Lung SBRT guideline 2017.pdf

ABSTRACTObjectives For this guideline, we investigated the effectiveness of radiotherapy with curative intent in medicallyinoperable patients with early-stage non-small-cell lung cancer (nsclc).Methods The guideline was developed by Cancer Care Ontario’s Program in Evidence-Based Care and by theLung Cancer Disease Site Group through a systematic review of mainly retrospective studies, expert consensus, andformal internal and external reviews.Recommendations■■ Stereotactic body radiation therapy (sbrt) with curative intent is an option that should be considered for patientswith early-stage, node-negative, medically inoperable nsclc.Qualifying Statements■■ Because of the high dose per fraction, the planning process and treatment delivery for sbrt require theuse of advanced technology to maintain an appropriate level of safety. Consistent patient positioning and4-dimensional analysis of tumour and critical structure motion during simulation and treatment deliveryare essential.■■ Preliminary results for proton-beam therapy have been promising, but the technique requires furtherclinical study.■■ Recommended fractionation schemes for sbrt should result in a biologically effective dose of 100 or greater bythe linear quadric model, choosing an α/β value of 10 [bed10(LQ) ≥ 100].Qualifying Statements■■ Because of the increased risk of treatment-related adverse events associated with centrally located tumours,consideration of tumour size and proximity to critical central structures is required when determining thedose and fractionation.■■ Examples of dose–fractionation schemes used in the included studies have been provided.■■ Based on the current evidence and the opinion of the authors, radiation doses at bed10(LQ) greater than 146might significantly increase toxicity and should be avoided.■■ Determination of the radiation bed by the linear quadratic model has limitations for the extreme hypofractionatedschemes used in sbrt

The Management of Thymoma: A Systematic Review and Practice Guideline

INTRODUCTION: Thymoma is a rare tumor for which there is little randomized evidence to guide treatment. Because of the lack of high-quality evidence, a formal consensus-based approach was used to develop recommendations on treatment. METHODS: A systematic refview of the literature was performed. Recommendations were formed from available evidence and developed through a two-round modified Delphi consensus approach. RESULTS: The treatment recommendations are summarized as follows: Stage I--complete resection of the entire thymus without neoadjuvant or adjuvant therapy. Stage II--complete resection of the entire thymus with consideration of adjuvant radiation for high-risk tumors. Stage IIIA--surgery either initially or after neoadjuvant therapy, or surgery followed by adjuvant therapy. Stage IIIB--treatment may include a combination of chemotherapy, radiation, and/or surgery, or if technically possible, surgery in combination with chemoradiotherapy (concurrent cisplatin based). For bulky tumors, consideration should be given to sequential chemotherapy followed by radiation. Stage IVA--as per stage III, with surgery only if metastases can be resected. Stage IVB--treatment on an individual case basis (no generic recommendations). Recurrent disease--consider surgery, radiation, and/or chemoradiation. Chemoradiation should be considered in all medically inoperable and technically inoperable patients. CONCLUSION: Consensus was achieved on these recommendations, which serve to provide practical guidance to the physician treating this rare disease

The Management of Thymoma: A Systematic Review and Practice Guideline

INTRODUCTION: Thymoma is a rare tumor for which there is little randomized evidence to guide treatment. Because of the lack of high-quality evidence, a formal consensus-based approach was used to develop recommendations on treatment. METHODS: A systematic refview of the literature was performed. Recommendations were formed from available evidence and developed through a two-round modified Delphi consensus approach. RESULTS: The treatment recommendations are summarized as follows: Stage I--complete resection of the entire thymus without neoadjuvant or adjuvant therapy. Stage II--complete resection of the entire thymus with consideration of adjuvant radiation for high-risk tumors. Stage IIIA--surgery either initially or after neoadjuvant therapy, or surgery followed by adjuvant therapy. Stage IIIB--treatment may include a combination of chemotherapy, radiation, and/or surgery, or if technically possible, surgery in combination with chemoradiotherapy (concurrent cisplatin based). For bulky tumors, consideration should be given to sequential chemotherapy followed by radiation. Stage IVA--as per stage III, with surgery only if metastases can be resected. Stage IVB--treatment on an individual case basis (no generic recommendations). Recurrent disease--consider surgery, radiation, and/or chemoradiation. Chemoradiation should be considered in all medically inoperable and technically inoperable patients. CONCLUSION: Consensus was achieved on these recommendations, which serve to provide practical guidance to the physician treating this rare disease

The International Association for the Study of Lung Cancer Thymic Epithelial Tumors Staging Project: An Overview of the Central Database Informing Revision of the Forthcoming (Ninth) Edition of the TNM Classification of Malignant Tumors

International audienceIntroduction: In 2014, a TNM-based system for thymic epithelial tumors was proposed. The TNM stage classification system was published as a result of a joint project from the International Association for the Study of Lung Cancer and the International Thymic Malignancy Interest Group for the eighth edition of the American Joint Commission on Cancer and the Union for International Cancer Control stage classification system. The Thymic Domain of the Staging and Prognostic Factors Committee of the International Association for the Study of Lung Cancer received the mandate to make proposals for the ninth edition of the TNM stage classification. Methods: A central thymic database was collected by the Cancer Research And Biostatistics with the contribution of the major thymic associations in the world. Results: A total of 11,347 patients were collected. Submitting organizations were the following: Japanese Association for Research in the Thymus, European Society of Thoracic Surgeons, Chinese Alliance for Research in Thymoma, Korean Association for Research in the Thymus, International Thymic Malignancy Interest Group, and Réseau tumeurs THYMiques et Cancer. Additional contributions came from centers in the United States, United Kingdom, Turkey, Australia, Spain, and Italy. A total of 9147 cases were eligible for analysis. Eligible cases for analysis came from Asia and Australia (5628 cases, 61.5%), Europe (3113 cases, 34.0%), and North America (406 cases, 4.4%). Conclusions: This report provides an overview of the database that has informed the proposals for the updated T, N, and M components and the stage groups for the ninth TNM of malignant tumors

The IASLC Thymic Epithelial Tumors Staging Project: unresolved issues to be addressed for the next 9th edition of the TNM classification of malignant tumors

: Thymic epithelial tumors are presently staged using a consistent tumor, node and metastasis (TNM) classification developed by the International Association for the Study of Lung Cancer (IASLC) and approved by the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC). The stage classification is incorporated in the 8th edition of the TNM classification of thoracic malignancies. The IASLC Staging and Prognostic Factors Committee (SPFC) - Thymic Domain is in charge for the next (9th) edition expected in 2024. The present paper represents the mid-term report of the SPFC Thymic Domain: in particular, it describes the unresolved issues identified by the group in the current stage classification which are worth being addressed and discussed for the 9th edition of the TNM classification based on the available data collected in the central thymic database which will be managed and analyzed by Cancer Research And Biostatistics (CRAB). These issues are grouped into issues of general importance, and those specifically related to T, N, and M categories. Each issue is described in reference to the most recent reports on the subject, and the priority assigned by the IASLC SPFC-Thymic Domain for the discussion of the 9th edition is provided

The International Association for the Study of Lung Cancer Thymic Epithelial Tumor Staging Project: Proposal for the T Component for the Forthcoming (Ninth) Edition of the TNM Classification of Malignant Tumors

International audienceIntroduction: A TNM-based stage classification system of thymic epithelial tumors was adopted for the eighth edition of the stage classification of malignant tumors. The Thymic Domain of the Staging and Prognostics Factor Committee of the International Association for the Study of Lung Cancer developed a new database with the purpose to make proposals for the ninth edition stage classification system. This article outlines the proposed definitions for the T categories for the ninth edition TNM stage classification of thymic malignancies. Methods: A worldwide collective database of 11,347 patients with thymic epithelial tumors was assembled. Analysis was performed on 9147 patients with available survival data. Overall survival, freedom-from-recurrence, and cumulative incidence of recurrence were used as outcome measures. Analysis was performed separately for thymomas, thymic carcinomas, and neuroendocrine thymic tumors. Results: Proposals for the T categories include the following: T1 category is divided into T1a (≤5 cm) and T1b (>5 cm), irrespective of mediastinal pleura invasion; T2 includes direct invasion of the pericardium, lung, or phrenic nerve; T3 denotes direct invasion of the brachiocephalic vein, superior vena cava, chest wall, or extrapericardial pulmonary arteries and veins; and T4 category remains the same as in the eighth edition classification, involving direct invasion of the aorta and arch vessels, intrapericardial pulmonary arteries and veins, myocardium, trachea, or esophagus. Conclusions: The proposed T categories for the ninth edition of the TNM classification provide good discrimination in outcome for the T component of the TNM-based stage system of thymic epithelial tumors