Thoracic Oncology Unit Research Articles

Comparison of seven comorbidity scores on four-month survival of lung cancer patients

BackgroundThe comorbidity burden has a negative impact on lung-cancer survival. Several comorbidity scores have been described and are currently used. The current challenge is to select the comorbidity score that best reflects their impact on survival. Here, we compared seven usable comorbidity scores (Charlson Comorbidity Index, Age adjusted Charlson Comorbidity Index, Charlson Comorbidity Index adapted to lung cancer, National Cancer Institute combined index, National Cancer Institute combined index adapted to lung cancer, Elixhauser score, and Elixhauser adapted to lung cancer) with coded administrative data according to the tenth revision of the International Statistical Classification of Diseases and Related Health Problems to select the best prognostic index for predicting four-month survival.Materials and methodsThis cohort included every patient with a diagnosis of lung cancer hospitalized for the first time in the thoracic oncology unit of our institution between 2011 and 2015. The seven scores were calculated and used in a Cox regression method to model their association with four-month survival. Then, parameters to compare the relative goodness-of-fit among different models (Akaike Information Criteria, Bayesian Information Criteria), and discrimination parameters (the C-statistic and Harrell’s c-statistic) were calculated. A sensitivity analysis of these parameters was finally performed using a bootstrap method based on 1,000 samples.ResultsIn total, 633 patients were included. Male sex, histological type, metastatic status, CCI, CCI-lung, Elixhauser score, and Elixhauser-lung were associated with poorer four-month survival. The Elixhauser score had the lowest AIC and BIC and the highest c-statistic and Harrell’s c-statistic. These results were confirmed in the sensitivity analysis, in which these discrimination parameters for the Elixhauser score were significantly different from the other scores.ConclusionsBased on this cohort, the Elixhauser score is the best prognostic comorbidity score for predicting four-month survival for hospitalized lung cancer patients.

Analysis of Postoperative Complications of Minimally Invasive Surgery for Carcinoma of Oesophagus: A Single Centre Retrospective Cohort Study

Introduction: Traditional transthoracic oesophagectomy is associated with high perioperative morbidity. Minimally Invasive Oesophagectomy (MIE) techniques have been shown to have a decreased incidence of respiratory complications and an improvement in perioperative outcomes, such as length of hospital stay and wound infection rates. Aim: To evaluate the incidence of postoperative respiratory complications, 30-day mortality, and length of hospital stay among patients with carcinoma of the oesophagus undergoing, VideoAssisted Thoracoscopic Surgery (VATS) oesophagectomy. Materials and Methods: A cross-sectional study was conducted in the Department of Anaesthesiology in a new thoracic oncology unit at a Tertiary Cancer care centre, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India. A total of 67 patients with resectable oesophageal cancer who underwent VATS oesophagectomy from September 2019 to December 2021 were included. Patients who had surgery by open thoracotomy and inoperable cases were excluded. The patients’ clinicodemographic profile, intraand postoperative variables, and complications were studied. Descriptive statistics were used for analysis. A p-value ≤0.05 was considered statistically significant at a 5% level of significance. Results: Out of 67 patients, 45 (67.2%) were male, and 22 (32.8%) were female. The age ranged from 33 to 78 years with a median age of 55 years (IQR 47-61). The median body weight was 45 kg (IQR 42-53). Nineteen (28.4%) patients developed postoperative complications, including respiratory distress in 7 (10.4%) and anastomotic leakage in 5 (7.5%) patients. Other complications included symptomatic Coronavirus Disease 2019 (COVID-19) infection, pneumonia, mediastinitis, Multiorgan Dysfunction Syndrome (MODS) with sepsis, seizure and cardiac arrest, and surgical re-exploration. The 30-day mortality was 2.98%. The median length of hospital stay was 19 days (Interquantile Range (IQR) 16-22), which was higher in those with complications (p<0.001). One-lung ventilation was associated with a higher risk of postoperative respiratory complications (p=0.077). Conclusion: VATS oesophagectomy, even in a new thoracic oncology unit, was associated with lower perioperative complications, a shorter hospital length of stay, and decreased mortality compared to historical controls.

Outbreak of carbapenem-resistant enterobacteria in a thoracic-oncology unit through clonal and plasmid-mediated transmission of the bla OXA-48 gene in Southern France.

Carbapenemase-producing Enterobacteriaceae (CPE) represent an increasing threat to public health, especially in hospitals. To investigate an outbreak of CPE in a thoracic-oncology unit by using whole genome sequencing (WGS) and to describe the control measures taken to limit the epidemic, including fecal microbiota transplantation (FMT). A retrospective study between December 2016 and October 2017 was performed to investigate an outbreak of CPE in a thoracic-oncology unit at the North Hospital in Marseille, France. The isolates were identified, and antimicrobial susceptibility tests were performed. All CPE were sequenced using MiSeq and/or MinIon technologies. Nucleotide variations between plasmids and similarity within the same species were investigated. The origin of this outbreak, its spread, and the decolonization of patients in the ward were also studied. Four Citrobacter freundii, one Enterobacter cloacae and four E. hormaechei OXA-48 carbapenemase producers were isolated in eight patients hospitalized the same year in a thoracic-oncology ward. The bla OXA-48 gene was present in a Tn1999.2 transposon located in IncL/M plasmids, with single nucleotide variants (SNV) ranging from 0 to 5. All C. freundii strains belonged to the same ST22 and had more than 99.6% similarity between them. Two strains of E. hormaechei ST1007 were almost identical at 99.98%, while the others belonged to a different ST (ST98, ST114, ST133). No single source was identified. FMT resulted in decolonization in 4/6 patients. WGS demonstrated the dissemination of the bla OXA-48 gene by both clonal (C. freundii ST22 and E. hormaechei ST1007) and plasmid spread (pOXA-48 IncL/M). The origin of this outbreak appeared to be both external and internal to the ward. This evidence of cross-infection supports the urgent need for the implementation of infection control measures to prevent CPE dissemination.

Prognostic factors for survival in extensive-stage small cell lung cancer: An Italian real-world retrospective analysis of 244 patients treated over the last decade.

Potential relationships with the prognosis of patients with extensive-stage non-small cell lung cancer (ES-SCLC) have been investigated without valid results. A retrospective analysis of real-world data of consecutive patients with ES-SCLC admitted to our Medical Thoracic Oncology Unit was carried out from 2010 to 2020, focusing on identification of prognostic factors. Kaplan-Meier analysis was used to represent progression-free survival (PFS) and overall survival (OS). Univariable and multivariable Cox models were used to investigate prognostic factors. The analysis included 244 patients. The median OS was 8months (95% confidence interval [CI]: 8-10) and the median PFS was 5months (95% CI: 5-6). The univariable analysis showed that factors associated with shorter OS were older age (p=0.047), TNM stage 4 versus 3 (p < 0.001), Eastern Cooperative Oncology Group (ECOG) performance status (PS) 1 and 2 versus 0 (p < 0.001), and >2 metastatic sites (p=0.004). Mediastinal radiotherapy (RT) (p < 0.001), >1 irradiated site (p=0.026), 3 and 4 chemotherapy (CT) lines versus 1 (p=0.044 and 0.001, respectively), prophylactic cranial irradiation (PCI) (p < 0.001), and surgery (p=0.001) correlated with longer OS. The multivariable analysis revealed statistically significant associations for TNM, ECOG PS 2 versus 0, number of CT lines, PCI, and surgery. A total of 23 patients (9.4%) survived ≥24 months, 39% of whom had received four CT lines and 48% had mediastinal RT. Our data suggest that tumor burden, PS, and mediastinal RT strongly correlate with outcome. With the addition of immunotherapy to CT, the identification of new biomarkers as predictive factors is urgently required.

Retrospective analysis: checkpoint inhibitor accessibility for thoracic and head and neck cancers and factors influencing it in a tertiary centre in India.

Access to cancer care is an issue in low and low middle-income countries. The problem is worse with respect to access to new therapies like checkpoint inhibitors. Hence, we decided to audit our practice in the head and neck and thoracic medical oncology unit from 2015 to 2019 to study the accessibility of checkpoint inhibitors and factors influencing it. All patients who were registered in the head and neck and thoracic medical oncology unit between 2015 and 2019 were included in the study. Patients who received immunotherapy were identified from the prospective database of immunotherapy maintained by the department. We made a list of patients who were eligible for immunotherapy per year and identified how many of them received recommended immunotherapy. The indication for eligibility of immunotherapy was based on published pivotal data and it was applicable from the date of publication of the study online. Descriptive statistics were performed. For nominal and ordinal variable percentage with 95% confidence intervals (95% CI) was provided. Factors impacting the accessibility of immunotherapy were identified. A total of 15,674 patients were identified who required immunotherapy; out of them only 444 (2.83%, 95% CI: 2.58-3.1) received it. Among head and neck cancer patients, 4.5% (156 out of 3,435) received immunotherapy versus 2.35% (288 out of 12,239) among thoracic cancer patients (p < 0.001). Among the general category (low socioeconomic), 0.29% (28 out of 9,405 ) versus 6.6% (416 out of 6,269) among the private category (high socioeconomic) received immunotherapy (p < 0.001). While 3.7% (361 out of 9,737) among males versus 1.39% (83 out of 5,937) females received immunotherapy (p < 0.001). There was also a temporal trend seen in the accessibility of immunotherapy (p < 0.001). The accessibility of immunotherapy is below 3% in India. Patients with head and neck cancers, those registered as private category and male patients had higher access to this therapy. There was also a temporal trend observed suggesting increased accessibility over the years.

Checkpoint inhibitor accessibility in 15,000+ Indian patients.

9012 Background: Access to newer therapies is an issue in low and low middle income countries. Hence we decided to audit our practice in the head and neck and thoracic medical oncology unit from 2015 to 2019 to study the accessibility of checkpoint inhibitors and factors influencing them. Methods: All patients who were registered in the head and neck and thoracic medical oncology unit between 2015-2019 were included in the study. The number of patients who received immunotherapy among them was identified from the prospective database of immunotherapy maintained in the department. We made a list of patients who were eligible for immunotherapy per year and identified how many of them received recommended immunotherapy. The indication for eligibility of immunotherapy was based on published pivotal data and its date of publication of the study online. For nominal and ordinal variable percentage with 95% CI was provided. Factors impacting the accessibility of immunotherapy were identified. Results: A total of 15,674 patients were identified who required immunotherapy; out of them only 444 (2.83%, 95% CI, 2.58-3.1) received it. The distribution of patients eligible as per cancer disease management group and time period is shown in the Table. Among head and neck cancer patients 4.5% (156 out of 3,435) received immunotherapy versus 2.35% (288 out of 12,239) among thoracic cancer patients (p &lt; 0.0001). Among the general category (low socioeconomic), 0.29% (28 out of 9,405) versus 6.6% (416 out of 6,269) among the private category (high socioeconomic) received immunotherapy (p &lt; 0.0001). While 3.7% (361 out of 9,737) among males versus 1.39% (83 out of 5,937) females received immunotherapy (p &lt; 0.0001). There was also a temporal trend seen in the accessibility of immunotherapy (p &lt; 0.0001, Table). Conclusions: The accessibility of immunotherapy is below 3% in India. Patients with head and neck cancers, those with private category and with male gender had higher access to this therapy. There was also a temporal trend observed suggesting increased accessibility over the years. [Table: see text]

PD1.03 A Primer on Genetic Counseling on the Thoracic Oncology Unit. Family History of Lung Cancer in Two Independent Populations Tested for BRCA1 &amp; amp;2 and EGFR.

PD1.03 A Primer on Genetic Counseling on the Thoracic Oncology Unit. Family History of Lung Cancer in Two Independent Populations Tested for BRCA1 &amp; amp;2 and EGFR.

EP1.11-22 Incorporating Genetic Counseling into the Thoracic Oncology Unit: A Pilot Project in the Real World

EP1.11-22 Incorporating Genetic Counseling into the Thoracic Oncology Unit: A Pilot Project in the Real World

P40 Analysis of Family Clustering in Lung Cancer (LC): Genetic Cancer Risk Assessment (GRCA) into the Thoracic Oncology Unit

Inherited susceptibility for lung cancer (LC) has been described, a recent paper showed that 2.5% of LC patients (pts) carried a pathogenic germline variation in genes such ATM, TP53, BRCA2, EGFR, and PARK2. Some of those genes cause well recognized syndromes. Thus, GRCA for LC could help to identify a genetic predisposition syndrome, guide genetic testing, offering specific treatments and genetic counseling. This is a retrospective and descriptive study. We performed a review of 66 medical records of LC pts diagnosed between 2011 and 2016. We collected age at diagnosis, smoking, previous cancer diagnosis, and family history (FH) for cancer: number of affected family members and sort of cancer. Genetic evaluation and testing was not available at time of first evaluation, but we tried to identify genetic syndromes according to the clustering pattern and NCCN criteria. Mean age was 62.5 years (range 26-88y); 30 pts (45.5%) had FH with 46 affected relatives: 21 pts had at least one first degree affected member, only 2 pts had more than 3 affected members. Among the tumors, Breast cancer (BrCa) was found in 12 family members; one pt had a previous BrCa diagnosis at 33y; LC was found in 1 relative; 4 cases of colon cancer were described; 1 case was found for prostate and melanoma respectively. Other tumors were described, but they are not frequently associated to other genetic syndromes. We found no statistical differences on smoking between pts with or without FH. Pts with FH tended to be younger (p=0.026). Based on the family assessment, 8 (10.6%) cases met NCCN criteria for genetic counseling and testing for BRCA and Homologous Recombination (HR) pathway genes. Unfortunately, age of diagnosis for family members was available in 8 out 46 cases, data available were taken from the first clinical assessment which limits this analysis. Even if the expected number of pts with inherited susceptibility to LC is low, a proper GRCA could improve the diagnosis of genetic syndromes. This could bring advantages, such as offering PARP inhibitors for Pts carrying mutations in HR pathway genes, cascade screening and set up prevention measures adapted for each gene risks. Finally, more extended genetic analysis could be offered based on clinical features of index cases. At our knowledge, GRCA clinics for LC is not frequent in Mexico, these results underline the importance of setting up this clinic at our center.

P36 Diagnostic Accuracy and Complication Rate of CT-Guided Core Biopsies of Lung Lesions in a Thoracic Oncology Unit in Mexico

P36 Diagnostic Accuracy and Complication Rate of CT-Guided Core Biopsies of Lung Lesions in a Thoracic Oncology Unit in Mexico

Abstract 5439: Study of polymorphisms in stra6 in Mexican population with non-small cell lung cancer

Abstract STRA6 mutations have been associated with severe pathologic phenotypes in multiple human organs, including the eye, brain, heart and lung. In this study, we analyzed the presence of two polymorphisms in patients with diagnosis of lung cancer in advanced stage. Patients consecutive, nonselected, pathologically confirmed with advanced NSCLC, who visited the Thoracic Oncology Unit at the Instituto Nacional de Cancerología from January 2014 to December 2015, were enrolled. Genomic DNA was obtained from peripheral blood. RT-PCR was used to genotype the different allelic variant. The SNPs, NC_000015.10:g.74194695T&amp;gt;A (rs351224) and NC_000015.10:g.74194103C&amp;gt;T (rs974456) were genotyped with commercially available TaqMan-validated SNP assays (C_3152256_10 and C_3152257_20, respectively). An allelic discrimination plot was used to identify individual genotypes. Subsequently, each allelic variant was confirmed by direct sequencing in 5% of the samples. All statistical analyses were carried out using the SPSS software package, v. 15 (SPSS Inc, Chicago, IL). This study included 145 patients, of whom 55.2% (80/145) were female. The mean age at diagnosis was 60.8 + 12.9 years. Around half of the patients had a tobacco history (52%) and 47% wood smoke exposure; most patients had a good performance status (≤ 1) (68%). Adenocarcinoma was the most common histologic subtype (83%). Approximately 15% of patients were known to have diabetes and at least 25% had a fasting glycemia upper of 126 mg/dL. Seventy-seven percent of patients received chemotherapy (QT) and 35.8% received treatment with TKIs, with a global response rate of 13% and 46%, respectively. We analyzed the frequency of the STRA6 SNPs in our population; we found a frequency of SNP1 (rs351224) of 0.503, 0.393 and 0.103, for wild-type homozygous patients (AA), heterozygous (AT), and variant homozygous (TT), respectively, whereas the frequency found for SNP2 (rs974456) was 0.352 for wild-type homozygous patients (CC), 0.531 for heterozygous (CT) and 0.117 for variant homozygous (TT). We analyzed the relationship between clinical characteristics and the polymorphism presence. According to our data, the absence of SNP2 was associated with response rate at QT (33% vs. 0%, p= 0.022), and patients with this polymorphism had glycemia below to 120 mg/dL (27.1% vs. 6.3%, p=0.068). No other clinicopathologic characteristics were found associated with the presence of any SNP. The overall survival of our patients was 15.5 months (10.6-20.3 months). We found a bordering difference in relation to SNP2 presence (presence vs. absence) (23.1 vs. 12.9 months, p=091). Other factors associated with a better OS were female gender (18 vs. 11 m, p=0.025), age &amp;lt;60 y (18 vs. 12 m, p=0.05), no tobacco history (23 vs. 10 m, p =0.021), and ECOG &amp;lt;2 (23 vs. 6 m, p &amp;lt; 0.001). We can suggest that the presence of SNP2 could be related to a better response to QT and better OS in our population. Citation Format: Sae Muniz-Hernandez, Laura-Alejandra Ramírez-Tirado, Oscar Arrieta. Study of polymorphisms in stra6 in Mexican population with non-small cell lung cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5439.

Interview: developing therapies for lung cancer.

Silvia Novello speaks to Roshaine Wijayatunga, Managing Commissioning Editor: Silvia Novello is a Full Professor of Medical Oncology in the Oncology Department at San Luigi Hospital in Orbassano, Italy, part of the University of Turin. She earned her medical degree and completed the postgraduate training in respiratory medicine and medical oncology at the University of Turin and partially at the Institut Gustave Roussy in France. Currently, she is head of the Thoracic Oncology Unit at the San Luigi Hospital, Orbassano (Turin), where she also tutors medical students and postgraduate students in respiratory medicine and medical oncology. Novello's research interests include thoracic malignancies, primary prevention, gender differences in lung cancer, basic and clinical applied research on lung cancer, including pharmacogenomics. She is involved in many European and national controlled clinical trials evaluating new approaches in diagnosis and lung cancer therapy. From July 2012 until 2016, Novello has been a Member of the Board of Directors of the International Association for the Study of Lung Cancer and since October 2016 Member of the Board of Directors of the Italian Association of Medical Oncology and member of other several scientific societies including the American Society of Clinical Oncology and the European Society of Medical Oncology. Currently, she is the President of Women Against Lung Cancer in Europe, a nonprofit European Association founded in 2006 in Turin, Italy, part of the scientific Committee of Lung cancer Europe and also a member of the Scientific Committee of Bonnie J Addario Lung Cancer Foundation and Member of the Scientific Committee of Investigación sobre Cáncer de Pulmón en Mujeres. She is the author or co-author of over 100 publications in peer-reviewed journals.

Management of solitary fibrous tumor of the pleura: a rare differential of solid lung masses

Solitary fibrous tumors of pleura are uncommon. Sometimes they pose challenge to differentiate from lung cancer. Here, we are briefly discussing about the literature review and management principles in relation to our experience. A total of three patients were presented in thoracic oncology unit of Rajiv Gandhi Cancer Institute in the last year. Correct diagnosis is the key as surgical resection is often curative and surgical resection is often possible despite huge sizes. Our aim is to highlight this uncommon entity and to gain some insight into its management.

P2.02-006 Targeted Next Generation Sequencing Reveals Prognostic Recurrent Somatic Mutations in the GNAQ Oncogene in NSCLC

GNAQ is a stimulatory αq subunit of heterotrimeric G-proteins that is highly mutated in human melanoma and currently has no targeted treatment. GNAQ protein is similar to the RAS protein, in which activating mutations occurring within the catalytic (GTPase) domain confer constitutive signaling activity of the RAS pathway. However, GNAQ mutations have not been documented in Non-Small Cell Lung Cancer (NSCLC). Therefore, the aim of this study was to examine genomic alterations in GNAQ and correlate its mutation status with clinical characteristics of NSCLC patients. A cohort of 53 patients treated at the Thoracic Oncology Unit of the Instituto Nacional de Cancerologia (INCan) of Mexico were screened in a mutation analysis of the GNAQ oncogene by targeted next generation sequencing (NGS). All information from the patients was recorded in a database containing clinicopathological characteristics. Patients characteristics included a median age of 66 years (36-82 years), with 77% of females, 39% of smokers, 51% with wood smoke exposure and the predominant histology was adenocarcinoma (86%) with intermediate grade (acinar-papillary) in 65% of cases. In this study, recurrent somatic mutations in GNAQ were found in 37/53 patients (70%) with a mutant allele (QNAQmut) frequency over 1%. GNAQ mutations were more frequently found in adenocarcinoma and stage IV (p=0.054 and p=0.098 respectively). The GNAQmut allele was associated with metastasis to the Central Nervous System (CNS) and bones (p < 0.001). This mutation was associated with a decrease in overall survival (69 vs. 12 months, p = 0.047). Additionally, two of these GNAQ-mutated patients having co-occurring oncogenic mutations in GNAS and GNA11 exhibited faster disease progression and a poorer overall survival of only two months. There was no association between GNAQ and frequently mutated genes like EGFR, KRAS or MET. This is the first report of the presence of recurrent somatic mutations in GNAQ, GNA11 and GNAS oncogenes in NSCLC based on targeted NGS. We found a correlation between these genomic alterations and the patients response measured as disease progression and overall survival.

Weekly paclitaxel as metronomic palliative chemotherapy in small cell lung cancer.

Background:Topotecan is the standard second line agent used in relapsed small cell lung cancer (SCLC). However, the erratic availability and the cost of the drug has been a prohibitive factor for its use in second-line setting in India. Paclitaxel has shown antitumor activity in heavily pretreated patients with SCLC. Hence, this audit was performed to study the efficacy of weekly paclitaxel as a form of metronomic therapy in the second-line setting in SCLC.Materials and Methods:Fifty-seven patients of relapsed SCLC who presented to the thoracic medical oncology unit of Tata Memorial Centre, Mumbai between January 2011 and December 2015 were selected for this analysis. Weekly paclitaxel at a dose of 80 mg/m2 was administered until progression or development of intolerable side effects or patient refusal. Data regarding baseline demographics, previous treatment history, response rate, progression-free survival, overall survival (OS), and toxicity to weekly paclitaxel was extracted from a prospectively maintained database in the thoracic medical oncology unit and was analyzed using SPSS version 16 (IBM, New York, USA). Kaplan–Meier survival analysis was performed.Results:Median age of the cohort was 58 years (40–77 years). Etoposide with carboplatin was the regimen used in 40 patients (70.2%) whereas the remaining 17 patients received etoposide with cisplatin (29.8%). Eastern Cooperative Oncology Group performance status at relapse was 1 in 3 (5.3%), 2 in 49 (86.0%), and 3 in 5 (8.7%) patients. The response rate and clinical benefit rate were 9.1% (5 patients) and 52.7% (29 patients), respectively. Grade 3–4 toxicities were seen in 10.5% (6 patients). The median PFS was 145 days (95% confidence interval [CI]: 116.6–173.5 days) whereas the median OS was 168 days (95% CI: 112.5–223.5 days).Conclusion:Weekly paclitaxel as a second line agent in relapsed small cell cancer of the lung is a feasible and well-tolerated agent.

Preferences for disclosure of disease related information among thoracic cancer patients.

Cancer patients in developed countries increasingly express a preference for more detailed information and involvement in decisions about their care. However, data is sparse and conflicting on preferences of ethnic minorities and immigrants. We aimed to identify preferences for illness related information and correlates with clinical characteristics among patients with thoracic cancers. Two hundred and fifty two consecutive cancer patients seen at the Thoracic Oncology Unit, Sheba Medical Center, Israel, participated in the study. Prior to their first oncologist visit, patients completed a questionnaire eliciting their preferences for disclosure of illness related information - full, partial or none - as well as additional demographic information. Eighty four percent of subjects requested full disclosure of disease related information including bad news. Patient age, gender, marital status, birth country, immigration status and smoking status were not associated with disclosure preferences. Patients who refused complete-disclosure were more likely to have metastatic disease with a 2.72 odds ratio (95% confidence interval 1.29-5.74). Most Israeli thoracic cancer patients request full disclosure of illness related information. This preference seems more significantly correlated to disease stage than demographic characteristics.

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.

Solitary cystic mediastinal lymphangioma

To the Editor: Solitary cystic mediastinal lymphangioma (CML) is a very uncommon benign vascular tumour developed from lymphatic vessels. Cystic lymphangioma is a cyst caused by a congenital malformation of the lymphatic vessels and can affect any site in the body, but <1% of lymphangiomas are mediastinal [1] and pulmonary lesions are even less common. They are most often located in the anterior mediastinum. We report a case of anterior CML in a 16-yr-old male, with a short review of the literature. A 16-yr-old male was admitted to the Thoracic Oncology unit (Hopital Nord, Marseilles, France) for recurrent left pleural effusion. The patient reported a 6-month history of chest pain and dyspnoea with hyperthermia. An initial diagnosis of left empyema was suspected. It was managed by iterative thoracentesis with saline pleural lavages, antibiotics and physiotherapy. On admission, physical examination was unremarkable except for left-sided dullness on percussion. The patient was afebrile. Chest radiography revealed a large basal opacity of the left lung silhouetting out the heart and diaphragm. Initially, this opacity was thought to represent a recurrent pleural effusion (fig. 1a). Computed tomography scans revealed a cystic lesion in the left basithoracic and anterolateral pleura with smooth borders measuring 63×90 mm (fig. 1b). No other intra- or extrapulmonary cystic lesions were found. With a presumptive diagnosis of a pleuropericardial cyst, video-assisted thoracic surgery was performed. Cytology and bacteriology were performed. The cyst contained serous fluid and had no connection or adhesion to adjacent organs, and was vascularised by …

Retrospective Study of Multidisciplinary Rounding on a Thoracic Surgical Oncology Unit

Multidisciplinary rounding (MDR) reduces medical errors and improves the quality of care for hospitalized patients. The purpose of this study was to evaluate hospital length of stay, patient satisfaction, admission to a skilled care facility, and the use of home health care or hospice in patients who received MDR compared to those who did not. This retrospective study included the records of 3,077 thoracic surgical patients with cancer who were admitted to a midwestern National Cancer Institute-designated comprehensive cancer center from January 1, 2006, through July 1, 2011. Overall mean length of stay was 5.3 days in the MDR group compared to 6.5 days in the no MDR group. The MDR group also had significantly shorter mean length of stay compared to the no MDR group among patients who were discharged home from the hospital, admitted to hospice following a hospital discharge, discharged to a skilled care facility, or admitted to home healthcare services. No significant differences in satisfaction scores were reported in patients who received MDR compared to those who did not. MDR is an important aspect of inpatient oncology care, and staff should be identified to participate who have expertise relevant to patients' needs.

Survival data and toxicity profile in advanced non-small cell lung cancer (NSCLC) patients (PTS) treated within or outside controlled clinical trials.

e18103 Background: Even without well defined data, a common perception is that clinical trials inclusion improve outcomes in pts with cancer. We conducted a retrospective analysis, in a single institution, evaluating survival data and tolerability in advanced NSCLC pts treated with standard therapy or within phase II/III clinical trials. Methods: We analysed 300 consecutive pts treated at the Thoracic Oncology Unit at San Luigi Gonzaga Hospital from 2004, January the 1st to 2011, December 31st having these characteristics: histo/cytological diagnosis of NCSLC, stage IV who received at least 3 chemotherapy cycles, minimum follow-up of 6 months. In this pts population 180 (60%) were enrolled in controlled clinical trials (T), while 120 (40%) were treated with standard therapy (S). Results: The most important differences between the two groups were about median age at the time of starting first line treatment (61.2 in group T vs 64 years in group S), pts older than 70 years (19% vs 27%, respectively) and ECOG/PS distribution (PS=2: 0 vs 9 pts, PS=1: 33 vs 53 pts, PS=0: 145 vs 60 pts in T and S group, respectively). Evaluating T and S population: 106 (59%) vs 43 (36%) pts were eligible for second line treatment and 45 (25%) vs 19 (16%) pts for third line treatment. Median OS was 16,3 in T population vs 14,4 months in S population and PFS was 7.1 vs 6.3 months respectively. Any relevant differences was seen between group T and S in terms of toxicity. Conclusions: This single institution retrospective analysis documented a trend of better outcome for pts enrolled in clinical trials compared to those treated with standard therapy (even without a statistical significance) with an higher percentage of pts reaching second and third line therapies. A larger multicenter prospective dedicated trial is needed to have further, more cleaned, data about this item.