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Frank Detterbeck
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MTE 23 - Mediastinal Tumors including Thymic Tumors, Lymphoma, Germ Cell Tumors: Biopsy, Diagnosis and Treatment (Sign Up Required) (ID 572)
- Event: WCLC 2017
- Type: Meet the Expert
- Track: Thymic Malignancies/Esophageal Cancer/Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 07:00 - 08:00, Room 311 + 312
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MTE 23.01 - Thymic Neoplasms (ID 7808)
07:00 - 07:30 | Presenting Author(s): Frank Detterbeck
- Abstract
- Presentation
Abstract:
Thymic malignacies are distintive by being relatively rare and by their generally more indolent behavior; nevertheless all thymomas are malignant tumors. Progress in the understanding of these tumors has been limited until recently. The advent of several regional and international collaborative groups (e.g. the Japanese Association for Research on the Thymus [JART] and the International Thymic Malignancy Interest Group [ITMIG] has provided an infrastructure to facilitate progress, and the field has advanced significantly. The level of understanding available now makes the previously common approach of empiric management of thymic malignancies inappropriate. Three major categories of thymic malnignancies with different biologic behavior are distinguished: thymoma, thymic carcinoma (TC) and Neuroendocrine tumors of the thymus (NETT, also known as thymic carcinoid). Thymomas are subdivided into 5 histotypes with slightly different clinical features, but these clinical differences are small and mixed histotypes are frequent. Through international collaboration, the first fromal stage classification system has been developed. Many patients with thymic malignancies have associated autoimmune conditions, most prominently myathenia gravis. Chest CT with intravenous contrast is the primary imaging modality for patient evaluation. A combination of patient demographics, clinical and imaging features allows a reliable clinical diagnosis of a thymic malignancy to be made in most patients; this can be supplemented with a needle biopsy if needed. However, the ability of imaging to accurately define the degree of local invasion or pleural dissemination is limited. In general, surgical exploration is warranted (in a facility prepared to handle resection of all possibly involved structures) unless imaging clearly demonstrates unresectable invasion. A complete resection of all involved structures is the cornerstone of treatment. The role of adjuvant radiotherapy after an R0 resection remains unclear, especially after resection of more invasive tumors or int he case of TC/NETT. It is easier to argue for adjuvant RT after an R1 resection or an R0 resection with close margins. Surgeons should be prepared to resect involved structures; a planned subtotal (debulking) resection is not recommended. When more invasive thymic tumors raise questions about the ability to achieve an R0 resection, preoperative chemo- or chemoradiotherapy is typically given. Recurrences are relatively low after complete resection. Longer-term (5- and 10-year) survival rates with aggressive multimodality treatment are fairly good, evin in tumors that invade major mediastinal structures or demonstrate pleural dissemination. When resection is not possible, management with palliative chemotherapy (± RT) can be useful. Several regimens have been shown to be active, and an optimal chemotherapy regimen has not been identified.
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P2.13 - Radiology/Staging/Screening (ID 714)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.13-022 - Lung Nodule Survey: One Pathology, Perspectives from Thoracic Surgeon, Pulmonologist and Radiology Point of View (ID 10408)
09:30 - 09:30 | Author(s): Frank Detterbeck
- Abstract
Background:
Screening program for lung cancer are leading for more incidental lung nodules diagnosis.This study aimed to address the lung nodule management from different specialty perspective working in different settings. This is the first survey uniting national societies in Brazil and in Latin America.
Method:
A web-based survey was developed by thoracic surgeons, pulmonologists and radiologists to evaluate lung nodule perception and management. This survey was sent to their respective national societies members and answers collected between August and December 2016. That included multiple choice questions regarding age, specialty, lung nodule management, accessibility to exams and interventional procedures characterizing public (SUS) and supplementary(SHS) working settings.
Result:
A total of 461 questionnaires were answered. More than half of participants live in cities with over one million population. Specialties were reasonable equilibrated with 43.5% radiologists, 33.5% thoracic surgeons, 20.3% pulmonologist and 2.6% others. Most of the respondents work in both public and private sector (72.7%). SHS has a similar reality compared to well developed nations regarding exams accessibility and interventions. SUS setting has a significant difference according to the participants. CT is only easily available in 31.9% of cases, PET-CT is easily available in 24.4%(graphic1), bronchoscopy is unavailable and almost unavailable for 33.1%, IR biopsy is unavailable in 38.2% and video-assisted thoracic surgery (VATS) biopsy is easily available in 42.8%. When there is a probability of malignancy of 50% or higher, 46.5% of participants would be comfortable recommending surgical biopsy. When the probability higher than 10%, only 36.9% would be comfortable following up radiologically. Figure 1
Conclusion:
Brazil has a very different setting for SUS and SHS patients regarding exams availability and management options. That might explain why participants have a higher tendency to choose interventional diagnosis and explains why current guidelines may not be applicable to developing countries reality.
