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Duranti L, Tavecchio L. Major vascular reconstructions in thoracic oncological surgery. Updates Surg 2024:10.1007/s13304-024-01763-0. [PMID: 38421567 DOI: 10.1007/s13304-024-01763-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/16/2024] [Indexed: 03/02/2024]
Abstract
The replacement of the superior vena cava and thoracic outlet vessels for thoracic malignancies often becomes necessary for radical oncological surgery. The pulmonary artery can be directly infiltrated by the tumor or affected by metastatic hilar lymph nodes. In some cases, it must be resected and reconstructed to achieve oncological radicality and/or avoid pneumonectomy. This study reflects a single-surgeon, retrospective experience spanning 6 years (2017-2023). We reviewed data from patients undergoing early anticoagulant therapy after superior vena cava or thoracic outlet vessels bypass and from patients undergoing early antiaggregation therapy following pulmonary artery reconstruction or resection. This series comprises 41 patients treated by a single surgeon. Fourteen patients underwent superior vena cava and thoracic outlet vessel procedures. Among these, eight patients received superior vena cava replacement (six for thymic malignancies and two for lung cancer), and six patients underwent jugular and subclavian artery/vein resection or replacement (all six had sarcomas). There was one death due to respiratory failure, not associated with bleeding or bypass closure. Additionally, there was one graft closure in a patient with severe coagulopathy and three instances of hemothorax (two patients had undiagnosed complex coagulopathies not evident in pre-operative routine blood tests). Following bleeding incidents, anticoagulation was initiated the next day in one case and based on hematological indications in the two coagulopathic patients. In the pulmonary artery series, 27 patients were involved: 20 underwent direct suture after tangential resection, and 7 received pericardial patch reconstruction. Only one case experienced bleeding necessitating redo-surgery. All these patients received early and chronic antiaggregation therapy after pulmonary artery reconstruction. We conclude that major thoracic oncological vascular surgery is safe and feasible with appropriate technical skills. However, achieving optimal results requires integration with correct early anticoagulant therapy or antiaggregation to maintain the patency of bypasses/grafts and prevent life-threatening risks associated with closure of the "new vessels."
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Affiliation(s)
- Leonardo Duranti
- Thoracic Surgery Unit, IRCCS Istituto Nazionale dei Tumori Foundation, Via Venezian 1, 20133, Milan, Italy.
| | - Luca Tavecchio
- Thoracic Surgery Unit, IRCCS Istituto Nazionale dei Tumori Foundation, Via Venezian 1, 20133, Milan, Italy
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Pilon Y, Rokah M, Seitlinger J, Sepesi B, Rayes RF, Cools-Lartigue J, Najmeh S, Sirois C, Mulder D, Ferri L, Abdulkarim B, Ezer N, Fraser R, Camilleri-Broët S, Fiset PO, Wong A, Sud S, Langleben A, Agulnik J, Pepe C, Shieh B, Hirsh V, Ofiara L, Owen S, Spicer JD. Transitioning to Neoadjuvant Therapy for Resectable Non-Small Cell Lung Cancer: Trends and Surgical Outcomes in a Regionalized Pulmonary Oncology Network. Clin Lung Cancer 2023:S1525-7304(23)00264-4. [PMID: 38378398 DOI: 10.1016/j.cllc.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/24/2023] [Accepted: 12/13/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND Several regulatory agencies have approved the use of the neoadjuvant chemo-immunotherapy for resectable stage II and III of non-small cell lung cancer (NSCLC) and numerous trials investigating novel agents are underway. However, significant concerns exist around the feasibility and safety of offering curative surgery to patients treated within such pathways. The goal in this study was to evaluate the impact of a transition towards a large-scale neoadjuvant therapy program for NSCLC. METHODS Medical charts of patients with clinical stage II and III NSCLC who underwent resection from January 2015 to December 2020 were reviewed. The primary outcome was perioperative complication rate between neoadjuvant-treated versus upfront surgery patients. Multivariable logistic regression estimated occurrence of postoperative complications and overall survival was assessed as an exploratory secondary outcome by Kaplan-Meier and Cox-regression analyses. RESULTS Of the 428 patients included, 106 (24.8%) received neoadjuvant therapy and 322 (75.2%) upfront surgery. Frequency of minor and major postoperative complications was similar between groups (P = .22). Occurrence in postoperative complication was similar in both cohort (aOR = 1.31, 95% CI 0.73-2.34). Neoadjuvant therapy administration increased from 10% to 45% with a rise in targeted and immuno-therapies over time, accompanied by a reduced rate of preoperative radiation therapy use. 1-, 2-, and 5-year overall survival was higher in neoadjuvant therapy compared to upfront surgery patients (Log-Rank P = .017). CONCLUSIONS No significant differences in perioperative outcomes and survival were observed in resectable NSCLC patients treated by neoadjuvant therapy versus upfront surgery. Transition to neoadjuvant therapy among resectable NSCLC patients is safe and feasible from a surgical perspective.
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Affiliation(s)
- Yohann Pilon
- Division of Thoracic Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Merav Rokah
- Division of Thoracic Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Joseph Seitlinger
- Division of Thoracic Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | | | - Roni F Rayes
- Division of Thoracic Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada; Goodman Cancer Institute, McGill University, Montreal, QC, Canada
| | - Jonathan Cools-Lartigue
- Division of Thoracic Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Sara Najmeh
- Division of Thoracic Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Christian Sirois
- Division of Thoracic Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - David Mulder
- Division of Thoracic Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Lorenzo Ferri
- Division of Thoracic Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | | | - Nicole Ezer
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, QC, Canada
| | - Richard Fraser
- Department of Pathology, McGill University, Montreal, QC, Canada
| | | | | | - Annick Wong
- Department of Oncology, McGill University, Montreal, QC, Canada; Hôpital du Suroît, Salaberry-de-Valleyfield, QC, Canada
| | - Shelly Sud
- Department of Oncology, Gatineau Hospital, Gatineau, QC, Canada
| | | | - Jason Agulnik
- Department of Oncology, McGill University, Montreal, QC, Canada; Division of Pulmonary Diseases, Jewish General Hospital, Montreal, Canada
| | - Carmela Pepe
- Department of Oncology, McGill University, Montreal, QC, Canada; Division of Pulmonary Diseases, Jewish General Hospital, Montreal, Canada
| | - Benjamin Shieh
- Department of Oncology, McGill University, Montreal, QC, Canada
| | - Vera Hirsh
- Department of Oncology, McGill University, Montreal, QC, Canada
| | - Linda Ofiara
- Department of Oncology, McGill University, Montreal, QC, Canada
| | - Scott Owen
- Department of Oncology, McGill University, Montreal, QC, Canada
| | - Jonathan D Spicer
- Division of Thoracic Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada; Goodman Cancer Institute, McGill University, Montreal, QC, Canada.
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3
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Phan AT, Ghantarchyan H, Khosravi C, Maknouni B, Bhagat A, Chen J, Ibrahim A, Hasan M. Sclerosing epithelioid fibrosarcoma associated with WRN gene variant presenting as chronic dyspnea and pathologic cervical fracture: a case report and review of the literature. J Med Case Rep 2023; 17:517. [PMID: 38104125 PMCID: PMC10725598 DOI: 10.1186/s13256-023-04249-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 11/07/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Sclerosing epithelioid fibrosarcoma is an aggressive sarcoma subtype with poor prognosis and limited response to conventional chemotherapy regimens. Diagnosis can be difficult owing to its variable presentation, and cases of sclerosing epithelioid fibrosarcoma are rare. Sclerosing epithelioid fibrosarcoma typically affects middle-aged individuals, with studies inconsistently citing gender predominance. Sclerosing epithelioid fibrosarcoma typically arises from the bones and soft tissues and often has local recurrence after resection and late metastases. Immunohistochemical staining typically is positive for mucin-4. Werner syndrome is due to an autosomal recessive mutation in the WRN gene and predisposes patients to malignancy. CASE PRESENTATION A 37-year-old Caucasian female presented to the emergency department with 4 months of dyspnea and back pain. She had been treated for pneumonia but had persistent symptoms. A chest, abdomen, and pelvis computed tomography showed near-complete right upper lobe collapse and consolidation, mediastinal lymphadenopathy, lytic spinal lesions, and a single 15-mm hypodense liver nodule. The patient underwent a transthoracic right upper lobe biopsy, bronchoscopy, endobronchial ultrasound with transbronchial lymph node sampling, and bronchoalveolar lavage of the right upper lobe. The bronchoalveolar lavage cytology was positive for malignant cells compatible with poorly differentiated non-small cell carcinoma; however, the cell block materials were insufficient to run immunostains for further investigation of the bronchoalveolar lavage results. Consequently, the patient also underwent a liver biopsy of the liver nodule, which later confirmed a diagnosis of sclerosing epithelioid fibrosarcoma. Next-generation sequencing revealed a variant of unknown significance in the WRN gene. She was subsequently started on doxorubicin. CONCLUSION Sclerosing epithelioid fibrosarcoma is a very rare entity, only cited approximately 100 times in literature to date. Physicians should be aware of this disease entity and consider it in their differential diagnosis. Though pulmonary involvement has been described in the context of sclerosing epithelioid fibrosarcoma, this malignancy may affect many organ systems, warranting extensive investigation. Through our diagnostic workup, we suggest a possible link between sclerosing epithelioid fibrosarcoma and the WRN gene. Further study is needed to advance our understanding of sclerosing epithelioid fibrosarcoma and its clinical associations as it is an exceedingly rare diagnosis.
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Affiliation(s)
- Alexander T Phan
- Department of Internal Medicine, Arrowhead Regional Medical Center, 400 N. Pepper Avenue, Colton, CA, 92324, USA.
- California University of Science and Medicine, Colton, CA, 92324, USA.
| | - Henrik Ghantarchyan
- Department of Internal Medicine, Arrowhead Regional Medical Center, 400 N. Pepper Avenue, Colton, CA, 92324, USA
- California University of Science and Medicine, Colton, CA, 92324, USA
| | - Chayanne Khosravi
- Department of Pulmonary and Critical Care Medicine, Arrowhead Regional Medical Center, Colton, CA, 92324, USA
- California University of Science and Medicine, Colton, CA, 92324, USA
| | - Bahareh Maknouni
- Department of Pulmonary and Critical Care Medicine, Arrowhead Regional Medical Center, Colton, CA, 92324, USA
- California University of Science and Medicine, Colton, CA, 92324, USA
| | - Ankur Bhagat
- Department of Internal Medicine, Arrowhead Regional Medical Center, 400 N. Pepper Avenue, Colton, CA, 92324, USA
- California University of Science and Medicine, Colton, CA, 92324, USA
| | - Jeff Chen
- California University of Science and Medicine, Colton, CA, 92324, USA
| | - Ahmad Ibrahim
- Department of Pathology, Arrowhead Regional Medical Center, Colton, CA, 92324, USA
| | - Mufadda Hasan
- Department of Pulmonary and Critical Care Medicine, Arrowhead Regional Medical Center, Colton, CA, 92324, USA
- California University of Science and Medicine, Colton, CA, 92324, USA
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4
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Shao H, Faris NR, Ward KD, Chen W, McHugh L, Smeltzer M, Ray MA, Osarogiagbon RU. Lung Cancer Patients' and Caregivers' Satisfaction With Multidisciplinary Versus Serial Care in a Community Healthcare Setting: A Prospective Comparative-Effectiveness Cohort Study. Clin Lung Cancer 2023; 24:e267-e274. [PMID: 37451932 DOI: 10.1016/j.cllc.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/25/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Multidisciplinary Care is recommended for complex oncologic conditions. We compared lung cancer patients' and caregivers' satisfaction with Multidisciplinary Care to routine, serial care. MATERIALS AND METHODS We analyzed validated surveys administered at baseline, 3 and 6 months to patients and their caregivers enrolled in a prospective cohort comparative-effectiveness study of Multidisciplinary versus Serial Care (clinicaltrials.gov NCT02123797). Multivariate mixed linear models examined the cross-group differences, time-related variances, and how interaction between groups and time-periods influenced satisfaction. RESULTS Compared to serial care (N = 297), the Multidisciplinary Care cohort (N = 159), was older (69 vs. 66 years), had earlier clinical stage (41% vs. 33% stage I/II), and less severe symptoms (45% vs. 35% asymptomatic). Demographic and social-economic characteristics of caregivers (N = 99 for Multidisciplinary and 123 for Serial Care, respectively) were similar. Multidisciplinary Care patients and caregivers were more likely to perceive their care to be better than that of other patients (p < .01). Although Serial Care patients and caregivers expressed greater satisfaction with their treatment plan (p < .01 patients, p = 0.04 caregivers), Multidisciplinary Care patients showed greater improvement at 6-months (p < .01). Multidisciplinary Care patients and caregivers reported better overall satisfaction with team members (p < .01) while Serial Care patients had greater improvement in their satisfaction with team members at 6-months (p = .04). Multidisciplinary Care patients perceived more financial burden at 6-months compared to Serial Care patients (p = .04). CONCLUSION Patient-caregiver dyads had mixed perceptions of their care experience. Recipients of Multidisciplinary Care perceived better experience with care and team members; Serial Care recipients expressed greater satisfaction with their treatment plan.
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Affiliation(s)
- Huibo Shao
- Thoracic Oncology Research Group, Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA
| | - Nicholas R Faris
- Thoracic Oncology Research Group, Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA
| | - Kenneth D Ward
- School of Public Health, University of Memphis, Memphis, TN, USA
| | - Weiyu Chen
- School of Public Health, University of Memphis, Memphis, TN, USA
| | - Laura McHugh
- Thoracic Oncology Research Group, Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA
| | - Matthew Smeltzer
- School of Public Health, University of Memphis, Memphis, TN, USA
| | - Meredith A Ray
- School of Public Health, University of Memphis, Memphis, TN, USA
| | - Raymond U Osarogiagbon
- Thoracic Oncology Research Group, Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA.
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Deeb AL, Garrity M, Cooper L, Frain LN, Jaklitsch MT, DuMontier C. Implementing 4-meter gait speed as a routine vital sign in a thoracic surgery clinic. J Geriatr Oncol 2023; 14:101481. [PMID: 37060720 PMCID: PMC10445274 DOI: 10.1016/j.jgo.2023.101481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 02/06/2023] [Accepted: 03/13/2023] [Indexed: 04/17/2023]
Affiliation(s)
- Ashley L Deeb
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, 15 Francis St, Boston, MA, USA.
| | - Matthew Garrity
- University of New England College of Osteopathic Medicine, 11 Hills Beach Rd, Biddeford, ME, USA
| | - Lisa Cooper
- Division of Aging, Brigham and Women's Hospital, 75 Francis St, Boston, MA, USA; Department of Geriatric Medicine, Rabin Medical Center, Campus Beilinson, 39 Jabotinski St, Petah Tikva, Israel
| | - Laura N Frain
- Division of Aging, Brigham and Women's Hospital, 75 Francis St, Boston, MA, USA
| | - Michael T Jaklitsch
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, 15 Francis St, Boston, MA, USA
| | - Clark DuMontier
- Division of Aging, Brigham and Women's Hospital, 75 Francis St, Boston, MA, USA; New England GRECC (Geriatrics Research, Education and Clinical Center), VA Boston Healthcare System, 150 S Huntington Ave, Boston, MA, USA
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6
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Coelho DB, Santos AR, Rodrigues ME, Fernandes AC, Paquete J, Araújo D. A potentially life-threatening complication of lung metastasis thermal-ablation. Pulmonology 2023; 29:92-93. [PMID: 35864054 DOI: 10.1016/j.pulmoe.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 01/28/2023] Open
Affiliation(s)
- D B Coelho
- Pulmonology Department, Centro Hospitalar Universitario de Sao Joao, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal.
| | - A R Santos
- Pulmonology Department, Centro Hospitalar Universitario de Sao Joao, Porto, Portugal
| | - M E Rodrigues
- Endocrinology Department, Centro Hospitalar Universitario de Sao Joao, Porto, Portugal
| | - A C Fernandes
- Oncology Department, Centro Hospitalar Universitario de Sao Joao, Porto, Portugal
| | - J Paquete
- Radiology Department, Centro Hospitalar Universitario de Sao Joao, Porto, Portugal
| | - D Araújo
- Pulmonology Department, Centro Hospitalar Universitario de Sao Joao, Porto, Portugal
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7
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Thomas QD, Basse C, Belaroussi Y, Beaucaire-Danel S, Daniel C, Quantin X, Girard N. Brief Report on Teleconsultation in Lung Cancer: Toward a Semiotic Paradigm Shift? JTO Clin Res Rep 2022; 3:100333. [PMID: 35677683 PMCID: PMC9168151 DOI: 10.1016/j.jtocrr.2022.100333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/15/2022] [Accepted: 05/01/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Telehealth is taking an increasingly important part of medicine. This practice change is being accelerated by the pandemic linked to coronavirus disease 2019. Oncology is a medical specialty for which this paradigm shift is particularly relevant. Methods We developed a survey aiming at evaluating the use of teleconsultation by physicians managing patients with lung cancer in France. The survey was available online from December 15, 2020, to February 10, 2021. Results Answers were obtained from 142 clinicians (73.9% pneumologists, 18.3% medical oncologists, and 7.7% with another specialty), 129 (90.8%) of whom had already performed teleconsultation. Among those, 123 (95.3%) started after the coronavirus disease 2019 pandemic. In addition, 72.9% had a moderate usage of this tool (<10 teleconsultations/mo). The frequency of clinicians never using teleconsultation was higher in private practices (p = 0.029). The two clinical situations for which teleconsultation was frequently used were visits during treatment without imaging assessment (53.5%) and post-treatment surveillance (80.3%). Depending on the type of treatment received, the frequency of teleconsultation was variable. Lung cancer subtype also affected the clinician's practice. Indeed, 47.2% never proposed this tool for SCLC. Teleconsultation was considered to be of no contribution, a moderate contribution, a significant contribution, or a revolution of the clinical practice for 14.1%, 66.2%, 10.6%, and 2.1% of the respondents, respectively. The participants expected to decrease, stabilize, or increase their teleconsultation activity in 18.3%, 52.8%, and 23.2% of the cases, respectively. Conclusions Most thoracic oncologists in France are using teleconsultation, mostly as an additional tool that should not replace the doctor-patient in-person relationship.
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Affiliation(s)
- Quentin Dominique Thomas
- Department of Medical Oncology, Montpellier Cancer Institute, Montpellier (ICM), France
- Oncogenic Pathways in Lung Cancer, Montpellier Cancer Research Institute (IRCM), University of Montpellier (UM), Montpellier, France
| | - Clémence Basse
- Thorax Institute, Institut Curie, Paris, France
- Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Paris Saclay Campus, Versailles, France
| | - Yaniss Belaroussi
- Bordeaux Population Health Centre Recherche U1219, Equipe Cancer et Environnement EPICeNE, Université de Bordeaux, Bordeaux, France
- Department of Thoracic Surgery Haut-Leveque Hospital Bordeaux University, University of Bordeaux, Bordeaux, France
| | | | | | - Xavier Quantin
- Department of Medical Oncology, Montpellier Cancer Institute, Montpellier (ICM), France
- Oncogenic Pathways in Lung Cancer, Montpellier Cancer Research Institute (IRCM), University of Montpellier (UM), Montpellier, France
| | - Nicolas Girard
- Thorax Institute, Institut Curie, Paris, France
- Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Paris Saclay Campus, Versailles, France
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8
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Mercier O. VATS vs. Open Thoracotomy for lung cancer resection: is the game still running? Eur J Cardiothorac Surg 2022; 62:6584011. [PMID: 35543476 DOI: 10.1093/ejcts/ezac303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 05/07/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Olaf Mercier
- Department of Thoracic Surgery and Heart-Lung Transplantation, International Center of Thoracic Cancers, Marie Lannelongue Hospital, Université Paris-Saclay, GHPSJ, Le Plessis Robinson, France
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9
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Ostberg NP, Elefteriades JA. Artificial intelligence in thoracic oncology: moving from proof of concept to clinical practice. Eur J Cardiothorac Surg 2022; 62:6498865. [PMID: 34999779 DOI: 10.1093/ejcts/ezab536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 11/24/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nicolai P Ostberg
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA.,New York University Grossman School of Medicine, New York, NY, USA
| | - John A Elefteriades
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
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10
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Williams BM, Herb J, Dawson L, Long J, Haithcock B, Mody GN. The Prevalence of Benign Pathology Following Major Pulmonary Resection for Suspected Malignancy. J Surg Res 2021; 268:498-506. [PMID: 34438191 DOI: 10.1016/j.jss.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/11/2021] [Accepted: 07/12/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND In the era of lung cancer screening with low-dose computed tomography, there is concern that high false-positive rates may lead to an increase in nontherapeutic lung resection. The aim of this study is to determine the current rate of major pulmonary resection for ultimately benign pathology. MATERIALS AND METHODS A single-institution, retrospective analysis of all patients > 18 y who underwent major pulmonary resection between 2013 and 2018 for suspected malignancy and had benign final pathology was performed. RESULTS Of 394 major pulmonary resections performed for known or presumed malignancy, 10 (2.5%) were benign. Of these 10, the mean age was 61.1 y (SD 14.6). Most were current or former smokers (60%). Ninety percent underwent a fluorodeoxyglucose positron emission tomography scan. Median nodule size was 27 mm (IQR 21-35) and most were in the right middle lobe (50%). Preoperative biopsy was performed in four (40%) but were nondiagnostic. Video-assisted thoracoscopic lobectomy (70%) was the most common surgical approach. Final pathology revealed three (30%) infectious, three (30%) inflammatory, two (20%) fibrotic, and two (20%) benign neoplastic nodules. Two (20%) patients had perioperative complications, both of which were prolonged air leaks, one (10%) patient was readmitted within 30 d, and there was no mortality. CONCLUSIONS A small percentage of patients (2.5% in our series) may undergo major pulmonary resection for unexpectedly benign pathology. Knowledge of this rate is useful to inform shared decision-making models between surgeons and patients and evaluation of thoracic surgery program performance.
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Affiliation(s)
- Brittney M Williams
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina.
| | - Joshua Herb
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Lauren Dawson
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Jason Long
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Benjamin Haithcock
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Gita N Mody
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
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11
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Mynard N, Saxena A, Mavracick A, Port J, Lee B, Harrison S, Chow O, Villena-Vargas J, Scheff R, Giaccone G, Altorki N. Lung Cancer Stage Shift as a Result of COVID-19 Lockdowns in New York City, a Brief Report. Clin Lung Cancer 2021; 23:e238-e242. [PMID: 34580031 PMCID: PMC8403338 DOI: 10.1016/j.cllc.2021.08.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/19/2021] [Indexed: 02/07/2023]
Abstract
Introduction The COVID-19 pandemic reached New York City in early March 2020 resulting in an 11-week lockdown period to mitigate further spread. It has been well documented that cancer care was drastically affected as a result. Given New York City's early involvement, we attempted to identify any stage shift that may have occurred in the diagnoses of non-small cell lung cancer (NSCLC) at our institution as a result of these lockdowns. Patients and Methods We conducted a retrospective review of a prospective database of lung cancer patients at our institution from July 1, 2019 until March 31, 2021. Patients were grouped by calendar year quarter in which they received care. Basic demographics and clinical staging were compared across quarters. Results Five hundred and fifty four patients were identified that underwent treatment during the time period of interest. During the lockdown period, there was a 50% reduction in the mean number of patients seen (15 ± 3 vs. 28 ± 7, P = .004). In the quarter following easing of restrictions, there was a significant trend towards earlier stage (cStage I/II) disease. In comparison to quarters preceding the pandemic lockdown, there was a significant increase in the proportion of patients with Stage IV disease in the quarters following phased reopening (P = .026). Conclusion After a transient but significant increase in Stage I/II disease with easing of restrictions there was a significant increase in patients with Stage IV disease. Extended longitudinal studies must be conducted to determine whether COVID-19 lockdowns will lead to further increases in the proportion of patients with advanced NSCLC.
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Affiliation(s)
- Nathan Mynard
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Ashish Saxena
- Department of Medicine, Division of Hematology & Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Alexandra Mavracick
- Department of Medicine, Division of Hematology & Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Jeffrey Port
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Benjamin Lee
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Sebron Harrison
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Oliver Chow
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | | | - Ronald Scheff
- Department of Medicine, Division of Hematology & Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Giuseppe Giaccone
- Department of Medicine, Division of Hematology & Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Nasser Altorki
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY.
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12
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Mercier O, Barlesi F. Precision follow-up for resected non-small-cell lung cancer: is it ready for prime time? Eur J Cardiothorac Surg 2021; 60:1232-1233. [PMID: 34347068 DOI: 10.1093/ejcts/ezab357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Olaf Mercier
- Department of Thoracic Surgery and Heart-Lung Transplantation, International Center of Thoracic Cancers, Marie Lannelongue Hospital, Université Paris-Saclay, GHPSJ, Le Plessis-Robinson, France
| | - Fabrice Barlesi
- Gustave Roussy Cancer Campus, International Center of Thoracic Cancers, Université Paris-Saclay, Villejuif, France.,Aix Marseille University, CNRS, INSERM, CRCM, Marseille, France
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13
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Piper-Vallillo AJ, Mooradian MJ, Meador CB, Yeap BY, Peterson J, Sakhi M, Do A, Zubiri L, Stevens S, Vaughn J, Goodwin K, Gavralidis A, Willers H, Miller A, Farago A, Piotrowska Z, Lin JJ, Dagogo-Jack I, Lennes IT, Sequist LV, Temel JS, Heist RS, Digumarthy S, Reynolds KL, Gainor JF. Coronavirus Disease 2019 Infection in a Patient Population with Lung Cancer: Incidence, Presentation, and Alternative Diagnostic Considerations. JTO Clin Res Rep 2020; 2:100124. [PMID: 33205053 PMCID: PMC7659804 DOI: 10.1016/j.jtocrr.2020.100124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/28/2020] [Accepted: 11/01/2020] [Indexed: 12/19/2022] Open
Abstract
Introduction Lung cancer is associated with severe coronavirus disease 2019 (COVID-19) infections. Symptom overlap between COVID-19 and lung cancer may complicate diagnostic evaluation. We aimed to investigate the incidence, symptoms, differential diagnosis, and outcomes of COVID-19 in patients with lung cancer. Methods To determine an at-risk population for COVID-19, we retrospectively identified patients with lung cancer receiving longitudinal care within a single institution in the 12 months (April 1, 2019 to March 31, 2020) immediately preceding the COVID-19 pandemic, including an “active therapy population” treated within the last 60 days of this period. Among patients subsequently referred for COVID-19 testing, we compared symptoms, laboratory values, radiographic findings, and outcomes of positive versus negative patients. Results Between April 1, 2019 and March 31, 2020, a total of 696 patients received longitudinal care, including 406 (58%) in the active therapy population. Among 55 patients referred for COVID-19 testing, 24 (44%) were positive for COVID-19, representing a cumulative incidence of 3.4% (longitudinal population) and 1.5% (active therapy population). Compared with patients who were COVID-19 negative, those who were COVID-19 positive were more likely to have a supplemental oxygen requirement (11% versus 54%, p = 0.005) and to have typical COVID-19 pneumonia imaging findings (5 versus 56%, p = 0.001). Otherwise, there were no marked differences in presenting symptoms. Among patients who were COVID-19 negative, alternative etiologies included treatment-related toxicity (26%), atypical pneumonia (22%), and disease progression (22%). A total of 16 patients positive for COVID-19 (67%) required hospitalization, and seven (29%) died from COVID-related complications. Conclusions COVID-19 was infrequent in this lung cancer population, but these patients experienced high rates of morbidity and mortality. Oncologists should maintain a low threshold for COVID-19 testing in patients with lung cancer presenting with acute symptoms.
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Affiliation(s)
- Andrew J Piper-Vallillo
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts.,Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Meghan J Mooradian
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Catherine B Meador
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Beow Y Yeap
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Jennifer Peterson
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Mustafa Sakhi
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Andrew Do
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Leyre Zubiri
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Sara Stevens
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Jeanne Vaughn
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Kelly Goodwin
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Alexander Gavralidis
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Henning Willers
- Department of Radiation Oncology, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Adam Miller
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Anna Farago
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Zofia Piotrowska
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Jessica J Lin
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Ibiayi Dagogo-Jack
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Inga T Lennes
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Lecia V Sequist
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Jennifer S Temel
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Rebecca S Heist
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Subba Digumarthy
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Kerry L Reynolds
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Justin F Gainor
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
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Kajikawa S, Ohashi W, Kato Y, Fukami M, Yonezawa T, Sato M, Kosaka K, Kato T, Tanaka H, Ito S, Yamaguchi E, Kubo A. Prognostic impact of serum procalcitonin in non-small cell lung cancer. Tumori 2020; 107:385-391. [PMID: 33079003 DOI: 10.1177/0300891620966647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Increased serum procalcitonin (PCT), a well-known biomarker for sepsis, has been reported in several cancer types. We aimed to investigate the prognostic impact of PCT in non-small cell lung cancer (NSCLC). METHODS Medical records of 51 consecutive patients with NSCLC (Aichi Medical University Hospital) admitted between July 2017 and July 2018 were retrospectively reviewed. The patients were divided into PCT-low (PCT < 0.1 ng/mL) and PCT-high (PCT ⩾ 0.1 ng/mL) groups, and their clinical characteristics and survival were compared. RESULTS In contrast to the PCT-low group (n = 24), the PCT-high group (n = 27) showed significantly worse Performance Status (PS) and overall survival (OS) (PS 0-2/3-4, 16/8 versus 12/15, p = 0.034; median OS, not reached versus 127 days, p < 0.001), irrespective of the presence of infection (p = 0.785). Multivariate analysis showed that the disease stage (IV versus I-III) and high PCT level (⩾0.1 versus <0.1 ng/mL) were significantly worse prognostic factors with hazard ratios of 3.706 (p = 0.023) and 3.951 (p = 0.010), respectively. CONCLUSION The results suggest that serum PCT in NSCLC was elevated regardless of the presence of infection. Higher PCT levels are associated with poor PS and shorter OS in NSCLC.
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Affiliation(s)
- Shigehisa Kajikawa
- Department of Respiratory Medicine and Allergology, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Wataru Ohashi
- Division of Biostatistics, Clinical Research Center, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Yasutaka Kato
- Department of Respiratory Medicine and Allergology, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Masaya Fukami
- Department of Respiratory Medicine and Allergology, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Toshiyuki Yonezawa
- Department of Respiratory Medicine and Allergology, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Mika Sato
- Department of Respiratory Medicine and Allergology, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Kenshi Kosaka
- Department of Respiratory Medicine and Allergology, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Toshio Kato
- Department of Respiratory Medicine and Allergology, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Hiroyuki Tanaka
- Department of Respiratory Medicine and Allergology, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Satoru Ito
- Department of Respiratory Medicine and Allergology, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Etsuro Yamaguchi
- Department of Respiratory Medicine and Allergology, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Akihito Kubo
- Department of Respiratory Medicine and Allergology, Aichi Medical University Hospital, Nagakute, Aichi, Japan
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15
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Radakrishnan A, Coughlin JM, Odell DD, Johnson JK. "Are We Gonna Talk About It or Not?" Thoracic Oncology Provider Perspectives on Smoking Cessation. J Surg Res 2020; 258:422-429. [PMID: 33059909 DOI: 10.1016/j.jss.2020.08.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/19/2020] [Accepted: 08/25/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Tobacco use is the greatest preventable cause of death and disease in the United States. Despite recommendations from the Centers for Disease Control and Prevention, United States Preventive Task Force, and major professional societies that all health-care providers provide smoking-cessation counseling, smoking-cessation interventions are not consistently delivered in clinical practice. We sought to identify important barriers and facilitators to the utilization of smoking-cessation interventions in a thoracic oncology program. MATERIALS AND METHODS We conducted 14 semistructured interviews with providers including thoracic surgeons (n = 3), interventional pulmonologists (n = 1), medical oncologists (n = 3), radiation oncologists (n = 2), and nurses (n = 5). Interviewees were asked about prior and current smoking-cessation efforts, their perspectives on barriers to successful smoking cessation, and opportunities for improvement. Responses were analyzed inductively to identify common themes. RESULTS All interviewees report discussing smoking cessation with their patients and realize the importance of a smoking-cessation counseling; however, smoking-cessation interventions are inconsistent and often lacking. Providers emphasized five domains that impact their delivery of smoking-cessation interventions: patient willingness and motivation to quit, clinical engagement and follow-up, documentation of smoking history, provider education in smoking cessation, and the availability of additional smoking-cessation resources. CONCLUSIONS Providers recognize the need for more efficient and consistent smoking-cessation interventions. Therefore, the development of interventions that address this need would not only be easily taught to providers and delivered to patients but also be welcomed into clinics.
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Affiliation(s)
| | - Julia M Coughlin
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David D Odell
- Northwestern University Feinberg School of Medicine, Chicago, Illinois; Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Julie K Johnson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois; Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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Arrieta O, Cardona AF, Lara-Mejía L, Heredia D, Barrón F, Zatarain-Barrón ZL, Lozano F, de Lima VC, Maldonado F, Corona-Cruz F, Ramos M, Cabrera L, Martin C, Corrales L, Cuello M, Arroyo-Hernández M, Aman E, Bacon L, Baez R, Benitez S, Botero A, Burotto M, Caglevic C, Ferraris G, Freitas H, Kaen DL, Lamot S, Lyons G, Mas L, Mata A, Mathias C, Muñoz A, Patane AK, Oblitas G, Pino L, Raez LE, Remon J, Rojas L, Rolfo C, Ruiz-Patiño A, Samtani S, Viola L, Viteri S, Rosell R. Recommendations for detection, prioritization, and treatment of thoracic oncology patients during the COVID-19 pandemic: the THOCOoP cooperative group. Crit Rev Oncol Hematol 2020; 153:103033. [PMID: 32650215 PMCID: PMC7305738 DOI: 10.1016/j.critrevonc.2020.103033] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/13/2020] [Indexed: 12/16/2022] Open
Abstract
The world currently faces a pandemic due to SARS-CoV-2. Relevant information has emerged regarding the higher risk of poor outcomes in lung cancer patients. As such, lung cancer patients must be prioritized in terms of prevention, detection and treatment. On May 7th, 45 experts in thoracic cancers from 11 different countries were invited to participate. A core panel of experts regarding thoracic oncology care amidst the pandemic gathered virtually, and a total of 60 initial recommendations were drafted based on available evidence, 2 questions were deleted due to conflicting evidence. By May 16th, 44 experts had agreed to participate, and voted on each of the 58 recommendation using a Delphi panel on a live voting event. Consensus was reached regarding the recommendations (>66 % strongly agree/agree) for 56 questions. Strong consensus (>80 % strongly agree/agree) was reached for 44 questions. Patients with lung cancer represent a particularly vulnerable population during this time. Special care must be taken to maintain treatment while avoiding exposure.
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Affiliation(s)
- Oscar Arrieta
- Instituto Nacional de Cancerología, Mexico City, Mexico.
| | - Andrés F Cardona
- Thoracic Oncology Clinic, Clínica del Country, Bogotá, Colombia; Foundation for Clinical and Applied Cancer Research, Bogotá, Colombia
| | | | - David Heredia
- Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | | | | | | | | | | | - Maritza Ramos
- Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Luis Cabrera
- Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Claudio Martin
- Thoracic Oncology Unit, Alexander Fleming Institute, Buenos Aires, Argentina; Hospital Maria Ferrer, Buenos Aires, Argentina
| | - Luis Corrales
- Oncology Department, Hospital San Juan de Dios, San José Costa Rica, Costa Rica; Oncología Médica, Centro de Investigación y Manejo del Cáncer (CIMCA), San José, Costa Rica
| | - Mauricio Cuello
- Department of Oncology, Hospital de Clínicas, Universidad de la República - UDELAR, Montevideo, Uruguay
| | | | - Enrique Aman
- Clinical Oncology Unit, Swiss Medical Group, Buenos Aires, Argentina
| | - Ludwing Bacon
- Centro de Oncología, Hospital Vivián Pellas, Nicaragua
| | - Renata Baez
- National Institute for Respiratory Diseases, Mexico City, Mexico
| | - Sergio Benitez
- Coordinador de la sección Oncología, asociación Argentina de Medicina Respiratoria, Argentina
| | | | - Mauricio Burotto
- Clínica Universidad de los Andes, Centro de Estudios Clínicos Bradford Hill, Chile
| | - Christian Caglevic
- Departamento de Investigación del Cáncer- Fundación Arturo López Pérez, Santiago, Chile
| | - Gustavo Ferraris
- Centro Médico Dean Funes, Radioterapia Oncológica, Córdoba, Argentina
| | - Helano Freitas
- Departamento de Oncologia Clínica - A C Camargo Cancer Center, São Paulo, Brazil
| | | | - Sebastián Lamot
- CONCIENCIA, Instituto Oncohematológico de la Patagonia, Chile
| | - Gustavo Lyons
- Department of Thoracic Surgery, Hospital Británico, Buenos Aires, Argentina
| | - Luis Mas
- Medical Oncology Department, National Institute for Neoplastic Diseases - INEN, Lima, Peru
| | - Andrea Mata
- Hospital La Católica Goicoechea, San José, Costa Rica
| | | | | | - Ana Karina Patane
- Hospital de Rehabilitacion Respiratoria María Ferrer, Buenos Aires, Argentina
| | | | - Luis Pino
- Medical Oncology Group, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Luis E Raez
- Thoracic Oncology Program Memorial Cancer Institute, Memorial Healthcare System, Pembroke Pines, FL, United States
| | - Jordi Remon
- Medical Oncology Department, Centro Integral Oncología Clara Campal Bacelona, HM-Delfos, Barcelona, Spain
| | - Leonardo Rojas
- Medical Oncology Department, Clínica Colsanitas, Bogotá, Colombia
| | - Christian Rolfo
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | | | - Suraj Samtani
- Medical Oncology Department, Clínica Bradford Hill, Santiago, Chile
| | - Lucia Viola
- Fundación neumológica colombiana, Bogotá, Colombia
| | - Santiago Viteri
- Instituto Oncológico Dr. Rosell. Centro Médico Teknon. Grupo QuironSalud. Barcelona, España
| | - Rafael Rosell
- Cancer Biology and Precision Medicine Program, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
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Ray MA, Smeltzer MP, Faris NR, Osarogiagbon RU. Survival After Mediastinal Node Dissection, Systematic Sampling, or Neither for Early Stage NSCLC. J Thorac Oncol 2020; 15:1670-1681. [PMID: 32574595 DOI: 10.1016/j.jtho.2020.06.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The American College of Surgeons Oncology Group Z0030 found no survival difference between patients with early stage NSCLC who had mediastinal nodal dissection or systematic sampling. However, a meta-analysis of 1980 patients in five randomized controlled trials from 1989 to 2007 associated better survival with nodal dissection. We tested the survival impact of the extent of nodal dissection in curative-intent resections for early stage NSCLC in a population-based observational cohort. METHODS Resections for clinical T1 or T2, N0 or nonhilar N1, M0 NSCLC in four contiguous United States Hospital Referral Regions from 2009 to 2019 were categorized into mediastinal nodal dissection, systematic sampling, and "neither" on the basis of of the evaluation of lymph node stations. We compared demographic and clinical characteristics, perioperative complication rates, and survival after assessing statistical interactions and confounding. RESULTS Of the 1942 eligible patients, 18% had nodal dissection, 6% had systematic sampling, and 75% had an intraoperative nodal evaluation that met neither standard. In teaching hospitals, nodal dissection was associated with a lower hazard of death than "neither" resections (0.57 [95% confidence interval: 0.41-0.79]) but not systematic sampling (0.74 [0.40-1.37]) after adjusting for multiple comparisons. There was no significant difference in hazard ratios at nonteaching institutions (p > 0.3 for all comparisons). Perioperative complication rates were not significantly worse after mediastinal nodal dissection or systematic sampling, compared with "neither," (p > 0.1 for all comparisons). CONCLUSIONS In teaching institutions, mediastinal nodal dissection was associated with superior survival over less-comprehensive pathologic nodal staging. There was no survival difference between teaching and nonteaching institutions, a finding that warrants further investigation.
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Affiliation(s)
- Meredith A Ray
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tennessee
| | - Matthew P Smeltzer
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tennessee
| | - Nicholas R Faris
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee
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Le T, Yang H, Rashdan S, Link MS, Zaha VG, Alvarez C, Gerber DE. QTc Interval-Prolonging Medications Among Patients With Lung Cancer: Implications for Clinical Trial Eligibility and Clinical Care. Clin Lung Cancer 2020; 21:21-27.e5. [PMID: 31780402 DOI: 10.1016/j.cllc.2019.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/09/2019] [Accepted: 07/25/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Concomitant medication use, including agents that prolong the corrected QT (QTc) interval, can result in the exclusion of patients with cancer from clinical trials. To estimate the potential effects on accrual, we determined the prevalence of QTc-prolonging medication prescriptions in a national patient cohort. PATIENTS AND METHODS We identified adult patients in the Veterans Affairs system with a diagnosis of lung cancer from 2003 to 2016. The use of QTc interval-prolonging medications and risk category were obtained from CredibleMeds. We calculated the prevalence of prescriptions for QTc-prolonging medications with a known or possible risk of torsade de pointes in the 3 months up to and including the date of cancer diagnosis. The rates across patient groups were compared using χ2 test. RESULTS A total of 280,068 patients were included in the present study. The mean age was 70 years, 98% were male, and 72% were white. Overall, 28.4% had been prescribed a QTc-prolonging medication, and 7.3% had been prescribed ≥2 in the 3 months before the cancer diagnosis. The most commonly prescribed QTc-prolonging medications were antimicrobial agents (14.0%), psychiatric agents (10.2%), antiemetic agents (2.6%), and cardiac medications (1.7%). Excluding the antimicrobial agents, 18.4% of the patients had been prescribed a QTc-prolonging medication. CONCLUSIONS A substantial proportion of individuals with lung cancer will be prescribed QTc-prolonging medications. These prescriptions can limit patients' eligibility for clinical trials and complicate the administration of standard cancer therapies. Further research into the actual clinical risks and optimal management of QTc-prolonging medications in cancer populations is warranted.
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Mignard X, Chaabane N, Fallet V, Wislez M. Actualités et perspectives concernant l’immunothérapie en oncologie thoracique. Bull Cancer 2019; 105 Suppl 1:S16-S23. [PMID: 30595194 DOI: 10.1016/s0007-4551(18)30386-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
IMMUNOTHERAPY IN THORACIC ONCOLOGY STATE OF THE ART AND PERSPECTIVES: Immune checkpoint inhibitors (ICI) are monoclonal antibodies that inhibit molecular interaction between an immune checkpoint and its ligand, which leads to increased anti-tumoral immune response, Programmed Death 1 (PD-1) and Cytotoxic T-Lymphocyte Associated-4 (CTLA-4) are the most commonly known immune checkpoints. ICIs are currently placed early in the course of the treatment of patients with non-small cell lung cancer (NSCLC). In France, approvals have been pronounced for nivolumab and pembrolizumab (anti-PD-1 antibodies) as second-line treatments after chemotherapy in patients with advanced NSCLC, and pembrolizumab has been approved as a first-line treatment in patients with advanced NSCLC, without EGFR mutation or ALK rearrangement, with strong (≥50%) PD-L1 (Programmed Death Ligand 1) expression. Atezolizumab is currently soon to be approved as a second-line treatment. Numerous studies are currently evaluating ICIs in thoracic oncology. In this article, we will develop perspectives regarding ICIs for early stage or locally advanced NSCLCs, ICIs used in other thoracic cancers (small cell lung cancer, malignant pleural mesothelioma, thymic epithelial tumors), and trials with combinations involving ICIs: two ICIs combined, or ICIs combined with chemotherapy, radiotherapy or other anti-cancer treatments.
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Affiliation(s)
- Xavier Mignard
- Sorbonne Université, GRC N° 04, Theranoscan, AP-HP, Hôpital Tenon, F-75020, Paris, France
| | - Nouha Chaabane
- Service de pneumologie, AP-HP, Hôpital Tenon, F-75020, Paris, France
| | - Vincent Fallet
- Service de pneumologie, AP-HP, Hôpital Tenon, F-75020, Paris, France
| | - Marie Wislez
- Sorbonne Université, GRC N° 04, Theranoscan, AP-HP, Hôpital Tenon, F-75020, Paris, France; Service de pneumologie, AP-HP, Hôpital Tenon, F-75020, Paris, France.
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Levy A, Doyen J. Metformin for non-small cell lung cancer patients: Opportunities and pitfalls. Crit Rev Oncol Hematol 2018; 125:41-47. [PMID: 29650275 DOI: 10.1016/j.critrevonc.2018.03.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/17/2018] [Accepted: 03/01/2018] [Indexed: 12/11/2022] Open
Abstract
Despite exciting advances of the anticancer armamentarium in the recent years, mortality of non-small cell lung cancer (NSCLC) remains high and novel treatments are requisite. Therapy intensification is explored with promising, but expensive and potentially toxic new compounds. Repositioning already existing drugs for cancer treatment could save money and improve patient outcomes in specific contexts. Observational data suggest that use of the standard antidiabetic agent metformin decreases lung cancer incidence and mortality. Several basic researches have shown various anticancer effects of metformin, acting both on the glycolytic metabolism and on the tumoral immune microenvironment. Synergistic actions of metformin with antitumoral agents in preclinical NSCLC models have then been highlighted. Recent retrospective studies advocated improved outcomes in NSCLC diabetic patients receiving metformin with chemoradiotherapy or systemic compounds (including conventional platinum-based chemotherapy and EGFR tyrosine kinase inhibitors). Several prospective randomized trials are therefore currently assessing the addition of metformin to standard therapy in non-diabetic lung cancer patients. This article reviews promises and possible limitations of concurrent metformin used as an anticancer agent in NSCLC patients.
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Affiliation(s)
- Antonin Levy
- Department of Radiation Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France; Univ Paris Sud, Université Paris-Saclay, F-94270, Le Kremlin-Bicêtre, France; INSERM U1030, Molecular Radiotherapy, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France.
| | - Jérôme Doyen
- Department of Radiation Oncology, Centre Antoine Lacassagne, 33 Avenue de Valombrose, 06189, Nice Cedex 2, France; University of Côte d'Azur, Nice, France; Institut for Research on Cancer and Aging (IRCAN), CNRS 7284 "Normal and Pathological Angiogenesis", Nice, France
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Ferrara R, Mezquita L, Besse B. Progress in the Management of Advanced Thoracic Malignancies in 2017. J Thorac Oncol 2018; 13:301-22. [PMID: 29331646 DOI: 10.1016/j.jtho.2018.01.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/04/2018] [Accepted: 01/04/2018] [Indexed: 12/21/2022]
Abstract
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 death ligand 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.
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Patrini D, Scolamiero L, Khiroya R, Lawrence D, Borg E, Hayward M, Panagiotopoulos N. Mediastinal hemangioendothelioma: Case report and review of the literature. Respir Med Case Rep 2017. [PMID: 28626633 PMCID: PMC5466594 DOI: 10.1016/j.rmcr.2017.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Epithelioid haemangioendothelioma (EHE) is a rare low-grade vascular neoplasm that can arise in the lung, liver, soft tissues or, less commonly, bone. Due to its low prevalence of less than one in a million and its non-specific clinical features, EHE is often misdiagnosed and managed inappropriately. Here we discuss the case of a 58 year-old gentleman with mediastinal EHE and review existing literature on pulmonary EHE (PEH). CASE HISTORY A 58 year-old gentleman presented to our outpatient Clinic with chest discomfort and palpitations. A whole-body FDG-CT-PET showed an FDG-avid single 6.3cm nodule in the superior anterior mediastinum which was fully excised by robotic approach. Histology showed a nodular structure with clusters of epithelioid and spindled cells with a low proliferative index and mitotic count, suspended in a sclerotic stroma. Immunohistochemistry staining was positive for CD3 and CD34, confirming endothelial lineage, and SMA, identifying smooth muscle clusters. DISCUSSION PEH typically presents in young Caucasian women, either incidentally as multiple small pulmonary nodules on CT or with respiratory symptoms that include cough, dyspnoea, chest pain and occasionally pleural effusions. Aetiology and prognosis remain unclear, although indicators of poor prognosis include the presence of respiratory symptoms, male gender, older age and multi-organ disease. Diagnosis is difficult and PEH is often misidentified as chronic granulomatous disease, amyloidosis or other malignancy of the lung. Histological features suggestive of PEH include nodules of hypocellular sclerotic stroma containing spindle-shaped tumour cells with abundant eosinophilic cytoplasm, vacuoles containing erythrocytes and low mitotic counts. CD31, CD34 and Fli-1 positive immunohistochemistry is strongly indicative of epithelioid lineage. There is no standard treatment for PEH but curative resection is the preferred treatment option where possible, with chemotherapy being used as adjuvant treatment or in widespread inoperable disease. CONCLUSION This case report outlines the clinicopathological features that are characteristic of EHE with the hope of facilitating correct and early diagnosis in the future.
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Affiliation(s)
- Davide Patrini
- Department of Thoracic Surgery, University College London Hospitals (UCLH), London, UK
| | | | - Reena Khiroya
- Department of Histopathology, University College London Hospitals (UCLH), London, UK
| | - David Lawrence
- Department of Thoracic Surgery, University College London Hospitals (UCLH), London, UK
| | - Elaine Borg
- Department of Histopathology, University College London Hospitals (UCLH), London, UK
| | - Martin Hayward
- Department of Thoracic Surgery, University College London Hospitals (UCLH), London, UK
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Hofman P, Ilié M, Lassalle S, Long E, Bence C, Butori C, Hofman V. [PD1/PD-L1 immunohistochemistry in thoracic oncology: Where are we?]. Ann Pathol 2017; 37:39-45. [PMID: 28159404 DOI: 10.1016/j.annpat.2016.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 12/06/2016] [Indexed: 10/20/2022]
Abstract
The assays for the assessment of the PD-L1 status by immunohistochemistry are available in clinical studies in thoracic oncology to predict response to immunotherapies targeting the PD-1/PD-L1 pathway. With the arrival of this new class of molecules in second line and very soon in first line of treatment for patients with advanced or metastatic non-small cell lung cancer, these tests will certainly be required in routine once these new drugs will be granted marketing authorization. The rapid introduction of these "companion" or "complementary" tests seems essential to select patients to benefit from these effective but also expensive and sometimes toxic therapies. Although challenged by some oncologists (as some patients not expressing PD-L1 may sometimes respond to PD-1/PD-L1 blockade), the anti-PD-L1 immunohistochemically approach seems inevitable in 2017. This new activity developed in the pathology laboratories raises several questions: which anti-PD-L1 clone should be used? On which device? What threshold of positivity should be considered? Should PD-L1 expression be assessed on tumor cells as well as on the immune cells? What controls should be used? Comparative studies are underway or have been already implemented in order to answer some of these questions. This review addresses the different evaluation criteria for immunohistochemistry using the main anti-PD-L1 antibodies used to date as well the recently published studies using these antibodies in thoracic oncology.
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Tsim S, Stobo DB, Alexander L, Kelly C, Blyth KG. The diagnostic performance of routinely acquired and reported computed tomography imaging in patients presenting with suspected pleural malignancy. Lung Cancer 2017; 103:38-43. [PMID: 28024694 PMCID: PMC5226066 DOI: 10.1016/j.lungcan.2016.11.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 11/13/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Contrast-enhanced computed tomography (CT) provides essential cross-sectional imaging data in patients with suspected pleural malignancy (PM). The performance of CT in routine practice may be lower than in previously reported research. We assessed this relative to 'real-life' factors including use of early arterial-phase contrast enhancement (by CT pulmonary angiography (CTPA)) and non-specialist radiology reporting. MATERIALS AND METHODS Routinely acquired and reported CT scans in patients recruited to the DIAPHRAGM study (a prospective, multi-centre observational study of mesothelioma biomarkers) between January 2014 and April 2016 were retrospectively reviewed. CT reports were classified as malignant if they included specific terms e.g. "suspicious of malignancy", "stage M1a" and benign if others were used e.g. "indeterminate", "no cause identified". All patients followed a standard diagnostic algorithm. The diagnostic performance of CT (overall and based on the above factors) was assessed using 2×2 Contingency Tables. RESULTS 30/345 (9%) eligible patients were excluded (non-contrast (n=13) or non-contiguous CT (n=4), incomplete follow-up (n=13)). 195/315 (62%) patients studied had PM; 90% were cyto-histologically confirmed. 172/315 (55%) presented as an acute admission, of whom 31/172 (18%) had CTPA. Overall, CT sensitivity was 58% (95% CI 51-65%); specificity was 80% (95% CI 72-87%). Sensitivity of CTPA (performed in 31/315 (10%)) was lower (27% (95% CI 9-53%)) than venous-phase CT (61% (95% CI 53-68%) p=0.0056). Sensitivity of specialist thoracic radiologist reporting was higher (68% (95% CI 55-79%)) than non-specialist reporting (53% (95% CI 44-62%) p=0.0488). Specificity was not significantly different. CONCLUSION The diagnostic performance of CT in routine clinical practice is insufficient to exclude or confirm PM. A benign CT report should not dissuade pleural sampling where the presence of primary or secondary pleural malignancy would alter management. Sensitivity is lower with non-thoracic radiology reporting and particularly low using CTPA.
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Affiliation(s)
- Selina Tsim
- Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK; Institute of Cancer Sciences, University of Glasgow, UK
| | - David B Stobo
- Department of Radiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Laura Alexander
- CRUK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, UK
| | - Caroline Kelly
- CRUK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, UK
| | - Kevin G Blyth
- Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK; Institute of Infection, Immunity and Inflammation, University of Glasgow, UK.
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Thomas DC, Arnold BN, Rosen JE, Salazar MC, Blasberg JD, Detterbeck FC, Boffa DJ, Kim AW. Defining outcomes of patients with clinical stage I small cell lung cancer upstaged at surgery. Lung Cancer 2016; 103:75-81. [PMID: 28024700 DOI: 10.1016/j.lungcan.2016.11.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 11/15/2016] [Accepted: 11/26/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND A proportion of patients with clinical stage I small cell lung cancer (SCLC) will be upstaged following surgical resection. The existing data regarding the management of upstaged SCLC patients and guidelines for their treatment remains sparse. The primary objective was to describe the impact of pathologic upstaging following surgical resection. METHODS The National Cancer Database was queried for patients with clinical stage I SCLC (cT1-2a,N0,M0) who underwent resection with curative intent followed by adjuvant therapy, excluding patients who underwent surgery alone. Clinical and pathologic T, N, and M staging were compared to identify patients that were upstaged. RESULTS Four-hundred and seventy-seven patients were identified with clinical stage I SCLC. Pathologic upstaging occurred in 25% (117). Of those upstaged, 30% (35) were due to a higher pathologic T descriptor and 81% (95) were due to the presence of nodal disease. Overall 5-year survival was significantly worse for upstaged patients compared with those patients who remained a pathologically stage I (36% vs 52%, p<0.001). Among patients with positive lymph node involvement, adjuvant chemotherapy and radiation therapy was associated a significantly improved 5-year survival compared to adjuvant chemotherapy alone (20% vs 55%, respectively, p<0.01). The use of adjuvant chemotherapy and radiation therapy in patients with nodal disease after surgical resection was an independent predictor of improved survival (HR 0.36, 95% CI 0.18-0.73, p<0.01). CONCLUSIONS Pathologic upstaging is common after surgical resection of stage I SCLC, and is associated with significantly inferior survival. These data provide evidence that recommend the use of adjuvant chemotherapy and radiation therapy in the setting of nodal upstaging after resection of clinical stage I SCLC patients.
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Affiliation(s)
- Daniel C Thomas
- Yale University School of Medicine, Department of Surgery, Section of Thoracic Surgery, New Haven, CT, USA
| | - Brian N Arnold
- Yale University School of Medicine, Department of Surgery, Section of Thoracic Surgery, New Haven, CT, USA
| | - Joshua E Rosen
- Yale University School of Medicine, Department of Surgery, Section of Thoracic Surgery, New Haven, CT, USA
| | - Michelle C Salazar
- Yale University School of Medicine, Department of Surgery, Section of Thoracic Surgery, New Haven, CT, USA
| | - Justin D Blasberg
- Yale University School of Medicine, Department of Surgery, Section of Thoracic Surgery, New Haven, CT, USA
| | - Frank C Detterbeck
- Yale University School of Medicine, Department of Surgery, Section of Thoracic Surgery, New Haven, CT, USA
| | - Daniel J Boffa
- Yale University School of Medicine, Department of Surgery, Section of Thoracic Surgery, New Haven, CT, USA
| | - Anthony W Kim
- Yale University School of Medicine, Department of Surgery, Section of Thoracic Surgery, New Haven, CT, USA.
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Arame A, Rivera C, Pricopi C, Mordant P, Abdennadher M, Foucault C, Dujon A, Le Pimpec Barthes F, Riquet M. [Place of bilobectomy in pulmonary oncology and prognostic factors in NSCLC]. Rev Pneumol Clin 2014; 70:260-268. [PMID: 24932506 DOI: 10.1016/j.pneumo.2014.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 02/11/2014] [Accepted: 02/13/2014] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Bilobectomy may be performed for different reasons and lung tumors. There are still controversies regarding the results of this procedure. We reviewed our experience of bilobectomy to evaluate the particularities of this resection. METHODS The clinical files of patients operated on for lung tumors in two French centers between 1980 and 2009 were prospectively recorded and retrospectively analyzed. The characteristics, management, pathology, and survival after right-sided resections for non-small cell lung cancer (NSCLC) were then compared. RESULTS During the study period, 3280 right-sided resections were performed, including 235 bilobectomy (7%), for NSCLC in 192 cases (82%). Lower-middle lobectomy (LML) represented 60% of bilobectomy, with carcinoid tumors and squamous cell carcinoma being more frequent in this group. Upper-middle lobectomy (UML) represented 40% of bilobectomy, with less postoperative complications and mortality in this group. In N0-NSCLC, the rate of postoperative mortality and 5-year survival rates after bilobectomy (4.7% and 46.1%, respectively) were intermediate between lobectomy (2.7% and 52.6%) and pneumonectomy (9.6% and 31.7%, P<10(-6) for both comparisons). There was no significant difference in 5-year survival rates according to the type of bilobectomy and the performance of any induction therapy. CONCLUSION Bilobectomy is associated with acceptable in-hospital mortality and encouraging 5-year survival rates despite an increased incidence of postoperative complications. Approximation in survival of UML and pneumonectomy and of LML and lobectomy may be due to differences in histologic features with different fissure extension and interlobar node involvement.
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Affiliation(s)
- A Arame
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20, rue Leblanc, 75015 Paris, France
| | - C Rivera
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20, rue Leblanc, 75015 Paris, France
| | - C Pricopi
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20, rue Leblanc, 75015 Paris, France
| | - P Mordant
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20, rue Leblanc, 75015 Paris, France
| | - M Abdennadher
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20, rue Leblanc, 75015 Paris, France
| | - C Foucault
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20, rue Leblanc, 75015 Paris, France
| | - A Dujon
- Service de chirurgie thoracique, centre médico-chirurgical du Cèdre, 76230 Bois-Guillaume, France
| | - F Le Pimpec Barthes
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20, rue Leblanc, 75015 Paris, France
| | - M Riquet
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20, rue Leblanc, 75015 Paris, France.
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Widder J, Klinkenberg TJ, Ubbels JF, Wiegman EM, Groen HJM, Langendijk JA. Pulmonary oligometastases: metastasectomy or stereotactic ablative radiotherapy? Radiother Oncol 2013; 107:409-13. [PMID: 23773410 DOI: 10.1016/j.radonc.2013.05.024] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 05/15/2013] [Accepted: 05/26/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE Stereotactic ablative radiotherapy (SABR; or stereotactic body radiotherapy, SBRT) emerges as treatment option for pulmonary oligometastatic disease (OMD), but there are no studies comparing SABR with pulmonary metastasectomy (PME). We analysed consecutive patients referred via a university-hospital based multidisciplinary team. MATERIAL AND METHODS Patients were offered PME as first choice and SABR in case they were considered to be less suitable surgical candidates. Overall survival was the primary endpoint. Secondary endpoints were progression-free-survival, local control of treated metastases, and freedom-from-failure of a local-only treatment strategy without systemic therapy. RESULTS From 2007 until 2010, 110 patients were treated and analysed (PME, n=68; SABR, n=42). Median follow-up time was 43 months (minimally, 25). Estimated overall survival rates at one, three, and five years were 87%, 62%, and 41% for PME, and 98%, 60%, and 49% for SABR, respectively (logrank-test, p=0.43). Local control at two years was 94% for SABR and 90% for PME. Progression-free survival was 17% at three years, but 43% of the patients still had not failed a local-only treatment strategy. CONCLUSIONS Although SABR was second choice after PME, survival after PME was not better than after SABR. Prospective comparative studies are clearly required to define the role of both, SABR and PME in OMD.
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Affiliation(s)
- Joachim Widder
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands.
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