Diagnosis and predictive molecular analysis of non-small cell lung cancer in the Africa-Middle East region : challenges and strategies for improvement

The identification of tumor biomarkers provides information on the prognosis and guides the implementation of appropriate treatment in patients with many different cancer types. In nonesmall cell lung cancer (NSCLC), targeted treatment plans based on biomarker identification have already been used in the clinic. However, such predictive molecular testing is not currently a universally used practice. This is the case, in particular, in developing countries where lung cancer is increasingly prevalent. In September 2012 and November 2013, a committee of 16 lung cancer experts from Africa and the Middle East met to discuss key issues related to diagnosis and biomarker testing in NSCLC and the implementation of personalized medicine in the region. The committee identified current challenges for effective diagnosis and predictive analysis in Africa and the Middle East. Moreover, strategies to encourage the implementation of biomarker testing were discussed. A practical approach for the effective diagnosis and predictive molecular testing of NSCLC in these regions was derived. We present the key issues and recommendations arising from the meetings.Pfizer Inc.http://www.journals.elsevier.com/clinical-lung-cancer/hb201

Interventional oncology: A snapshot of expanding practice

Interventional oncology (IO) was a minor part of interventional radiology. However, with the development of novel technologies and introduction of innovative therapeutics with dramatic transformations in the practice of oncology, IO is facing challenges in adopting and responding to these new changes to maintain its integral role and maximize its potentials in the efficient management of patients with cancer. In this snapshot, some of the novel therapeutic approach principles relevant to IO practice will be explained briefly

Demystifying CyberKnife Stereotactic Body Radiation Therapy for Interventional Radiologists

Stereotactic body radiation therapy (SBRT) using CyberKnife system is a relatively new radiation therapy that has demonstrated feasibility, safety, and efficacy with a high local control of various extracranial unresectable primary cancer and oligometastasis. It involves accurate delivery of very high dose of radiation to the target or tumor volume with high precision and conformity, while minimizing the radiation exposure of nontargeted tissue. Radiopaque fiducial markers (FMs) implantation in and around the tumors is required to track the selected tumor during CyberKnife SBRT, especially in those organs moving with respiration. They act as internal radiographic landmarks that maintain a fixed relationship within the tumor and with each other. Although their implantation can be technically demanding, it can be performed using various techniques with varying success; however, percutaneous implantation under image guidance by interventional radiologists is the most common method. Close collaboration between interventional radiologists and radiation oncologists with understanding of the technical aspects of CyberKnife SBRT and FMs implantation has important implications for optimal delivery of therapy and direct impact on the interventional radiology practice in selected patients proposed for CyberKnife SBRT

Image-guided percutaneous transthoracic biopsy in lung cancer – Emphasis on CT-guided technique

Summary: Image-guided percutaneous transthoracic core biopsy especially with CT guidance is playing an increasing role in the diagnosis and management of lung cancer. The recent advances in the specific chemotherapy and novel targeted therapy and the increasing need for specific diagnosis of tumor histopathologic subtypes have direct impact on the radiologists performing lung biopsy and important implications for the biopsy technique. Close cooperation between radiologists and referring physicians with understanding of the technical aspects of the biopsy procedure can help clinicians make appropriate referrals for this procedure and understand the significance and limitations of the results. Additionally, the appropriate management of complications can limit morbidity related to the biopsy procedure. Keywords: Lung biopsy, Lung cancer, Computed tomograph

Guidelines for multimodality radiological staging of lung cancer

Summary: Lung cancer is among the most common type of cancers and is a leading cause of cancer-related deaths with smoking representing the leading risk factor.It is classified into non-small cell lung cancer (NSCLC) representing 70–80% of cases and small cell lung cancer (SCLC) which has neuroendocrine properties with poor outcome.Staging of NSCLC is based on the TNM classification system while SCLC was usually classified into limited and extensive disease, though the use of TNM staging system for SCLC is recommended.Imaging studies are used to determine the pre-operative staging of lung cancer. Accurate radiological staging is essential to determine tumor resectability as well as to avoid futile surgeries and to assess patient's outcome. Moreover, radiological examinations are used for the evaluation of tumor response to treatment.This manuscript will review the utilization of imaging studies in the management of lung cancer based on the most recent guidelines by the National Comprehensive Cancer Network (NCCN). Keywords: Lung Cancer, Staging, Guideline

Transarterial therapy: An evolving treatment modality of hepatocellular carcinoma

Liver cancer is the fifth most common cancer in men, the seventh most common in women, and the third most common cause of death from cancer worldwide. Only 30-40% of liver cancer patients present early enough to undergo curative treatments such as surgery or liver transplantation. Local treatment with radiofrequency ablation or ethanol injection is often reserved for non-surgical candidates with early stages of disease. Transarterial embolization has become a widely accepted treatment for asymptomatic patients with unresectable lesions. This review discusses in details the three major forms of transarterial therapies: Bland embolization, chemoembolization, and radioembolization