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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (15 August 2024) | Viewed by 16546

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Prof. Dr. Paul Van Schil

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Guest Editor

Department of Thoracic and Vascular Surgery, Antwerp University and Antwerp University Hospital, Edegem, Belgium
Interests: lung cancer; thoracic surgery; thoracic oncology; neuroendocrine tumors (NETs)

Prof. Dr. Jan Van Meerbeeck

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Guest Editor

Department of Thoracic Oncology, Antwerp University and Antwerp University Hospital, Edegem, Belgium
Interests: lung cancer; thoracic oncology

Special Issue Information

Dear Colleagues,

In this Special Issue of Cancers, we focus on “Advances in Thoracic Oncology” and provide an overview of recent developments in the diagnosis and treatment of lung cancer, thymic epithelial tumors and mesothelioma. The landscape of thoracic oncology has changed significantly during the last decade. Due to advances in biomarker testing, medical oncologists are able to provide personalized therapy for lung cancer patients consisting of targeted therapies and immune checkpoint inhibitors, not only in metastatic disease but also in patients with locally advanced lung cancers and even early-stage disease. This also has an impact on surgical management. Specifically for thoracic surgeons, new insights have been obtained in the role of sublobar resection. For radiation oncologists, newer treatment modalities have become available, allowing more precise delivery of radiotherapy, limiting collateral damage to surrounding vital organs in the chest.

Multidisciplinary approaches have been developed for thymic epithelial tumors and mesothelioma, with ongoing trials further shaping specific therapeutic algorithms.

These are fascinating times for all specialists dealing with thoracic oncology and we sincerely hope you will find useful, updated information in this Special Issue. As we are currently witnessing the significant results of new therapeutic modalities, the main goal still remains to improve long-term outcomes in patients with thoracic malignancies.

Prof. Dr. Paul Van Schil
Prof. Dr. Jan Van Meerbeeck
Guest Editors

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Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

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Keywords

thoracic oncology
non-small cell lung cancer
targeted therapy
immunotherapy
radiation oncology
thoracic surgery
thymic tumors
mesothelioma
mesothelioma
multidisciplinary approach
outcome

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Published Papers (9 papers)

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Research

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10 pages, 555 KiB

Open AccessArticle

Physical Deconditioning in Lung Cancer Patients Who Underwent Lung Resection Surgery in Spain: A Prospective Observational Study

by Alejandro Heredia-Ciuró, Florencio Quero-Valenzuela, Javier Martín-Núñez, Andrés Calvache-Mateo, Geraldine Valenza-Peña, Laura López-López and Marie Carmen Valenza

Cancers 2024, 16(16), 2790; https://doi.org/10.3390/cancers16162790 - 8 Aug 2024

Viewed by 711

Abstract

Background. Lung resection represents the main curative treatment modality for lung cancer. These patients present with physical deterioration that has been studied previously using objective variables; however, no previous studies have evaluated the self-perceived physical fitness of these patients. For these reasons, to increase the current knowledge on lung cancer patients’ impairment, the aim of this study was to characterize the self-perceived physical deconditioning of lung cancer patients undergoing lung resection in the short and medium term after surgery. Methods. A longitudinal, observational, prospective cohort study was performed in the Thoracic Surgery Service of the Hospital Virgen de las Nieves (Granada). Symptoms (pain, fatigue, cough and dyspnea) and physical fitness (upper and lower limbs) were assessed before surgery, at discharge and at one month after discharge. Results. Among the total of 88 patients that we included in our study, significant differences were found at discharge in symptoms (p < 0.05) and physical fitness (p < 0.05). One month after surgery, higher levels of pain (p = 0,002) and dyspnea (p = 0.007) were observed, as well as poorer results in the upper (p = 0.023) and lower limbs’ physical fitness, with regard to the initial values. Conclusions. Patients undergoing lung resection present an increase in symptoms and physical fitness deterioration at discharge, which is maintained one month after surgery. Full article

(This article belongs to the Special Issue Advances in Thoracic Oncology)

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12 pages, 1314 KiB

Open AccessArticle

Exploring the Efficacy of Pembrolizumab in Combination with Carboplatin and Weekly Paclitaxel for Frail Patients with Advanced Non-Small-Cell Lung Cancer: A Key Investigative Study

by Quentin Dominique Thomas, Mohamed Chaabouni, Anas Al herk, Cesar Lefevbre, Sarah Cavaillon, Léa Sinoquet, Stéphane Pouderoux, Marie Viala, Lise Roca and Xavier Quantin

Cancers 2024, 16(5), 992; https://doi.org/10.3390/cancers16050992 - 29 Feb 2024

Viewed by 1844

Abstract

Introduction: Immune checkpoint blockers have revolutionized the first-line treatment of advanced non-small-cell lung cancer (NSCLC). Pembrolizumab, an anti-PD-1 monoclonal antibody, is a standard therapy either alone or in combination with chemotherapy (chemo-IO). The current study explores the efficacy and safety of pembrolizumab with carboplatin and weekly paclitaxel in a cohort of frail patients. Methods: A monocentric retrospective study was conducted between 22 September 2020 and 19 January 2023 regarding patients with stage IV NSCLC treated with chemo-IO combination: carboplatin (AUC 5 mg/mL/min; Q4W), weekly paclitaxel (90 mg/m² on days 1, 8, and 15), and pembrolizumab (200 mg Q4W). The primary objective was real-world progression-free survival (rwPFS). Secondary objectives were overall survival (OS), toxicity profile, and outcomes based on histological subtype. Results: A total of 34 patients (20 squamous and 14 non-squamous NSCLC) benefited from the chemo-IO regimen for frail patients; 41.9% had an ECOG-PS = 2. The median age was 75.5 years. We observed an overall response rate (ORR) of 55.9%. Notably, squamous NSCLC exhibited a significantly higher ORR (80%) than non-squamous NSCLC (21.4%); p = 0.001. The median rw-PFS was 10.6 months (95% CI [6.0, NA]), with 6- and 12-month rw-PFS rates of 69% and 45.8%, respectively. The median OS was not reached, with 12- and 18-month OS rates of 75.6% and 61.4%, respectively. The median number of maintenance cycles of pembrolizumab was 5 (0; 27). Nine patients (26.5%) experienced a toxicity related to chemotherapy leading to a reduction of the dose administered and, in five patients (14.7%), to the permanent discontinuation of chemotherapy. Six patients (17.6%) had an immune-related adverse event leading to the discontinuation of immunotherapy. Discussion: Pembrolizumab plus carboplatin and weekly paclitaxel demonstrates promising efficacy and safety in frail patients with metastatic NSCLC, especially for ORR in sq-NSCLC. Prospective studies focusing on frail populations are warranted in order to validate these findings and optimize therapeutic strategies in the first-line setting. Full article

(This article belongs to the Special Issue Advances in Thoracic Oncology)

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11 pages, 424 KiB

Open AccessArticle

Thoracoscopy for Pediatric Thoracic Neurogenic Tumors—A European Multi-Center Study

by Jean François Lecompte, Sabine Sarnacki, Sabine Irtan, Christian Piolat, Aurélien Scalabre, Isabelle Talon, Julien Rod, Nicoleta Panait, Gregory Rodesch, Ana Lourdes Luis Huertas, Olivier Abbo, Martine Demarche, Edouard Habonimana, Quentin Ballouhey, Dominique Valteau-Couanet and Florent Guérin

Cancers 2023, 15(22), 5467; https://doi.org/10.3390/cancers15225467 - 18 Nov 2023

Viewed by 1454

Abstract

Objectives: To assess the efficacy of thoracoscopy and the outcome for children with thoracic neurogenic tumors. Methods: We performed a retrospective review of 15 European centers between 2000 and 2020 with patients who underwent thoracoscopy for a neurogenic mediastinal tumor. We assessed preoperative data, complications, and outcomes. Results were expressed with the median and range values. Results: We identified 119 patients with a median age of 4 years old (3 months–17 years). The diameter was 5.7 cm (1.1–15). INRG stage was L1 n = 46, L2 n = 56, MS n = 5, M n = 12. Of 69 patients with image-defined risk factors (IDRF), 29 had only (T9–T12) locations. Twenty-three out of 34 patients with preoperative chemotherapy had an 18 mm (7–24) decrease in diameter. Seven out of 31 patients lost their IDRF after chemotherapy. Fourteen had a conversion to thoracotomy. The length of the hospital stay was 4 days (0–46). The main complications included chylothorax (n = 7) and pneumothorax (n = 5). Long-term complications included Horner’s syndrome (n = 5), back pain, and scoliosis (n = 5). Pathology was 53 neuroblastomas, 36 ganglioneuromas, and 30 ganglioneuroblastomas. Fourteen had a postoperative residue. With a median follow-up of 21 months (4–195), 9 patients had a recurrence, and 5 died of disease. Relapses were associated with tumor biology, histology, and the need for chemotherapy (p = 0.034, <0.001, and 0.015, respectively). Residues were associated with preoperative IDRF (excluding T9–T12 only) and the need for preoperative chemotherapy (p = 0.04 and 0.020). Conclusion: Our results show that thoracoscopy is safe, with good outcomes for thoracic neurogenic tumors in selected cases. Surgical outcomes are related to the IDRFs, whereas oncologic outcomes are related to tumor histology and biology. Full article

(This article belongs to the Special Issue Advances in Thoracic Oncology)

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14 pages, 2118 KiB

Open AccessArticle

Health Outcomes with Curative and Palliative Therapies in Real World: Role of the Quality of Life Summary Score in Thoracic Oncology Patients

by Kurt G. Tournoy, Valerie Adam, Inge Muylle, Helene De Rijck, Ellen Everaert, Ehsan Eqlimi, Jan P. van Meerbeeck and Piet Vercauter

Cancers 2023, 15(15), 3821; https://doi.org/10.3390/cancers15153821 - 27 Jul 2023

Cited by 1 | Viewed by 1417

Abstract

Background: For patients receiving therapy with curative or palliative intent for a thoracic malignancy, prediction of quality of life (QOL), once therapy starts, remains challenging. The role of health assessments by the patient instead of the doctor herein remains ill-defined. Aims: To assess the evolution of QOL in patients with thoracic malignancies treated with curative and palliative intent, respectively. To identify factors that determine QOL one year after the start of cancer therapy. To identify factors that affect survival. Methods: We prospectively included consecutive patients with a thoracic malignancy who were starting anti-cancer therapy and measured QOL with QLQ-C30 before the start of therapy, and thereafter at regular intervals for up to 12 months. A multivariate regression analysis of the global health score (GHS) and QOL summary scores (QSS) one year after the start of therapy was conducted. A proportional hazards Cox regression was conducted to investigate the effects of case-mix variables on survival. Results: Of 587 new patients, 375 started different forms of therapy. Most had non-small cell lung cancer (n = 298), 35 had small cell lung cancer, and 42 had other thoracic malignancies or were diagnosed on imaging alone. There were 203 who went for a curative intent and 172 for a palliative intent strategy. The WHO score of 0–1 was more prevalent in the former group (p = 0.02), and comorbidities were equally distributed. At baseline, all QOL indices were better in the curative group (p < 0.05). The curative group was characterized by a significant worsening of GHS and QSS (p < 0.05). The palliative group was characterized by an improvement in GHS and emotional health (p < 0.05), while other dimensions of functioning remained stable. GHS at 12 months was estimated in a multivariate linear regression model (R² = 0.23—p < 0.001) based on baseline GHS, QSS, and comorbidity burden. QSS at 12 months was estimated (R² = 0.31—p < 0.001) by baseline QSS and therapeutic intent strategy (curative vs. palliative). The prognostic factors for overall survival were the type of therapy (curative vs. palliative intent, p < 0.001) and occurrence of early toxicity-related hospitalization (grade ≥ 3, p = 0.001). Conclusion: Patients with thoracic malignancies treated with curative intent experience a worsening of their QOL in the first year, whereas those receiving palliative anti-cancer therapy do not. QOL one year after the start of therapy depends on the baseline health scores as determined by the patient, comorbidity burden, and therapeutic strategy. Survival depends on therapeutic strategy and early hospitalization due to toxicity. Full article

(This article belongs to the Special Issue Advances in Thoracic Oncology)

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15 pages, 570 KiB

Open AccessArticle

A Cross-Sectional Study on the Acceptability of Implementing a Lung Cancer Screening Program in Belgium

by Paloma Diab Garcia, Annemiek Snoeckx, Jan P. Van Meerbeeck and Guido Van Hal

Cancers 2023, 15(1), 278; https://doi.org/10.3390/cancers15010278 - 31 Dec 2022

Cited by 2 | Viewed by 1633

Abstract

Lung cancer is the most common and deadliest cancer in the world, and its incidence is expected to grow. Nonetheless, this growth can be contained through smoking cessation programs and effective lung cancer screening programs. In 2018, Belgium had the seventh highest incidence of lung cancer in the world, with lung cancer incidence accounting for 11.8% of all cancers diagnosed and 23.8% of all cancer-related deaths that same year. The aims of this study were to determine the overall acceptability of a lung cancer screening program in the Flemish population and to determine the main factors that would influence the overall acceptability of such a program. A questionnaire-based cross-sectional study was performed in the Flemish population and distributed online and on paper. The results are presented with the variables of interest and the main outcome, i.e., the acceptability of participating in such a program if implemented. Odds ratios were used to compare acceptability between subgroups. A multivariate regression model was used to determine the key factors that would have the largest impact on the level of acceptability and, thus, on the possible efficiency of such a program. This study estimated that acceptability of participating in a lung cancer screening program was 92%. Irrespective of the smoking status, levels of acceptability were higher than 89%. The key factors which could significantly influence the acceptability of a lung cancer screening program were individuals with low education, low protective factor knowledge and total knowledge, and lung cancer screening reimbursement, which were significantly associated with acceptability (0.01, 0.001, 0.01, and 0.05 respectively). Low protective factor knowledge decreased the log odds of acceptability 3.08-fold. In conclusion, the acceptability of implementing a lung cancer screening program in Flanders seems to be extremely high and would be well received by all. When implementing such a program, policymakers should aim for it to be reimbursed, campaigns should be gender-specific, focused on those with lower educational and socioeconomic status, and there should be investment in increasing total knowledge about lung cancer and knowledge about protective factors. Full article

(This article belongs to the Special Issue Advances in Thoracic Oncology)

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Review

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16 pages, 310 KiB

Open AccessReview

Minimally Invasive Surgery in Non-Small Cell Lung Cancer: Where Do We Stand?

by Lawek Berzenji, Wen Wen, Stijn Verleden, Erik Claes, Suresh Krishan Yogeswaran, Patrick Lauwers, Paul Van Schil and Jeroen M. H. Hendriks

Cancers 2023, 15(17), 4281; https://doi.org/10.3390/cancers15174281 - 26 Aug 2023

Cited by 6 | Viewed by 2129

Abstract

In the last two decades, robotic-assisted thoracoscopic surgery (RATS) has gained popularity as a minimally invasive surgical (MIS) alternative to multi- and uniportal video-assisted thoracoscopic surgery (VATS). With this approach, the surgeon obviates the known drawbacks of conventional MIS, such as the reduced in-depth perception, hand-eye coordination, and freedom of motion of the instruments. Previous studies have shown that a robotic approach for operable lung cancer has treatment outcomes comparable to other MIS techniques such as multi-and uniportal VATS, but with less blood loss, a lower conversion rate to open surgery, better lymph node dissection rates, and improved ergonomics for the surgeon. The thoracic surgeon of the future is expected to perform more complex procedures. More patients will enter a multimodal treatment scheme making surgery more difficult due to severe inflammation. Furthermore, due to lung cancer screening programs, the number of patients presenting with operable smaller lung nodules in the periphery of the lung will increase. This, combined with the fact that segmentectomy is becoming an increasingly popular treatment for small peripheral lung lesions, indicates that the future thoracic surgeons need to have profound knowledge of segmental resections. New imaging techniques will help them to locate these lesions and to achieve a complete oncologic resection. Current robotic techniques exist to help the thoracic surgeon overcome these challenges. In this review, an update of the latest MIS approaches and nodule detection techniques will be given. Full article

(This article belongs to the Special Issue Advances in Thoracic Oncology)

25 pages, 3232 KiB

Open AccessReview

True Prevalence of Unforeseen N2 Disease in NSCLC: A Systematic Review + Meta-Analysis

by Wing Kea Hui, Zohra Charaf, Jeroen M. H. Hendriks and Paul E. Van Schil

Cancers 2023, 15(13), 3475; https://doi.org/10.3390/cancers15133475 - 3 Jul 2023

Cited by 4 | Viewed by 1808

Abstract

Patients with unforeseen N2 (uN2) disease are traditionally considered to have an unfavorable prognosis. As preoperative and intraoperative mediastinal staging improved over time, the prevalence of uN2 changed. In this review, the current evidence on uN2 disease and its prevalence will be evaluated. A systematic literature search was performed to identify all studies or completed, published trials that included uN2 disease until 6 April 2023, without language restrictions. The Newcastle-Ottawa Scale (NOS) was used to score the included papers. A total of 512 articles were initially identified, of which a total of 22 studies met the predefined inclusion criteria. Despite adequate mediastinal staging, the pooled prevalence of true unforeseen pN2 (9387 patients) was 7.97% (95% CI 6.67–9.27%), with a pooled OS after five years (892 patients) of 44% (95% CI 31–58%). Substantial heterogeneity regarding the characteristics of uN2 disease limited our meta-analysis considerably. However, it seems patients with uN2 disease represent a subcategory with a similar prognosis to stage IIb if complete surgical resection can be achieved, and the contribution of adjuvant therapy is to be further explored. Full article

(This article belongs to the Special Issue Advances in Thoracic Oncology)

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10 pages, 251 KiB

Open AccessReview

Sub-Lobar Resection: The New Standard of Care for Early-Stage Lung Cancer

by Benjamin E. Lee and Nasser Altorki

Cancers 2023, 15(11), 2914; https://doi.org/10.3390/cancers15112914 - 25 May 2023

Cited by 8 | Viewed by 1948

Abstract

The Lung Cancer Study Group previously established lobectomy as the standard of care for treatment of clinical T1N0 NSCLC. Advances in imaging technology and refinements in staging have prompted a re-investigation to determine the non-inferiority of sub-lobar resections to lobectomies. Two recent randomized studies, JCOG 0802 and CALGB 140503, are reviewed here in the context of LCSG 0821. The studies confirm non-inferiority for sub-lobar resection (wedge or segmentectomy) compared to lobectomy for peripheral T1N0 NSCLC less than or equal to 2 cm. Sub-lobar resection should therefore be considered the new standard of care in this sub-set of patients with NSCLC. Full article

(This article belongs to the Special Issue Advances in Thoracic Oncology)

17 pages, 817 KiB

Open AccessReview

Innovative Invasive Loco-Regional Techniques for the Treatment of Lung Cancer

by Erik Claes, Reinier Wener, Arne P. Neyrinck, Axelle Coppens, Paul E. Van Schil, Annelies Janssens, Thérèse S. Lapperre, Annemiek Snoeckx, Wen Wen, Hanne Voet, Stijn E. Verleden and Jeroen M. H. Hendriks

Cancers 2023, 15(8), 2244; https://doi.org/10.3390/cancers15082244 - 11 Apr 2023

Cited by 1 | Viewed by 2656

Abstract

Surgical resection is still the standard treatment for early-stage lung cancer. A multimodal treatment consisting of chemotherapy, radiotherapy and/or immunotherapy is advised for more advanced disease stages (stages IIb, III and IV). The role of surgery in these stages is limited to very specific indications. Regional treatment techniques are being introduced at a high speed because of improved technology and their possible advantages over traditional surgery. This review includes an overview of established and promising innovative invasive loco-regional techniques stratified based on the route of administration, including endobronchial, endovascular and transthoracic routes, a discussion of the results for each method, and an overview of their implementation and effectiveness. Full article

(This article belongs to the Special Issue Advances in Thoracic Oncology)

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