Concurrent chemoradiotherapy (CHRT) remains the therapeutic standard for locally advanced inoperable non-small-cell lung cancer (NSCLC). The median overall survival (OS) with this approach is in

BackgroundThe aim of this project was to collect real-world evidence and describe treatment patterns for stage III non-small cell lung cancer in Central and Eastern Europe. Based on real-world evidence, an expert opinion was developed, and the unmet needs and quality indicators were identified.Patients and methodsA systematic literature search and a multidisciplinary expert panel of 10 physicians from 7 countries used a modified Delphi process to identify quality indicators and unmet needs in patients with stage III non-small cell lung cancer. The profound questionnaire was used to characterize treatment patterns used for stage III non-small cell lung cancer, and a systematic review identified patterns in Central and Eastern Europe. The first questionnaire was completed by a group of medical oncologists, radiation oncologists and pneumologists. The panel of experts attended an in-person meeting to review the results of the questionnaire and to process a second round Delphi. An additional survey was then compiled and completed by the panel.ResultsA complete consensus was reached by the panel of experts on a set of evidence-based clinical recommendations. The experience-based questionnaire generated a highly variable map of treatment patterns within the region. A list of unmet needs and barriers to quality care were developed with near-unanimous consent of the panel of experts.ConclusionsThe current landscape of diagnostic and therapeutic approaches in Central and Eastern European countries is highly variable. We identified several significant barriers, mainly related to the availability of diagnostic and imaging methods and low rates of chemoradiotherapy with curative intention as initial treatment for unresectable stage III NSCLC.

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Background: Superior sulcus tumor (SST), also known as Pancoast tumor, occurs in up to 5% of all non-small cell lung cancer patients. Owing to its proximity to vital thoracic structures, SST remains one of the biggest challenges of thoracic surgery. The results of the Southwest Oncology Group Trial 9416, in which SST patients were subjected to induction chemoradiation followed by surgical resection, established a widely accepted standard-of-care. Data on the efficacy of this approach outside of clinical trial setting are scarce. We present long-term outcomes in a large group of patients with SST who underwent surgery with or without preoperative treatment (PT) in a single tertiary referral center. Method: Study group included 76 consecutive patients treated between February 2006 and June 2017. All patients had histologically-proven and radiologically-defined T3-T4 N0-N1 M0 superior sulcus non-small cell lung cancer. Study group included 50 men (66%) and 26 women (34%) with a mean age of 56 years (range, 41-81 years). Squamous cell lung cancer constituted 55% of the population. Result: Fifty-four patients (71%) underwent PT, 44 of whom received radiochemotherapy (58%), 4 radiotherapy (5%) and 6 chemotherapy (8%), and 22 (29%) were managed with surgery alone. All patients selected to PT underwent subsequent pulmonary surgery including lung and chest wall en bloc resection, and complete lymphadenectomy. In the entire group 71 lobectomies (93%), 3 segmentectomies (4%) and 2 pneumonectomies (3%) were performed. Surgery in patients managed with PT included 52 lobar resections (96%) and 2 pneumonectomies (4%). Complete or near complete pathologic response following PT was achieved in 67% of operated patients. In the entire group resection was complete (R0) in 62 patients (82%). Overall 30-day and 90-day mortality in the entire treatment group was 2.6% and 6.6%, respectively. Overall 3-year and 5-year survival probabilities were 44% (95% CI: 32%e56%) and 38% (95% CI: 26%e50%) respectively. A non-significantly higher 3-year survival probability was recorded in patients, who underwent PT compared to those managed with surgery alone (50% vs. 36%, respectively; log-rank p¼0.27). Conclusion: Real-world treatment outcomes in SST patients amenable to surgery are similar to those obtained in the general population of lung cancer patients. PT may increase long-term survival rate and is associated with low perioperative mortality, which justifies its routine application.

Przerzuty do tarczycy i trzustki występują rzadko. Względnie częstym ogniskiem pierwotnym jest rak nerki. Brak jest jasnych wytycznych dotyczących leczenia chirurgicznego zmian przerzutowych w tych lokalizacjach. W pracy przedstawiono rzadki przypadek równoczesnych przerzutów do tarczycy i trzustki wiele lat po leczeniu operacyjnym z powodu raka nerki. Concomitant renal cancer metastases to the pancreas and thyroid gland: case report and literature review Metastases to the thyroid gland or pancreas are rare and renal cancer is one of the most common primary tumours. There is no consensus regarding surgical treatment of metastases in these sites. We present a rare case of concomitant pancreatic and thyroid metastases in a renal cancer patient many years after surgery.

Laryngeal cancer occurs rarely in adolescents and young people. Castleman’s disease is a rare lymphoproliferative disorder of uncertain etiopathogenesis and heterogeneous clinicopathological forms. Involved lymph nodes and extranodal lesions in the course of Castleman’s disease may mimic malignant involvement. We report a case of an 18-year-old woman with T2N0M0 laryngeal glottis cancer treated with definitive radiotherapy. During the irradiation, the patient underwent an excision of incidentally discovered left-sided enlarged cervical lymph nodes located outside the irradiated area. Coincidental hyaline vascular type of Castleman’s disease was diagnosed. During six-year follow-up she has been free of cancer relapse and Castleman’s disease symptoms.

Objectives: Treatment of superior sulcus tumors (SST) using concurrent chemoradiation followed by surgery is a current standard. However, due to the rarity of this entity, clinical experience in its treatment remains scarce. Here, we present the results of a large consecutive series of patients treated with concurrent chemoradiation followed by surgery at a single academic institution. Materials and Methods: The study group included 48 patients with pathologically confirmed SST. The treatment schedule consisted of preoperative 6-MV photon-beam radiotherapy (45–66 Gy delivered in 25–33 fractions over 5–6.5 weeks) and concurrent two cycles of platinum-based chemotherapy. Five weeks after completion of chemoradiation, pulmonary and chest wall resection was performed. Results: From 2006 to 2018, 47 of 48 consecutive patients meeting protocol criteria underwent two cycles of cisplatin-based chemotherapy and concurrent radiotherapy (45–66 Gy) followed by pulmonary resection. One patient did not undergo surgery due to brain metastases that occurred during induction therapy. The median follow-up was 64.7 months. Chemoradiation was well tolerated, with no toxicity-related deaths. Twenty-one patients (44%) developed grade 3–4 side effects, of which the most common was neutropenia (17 patients; 35.4%). Seventeen patients (36.2%) had postoperative complications, and 90-day mortality was 2.1%. Three- and five-year overall survival (OS) were 43.6% and 33.5%, respectively, and three- and five-year recurrence-free survival were 42.1% and 32.4%, respectively. Thirteen (27.7%) and 22 (46.8%) patients had a complete and major pathological response, respectively. Five-year OS in patients with complete tumor regression was 52.7% (95% CI 29.4–94.5). Predictive factors of long-term survival included age below 70 years, complete resection, pathological stage, and response to induction treatment. Conclusions: Chemoradiation followed by surgery is a relatively safe method with satisfactory outcomes.