Carsten Schroeder

Absence of Gal epitope prolongs survival of swine lungs in an ex vivo model of hyperacute rejection

Nguyen B‐NH, Azimzadeh AM, Schroeder C, Buddensick T, Zhang T, Laaris A, Cochrane M, Schuurman H‐J, Sachs DH, Allan JS, Pierson RN. Absence of Gal epitope prolongs survival of swine lungs in an ex vivo model of hyperacute rejection. Xenotransplantation 2011; 18: 94–107.

Free Lung Cancer Screening Trends Toward a Twofold Increase in Lung Cancer Prevalence in the Underserved Southeastern United States

Objectives The National Lung Screening Trial (NLST) reported that the prevalence of lung cancer in individuals at high risk for the disease is 1%, and that screening these individuals using low-dose helical computed tomography of the chest saves lives. To increase screening accessibility in the underserved southeastern United States, we developed a free lung screening program, modeled after the Lahey Hospital & Medical Center Free Lung Screening Program, for individuals meeting National Comprehensive Cancer Network high-risk criteria. Methods This was a chart review of 264 participants screened in the first year of our program. Participants were divided into categories based on the Lung Imaging Reporting and Diagnostic System. Categories three and four were considered positive findings, with demographic and disease criteria collected on these patients. Results Of 264 participants screened, 28 (10.6%) were Lung Imaging Reporting and Diagnostic System category four, 23 (8.7%) were category three, 78 (29.5%) were category two, and 135 (51.1%) were category one. Eight of the 264 participants (3.0%) had lung cancer, with 75% detected in early stages. Conclusions We found a lung cancer prevalence in our high-risk screened population of 3.0% (8 of 264). After adjusting for patients who were symptomatic on clinical evaluation, we report a prevalence of cancer at 2.2% compared with 1.1% in the first year of the National Lung Screening Trial and a prevalence of 1.9% versus 0.6% compared with the National Comprehensive Cancer Network criteria in the first 10 months at Lahey Hospital & Medical Center. This study justifies low-dose helical computed tomography screening in high-risk regions because lung cancer treatment before symptoms appear is more effective, and the prevalence of disease in the detectable preclinical phase is high.

Uneven distribution of cancer histology in the national lung screening trial

Abstract:The National Lung Screening Trial reported a 20% lower mortality due to lung cancer in the patients screened with low-dose computed tomography (LDCT) compared with plain chest radiography (XRAY). A hypothesis was raised that LDCT should detect more cases of all tissue types or else the distribution of tissue types should be equal between groups. Data were extracted regarding the tissue types of lung cancer and presenting stages from the 2011 NSLT report. A total of 1,993 cases of tissue diagnosed lung cancer were reported, 1,054 for the LDCT group and 939 for the XRAY group. Two tissue types were more prevalent in the XRAY group: small cell carcinomas (16.9% versus 13%; P < 0.05) and other non-small cell (ONSC) carcinomas (16.8% versus 12.4%; P < 0.05). The ONSC category excluded the usual non-small cell tissue types: adenocarcinomas, squamous, and large cell carcinomas and did include other known biologically unfavorable tissue types. The XRAY group also had a disproportionately large number of stage IV small cell and ONSC tumors (P < 0.05 for ONSC). Bronchoalveolar cell carcinomas were more prevalent in the LDCT group (10.4% versus 3.7%, P < 0.05), likely reflecting greater sensitivity for detection. In summary, this review found uneven distribution of cases and higher preponderance of stage IV tumors for 2 adverse tissue types in the XRAY group. The results are consistent with greater severity of disease in the XRAY group with potential for length time bias and reduced mortality benefit from LDCT screening.

Routine use of staging thoracoscopy for pancoast tumors without overt radiographic chest wall invasion.

A retrospective review was performed of all patients with upper lobe non-small cell lung cancers to assess the use of thoracoscopy in determining chest wall invasion in patients with lung cancers abutting the first rib, but without overt radiographic invasion. Of the 12 patients with tumors abutting the first rib without overt radiographic invasion, thoracoscopy was able to correctly determine chest wall invasion in 8 patients. There was no significant morbidity related to thoracoscopy. Large tumor size did not preclude thoracoscopic staging, whereas dense adhesions did limit the use of staging thoracoscopy. Patients with invasion by thoracoscopy were able to begin radiation or chemotherapy much sooner (median 22.3 d) than patients requiring thoracotomy (median 60 d). The routine use of staging thoracoscopy in all tumors abutting the first rib without overt radiographic evidence of invasion accurately identified apical chest wall involvement in 8 of 12 patients. With this strategy, unnecessary neoadjuvant treatment and futile thoracotomy may be avoided.

Battling regional (stage III) lung cancer: bumpy road of a cancer survivor in the immunotherapy age

A 58-year-old woman, a heavy smoker, was diagnosed with stage III squamous cell lung cancer. She was treated with concurrent chemotherapy and radiotherapy, with partial response. 2 months later, she had haemoptysis caused by brisk bleeding from the radiated right upper lobe. Fortunately, her bleed was self-limited. 4 months later, a rapidly enlarging renal mass was discovered and turned out to be metastatic from the lung primary. Second-line chemotherapy with docetaxel and ramucirumab did not have effects on the renal mass after 2 cycles. Despite not being eligible for a durvalumab trial because of lack of PD-L1 expression, she had a meaningful response to nivolumab. Once every 2 weeks, infusion of nivolumab resulted in rapid tumour shrinkage in multiple areas. In the next few months, she experienced a variety of side effects, some of which were potentially life-threatening. She had disease progression 9 months into treatment.

Abstract B62: Tailored parental cessation delivered concurrently with tobacco prevention in children enrolled in urban and rural southern elementary schools

Purpose: Socioeconomically disadvantaged populations have higher tobacco use rates resulting in more disparate cancer outcomes. The effectiveness of tailored cessation interventions in parent/caregiver smokers delivered within an elementary school setting while their child is concurrently enrolled in a smoking prevention program has been minimally explored. Procedures/Methods: During a randomized controlled trial (RCT) that included children and one parent/caregiver per child, parent/caregiver smokers were offered cessation in years 1 and 2 (if relapsed/refused in year 1) at their child9s respective school or local community setting. Parent/caregiver smokers in the intervention group received tailored cessation including eight individual face-to-face motivational interviewing sessions with a matched gender and/or racial/ethnically similar counselor and eight weeks of nicotine replacement therapy. The control parents/caregivers who smoked received information for contacting the state toll-free Tobacco Quit Line and tailored (based on race/ethnicity) written materials to assist with cessation. Children in the intervention arm received concurrently a tobacco prevention curriculum, Botvin9s LifeSkills Training, over the same time period in years 1 & 2. The control group children received the standard health education curriculum for public school systems. This study reports on the effectiveness of the parent/caregiver cessation intervention including outcomes of self-reported smoking status (percentages) and the biological measure, salivary cotinine (ng/ml), both obtained at baseline, end of treatment (EOT)/year 2, and in year 4 follow-up. Results/Summary: Parent/Caregiver smokers (n=110) comprised 24.6% of the enrolled (n=447) parent/caregiver sample. The parent/caregiver smokers were predominantly female (81%), mean age 37.2 yrs. (SD 11.1); 37% Black; 54% had Conclusions: This study provides beginning evidence that tailored cessation offered to parents/caregivers in their child9s school setting while their child is enrolled in tobacco prevention classes may be an avenue for more robust success in quitting smoking. Such a strategy may serve as an initial step for improving public health and for decreasing tobacco-related disparities and associated poor health outcomes among disadvantaged populations. By improving parent9s/caregiver9s success and maintenance of tobacco cessation, a joint program may reinforce the child9s resistance to the lure of tobacco products and may also potentially decrease his or her secondhand smoke exposure within the home. Citation Format: Martha S. Tingen, Jeannette O. Andrews, Janie Heath, Lovoria B. Williams, Carsten Schroeder, Paul Dainer, Samir N. Khleif, Jennifer L. Waller. Tailored parental cessation delivered concurrently with tobacco prevention in children enrolled in urban and rural southern elementary schools. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B62.

Sublobar/wedge resection or stereotactic body radiation therapy for stage I marginally operable non-small-cell lung cancer

The optimal therapy for stage I non-smallcell lung cancer (NSCLC) is lobectomy for patients who are considered to be at risk [1]. However, for those considered to be at high risk for lobectomy, due either to poor pulmonary reserve or heart disease, alternative options include observation, conventional fractionated radiotherapy, sublobar resection (segmentectomy or wedge resection) and stereotactic body radiation therapy (SBRT) [2]. Various studies have demonstrated that high-risk NSCLC patients die of cancer rather than their comorbidities, demonstrating the importance of achieving local tumor control in all patients, including those considered medically inoperable [3 – 5]. Conventional fractionated radiotherapy has been used to treat medically inoperable stage I NSCLC, but the reported local control rates are suboptimal compared with lobectomy [1]. Sublobar resection has also been offered to marginally resectable patients who have poor pulmonary reserve but are candidates for less radical surgery. However, sublobar resection was associated with an increased incidence of local recurrence compared with lobectomy in the Lung Cancer Study Group randomized trial [6]. Postoperative radiotherapy or intraoperative brachytherapy has been used in conjunction with wedge resection to improve local control. Colleagues from Sweden and Japan pioneered the use of SBRT for lung and liver tumors in the early 1990s, and this procedure was then studied prospectively for medically inoperable stage I NSCLC by Timmerman et al. at Indiana University and Nagata et al. at Kyoto University, with rates of local tumor control approaching those of lobectomy with reduced toxicity compared with traditional external beam radiotherapy [7]. SBRT was subsequently evaluated in multiple prospective Phase I/II trials, including the Radiation Therapy Oncology Group trials [101], for stage I medically inoperable NSCLC, yielding similar impressive results comparable with those obtained from lobectomy [7,8]. Patients with stage I high-risk or marginally operable NSCLC represent a unique entity. Although they are deemed not suitable for a lobectomy, a sublobar or wedge resection can generally be tolerated [1]. There have been a few studies comparing the effectiveness of surgical intervention and SBRT in this group of patients. In a study from William Sublobar/wedge resection or stereotactic body radiation therapy for stage I marginally operable non-small-cell lung cancer