The number of pulmonary nodules identified incidentally or through lung cancer screening programs has dramatically increased. The role of radiation therapy (RT) in this patient population is not defined. Our institution established a multidisciplinary Pulmonary Nodule and Lung Cancer Screening Clinic (PNLCSC) to optimize the management of these patients. In this study, we describe the role of radiation oncologists in the multidisciplinary evaluation and management of incidental and screening-identified pulmonary nodules. Materials/Methods: This study included patients referred to the PNLCSC between 10/2012 and 9/2019. Indications for referral included a Lung-RADS 4 finding on screening CT or an incidental pulmonary nodule measuring 6 mm. At each clinic session, a multidisciplinary team including diagnostic/interventional radiologists, pulmonologists, medical oncologists, thoracic surgeons, and radiation oncologists made recommendations regarding the work-up, management, and follow-up of each patient. Demographic and clinical characteristics as well as data on followup and treatments were prospectively recorded. Collection and analysis of the data was approved by institutional IRB. Results: Of 1,150 patients evaluated by the PNLCSC, 234 (20.3%) were screening patients, and 916 (79.7%) had incidental nodules. Among screening patients, 41 (17.5%) underwent therapeutic intervention, 31 (13.2%) with surgical resection and 10 (4.3%) with RT. RT represented 24.4% of all treatments received by screening patients. Among patients with incidental pulmonary nodules, 227 underwent therapeutic intervention, with 167 (18.2%) and 60 (6.6%) receiving surgery and RT, respectively. The overall rate of patients undergoing RT was stable over time, ranging from 6.

Background: Whole-brain radiation therapy (WBRT) and epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) are both treatment options for EGFR-mutated NSCLC patients with brain metastases. This study aimed to investigate the possible cerebral toxicities caused by the combined treatment in rats. Methods: Thirty-six, 12 weeks old, male, SD rats were randomized into 6 groups (6 rats in each group named A to F). Rats in group A and B received high dose (101.25 mg/kg qd) or low dose (33.75 mg/kg qd) icotinib (one kind of EGFR-TKIs) plus WBRT, group C and D received high dose or low dose icotinib only, group E received WBRT only, and group F was the sham control group. Icotinib was administered intragastrically once daily from day 1 and WBRT (30 Gy/5f/5d) was carried out 2 weeks later. All rats received Morris water maze test, including place navigation test and spatial probe test, at baseline, 4 th week, 8 th week, and 12 th week to investigate their learning and memory abilities. All rates were sacrificed after the last water maze test, and the number of positive cells of GFAP (astrocyte), CD11b (microglia), and CNPase (oligodendrocyte) were evaluated in immunohistochemical samples from Hippocampus. Results: There were no difference in the target finding latency and journey distance in place navigation tests between different groups and time points, neither in the percentage of stay time and journey distance of the target quadrant to total in spatial probing tests. Compare to group F, significantly more GFAP+ astrocytes could be observed in treatment groups (Group A to F: 87.4±15.8 vs. 92.8±28 vs. 91.7±14.4 vs. 92±19.6 vs. 87.6±16.6 vs. 64.8±24.4, p < 0.001). Compare to other groups, significantly more CD11b+ microglias could be observed in groups received WBRT (Group A to F: 54.5±14.8 vs. 47.7±15.4 vs. 38.6±15 vs. 36.7±19 vs. 58.1±18.1 vs. 35.2±24.2, p < 0.001; Group A+B+E, C+D, and F: 52.6±22.2 vs. 36.1±17.9 vs. 33.1±24.5, p < 0.001). There was no significant difference in number of CNPase+ oligodendrocytes between different groups. Conclusions: In rats, even there was no deterioration in cognitive function detected by water maze tests, pathological changes in hippocampus could be detected within a relatively short period after the combined treatment or icotinib treatment alone.

Background: Previously we found that imaging central and peripheral LCNEC has distinct clinicopathologic features and survival. As LCNEC and SCLC are all neuroendocrine tumor, this study further investigated whether imaging tumor location impact the outcome of first line chemotherapy in patients with small cell lung cancer extensive disease. Method: Patients with ES-SCLC diagnosis between May 2014 and September 2015 in Shanghai Pulmonary Hospital, Tongji University were included. Contrast enhanced CT scans were reviewed retrospectively for tumor location (central or peripheral) and imaging features. The clinical characteristics and outcomes of chemotherapy were collected and compared. Result: 140 patients were identified with a median age of 64, 89.3%, 76.4% and 98.6% were male, smokers and ECOG PS 1 respectively. Among them, 135 received etopside based chemotherapy and 5 received irinotecan based chemotherapy.111 (79.3%) had central-type and 29 (20.7%) had peripheral-type SCLC. The patients characteristics were similar between the central and peripheral subgroups. Peripheral subgroup showed less marginal GGO (65.5% vs 84.7%, p¼0.02), obstructive pneumonia (48.3% vs 80.2%, p¼0.001), obstructive atelectasis (3.4% vs 40.5%, p<0.001) and effusion (37.9% vs 61.3%, p¼0.011) than central tumors. Peripheral subgroup had lower ORR (44.8% vs 73%, p¼0.004) and DCR (79.3% vs 92.8%, p¼0.042). The median PFS was 4.6 months in the entire cohort and peripheral subgroup had significantly short PFS than central one (median PFS: 3.4 vs 5.1 months, p¼0.001, figure A). The median OS was 12.9 months and peripheral subgroup had numerally short OS (median 11.6 vs 13.3 months, p¼0.266, figure B). Conclusion: Central type tumors account for most of SCLC, while patients with peripheral tumors had a significantly lower ORR, shorter PFS and OS after the first line chemotherapy than central type.