Treatment of stage IV non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American college of chest physicians evidence-based clinical practice guidelines

Stage IV non-small cell lung cancer (NSCLC) is a treatable, but not curable, clinical entity in patients given the diagnosis at a time when their performance status (PS) remains good

Intensity modulated radiotherapy for inoperable, locally-advanced non-small cell lung cancer : development and clinical outcomes at a cancer centre in Eastern India

Background The submitted publications outline the sequential steps taken for clinical implementation of intensity modulated radiotherapy (IMRT) for lung cancer at a cancer centre in Eastern India. A literature review combined with a detailed risk assessment for IMRT in lung cancer guided the careful implementation for cases where three-dimensional conformal radiotherapy (3D-CRT) did not generate a safe radiotherapy (RT) plan with acceptable tumour coverage. With growing experience, IMRT was expanded to patients receiving concurrent chemoradiation (CCRT) and accelerated RT, including continuous hyperfractionated accelerated radiotherapy (CHART) as well as moderately hypofractionated accelerated radiotherapy. Survival outcomes from radical radiotherapy and chemoradiation (both sequential and concurrent) were audited and found to be comparable to contemporary published literature. In patients with large volume (>500ml) disease, IMRT resulted in non-inferior outcomes despite treating larger volumes and more advanced stage disease. A predictive model that estimates the probability that IMRT would be necessary to produce an acceptable and safe RT plan, was developed from the planning data of 202 patients. Methods An external prospective study was designed to validate this data-driven, decision aid in cohort of patients from multiple hospitals. Apart from assessing the accuracy of the developed predictive model, we are hoping to quantify the planning time saved by opting for IMRT without attempting a 3D-CRT plan. Updated systematic review of prospective studies was carried out to assess the efficacy and safety of IMRT for locally-advanced NSCLC. 9 Results and conclusion No direct impact of IMRT or volumetric modulated arc therapy (VMAT) was seen on local control and survival for these patients, on updated systematic review. IMRT and VMAT was shown to be feasible and safe in the treated patient population. IMRT makes curative treatment possible for large-volume or complex-shaped, locally-advanced NSCLC, resulting non-inferior survival outcomes

The role of organisational and resource factors in determining lung cancer outcomes

Lung cancer outcomes in the UK show significant variation which are not entirely explained by case mix. Differences in access to lung cancer services contribute. However, the specific factors that underlie the relationship between service organisation and disease outcomes are not known. The systematic review highlights that co-ordinated access to specialist care is likely to be an important determinant of patient outcomes. In addition, a bundle of service factors, rather than an individual factor is a more robust proxy for hospital infrastructure quality. This hypothesis is explored through the creation of a novel organisational score. When adjusted for patient factors a higher score is associated with higher curative intent treatment rates, increased likelihood of patients receiving treatment within 62 days and improved one-year survival. To achieve these improved outcomes national variation in the provision of services and workforce as well as gaps in the optimal care of stage III patients in England need to be addressed. As well as aligning units with national commissioning guidance, qualitative work into decision making suggests that clinician preconceptions and nihilistic attitudes also require consideration. This work shows that inequity in access to essential services exists in the UK and this has a direct impact on patients

Ovarian Cancer

"Ovarian Cancer: A Clinical and Translational Update" embraces the most recent advances in diagnosis and treatment of ovarian cancer. With the valuable collaboration of international experts in the field, this book is intended to provide the readership with a comprehensive update in the subject of epithelial ovarian cancer

Diagnostic Significance of Exosomal miRNAs in the Plasma of Breast Cancer Patients

Poster Session AbstractsBackground and Aims: Emerging evidence that microRNAs (miRNAs) play an important role in cancer development has opened up new opportunities for cancer diagnosis. Recent studies demonstrated that released exosomes which contain a subset of both cellular mRNA and miRNA could be a useful source of biomarkers for cancer detection. Here, we aim to develop a novel biomarker for breast cancer diagnosis using exosomal miRNAs in plasma. Methods: We have developed a rapid and novel isolation protocol to enrich tumor-associated exosomes from plasma samples by capturing tumor specific surface markers containing exosomes. After enrichment, we performed miRNA profiling on four sample sets; (1) Ep-CAM marker enriched plasma exosomes of breast cancer patients; (2) breast tumors of the same patients; (3) adjacent non-cancerous tissues of the same patients; (4) Ep-CAM marker enriched plasma exosomes of normal control subjects. Profiling is performed using PCR-based array with human microRNA panels that contain more than 700 miRNAs. Results: Our profiling data showed that 15 miRNAs are concordantly up-regulated and 13 miRNAs are concordantly down-regulated in both plasma exosomes and corresponding tumors. These account for 25% (up-regulation) and 15% (down-regulation) of all miRNAs detectable in plasma exosomes. Our findings demonstrate that miRNA profile in EpCAM-enriched plasma exosomes from breast cancer patients exhibit certain similar pattern to that in the corresponding tumors. Based on our profiling results, plasma signatures that differentiated breast cancer from control are generated and some of the well-known breast cancer related miRNAs such as miR-10b, miR-21, miR-155 and miR-145 are included in our panel list. The putative miRNA biomarkers are validated on plasma samples from an independent cohort from more than 100 cancer patients. Further validation of the selected markers is likely to offer an accurate, noninvasive and specific diagnostic assay for breast cancer. Conclusions: These results suggest that exosomal miRNAs in plasma may be a novel biomarker for breast cancer diagnosis.link_to_OA_fulltex