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C. Lo



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    P1.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 206)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Treatment of Advanced Diseases - NSCLC
    • Presentations: 1
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      P1.01-038 - Endosonographic vs Surgical Staging for Mediastinal Nodal Staging of Lung Cancer: A Systematic Review (ID 3016)

      09:30 - 09:30  |  Author(s): C. Lo

      • Abstract

      Background:
      Endosonographic staging techniques mainly endoscopic (EUS-FNA) or endobronchial (EBUS-TBNA) with needle aspiration modalities has been increasingly described and used in many established centres since the early year 2000 as 1[st ]line mediastinal staging compared to surgical staging (video / cervical mediastinoscopy) . Its minimally-invasive nature , with low complications rate , excellent diagnostic accuracy and ultimately cost-effectiveness are some of the main deciding factors involved .The aim of this review is to evaluate the diagnostic yield of endosonographic staging compared to surgical staging for mediastinal lymphadenopathy in lung cancer patients.

      Methods:
      A thorough extensive electronic literature database search in PUBMED ,EMBASE ,MEDLINE and ISI web of Science was conducted systematically , emphasizing endosonographic staging modalities vs surgical staging ,ranging from year 2000 up to April 2015 . These search engines were not confined to English-literature language only . Lung cancer patients were identified as a separate unit of analysis ,as well as these endosonographic staging methods at the level of mediastinum and its diagnostic yield ( positive lymph nodes) were clustered in a different analysis group. In this review , the methodological analysis used was the Quality Assessment of Diagnostic Accuracy Study (QUADAS-2) as a tool to allow transparent rating of potential bias and application of primary diagnostic accuracy study. The primary end-point was the number of positive successful mediastinal nodal biopsies ,which was grouped according to the American Thoracic Society (ATS) classification .

      Results:
      A total of 10 major trials & reviews pertaining to this topic were extensively reviewed . Approximately nearly 1000 patients were grouped in this study ,who underwent either EUS-FNA staging with or without EBUS-TBNA and mediastinoscopy following diagnosis of lung cancer , either in a small or large , single or multiple centres across the world . The sensitivity , specificity , positive (PPV) & negative predictive values (NPV) and diagnostic accuracy or yield for endosonographic staging vs surgical staging modalities were cross-examined .

      Conclusion:
      According to the systematic analysis , these groups are moving forward for endosonographic (EUS-FNA or EBUS-TBNA) modalities compared to solely surgical staging (mediastinoscopy) in most cases . It seems to be a more promising ,successful & cost-effective method for sampling mediastinal nodes in lung cancer patients .

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    P3.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 211)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Treatment of Localized Disease - NSCLC
    • Presentations: 1
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      P3.02-015 - Impact of a Lung Multidisciplinary Team Meeting (ID 2340)

      09:30 - 09:30  |  Author(s): C. Lo

      • Abstract

      Background:
      Multidisciplinary team meetings (MDM) have become the standard of practice across a variety of medical disciplines. In particular, MDMs have found utility in the management of complex diseases requiring multi-modal treatment such as cancer. Advancements in information sharing technology have extended the reach of MDMs to improve care in previously remote and underserved areas. Lung cancer management is now largely directed through MDMs. However, MDMs are, by their very nature, resource intensive. In a world of increasing accountability for the distribution of limited resources, a review of the evidence for benefit of MDMs, as well as the different strategies employed in running a successful MDM, is necessary to ensure efficient provision of this care.

      Methods:
      A review of the existing peer-reviewed literature on MDM was conducted on Pubmed, using the broad search term of “multidisciplinary team meeting.” Existing reviews and original research were included, while non-English studies and letters were excluded.

      Results:
      Introduction of MDMs have been attributed to a variety of positive outcomes in the management of multiple oncological diseases. While there are a handful of studies questioning the cost-benefit of MDM without adequate patient selection in colorectal cancers, the evidence for improving management in most cancers (including lung cancer) is strong. An additional benefit is the increased reach of clinical trials, with MDMs being demonstrated to improve subscription rates. However, while lung MDMs have been demonstrated to make significant improvements to the overall care of a lung cancer patient, the evidence for improved survival remains limited. The limited impact of lung MDM to overall survival may be at least partially attributable to the late-presenting nature of the disease. This may be exacerbated by geographical limitations of some healthcare networks. However, with improvements in health informatics and telemedicine, standardising early care across a vast region has been shown to be possible and improve outcomes in other cancers.

      Conclusion:
      While it is clear that disease management is improved with the introduction of lung MDM, further study is needed to optimise its efficacy and define its impact on survival.