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Jose A. B. Araujo-Filho, Darragh Halpenny, Colin McQuade, Gregory Puthoff, Caroline Chiles, Mizuki Nishino, Michelle S. Ginsberg
American Journal of Roentgenology, Volume 216, pp 1423-1431; doi:10.2214/ajr.20.24907

The publisher has not yet granted permission to display this abstract.
, Andreas Rimner, Walter Weder, Christopher G. Azzoli, Mark G. Kris, Tina Cascone
Nature Reviews Clinical Oncology pp 1-11; doi:10.1038/s41571-021-00501-4

The publisher has not yet granted permission to display this abstract.
, Kastelik Jack A, Loubani Mahmoud
Journal of Surgery and Surgical Research, Volume 7, pp 052-056; doi:10.17352/2455-2968.000137

, José Belda-Sanchis, Mauro Guarino, Laura Tilea, Jady Vivian Rojas Cordero, Elisabeth Martínez-Téllez
Published: 17 February 2021
Abstract:
Early stage small cell
lung
cancer
(T1-2N0M0SCLC) represents 7% of all SCLC. The standard treatment in patients with intrathoracic SCLC disease is the use of concurrent chemoradiotherapy (CRT). Nowadays, the recommended
management
of this highly selected group is
surgical
resection due to favorable survival outcomes. For
medically
inoperable patients or those who refuse surgery, there is an increasing interest in evaluating the role of Stereotactic Body Radiotherapy (SBRT) for T1-2N0SCLC, transferring the favorable experience obtained on inoperable NSCLC (Non-Small-cell
Lung
Cancer
). In the era of multimodality treatment, adjuvant systemic therapy plays an important role even in the
management
of early SCLC, increasing the disease-free survival (DFS) and Overall Survival (OS). The benefit of Prophylactic Cranial Irradiation (PCI), that
currently
has a Category I recommendation for localized stage SLCL, remains controversial in this selected subgroup of patients due to the lower risk of brain metastasis. This review summarizes the most relevant data on the local
management
of T1-2N0M0SCLC (surgery and radiotherapy), and evaluates the relevance of adjuvant treatment. Provides a critical evaluation of best
current
clinical
management
options for T1-2N0M0 SCLC.
, Joshua Siglin, Aleem Khan
Published: 20 October 2020
by Wiley
Cancer Medicine, Volume 9, pp 9205-9218; doi:10.1002/cam4.3534

Abstract:
Coronavirus disease‐2019 (COVID‐19) has emerged as a novel infection which has spread rapidly across the globe and
currently
presents a grave threat to the health of vulnerable patient populations like those with malignancy, elderly, and immunocompromised. Healthcare systems across the world are grappling with the detrimental impact of this pandemic while learning about this novel disease and concurrently developing vaccines, strategies to mitigate its spread, and treat those infected.
Cancer
patients today face with a unique situation. They are susceptible to severe clinically adverse events and higher mortality from COVID‐19 infection as well as morbidity and mortality from their underlying malignancy. Conclusion: Our review suggests increased risk of mortality and serious clinical events from COVID‐19 infection in
cancer
patients. However, risk of adverse events does not seem to be increased by
cancer
therapies. True impact of COVID‐19 on
cancer
patients will unravel over the next few months. We have also reviewed clinical features of COVID‐19, recent recommendations from various
medical
,
surgical
, and radiation oncology societies for major solid tumor types like
lung
, breast, colorectal, and prostate
cancer
during the duration of this pandemic.
, Gurdeep S. Sagoo, Leon Jackson, Mike Fisher, Geoffrey Hamilton-Fairley, Andrea Murray, Adam Hill
Published: 2 September 2020
PLoS ONE, Volume 15; doi:10.1371/journal.pone.0237492

Abstract:
Oncimmune's
EarlyCDT®-Lung
is a simple ELISA blood test that measures seven
lung
cancer
specific autoantibodies and is used in the assessment of malignancy risk in patients with indeterminate pulmonary nodules (IPNs). The objective of this study was to examine the cost-effectiveness of EarlyCDT-
Lung
in the diagnosis of
lung
cancer
amongst patients with IPNs in addition to CT surveillance, compared to CT surveillance alone which is the
current
recommendation by the British Thoracic Society guidelines. A model consisting of a combination of a decision tree and Markov model was developed using the outcome measure of the quality adjusted life year (QALY). A life-time time horizon was adopted. The model was parameterized using a range of secondary sources. At £70 per test, EarlyCDT-
Lung
and CT surveillance was found to be cost-effective compared to CT surveillance alone with an incremental cost-effectiveness ratio (ICER) of less than £2,500 depending on the test accuracy parameters used. It was also found that EarlyCDT-
Lung
can be priced up to £1,177 and still be cost-effective based on cost-effectiveness acceptance threshold of £20,000 / QALY. Further research to resolve parameter uncertainty, was not found to be of value. The results here demonstrate that at £70 per test the EarlyCDT-
Lung
will have a positive impact on patient outcomes and coupled with CT surveillance is a cost-effective approach to the
management
of patients with IPNs. The conclusions drawn from this analysis are robust to realistic variation in the parameters used in the model.
, Steven Chmura, Clifford Robinson, Steven H. Lin, Shirish M. Gadgeel, Jessica Donington, Josephine Feliciano, Thomas E. Stinchcombe, Maria Werner-Wasik, Martin J. Edelman, Drew Moghanaki
Published: 1 July 2020
Journal of Thoracic Oncology, Volume 15, pp 1137-1146; doi:10.1016/j.jtho.2020.04.016

The publisher has not yet granted permission to display this abstract.
, Jonathan Goldman, Jessica S. Donington
Seminars in Respiratory and Critical Care Medicine, Volume 41, pp 333-334; doi:10.1055/s-0040-1709995

The publisher has not yet granted permission to display this abstract.
Wanda Marini, David Moher, David McCready,
Annals of Surgical Oncology, Volume 27, pp 751-752; doi:10.1245/s10434-020-08589-1

The publisher has not yet granted permission to display this abstract.
, Carl Van Laer, Christian Simon, , Jean Bourhis,
Published: 6 May 2020
Frontiers in Oncology, Volume 10; doi:10.3389/fonc.2020.00688

Abstract:
The traditional concept of post-treatment surveillance in head and neck
cancer
patients relies on examinations directed at early detection of disease recurrence and/or second primary tumors. They are usually provided by ear, nose and throat specialists with complementary input from radiation oncologists and
medical
oncologists. Emerging evidence underscores the importance of monitoring and effective
management
of late adverse events. One of the major drawbacks is a lack of prospective controlled data. As a result, local institutional policies differ, and practice recommendations are subject to continuing debate. Due to the economic burden and impact on emotional comfort of patients, intensity and content of follow-up visits are a particularly conflicting topic. According to the
current
evidence-based medicine, follow-up of head and neck
cancer
patients does not prolong survival but can improve quality of life. Therefore, an approach giving priority to a multidisciplinary care involving a speech and swallowing expert, dietician, dentist, and psychologist may indeed be more relevant. Moreover, on a case-by-case basis, some patients need more frequent consultations supplemented by imaging modalities. Human papillomavirus positive oropharyngeal
cancer
tends to develop late failures at distant sites, and asymptomatic oligometastatic disease, especially in the
lungs
, can be successfully salvaged by local ablation, either
surgically
or by radiation. The deep structures of the skull base related to the nasopharynx are inaccessible to routine clinical examination, advocating periodic imaging supplemented by nasofibroscopy as indicated. Anamnesis of heavy smoking justifies annual low-dose computed tomography screening of the thorax and intensive smoking cessation counseling. Finally, some
cancer
survivors feel more comfortable with regular imaging, and their voice should be taken into consideration. Future development of surveillance strategies will depend on several variables including identification of reliable predictive factors to select those who could derive the most benefit from follow-up visits, the availability of long-term follow-up data, the results of the first randomized trials, resource allocation patterns, infrastructure density, and the therapeutic landscape of locally advanced and recurrent and/or metastatic disease, which is rapidly changing with the advent of immune checkpoint inhibitors and better utilization of local approaches.
Published: 15 April 2020
Abstract:
Importance: The COVID-19 pandemic is
currently
accelerating. Patients with locally advanced non-small cell
lung
cancer
(LA-NSCLC) may require treatment in locations where resources are limited and the prevalence of infection is high. Patients with LA-NSCLC frequently present with comorbidities that increase the risk for severe morbidity and mortality from COVID-19. These risks may be further increased by treatments for LA-NSCLC. Observation: We present expert thoracic oncology multidisciplinary (radiation oncology,
medical
oncology,
surgical
oncology) consensus of alternative strategies for the treatment of LA-NSCLC during a pandemic. The overarching goals of these approaches are to reduce the number of visits to a healthcare facility, reduce the risk of SARS-CoV-2 exposure, and attenuate the immunocompromising effects of
lung
cancer
therapies. Patients with resectable disease can be treated with definitive non-operative
management
if
surgical
resources are limited or the risks of perioperative care are high. Non-operative options include chemotherapy, chemoimmunotherapy, and radiation therapy with sequential schedules. The order of treatments may be based on patient factors and clinical resources. Whenever radiation therapy is delivered without concurrent chemotherapy, hypofractionated schedules are appropriate. For patients who are confirmed to have COVID-19, usually
cancer
therapies may be withheld until symptoms have resolved with negative viral test results. Conclusions and Relevance: The risk of severe treatment-related morbidity and mortality is significantly elevated for patients undergoing treatment for LA-NSCLC during the COVID-19 pandemic. Adapting alternative treatment strategies as quickly as possible may save lives and should be implemented through communication with the multidisciplinary
cancer
team.
The COVID19 Subcommittee of the O.R. Executive Committee at Memorial Sloan Kettering
Annals of Surgical Oncology, Volume 27, pp 1713-1716; doi:10.1245/s10434-020-08462-1

Abstract:
We initially faced this question when notified that the state and local government wanted all hospitals to cancel elective surgery in preparation for a surge of COVID19 patients. A similar recommendation from the American College of Surgeons (ACS) appeared shortly afterward. At MSK, our surgeons
manage
approximately 30,000 cases annually in one of 13 Department of Surgery services (Breast, Colorectal, Dental, Gastric and Mixed Tumor, Gynecology, Head and Neck, Hepato-Pancreatico-Biliary, Ophthalmologic Oncology, Orthopedic, Pediatric Surgery, Plastic Surgery, Thoracic, and Urology) and the Department of Neurosurgery. Our immediate response to the edict calling for the cancellation of elective surgery was to distinguish elective surgery from potentially curative
cancer
surgery, which we have called “essential
cancer
surgery.” Approximately 5–10% of our
surgical
volume consists of cases that are truly elective (e.g., incisional hernia repairs, cholecystectomy for biliary colic, ostomy takedowns, and some plastic/reconstructive procedures), and another 20–30% of our cases are more
cancer
-specific but can safely be deferred for several months (including prostatectomy for low-grade prostate
cancer
, pancreatectomy for cystic neoplasms without
cancer
or high-risk features, and thyroidectomy for low-grade thyroid malignancies). We initially moved these cases off our schedule in compliance with the governmental edicts while continuing to perform essential
cancer
surgical
procedures such as brain tumor, breast, colon, stomach, pancreas, liver, bladder, kidney, and
lung
resections. Subsequent guidance from the ACS has validated this approach (https://www.facs.org/about-acs/covid-19/information-for-surgeons/triage), and the NY State Department of Health has endorsed this position. Our rules for choosing patients to undergo surgery are outlined in Table 1. In framing our institutional response to a potentially escalating number of COVID19 patients, we planned a stepwise reduction in
surgical
activity based on competing needs for beds, ORs, and ICUs/ventilators. We also recognized that staff illness and quarantine requirements together with critical supply shortages had the potential to limit our ability to perform essential
cancer
surgery even with sufficient ORs and beds. Our planning ranged from continuing to
manage
the full range of essential cases while taking some ORs off line due to the cancellation of elective and nonessential surgery, to reducing activity by 25%, 50%, or 75% due to limitations of resources being diverted to COVID19 care, to closing all scheduled ORs and recovery space and devoting most of our anesthesia machines to use as auxiliary ventilators while preserving a small number of ORs for true
surgical
emergencies. The unpredictable nature of the prospective “surge” in COVID19 patients, at least
currently
, has caused us to try to tread the line between unnecessarily cancelling essential
surgical
procedures while the hospital has ample bed and staff capacity and not being ready to pivot to postponing cases as a COVID19 surge materializes. The Operating Room Executive Committee, consisting of leaders from Surgery, Anesthesia, and Nursing, meets twice daily to review the hospital census, bed and ICU availability, COVID19 activity at our institution and in the city, and requests for case scheduling. All cases are scrutinized to determine whether they are truly essential. When necessary, individual surgeons are contacted to justify
medical
necessity. We also have shortened the time for definitive scheduling of cases. Our
current
expeditious scheduling in 48–72 h will allow
surgical
volume to be ramped down quickly if necessary. Service chiefs have been asked to review the weekly schedules for their services and to prioritize a triage list for use in the event that we need to cancel even some essential cases. We believe this approach recognizes our primary mission to treat
cancer
patients while allowing us to be ready to deal with an increasing volume of COVID19 patients as they arrive. Recommendations from the Centers for Disease Control and Prevention (CDC) and professional organizations for best practices to reduce risk to care providers have continued to evolve as the pandemic has unfolded. An ideal solution would be to test all patients immediately before surgery and postpone procedures for COVID19-infected patients. However, limitations on testing capacity may make this approach impossible. Because droplet-based transmission is a primary means of COVID19 spread, procedures involving the airway, including intubation, may place anesthesiology staff and surgeons at particularly high risk. To maximize protection of staff in the OR, anesthesiology staff are provided N95 masks for all procedures. Due to the shortage of N95 masks, other OR staff are asked either to vacate the OR or to maintain a distance of at least 6 feet during induction and extubation. Head and neck, thoracic, and neurosurgeons may face particularly high risks for certain procedures, and chiefs in each of these disciplines have worked to minimize service-specific high-risk procedures. Guidelines have been created for high-risk procedures that must be followed for these services, including the selective use of preoperative testing (with postponement of COVID19-infected patients), the standard use of N95 masks and face shields or goggles, and selective use of filtered positive-pressure airflow helmets. All physicians have a responsibility to provide the best care to their patients. The COVID19 pandemic creates competing and, in some cases, opposing institutional and societal responsibilities with regard to health care provider safety, use of PPE, and allocation of hospital beds and ventilators.
Surgical
oncologists may be placed in a position of deciding whether health benefits, and even the chance of survival, for their individual patients potentially able to undergo...
International Journal of Surgery Case Reports, Volume 77, pp 349-352; doi:10.1016/j.ijscr.2020.11.043

Abstract:
Bronchial carcinoid tumors are rare, slow growing, malignant neuroendocrine tumors and account for less than 2% of all
lung
tumors. Early diagnosis is extremely important as the main stay of treatment is
surgical
excision. We present a rare case of bronchial typical carcinoid tumor in a 22-year-old female who presented with a complaint of intermittent productive cough with bloody sputum of 3 weeks’ duration associated with wheezing, low grade intermittent fever and loss of appetite. She was being treated as bronchial asthma for 10 years prior to her
current
presentation. Right
lung
bi-lobectomy with regional lymph node resection was done and she was discharged home in good condition. Majority of typical carcinoids are located in the central airways leading to bronchial obstruction with recurrent pneumonia, chest pain, wheezing and hemoptysis. Due to such nonspecific presentation most patients are misdiagnosed or diagnosed late. Both typical and atypical Carcinoids have similar radiologic features and definitive diagnosis relies on bronchoscopic tissue biopsy. Although hilar and mediastinal lymph nodes are the most common metastatic sites for typical carcinoids most lymphadenopathies are caused by a reactive inflammatory reaction. Bronchial carcinoids are rare, malignant neuroendocrine tumors with complete
surgical
resection being the only curative
management
. Thus patients with recurrent respiratory symptoms despite optimum
medical
treatment should be thoroughly investigated for accurate and early diagnosis The outcome of typical carcinoids with lymph node metastasis is excellent with complete resection but close follow up is mandatory when dealing with larger tumors.
Yan Leyfman, Erel Joffe, Esther Drill, Sridevi Rajeeve, Andrew D. Zelenetz, Maria Lia Lia Palomba, Craig H. Moskowitz, Carol S. Portlock, Ariela Noy, Steven M. Horwitz, Alison J. Moskowitz, Paul A. Hamlin, Matthew J Matasar, Anita Kumar, Gottfried R. Von Keudell, Connie Lee Batlevi, Anas Younes, David J. Straus
Published: 13 November 2019
Blood, Volume 134, pp 2826-2826; doi:10.1182/blood-2019-123257

The publisher has not yet granted permission to display this abstract.
, Niccolò Giaj-Levra, Patrizia Ciammella, Virginia Maragna, Katia Ferrari, Viola Bonti, , Stefania Greco, Carlo Greco, Paolo Borghetti, , Enrica Capelletto, Marco Perna, , Stefano Vagge, Editta Baldini, , Andrea Botti, , Massimiliano Paci, et al.
Published: 13 November 2019
PLoS ONE, Volume 14; doi:10.1371/journal.pone.0224027

Abstract:
Concurrent chemotherapy and radiotherapy (cCRT) is considered the standard treatment of locally advanced non-small cell
lung
cancer
(LA-NSCLC). Unfortunately,
management
is still heterogeneous across different specialists. A multidisciplinary approach is needed in this setting due to recent, promising results obtained by consolidative immunotherapy. The aim of this survey is to assess
current
LA-NSCLC
management
in Italy. From January to April 2018, a 15-question survey focusing on diagnostic/therapeutic LA-NSCLC
management
was sent to 1,478 e-mail addresses that belonged to pneumologists, thoracic surgeons, and radiation and
medical
oncologists. 421 answers were analyzed: 176 radiation oncologists, 86
medical
oncologists, 92 pneumologists, 64 thoracic surgeons and 3 other specialists. More than a half of the respondents had been practicing for >10 years after completing residency training. Some discrepancies were observed in clinical LA-NSCLC
management
: the lack of a regularly planned multidisciplinary tumor board, the use of upfront surgery in multistation stage IIIA, and territorial diffusion of cCRT in unresectable LA-NSCLC. Our analysis demonstrated good compliance with international guidelines in the diagnostic workup of LA-NSCLC. We observed a relationship between high clinical experience and good clinical practice. A multidisciplinary approach is mandatory for
managing
LA-NSCLC.
, Silvia Novello
Translational Lung Cancer Research, Volume 8; doi:10.21037/tlcr.2019.07.07

The publisher has not yet granted permission to display this abstract.
Chin Heng Fong, Natasha Leighl, Marcus Butler, Mark Doherty, Timothy Kruser, David Shultz
Neuro-Oncology Advances, Volume 1; doi:10.1093/noajnl/vdz014.101

Abstract:
INTRODUCTION: The standard of care for 1–4 brain metastases (BrM) is stereotactic radiosurgery (SRS), whereas whole brain radiation remains the standard treatment for extensive BrM, and
surgical
resection is appropriate in certain scenarios. Some newer systemic therapies such as tyrosine kinase inhibitors and immunotherapy have impressive CNS activity and are used by some practitioners either alone or in combination with other modalities as first-line treatment for BrM. We conducted a survey to ascertain
current
real-world practices for the treatment of BrM from NSCLC and melanoma. OBJECTIVES: Our study aimed to assess practice patterns of oncologists who treat BrM from NSCLC or melanoma. We also investigated the extent to which various clinical factors influence decision making. METHODOLOGY: We created 2 sets of surveys: one for
Medical
-/Clinical-/Neuro- oncologists and another for Radiation oncologists/Neurosurgeons. Surveys were conducted online or on-line. Following administration, data was tabulated and analyzed. Statistical analyses were performed using Fisher’s exact test. RESULTS: Of 361 respondents, 250 were Radiation oncologists/Neurosurgeons, and 111 were
Medical
-/Clinical-/Neuro- oncologists. For patients with 1–3 brain lesions, all < 2cm, 34% of respondents recommended systemic therapy alone as first-line treatment. In contrast, only 15% recommend systemic therapy alone for >9 lesions, at least one > 2cm.
Medical
-/Clinical-/Neuro- oncologists were more likely to recommend systemic therapy alone compared to Radiation oncologists/ Neurosurgeons for 1–3 lesions, all < 2cm (53% vs. 28%, p< .0001). For patients with > 9 BrM, one >2cm diameter,
Medical
-/Clinical-/Neuro- oncologists were not significantly more likely to recommend systemic therapy alone (20% vs 13%, p=.11). DISCUSSION: Our results reveal that significant numbers of physicians recommend systemic therapy alone as first-line therapy in BrM and that
management
decisions correlate with a physician’s type of practice. These findings underscore the need for prospective clinical trials to direct appropriate BrM
management
.
Parvarish Sharma, Meenu Mehta, Daljeet Singh Dhanjal, Simran Kaur, Gaurav Gupta, Harjeet Singh, Lakshmi Thangavelu, S. Rajesh Kumar, , Hamid A. Bakshi, Dinesh Kumar Chellappan, ,
Published: 1 August 2019
Chemico-Biological Interactions, Volume 309; doi:10.1016/j.cbi.2019.06.033

The publisher has not yet granted permission to display this abstract.
Nannapat Trisiripanit, Soraya Suntornsawat, Worapan Phonkaew
The ASEAN Journal of Radiology, Volume 20, pp 35-39; doi:10.46475/aseanjr.2019.05

Abstract:
Diffuse interstitial
lung
diseases (ILDs) include more than hundreds of diseases which have different causes or underlying, target groups, signs and symptoms, clinical courses, radiographic appearances, treatments, and prognosis. Among them, idiopathic pulmonary fibrosis (IPF) is the most fatal, with prognosis worse than many
cancers
. After decades of no specific treatment, new
medications
that may help slow the progression of the fibrosis have been introduced and approved in some countries. Similar to corticosteroid, anti-inflammatory and immunosuppressive drugs which are used to treat some ILDs; these antifibrotic
medications
could cause certain side effects. In contrast, the cost of treatment is much higher. To monitor ILDs in terms of incidence, demographic and geographic distributions, and life expectancy; T.S.T. is developing a national ILD database. To ensure that this data base will provide the most accurate information, diagnosis should be as much precise as possible. However, the diagnoses of most ILDs are multidisciplinary. With the facts that
surgical
lung
biopsies are available in patients fewer than 20% in most countries1, HRCT plays important role in showing disease characters and extension. Certain HRCT patterns are accepted to replace
surgical
lung
biopsies (SLB) in some diseases. Unfortunately typical diagnostic HRCT patterns to replace SLB are not possible in all cases; for example, only about half of usual interstitial pneumonia2. Initially, diagnosis could not be made in some cases whose HRCT patterns are not specific and other clinical information is not sufficient. Longitudinal study by following up HRCTs and adding subsequently exhibited clinical data, or even
surgical
lung
biopsy, could eventually establish the diagnosis. These patients need a system that provide regular clinical and HRCT follow up, also the multidisciplinary team to evaluate those newly acquired clinical and radiographic information . As an important role in
managing
patients with ILDs, standard HRCT is required to ensure that the initial examination will provide sufficient radiographic information, both the initial and follow-up examinations could be compared, the interpretation of all examinations is reproducible, and it could be performed in most institutes. To develop national standard HRCT protocol;
current
situation of interstitial
lung
diseases in Thailand,the purpose to develop the protocol, and a probable draft of the standard protocol (made by the committee from RCRT) were presented to a panel consisted of thoracic radiologist experts from all parts of Thailand in a meeting held on 11 January 2019 by Foundation of Orphan and Rare
Lung
Disease (FORD) and Imaging Academic Outreach Center (iAOC). Knowledge sharing, benefits and disadvantages of the drafted protocol were discussed. Adjustment was done based on feasibility, coverage of all
lung
diseases, diagnostic accuracy, and radiation safety. The panel provided a standard protocol describing scan coverage, technique, collimation, rotation time, pitch, radiation dose, and reconstruction images. The standard protocol recommends a mandatory acquisition for the first HRCT and optional or additional ones for the follow-up or particular cases.
V D Palumbo, S Fazzotta, F Fatica, B D'orazio, F P Caronia, M Cajozzo, G Damiano, A Maffongelli, B M Cudia, M Messina, A I Lo Monte
Published: 16 July 2019
The publisher has not yet granted permission to display this abstract.
Mark E. Gray, Paul Sullivan, Jamie R. K. Marland, Stephen N. Greenhalgh, James Meehan, Rachael Gregson, R. Eddie Clutton, Chris Cousens, David J. Griffiths, Alan Murray, David Argyle
Published: 19 June 2019
Frontiers in Oncology, Volume 9; doi:10.3389/fonc.2019.00534

Abstract:
In vitro cell line and in vivo murine models have historically dominated pre-clinical
cancer
research. These models can be expensive and time consuming and lead to only a small percentage of anti-
cancer
drugs gaining a license for human use. Large animal models that reflect human disease have high translational value; these can be used to overcome
current
pre-clinical research limitations through the integration of drug development techniques with
surgical
procedures and anesthetic protocols, along with emerging fields such as implantable
medical
devices. Ovine pulmonary adenocarcinoma (OPA) is a naturally-occurring
lung
cancer
that is caused by the jaagsiekte sheep retrovirus. The disease has similar histological classification and oncogenic pathway activation to that of human
lung
adenocarcinomas making it a valuable model for studying human
lung
cancer
. Developing OPA models to include techniques used in the treatment of human
lung
cancer
would enhance its translational potential, making it an excellent research tool in assessing
cancer
therapeutics. In this study we developed a novel OPA model to validate the ability of miniaturized implantable O2 and pH sensors to monitor the tumor microenvironment. Naturally-occurring pre-clinical OPA cases were obtained through an on-farm ultrasound screening programme. Sensors were implanted into OPA tumors of anesthetized sheep using a CT-guided trans-thoracic percutaneous implantation procedure. This study reports the findings from 9 sheep that received sensor implantations. Time taken from initial CT scans to the placement of a single sensor into an OPA tumor was 45 ± 5 min, with all implantations resulting in the successful delivery of sensors into tumors. Immediate post-implantation mild pneumothoraces occurred in 4 sheep, which was successfully
managed
in all cases. This is, to the best of our knowledge, the first description of the use of naturally-occurring OPA cases as a pre-clinical
surgical
model. Through the integration of techniques used in the treatment of human
lung
cancer
patients, including ultrasound, general anesthesia, CT and surgery into the OPA model, we have demonstrated its translational potential. Although our research was tailored specifically for the implantation of sensors into
lung
tumors, we believe the model could also be developed for other pre-clinical applications.
Principles of Specialty Nursing pp 235-254; doi:10.1007/978-3-319-76457-3_15

The publisher has not yet granted permission to display this abstract.
P Maheshwari, C Moran, M Farman, S Kumar, G Harewood, S Sengupta, D Cheriyan
Published: 18 March 2019
ESGE Days 2019, Volume 51; doi:10.1055/s-0039-1681629

The publisher has not yet granted permission to display this abstract.
Hung-Wen Lai, Chih-Yu Chen, , Chiung-Ying Liao, Chih-Jung Chen, Shou-Tung Chen, Shih-
Lung
Lin, Dar-Ren Chen, Shou-Jen Kuo
Published: 1 January 2019
Formosan Journal of Surgery, Volume 52; doi:10.4103/fjs.fjs_117_18

The publisher has not yet granted permission to display this abstract.
Ni Fan, Sravanthi Lavu, Curtis A. Hanson, Ayalew Tefferi
Published: 29 November 2018
Blood, Volume 132, pp 5457-5457; doi:10.1182/blood-2018-99-112587

The publisher has not yet granted permission to display this abstract.
Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism pp 799-808; doi:10.1002/9781119266594.ch104

The publisher has not yet granted permission to display this abstract.
Marcelo Cunha, Luiza Grosbelli
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery, Volume 37, pp 19-26; doi:10.1055/s-0038-1639588

Abstract:
Objectives To analyze the epidemiological aspects of primary and metastatic tumors of the central nervous system (CNS) among patients operated on by a single surgeon dedicated to neuro-oncology at Hospital Regional do Oeste, in Chapecó (Santa Catarina, Brazil), between 2013 and 2016. Methods Cross-sectional, retrospective, and observational analysis of 347 patients undergoing surgery due to intracranial tumors. The patients' data were obtained from the hospital registry,
medical
records, and pathology reports. Results Primary CNS tumors comprised 72.1% of the sample. There was a predominance of females (52.7%), and the mean age was 49.3 years, with a peak of incidence between the ages of 25 and 64 years. Gliomas were the most common primary brain tumors (23.7%), followed by meningiomas (17.0%).
Lung
cancer
(15.3%), breast
cancer
(4.9%), and melanoma (3.5%) were, in descending order, the most frequent primary sites of metastases, which were recorded in 97 cases (27.9%). Conclusion The lack of standardization in the process of notification of tumor diseases imposes challenges in the establishment of estimates close to the real ones, preventing improvement of public health care policies to protect patients with neuro-oncological conditions. Based on the
current
model, regionalization of the data seems to be the best option in the
management
of this subgroup of patients.
Simon L Greenbaum, Beverly A Thornhill,
Published: 9 January 2018
The American Journal of Orthopedics, Volume 46

The publisher has not yet granted permission to display this abstract.
Benoît Fréchet, , Vicky Thiffault, ,
Journal of Bronchology & Interventional Pulmonology, Volume 25, pp 17-24; doi:10.1097/lbr.0000000000000425

The publisher has not yet granted permission to display this abstract.
Comment
The Journal of Thoracic and Cardiovascular Surgery, Volume 154, pp 1404-1405; doi:10.1016/j.jtcvs.2017.06.045

Abstract:
Alessandro Brunelli, MDView Large Image | View Hi-Res Image | Download PowerPoint SlideCentral MessageThe assessment of quality of care should be comprehensive to be reliable. Traditional clinical indicators must be complemented by measurement of patient perspectives and patient-reported outcomes.See Article page XXX.Quality of care is a complex concept. It is multifaceted and difficult to measure. In addition, physicians, administrators, payers, and patients are focused on different aspects or elements of quality.The article in this issue of the Journal of Brandt and colleagues1 from Memorial Sloan Kettering
Cancer
Center is an excellent review of the most commonly used quality indicators in our specialty. Brandt and colleagues1 covered all 3 domains of the
surgical
practice for
lung
cancer
management
(preoperative, intraoperative, and postoperative care), discussing different indicators of quality, including both processes and outcomes.One of the important messages of this review is the difficulty of finding a comprehensive metric to measure quality in light of the multiple indicators that contribute to it. The European Society of Thoracic Surgeons has recently developed a Composite Performance Score incorporating 3 process indicators and 2 risk-adjusted outcome indicators. The score is based entirely on the data and information present in the European Society of Thoracic Surgeons database.2 This score is just a preliminary and certainly incomplete attempt to generate a comprehensive metric to measure quality, overcoming the inherent limitation of individual end points (mortality and morbidity). There is much work to do in identifying other important and representative indicators and most of all in tailoring the quality assessment to the different health care parties. In particular, there are 2 nonclinical quality indicators needing further research: patient perspectives and costs.In a marketing system, patients should be regarded as consumers when they participate in the shared decision-making process to select the best
management
for their
medical
condition. Satisfaction with care depends on multiple subjective factors and is affected by different socioeconomic and cultural backgrounds. There have been very few attempts to use patient satisfaction scales as a measure of quality in our specialty,3,4 and in my opinion this is an end point that deserves more attention when evaluating provider performance.Residual quality of life after surgery should also be included as a critical end point to assess our practice. Long-term survival in fact cannot be assessed in isolation and without taking into consideration the actual quality of life of the
cancer
survivors. This is most needed as an informational tool to be used in the shared decision-making process.5,6Finally, financial costs of
surgical
care should also be used as a quality indicator. Outcome indicators of cost need clinical risk adjustment. Surgeons should take the lead in stratifying the financial risk by adjusting for case mix and complexity of
surgical
procedures to prevent misleading evaluations by third parties. There have been few studies reporting on financial risk models in our specialty,7,8 and more research is needed in this field.I congratulate Brandt and colleagues1 for this excellent and timely review. It will be an important addition to the
current
scientific literature and will stimulate further research in this field. The assessment of quality of care should be comprehensive to be reliable. Traditional clinical indicators must be complemented by measurement of patient perspectives and patient-reported outcomes. See Article page XXX.
Surgical Case Reports, Volume 3, pp 1-5; doi:10.1186/s40792-017-0368-1

Abstract:
Stereotactic body radiotherapy has been a treatment choice for
lung
cancer
, especially in
medically
inoperable patients. However, the acute and late toxicity to adjacent organs have been reported as an uncommon but severe adverse effect. A 65-year-old male was presented with his back pain and pyrexia. He had been followed up for non-small-cell
lung
cancer
, which was treated by the stereotactic body radiotherapy 4 years prior to the
current
visit. The endoscopy revealed an esophageal perforation on its left side in the upper thoracic locus. Because of his poor
lung
function, he was
managed
by the conservative treatment. After 3 months, his back pain recurred with developing paraplegia in the lower extremities. The MRI revealed an abscess formation at the posterior side of the upper thoracic esophagus which destroyed the vertebral body and compressed the spinal cord. Laminectomy and two-stage operation—the first stage, nontransthoracic esophagectomy, cervical and transhiatal approach using mediastinoscope and laparoscope, and the second stage, esophageal reconstruction—were performed. This complex disease status was successfully
managed
by the orthopedic surgery followed by a two-stage esophagectomy without transthoracic approach.
, Kevin N. Franks, Alessandro Brunelli, Yusuf S. Hussain, , Matthew E. Callister, , Kostas Papagiannopoulos, Galina Velikova
Journal of Thoracic Disease, Volume 9, pp 2703-2713; doi:10.21037/jtd.2017.07.35

The publisher has not yet granted permission to display this abstract.
Surgical Oncology Clinics of North America, Volume 26; doi:10.1016/j.soc.2017.04.001

The publisher has not yet granted permission to display this abstract.
Published: 1 July 2017
Mayo Clinic Proceedings, Volume 92, pp 1015-1018; doi:10.1016/j.mayocp.2017.05.024

The publisher has not yet granted permission to display this abstract.
International Journal of Molecular Sciences, Volume 18; doi:10.3390/ijms18061130

Abstract:
A major
current
challenge in the treatment of advanced prostate
cancer
, which can be initially controlled by
medical
or
surgical
castration, is the development of effective, safe, and affordable therapies against progression of the disease to the stage of castration resistance. Here, we showed that in LNCaP and 22Rv1 prostate
cancer
cells transiently overexpressing androgen receptor splice variant-7 (AR-V7), nuclear factor-kappa B (NF-κB) was activated and could result in up-regulated interleukin (IL)-6 gene expression, indicating a positive interaction between AR-V7 expression and activated NF-κB/IL-6 signaling in castration-resistant prostate
cancer
(CRPC) pathogenesis. Importantly, both AR-V7-induced NF-κB activation and IL-6 gene transcription in LNCaP and 22Rv1 cells could be inhibited by melatonin. Furthermore, stimulation of AR-V7 mRNA expression in LNCaP cells by betulinic acid, a pharmacological NF-κB activator, was reduced by melatonin treatment. Our data support the presence of bi-directional positive interactions between AR-V7 expression and NF-κB activation in CRPC pathogenesis. Of note, melatonin, by inhibiting NF-κB activation via the previously-reported MT1 receptor-mediated antiproliferative pathway, can disrupt these bi-directional positive interactions between AR-V7 and NF-κB and thereby delay the development of castration resistance in advanced prostate
cancer
. Apparently, this therapeutic potential of melatonin in advanced prostate
cancer
/CRPC
management
is worth translation in the clinic via combined androgen depletion and melatonin repletion.
New version
, Katharine See, Stephen Barnett, Renée Manser
Published: 21 April 2017
by Wiley
Cochrane Database of Systematic Reviews, Volume 4; doi:10.1002/14651858.cd011917.pub2

The publisher has not yet granted permission to display this abstract.
A Goel, Sh Shah, Vpp Selvakumar, S Garg, K Siddiqui, K Kumar
Published: 1 January 2017
Indian Journal of Cancer, Volume 54; doi:10.4103/0019-509x.219569

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Annals of Surgery, Volume 264; doi:10.1097/01.sla.0000508571.94143.74

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Therapeutic Advances in Medical Oncology, Volume 9, pp 189-199; doi:10.1177/1758834016678149

Abstract:
Neuroendocrine tumors (NETs) are rare neoplasms that can arise from any tissue. They are classified based on embryonic gut derivative (i.e. foregut, midgut and hindgut) with midgut tumors being the most common (e.g. gastrointestinal NET). The second most common category of NETs is that which arises from the
lung
. In fact, 25% of primary
lung
cancers
are NETs, including small cell
lung
cancer
(SCLC), which comprises 20% of all
lung
cancers
. The remaining 5% are large cell neuroendocrine
cancer
(LCNEC, 3%), typical carcinoids (TCs, 1.8%), and atypical carcinoids (ACs, 0.2%). The less common TCs/ACs are well differentiated
lung
NETs. Their incidence has been increasing in more recent years and although these tumors are slow growing, advanced disease is associated with poor survival. There have been advances in classification of
lung
NETs that have allowed for more appropriate
management
upfront. They are cured by
surgical
resection when disease is limited. However, advanced and metastatic disease requires
medical
therapy that is ever changing and expanding. In this review, the aim is to summarize the
current
understanding and classification of well differentiated
lung
NETs (i.e. TCs and ACs), and focus on recent updates in
medical
management
of advanced disease, along with a brief discussion on potential future discoveries.
Steven Dubinett,
Seminars in Respiratory and Critical Care Medicine, Volume 37, pp 647-648; doi:10.1055/s-0036-1592297

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New version
, Alina Andras, Karen Welch, Karen Sheares, , Francesca M Chappell
Published: 5 August 2016
by Wiley
Cochrane Database of Systematic Reviews, Volume 2016; doi:10.1002/14651858.cd010864.pub2

Abstract:
Pulmonary embolism (PE) can occur when a thrombus (blood clot) travels through the veins and lodges in the arteries of the
lungs
, producing an obstruction. People who are thought to be at risk include those with
cancer
, people who have had a recent
surgical
procedure or have experienced long periods of immobilisation and women who are pregnant. The clinical presentation can vary, but unexplained respiratory symptoms such as difficulty breathing, chest pain and an increased respiratory rate are common. D-dimers are fragments of protein released into the circulation when a blood clot breaks down as a result of normal body processes or with use of prescribed fibrinolytic
medication
. The D-dimer test is a laboratory assay
currently
used to rule out the presence of high D-dimer plasma levels and, by association, venous thromboembolism (VTE). D-dimer tests are rapid, simple and inexpensive and can prevent the high costs associated with expensive diagnostic tests. To investigate the ability of the D-dimer test to rule out a diagnosis of acute PE in patients treated in hospital outpatient and accident and emergency (A&E) settings who have had a pre-test probability (PTP) of PE determined according to a clinical prediction rule (CPR), by estimating the accuracy of the test according to estimates of sensitivity and specificity. The review focuses on those patients who are not already established on anticoagulation at the time of study recruitment. We searched 13 databases from conception until December 2013. We cross-checked the reference lists of relevant studies. Two review authors independently applied exclusion criteria to full papers and resolved disagreements by discussion. We included cross-sectional studies of D-dimer in which ventilation/perfusion (V/Q) scintigraphy, computerised tomography pulmonary angiography (CTPA), selective pulmonary angiography and magnetic resonance pulmonary angiography (MRPA) were used as the reference standard. • Participants: Adults who were
managed
in hospital outpatient and A&E settings and were suspected of acute PE were eligible for inclusion in the review if they had received a pre-test probability score based on a CPR. • Index tests: quantitative, semi quantitative and qualitative D-dimer tests. • Target condition: acute symptomatic PE. • Reference standards: We included studies that used pulmonary angiography, V/Q scintigraphy, CTPA and MRPA as reference standard tests. Two review authors independently extracted data and assessed quality using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). We resolved disagreements by discussion. Review authors extracted patient-level data when available to populate 2 × 2 contingency tables (true-positives (TPs), true-negatives (TNs), false-positives (FPs) and false-negatives (FNs)). We included four studies in the review (n = 1585 patients). None of the studies were at high risk of bias in any of the QUADAS-2 domains, but some uncertainty surrounded the validity of studies in some domains for which the risk of bias was uncertain. D-dimer assays demonstrated high sensitivity in all four studies, but with high levels of false-positive results, especially among those over the age of 65 years. Estimates of sensitivity ranged from 80% to 100%, and estimates of specificity from 23% to 63%. A negative D-dimer test is valuable in ruling out PE in patients who present to the A&E setting with a low PTP. Evidence from one study suggests that this test may have less utility in older populations, but no empirical evidence was available to support an increase in the diagnostic threshold of interpretation of D-dimer results for those over the age of 65 years.
Published: 1 June 2016
Lung Cancer Management, Volume 5, pp 61-78; doi:10.2217/lmt-2016-0001

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, , Jonathan Tan, Aye Sandar Zaw
Published: 1 April 2016
Global Spine Journal, Volume 6; doi:10.1055/s-0036-1583161

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Hung-Wen Lai, Shou-Tung Chen, Dar-Ren Chen, Shu-Ling Chen, Tsai-Wang Chang, Shou-Jen Kuo, ,
Published: 7 March 2016
PLoS ONE, Volume 11; doi:10.1371/journal.pone.0150310

Abstract:
Endoscopy-assisted breast surgery (EABS) performed through minimal axillary and/or periareolar incisions is a possible alternative to open surgery for certain patients with breast
cancer
. In this study, we report the early results of an EABS program in Taiwan. The
medical
records of patients who underwent EABS for breast
cancer
during the period May 2009 to December 2014 were collected from the Taiwan Endoscopic Breast Surgery Cooperative Group database. Data on clinicopathologic characteristics, type of surgery, method of breast reconstruction, complications and recurrence were analyzed to determine the effectiveness and oncologic safety of EABS in Taiwan. A total of 315 EABS procedures were performed in 292 patients with breast
cancer
, including 23 (7.8%) patients with bilateral disease. The number of breast
cancer
patients who underwent EABS increased initially from 2009 to 2012 and then stabilized during the period 2012–2014. The most commonly performed EABS was endoscopy-assisted total mastectomy (EATM) (85.4%) followed by endoscopy-assisted partial mastectomy (EAPM) (14.6%). Approximately 74% of the EATM procedures involved breast reconstruction, with the most common types of reconstruction being implant insertion and autologous pedicled TRAM flap surgery. During the six-year study period, there was an increasing trend in the performance of EABS for the
management
of breast
cancer
when total mastectomy was indicated. The positive
surgical
margin rate was 1.9%. Overall, the rate of complications associated with EABS was 15.2% and all were minor and wound-related. During a median follow-up of 26.8 (3.3–68.6) months, there were 3 (1%) cases of local recurrence, 1 (0.3%) case of distant metastasis and 1 (0.3%) death. The preliminary results from the EABS program in Taiwan show that EABS is a safe procedure and results in acceptable cosmetic outcome. These findings could help to promote this under-used
surgical
technique in the field of breast
cancer
.
Nestor F. Esnaola, Debbie C. Bryant, Kathleen B. Cartmell, Elizabeth Calhoun, Katherine Sterba, Dana R. Burshell, Elizabeth G. Hill, Amy E. Wahlquist, Kendrea D. Knight, Marvella E. Ford
Health Economics, Outcomes, and Policy Research, Volume 25; doi:10.1158/1538-7755.disp15-c45

The publisher has not yet granted permission to display this abstract.
Marla Lipsyc,
Journal of Gastrointestinal Oncology, Volume 6, pp 645-649; doi:10.3978/j.issn.2078-6891.2015.045

Abstract:
Somatic mutation status in metastatic colorectal
cancer
(mCRC) is becoming increasingly clinically relevant as it may be correlated not only with response to biologic therapies, but also with site-specific pattern of metastatic spread and outcome. In this review, we describe our
current
understanding of associations between mutational activation of the KRAS, BRAF, PIK3CA, and NRAS oncogenes and clinical outcomes and metastatic patterns of mCRC. The presence of a KRAS mutation is associated with a distinct pattern of metastatic spread with decreased liver metastases and increased
lung
, brain, and bone metastases. In patients who undergo resection of colorectal liver metastases (CLM) with curative intent, KRAS mutation is associated increased risk of recurrence, worse survival, and increased recurrence outside of the liver, particularly in the
lung
, but also in the brain and bone. BRAF mutation, a poor prognostic factor in mCRC, is associated with decreased liver-limited metastasis and increased peritoneal and distant lymph node metastases. PIK3CA mutation does not clearly affect outcomes in the metastatic setting, but is associated with concurrent KRAS mutations, and has been associated with an increased incidence of
lung
and brain metastases, metastatic sites preferentially involved in KRAS mutant mCRC. NRAS mutation may confer worse survival and early studies suggest NRAS mutation may promote tumorigenesis in the setting of colorectal inflammation. As metastasectomy with curative intent is increasingly considered in patients with mCRC, understanding patterns of metastasis associated with tumor mutations may help focus
medical
treatment,
surgical
management
, and surveillance in patients with mCRC.
, Jean Baptiste Chadeyras, , Marie M Tardy, , Patrick Bailly,
Published: 1 December 2015
Chinese Clinical Oncology, Volume 4; doi:10.3978/j.issn.2304-3865.2015.06.08

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Abhishek Agarwal, , Karim Nathan, Vinay Palli, Deborah Park, Erin Jepsen
Published: 1 October 2015
Chest, Volume 148, pp 540A-540A; doi:10.1378/chest.2278839

The publisher has not yet granted permission to display this abstract.
Lucile Gust, Alexis Toullec, Charlotte Benoit, René Farcy, Stéphane Garcia, Veronique Secq, Jean-Yves Gaubert, Delphine Trousse, Bastien Orsini, Christophe Doddoli, Helene Moniz-Koum, Pascal Alexandre Thomas,
Published: 5 August 2015
PLoS ONE, Volume 10; doi:10.1371/journal.pone.0134559

Abstract:
Pre-therapeutic pathological diagnosis is a crucial step of the
management
of pulmonary nodules suspected of being non small cell
lung
cancer
(NSCLC), especially in the frame of
currently
implemented
lung
cancer
screening programs in high-risk patients. Based on a human ex vivo model, we hypothesized that an embedded device measuring endogenous fluorescence would be able to distinguish pulmonary malignant lesions from the perilesional
lung
tissue. Consecutive patients who underwent
surgical
resection of pulmonary lesions were included in this prospective and observational study over an 8-month period. Measurements were performed back table on
surgical
specimens in the operative room, both on suspicious lesions and the perilesional healthy parenchyma. Endogenous fluorescence signal was characterized according to three criteria: maximal intensity (Imax), wavelength, and shape of the signal (missing, stable, instable, photobleaching). Ninety-six patients with 111 suspicious lesions were included. Final pathological diagnoses were: primary
lung
cancers
(n = 60),
lung
metastases of extra-thoracic malignancies (n = 27) and non-tumoral lesions (n = 24). Mean Imax was significantly higher in NSCLC targeted lesions when compared to the perilesional
lung
parenchyma (p<0,0001) or non-tumoral lesions (p<0,0001). Similarly, photobleaching was more frequently found in NSCLC than in perilesional
lung
(p<0,0001), or in non-tumoral lesions (p<0,001). Respective associated wavelengths were not statistically different between perilesional
lung
and either primary
lung
cancers
or non-tumoral lesions. Considering
lung
metastases, both mean Imax and wavelength of the targeted lesions were not different from those of the perilesional
lung
tissue. In contrast, photobleaching was significantly more frequently observed in the targeted lesions than in the perilesional
lung
(p≤0,01). Our results demonstrate that endogenous fluorescence applied to the diagnosis of
lung
nodules allows distinguishing NSCLC from the surrounding healthy parenchyma and from non-tumoral lesions. Inconclusive results were found for
lung
metastases due to the heterogeneity of this population.
, Meinoshin Okumura, Shunsuke Endo, , Hiroyasu Yokomise, Munetaka Masuda
General Thoracic and Cardiovascular Surgery, Volume 63, pp 279-283; doi:10.1007/s11748-015-0524-0

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