Abstract Aims Lung metastasectomy and, more recently, stereotactic body radiotherapy (SBRT), are frequently proposed to stage IV oligometastatic colorectal cancer (CRC) patients. In the absence of a ...randomised comparison between the two treatments, we aimed to retrospectively explore the effect on overall survival and progression-free survival (PFS) in a comparative cohort study. Materials and methods We included patients who consecutively underwent surgery ( n = 142) or SBRT ( n = 28) as first local therapy at the time of lung progression, between 2005 and 2012. Both overall survival and PFS functions according to treatment were calculated using the Kaplan–Meier method and compared using the Log-rank test. The effect of treatment on overall survival and PFS was estimated by Cox models using different adjustment methods. Results Patients receiving SBRT were older and were treated more recently, whereas the two cohorts were similar for most baseline prognostic factors. Overall survival at 1 and 2 years was 0.89 and 0.77 for SBRT and 0.96 and 0.82 for surgery ( P = 0.134), respectively. Multivariable analyses did not highlight a clear treatment effect on overall survival (adjusted hazard ratioSBRT versus surgery = 1.71; 95% confidence interval 0.82–3.54; P = 0.149) and even smaller differences using the inverse probability treatment weighting method (hazard ratioSBRT versus surgery = 1.28, 95% confidence interval 0.58–2.82; P = 0.547). The results of PFS were unreliable because different follow-up protocols were applied in the two cohorts. Conclusion With limitations consisting in the retrospective observational design and different sample sizes, the results of this explorative analysis indicate that overall survival probability after SBRT is similar to surgery for the first 2 years from treatment. This finding supports the need for high-quality trials comparing different treatment modalities for lung oligometastases from CRC.
OBJECTIVES
In thymomas, the roles of Masaoka-Koga stage, histology and the presence of myasthenia gravis (MG) have been considered fundamental for patient management and outcomes. In this study, we ...retrospectively evaluated several clinical variables, with the aim of outlining their relationships and clinical/prognostic significance in resected thymoma patients.
METHODS
A retrospective search of our surgical database for patients operated on for thymoma in six Italian high-volume thoracic surgery centres between 2000 and 2011 was conducted. The following clinical variables were evaluated: Masaoka-Koga Stage, tumour histology, the presence of MG, other autoimmune syndromes or second tumours, the completeness of tumour resection and the development of recurrences.
RESULTS
Five hundred and thirty-seven (273 males—51%) were retrospectively included in this study. Our results indicate that: (i) MG correlates with early Masaoka-Koga stage and B-type thymoma; (ii) Stage III–IVa tumours correlate with B-type tumour; (iii) autoimmune paraneoplastic syndromes correlate with Stage I–II thymoma; (iv) second malignancies correlate with the absence of paraneoplastic disorders and weakly with B-type tumour and (v) overall survival was influenced by Masaoka-Koga stage and completeness of surgical resection.
CONCLUSIONS
In thymomas, Masaoka-Koga stage, histology, MG, other autoimmune syndromes and second malignancies are inter-related, but only Masaoka-Koga tumour stage, amid these clinical variables, has been demonstrated to be a strong prognostic indicator of survival.
At present, the interrelation of people, countries and cultures is undeniable. The advances in communications, the greater facility in the transfer of people, merchandise and capital; but also the ...supranational institutional advances resulting from globalization have generated phenomena rarely seen before and that require new tools for their analysis. Our intention in bringing together the different contributions was to offer a range of issues and problems that do not exhaust the increasingly broad and complex agenda of problems arising from migratory groups. But we believe that the quality and diversity of the works presented here undoubtedly constitute a valuable contribution to the production of knowledge and the scientific debate about the construction of citizenship in a global world.
The Italian Association of Medical Oncology recommendations on thymic epithelial tumors, which have been drawn up for the first time in 2020 through an evidence-based approach, report indications on ...all the main aspects of clinical management of this group of rare diseases, from diagnosis and staging, to new available systemic treatments, such as targeted therapies and immunotherapies. A summary of key recommendations is presented here and complete recommendations are reported as Supplementary Materials, available at https://doi.org/10.1016/j.esmoop.2021.100188.
•Thymic epithelial tumors (TETs).•Multidisciplinary management of patients with TETs.•Rare cancers.•Updated recommendations.
Abstract Aims To assess the role of surgery in the diagnosis and treatment of a solitary pulmonary nodule (SPN) in patients who had received previous surgery for breast cancer. Methods A series of 79 ...consecutive patients who underwent surgery for an SPN between 1990 and 2003 after a curative resection for breast cancer were reviewed. Results Surgical diagnosis was obtained by open procedure before 1996 (37 cases), and by video-assisted thoracoscopic surgery (VATS) after 1996 (33 out of 42 cases, 9 open procedures) and intraoperative evaluation. Histology of SPN was primary lung cancer in 38 patients, pulmonary metastasis of breast cancer in 27, and benign condition in 14. VATS was converted to open procedure for anatomical resection in primary lung cancer and for the palpation of the lung in metastatic disease. Average disease-free interval from the initial mastectomy was significantly longer in primary lung cancer than in metastatic patients (179 ± 107 vs 51 ± 27 moths). Manual palpation identified multiple pulmonary nodules in 3 out of 27 metastatic patients. Five-year survival rate after pulmonary metastasectomy was 38% and was significantly influenced by disease-free interval; 5-year survival rate after resection of primary lung cancer was 43% and was significantly influenced by the pathological stage. Conclusions VATS is a good procedure for diagnostic management of peripheral SPN. As SPN in breast cancer patients is primary lung cancer in half cases, it deserves confirmation of pathological diagnosis and appropriate surgical treatment. When breast cancer metastasis is demonstrated, open procedure must be performed to palpate the entire lung to exclude previously unknown nodules.
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