03-08: New diagnostic tools for bone health assessment: Perspectives in medical oncology

Abstract Background Pituitary down regulators, aromatase inhibitors tamoxifen and chemotherapeutic drugs, all have a negative impact on bone health in breast cancer patients. Although trabecular bone accounts for only 20% of skeleton mass, bone resistance depends also on the its micro-architecture, or quality, of, in addition to bone density. The BESTEST® is an innovative and inexpensive diagnostic method that gives an indication of the quality of the bone structure: it measures the weight-bearing capacity of the bone structure, evaluated from simulated application of loads on bone structure images acquired by radiograms in the proximal epiphysis of the hand. Results are expressed as BSI_T-score and BSI_Z-score (which refers the results to the average value for the same age) and provide precious add-on information to densitometry. We discuss the preliminary results obtained in female patients undergoing breast cancer treatment. Material and methods 100 Caucasian women, took BESTEST® as follow-up while undergoing oncological treatment. Femoral neck DXA T-score available in a subgroup of 60. 10 patients self-reported an osteoporotic fracture, DXA T-score available for 8. Control population: 200 women, accessing BESTEST® and DXA for screening purposes, 30 self-reporting an osteoporotic fracture. Results Statistics: mean (min, max). NAgeBSI_T-scoreBSI_Z-scoreDXA_T-scorePopulation10061 (33, 88)-1.7 (-3.4, -0.0)-1.3 (-2.6, 0.6)NADXA subgroup (of oncological population)6062 (35, 88)-1.8 (-3.4, -0.1)-1.3 (-2.6, 0.6)-1.6 (-3.2, 0.5)Fractured subgroup1067 (56, 82)-2.4 (-2.9, -1.3)-1.8 (-2.6 -0.1)NAFractured subgroup with DXA868 (60, 82)-2.4 (-2.9, -1.3)-1.8 (-2.6 -0.1)-1.5 (-2.9, 0.1)Control20063 (32, 89)-1.1 (-3.6, 2.9)-0.6 (-3.0, 2.9)-1.9 (-3.7, 1.0) The fractured subgroup exhibits significantly lower BSI T-score than the population (T-test p< 0.0100) and results are similar after BSI Z-score correction for age (T-test p = 0.0300). The BSI T-score of the DXA subgroup is representative of the oncological population undergoing treatment (T-test p=0.8668). As expected, BSI T-score and DXA T-score are not correlated: R2 = 0.0917 in the control and R2 = 0.0294 in the population. The DXA subgroup exhibit significantly lower BSI T-score than the control (T-test p = 0.0002) and similar results are obtained after BSI Z-score correction for age. A lower significance (T-test p = 0.0281) is found for DXA T-score. The 8 fractured oncological patients exhibit significantly lower values of BSI T-score that the oncological population (T-test p = 0.038) and all patients have a BSI T-score indicative of a compromised trabecular structure. DXA T-score values cannot be considered statistically different (T-test p = 0.6744) and results span all possible diagnostic results from high risk to normal. Conclusions Statistical analyses show that bone micro-architecture is indeed affected by oncological treatment and that bone alterations due to oncological treatment are easily detected with BESTEST, especially when associated with fractures. This preliminary study clearly provides a rational background for further, deeper investigations into the use of a new, rapid and safe technique for monitoring the effect of breast and prostate cancers therapies on bone micro-architecture modifications. Citation Format: Cosmi F, Del Conte A, Foltran L, Nicolosi A, Saracchini S. New diagnostic tools for bone health assessment: Perspectives in medical oncology [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-03-08.

Abstract P4-11-04: Palliative care and older women with advanced breast cancer in Mexico

Abstract Background: Mexico is an upper-middle income country, as other developing regions, there is an accelerated aging of the population that will double the absolute number of new breast cancer (BC) cases by 2035. Unfortunately, the incidence of stage III and IV in women older than 65 years old represented 45% of new cases (higher than high-income regions); also, 21% had diabetes, 41.1% hypertension and 71% overweight/obese. These factors make our older adults patients with BC a high-risk population of recurrence and dead from disease. Objective: Describe the characteristics of older women with BC that received palliative care in a multidisciplinary setting. Patients and Methods:A cross-sectional, retrospective, descriptive of 178 patients with advanced breast cancer, older than 65 years from our data based, that were referred to palliative service during 2010-2016 at National Cancer Institute, Mexico. Statistical analysis was done with STATA V12.0. We described clinical, pathological and sociodemographic characteristics of this older women with advanced BC and analyzed the risk factors that influence dead. Approval from IRB was obtained. Results:The median age was 75 years old (range 69-82), 71(41%) was widows, 51(29%) had none education, 93(52%) had elementary school. Highlights that 93 (52%) of the patients evaluated had any income source. Diabetes was present in 43(24%), hypertension in 81 (46%) and cardiopathy in 17(10%) of cases. ECOG-2 were 58 (33%) patients, ECOG-3 was in 47 (26%)patients and ECOG-4 was reported in 19 (11%). None patient had geriatric assessment. Affected metastasis sites were bone 90 (51%), lung 66 (37%), central nervous system 31 (17%), liver 27 (15%). 69 (62%) patients had hormonal receptor positive, 17 (15%) triple negative, 12 (11%) HER2positive and 13(12%) of the cases were triple positive, 41 (74%) patients had Ki-67 higher than 50%. Polypharmacy was identified in 77 (43%) of the patients. The median survival after the admission in the palliative service was 2 months (IQR 0-10). After a logistic regression univariate Ki-67>20% (OR 10.25), triple negative (OR 1.5), HER2 positive (OR 2.3), influence negative survival. Conclusions: Management of BC in the elderly is complex. Our data show that we have highly vulnerable population. Additionally, we found an unfortunate late reference to palliative care services that limited the impact of the multidisciplinary approach. We need to identify the barriers that influence this delay. Health care provides have a challenge in early reference of older women with advanced breast cancer patients to the palliative care and need to think in integrate to the multidisciplinary team a geriatrician with oncology perspective. Citation Format: Cabrera-Galeana P, Sánchez N, Verastegui E, Rodriguez C, Bargallo E, Monreal E, Allende S. Palliative care and older women with advanced breast cancer in Mexico [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-11-04.

Surface enhanced Raman spectroscopy as a diagnostic tool for circulating miRNA detection in HCC: the SERMI4cancer project

Introduction: Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide with more than 800,000 newly diagnosed cases every year. The late diagnosis, that limits the treatments options, makes this tumor the fifth cause of cancer-related death. The existing diagnostic procedures are expensive and lack of adequate sensitivity and the specificity. The growing interest in the use of circulating miRNAs as reliable biomarkers for cancer diagnosis opens new perspectives in clinical oncology.

Geriatric Hematology Research presented at the 2018 American Society of Hematology Annual Meeting: Young International Society of Geriatric Oncology Perspective Paper.

Geriatric Hematology Research presented at the 2018 American Society of Hematology Annual Meeting: Young International Society of Geriatric Oncology Perspective Paper.

Literature Review of Traditional Chinese Medicine Herbs-Induced Liver Injury From an Oncological Perspective With RUCAM.

Traditional Chinese medicine (TCM) herbs are commonly regarded to be safe with minimal toxicities in Chinese communities. Cancer patients who are receiving Western oncology therapy often concurrently take TCM herbs for anticancer and symptom relief purposes. We performed a literature review for current evidence on TCM herb–induced liver injury from an oncological perspective. A literature search on PubMed was performed to identify publications regarding TCM herbs and concoctions with hepatoprotective or hepatotoxic properties. Lists of commonly used herbs and their causality levels were compiled. In view of the wide range of evidence available, cases assessed by the well-established RUCAM (Roussel Uclaf Causality Assessment Method) algorithm were categorized as the highest level of evidence. More than one case of TCM herb–induced liver injury was confirmed by RUCAM in the following herbs and concoctions: Lu Cha (Camellia sinensis), Bai Xian Pi (Dictamnus dasycarpus), Tu San Qi (Gynura segetum), Jin Bu Huan (Lycopodium serratum), He Shou Wu (Polygoni multiflora), Ge Gen (Pueraria lobata), Dan Lu Tong Du tablet, Shou Wu Pian, Xiao Chai Hu Tang, Xiao Yin pill, and Yang Xue Sheng Fa capsule. Finally, TCM with anticancer or symptom relief uses were discussed in detail with regard to their hepatotoxic or hepatoprotective properties.

Pancreaticoduodenectomy in septuagenarian and octuagenarian: single Center experience with 78 Patients

Background: Pancreaticoduodenectomy (PD) for pancreatic cancer in patients >70 and >80 years, still matter of debate in terms of clinical, oncological and economical perspectives Aim to evaluate the impact of age (>70/ >80 years) in mortality and morbidity after PD Methods: Retrospective analysis of single centre experience.78 patient aged ≥70 years underwent PD from 2010 to 2016. The patients divided in 3 subgroups: G1 (70-74 years; n=37), G2 (75-79 years; n=30), G3 (≥80 years; n=11). Operative morbidity and mortality graded according Dindo-Clavien were analyzed (i.e. POPF, PPH, DGE, BL, LOS) Results: Mean age was 75,2 yrs (range 70-86). Malignancy was the main indication to surgery (G1: 82% G2: 97% G3: 91%). The 3 groups were comparable for gender, symptoms and procedure. ASA score of 3 was higher in G3 patients (G1: 45,9%, G2: 50%, G3: 63,9%). Overall postop morbidity and mortality rate was 67,7% and 1,2% respectively. G3 patients higher incidence of minor complications (i.e. DC grade II and IIIa, such as POPF grade A and B, DGE, BL grade A and minor PPH), (G1: 21.1%; G2: 16.6%; G3: 63.6%). No significant differences among the three groups regarding major complications (i.e. DC grade IIIb and IV POPF grade C, major PPH and severe pancreatitis) was observed (29% globally). Median LOS was 24.2 days in G1, 22.8 in G2 and 27.3 in G3. Conclusion: PD can be performed safely in selected elderly patients older than 80 in specialized centers. A higher risk for minor complications and longer LOS should be considered.

Harnessing immunotherapy for liver recipients with hepatocellular carcinoma: a review from a transplant oncology perspective.

Without stringent criteria, liver transplantation for hepatocellular carcinoma (HCC) can lead to high cancer recurrence and poor prognosis in the current treatment context. Checkpoint inhibitors can lead to long survival by targeting coinhibitory pathways and promoting T-cell activity; thus, they have great potential for cancer immunotherapy. Therapeutic modulation of cosignaling pathways may shift paradigms from surgical prevention of recurrence to oncological intervention. Herein, we review the available evidence from a therapeutic perspective and focus on immune microenvironment perturbation by immunosuppressants and checkpoint inhibitors. Partial and reversible interleukin-2 signaling blockade is the mainstream strategy of immunosuppression for graft protection. Programmed cell death protein 1 (PD-1) is abundantly expressed on human liver allograft-infiltrating T-cells, which proliferate considerably after programmed death-ligand 1 (PD-L1) blockade. Clinically, checkpoint inhibitors are used in heart, liver, and kidney recipients with various cancers. Rejection can occur after checkpoint inhibitor administration through acute T-cell-mediated, antibody-mediated, or chronic allograft rejection mechanisms. Nevertheless, liver recipients may demonstrate favorable responses to treatment for HCC recurrence without rejection. Pharmacodynamically, substantial degrees of receptor occupancy can be achieved with lower doses, with favorable clinical outcomes. Manipulation of the immune microenvironment is a therapeutic niche that balances seemingly conflicting anticancer and graft protection needs. Additional translational and clinical studies emphasizing the comparative effectiveness of signaling networks within the immune microenvironment and conducting overall assessment of the immune microenvironment may aid in creating a therapeutic window and benefiting future liver recipients with HCC recurrence.

Survivorship Care Planning in Gynecologic Oncology—Perspectives From Patients, Caregivers, and Health Care Providers

(Abstracted from J Cancer Surviv 2018; https://doi.org/10.1007/s11764-018-0713-9) Survivors of gynecological cancer experience a significant level of disease- and treatment-related symptoms after the end of first-line treatment that persist and greatly impact their long-term quality of life. Fear of cancer recurrence is a significant and overwhelming psychological concern among women who survive.

Primary medical therapy and breast conservation treatment: the medical oncology perspective.

Primary systemic therapy (PST) is a widely adopted strategy for increasing operability and breast conservation rates. Although first generation PST trials failed to demonstrate improvements in disease free and overall survival compared to adjuvant systemic therapy (AST), they did demonstrate a strong association between attainment of pathologic complete response (pCR) and improved survival outcomes, leading to the widespread adoption of pCR as the primary endpoint in subsequent PST trials. First generation trials also showed that preoperative PST can improve breast conservation rates and downstage the axilla. Although individual trials did not demonstrate statistically significant increase in local recurrence with PST when compared to AST, a recent meta-analysis did note an increased in such risk, mainly driven by trials in which surgery was omitted in patients with good response to PST. Successive generations of PST clinical trials have since explored the activity of taxanes, optimization of anthracycline and taxane dose and schedules, incorporation of single and dual anti-HER2 therapy in HER2 overexpressing breast cancer, the use of platinums in triple negative breast cancer, and the role of endocrine therapy in hormone receptor positive breast cancer. While these PST trials have generally found increased pCR rates with the introduction of modern chemotherapy regimens and targeted therapies, they have not consistently demonstrated further improvements in breast conservation rates compared to first generation regimens. The reasons for this are complex and may lie beyond differences in anti-tumour activity between different systemic regimens but rather in other potential confounding factors such as tumour to breast volume ratio, tumour location, multicentricity as well as patient or surgeon preference.

The History of Lymphatic Anatomy and the Contribution of Frederik Ruysch

Discovery of the lymphatic system is documented in numerous sources and can be attributed to a variety of persons. Like many other important developments in medicine, the recognition of the lymphatic system starts with Hippocrates (ca. 460–370 BC), who described a disease course consistent with metastasis to lymph nodes. Until the 17th century, knowledge about the anatomy and pathophysiology of the lymphatic system was limited, probably because of the difficulty of visualizing lymph vessels in animals and humans. Frederik Ruysch (1638-1731), a “praelector anatomiae” of the Amsterdam Guild of Surgeons, must be considered one of the pioneers in lymphatic research. His contribution relied on meticulous anatomical dissection of lymph vessels, and with his innovative preservation techniques, he was the first to visualize lymphatic valves. This major step provided a better understanding of lymphatic anatomy and the circulation of lymph. The German pathologist Rudolf Virchow (1821–1902) suggested that lymph nodes function as filters in the lymphatic system and could therefore contain cancer. He was the first to propose that lymph fluid from any given area of the body drains through lymphatics to a specific lymph node and subsequently to other lymph nodes. Consequently, clinicians began to recommend that local therapy of cancer should be supplemented with regional lymph node treatment to improve the cure rate. Subsequently, lymph node surgery became an essential element of surgical oncology. Lymphatic mapping and sentinel lymph node biopsy were developed several decades ago by Donald Morton (1934–2014) to stage melanoma accurately and to avoid unnecessary lymph node dissection. In a way, history is now repeating itself, as today there is renewed interest in imaging lymph vessels and lymph nodes from an oncological perspective, more than 300 years since Ruysch committed himself to visualizing the lymphatic system. From this perspective, it is important to acknowledge early contributions of Ruysch in providing the foundations to our knowledge of lymphatic anatomy.

Assessment of a Dedicated Preclinical Oncology Module from the Perspective of Future Radiation Oncologists

Preclinical medical education is widely acknowledged to lack adequate exposure to the field of radiation oncology. Our institution implemented a radiation oncologist-led, dedicated oncology module into the preclinical medical education curriculum in 2009. The module included introductory lectures on radiation oncology and the opportunity for an observership within the radiation oncology department. This survey assessed the attitudes of students applying into radiation oncology from our institution’s Radiation Oncology Mentorship Initiative (ROMI) toward the preclinical oncology exposure provided by the module. A Qualtrics internet-based survey was sent to all 19 current and former students who matched into or are applying for radiation oncology from our medical school between 2011 and 2018. Responses varied between those on a Likert scale (1-5) and those written as free responses. Data were analyzed using Qualtrics software. The survey response yield was 100%. 57.9% (11 of 19) of students were satisfied or very satisfied with the preclinical oncology module (Likert average=3.79, “neutral” to “satisfied”). 36.8% (7 of 19) of students reported the school did a “good” to “excellent” job in introducing radiation oncology in the preclinical curriculum (Likert average=2.21, “fair” to “good”). 68.4% (13 of 19) students reported that the oncology module had an impact on their decision to apply for radiation oncology. 31.6% (6 of 19) of these students reported the module had “quite a bit” to “an extreme amount” of influence on their decision (Likert average=2.15, “some” to “quite a bit”). Free text responses asking what could be done to improve radiation oncology education at the medical school yielded answers desiring increased exposure in the preclinical years from 15.8% (3 of 19) students. Future radiation oncologists reported that a radiation oncologist-led, dedicated oncology module was a useful addition to the preclinical curriculum at one institution. Students who applied to radiation oncology were overall satisfied with the module and a majority reported that it influenced their career choice; with almost one-third reporting, it had a strong impact on their decision. This finding is important, as it shows the considerable effect a preclinical curriculum can have on attracting students to radiation oncology, a field often underrepresented in medical education. Increased radiation oncology didactic sessions are warranted in this module to provide a more thorough introduction to the field. With the success of this module, nationwide implementation of preclinical oncology curricula with early exposure to radiation oncology should be explored.

Treatment of early-stage laryngeal cancer: A comparison of treatment options

Over the course of the last several decades, the treatment options for early laryngeal cancers (T1 and T2) have evolved; however, simultaneously the mortality rate has increased. As larynx preservation approaches have become the standard of care, the selection of the proper treatment modality has become paramount. Radiation therapy or transoral laser microsurgery are the most common options for treatment of these early lesions. Oncologic and functional outcomes are considered equivalent between the two modalities for early glottic cancers; however, no direct comparisons exist for robust analysis. In terms of larynx preservation, there also is not compelling data favoring one treatment option or another. For early stage lesions, the goal for any larynx-sparing technique, either radiation or surgery, should be the intent to cure with single modality treatment and minimal short- and long-term toxicity. This article is designed to create a frame of reference for managing early stage disease with respect to lesions of the glottis and supraglottis while weighing treatment implications from an oncologic, functional, and cost perspective.

Oncologist perspectives on chemotherapy-induced nausea and vomiting (CINV) management and outcomes: A quantitative market research-based survey.

BackgroundChemotherapy‐induced nausea and vomiting (CINV) is a distressing side effect that can negatively impact patients' quality of life and could discourage completion of chemotherapy, thereby affecting overall treatment outcomes. Although adherence to antiemetic guidelines can reduce CINV incidence in patients receiving highly or moderately emetogenic chemotherapy, CINV control remains inadequate.AimsThe objectives of this survey were to determine oncologists' practice patterns in CINV management, identify factors that contribute to antiemetic treatment failure, and determine the outcomes of uncontrolled CINV on health care resource utilisation and on patients' attitude towards chemotherapy.Methods and resultsQuantitative market research was performed using an online questionnaire. Responses from 300 European oncologists who prescribe antiemetics and see ≥50 patients/month were analysed. Results showed that the main reasons reported by oncologists for antiemetic treatment failure were underestimating the emetogenic potential of chemotherapy, utilising weaker antiemetic regimens than required, and patient non‐adherence because of administration mistakes or missed/delayed doses. Educational initiatives for the oncology multidisciplinary team may help improve guideline‐consistent prescribing. Also, the availability of simpler, more convenient antiemetic therapies may improve guideline adherence and patient compliance during home administration.ConclusionAchieving effective CINV control is a crucial goal to improve patients' quality of life, which should optimise chemotherapy outcomes, and would ultimately reduce health care costs.

MTE07.01 From Radiation Oncology Perspective

MTE07.01 From Radiation Oncology Perspective

Comparative oncology: The paradigmatic example of canine and human mast cell neoplasms.

In humans, advanced mast cell (MC) neoplasms are rare malignancies with a poor prognosis. Only a few preclinical models are available, and current treatment options are limited. In dogs, MC neoplasms are the most frequent malignant skin tumours. Unlike low‐grade MC neoplasms, high‐grade MC disorders usually have a poor prognosis with short survival. In both species, neoplastic MCs display activating KIT mutations, which are considered to contribute to disease evolution. Therefore, tyrosine kinase inhibitors against KIT have been developed. Unfortunately, clinical responses are unpredictable and often transient, which remains a clinical challenge in both species. Therefore, current efforts focus on the development of new improved treatment strategies. The field of comparative oncology may assist in these efforts and accelerate human and canine research regarding diagnosis, prognostication, and novel therapies. In this article, we review the current status of comparative oncology approaches and perspectives in the field of MC neoplasms.

Video-assisted thoracoscopic surgery lobectomy for non-small cell lung cancer.

Since 1990s, video-assisted thoracoscopic surgery (VATS) lobectomy has become a standard procedure for early-stage non-small cell lung cancer. However, VATS lobectomies are less common, and no randomized controlled trial of VATS versus conventional open lobectomy for early-stage lung cancer has been performed in Japan. Furthermore, VATS lobectomy procedures are not standardized in Japan, and may vary by institution or by practitioner, which complicates their evaluation. Although VATS procedures (such as pneumonectomy, bronchoplasty, and chest wall resection) have been reportedly performed for patients with advanced disease, whether VATS could be a standard modality for advanced lung cancer is unclear from an oncological perspective. Until recently, VATS lobectomies commonly used three or four ports to conduct systemic lymph node dissection; however, VATS lobectomies with reduced port have been recently reported. This article reviews current trends in VATS lobectomy procedures.