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Advanced-stage lung cancer (LC) causes significant morbidity and impacts patients’ quality of life (QoL). Exercise has been proven to be safe, feasible, and beneficial for symptom reduction and QoL improvement in many types of cancers, but research is limited in advanced-stage LC patients. This systematic review evaluates the effect of exercise interventions on the symptoms and QoL in patients with advanced-stage LC. Twelve prospective studies (744 participants) were included, evaluating different combinations of exercises and training such as aerobics, tai chi, strength, inspiratory muscle training, and relaxation. Studies found outcomes including but not limited to improved QoL, symptom burden, psychosocial health, functional status, and physical function. The results of this review support that exercise is safe and feasible with evidence supporting improved QoL and symptom mitigation. Integration of exercise should be considered in the individualized management of advanced-stage LC patients under the guidance of their healthcare providers.

Yingyun Zhang,1,2 Wei Wang,1,2 Xuedong Xu,1,2 Yankang Li,1,3 Hui Zhang,4 Jianbin Li,1,2 Zhenxiang Li1 1Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, People’s Republic of China; 2Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, People’s Republic of China; 3Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China; 4Tumor Hospital of Xiangxi Tujia and Miao Autonomous Prefecture, Jishou, People’s Republic of ChinaCorrespondence: Jianbin Li; Zhenxiang LiDepartment of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, People’s Republic of ChinaTel +86 13869135266; +86 18654536783Email lijianbin@msn.com; lizx0108@163.comIntroduction: The aim of this study was to investigate the role of local radiotherapy in the management of epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancers (NSCLCs) treated with EGFR tyrosine kinase inhibitors (TKIs).Materials and Methods: Patients with stage IV EGFR-mutant NSCLC treated with radiotherapy concomitant to EGFR TKIs from May 2010 to December 2017 were retrospectively identified. Overall survival (OS) was the primary endpoints of the study.Results: A total of 205 patients were enrolled in the study. One hundred eleven patients received one-time single-site radiotherapy (SSR), and 94 patients received multiple-site radiotherapy (MSR). Patients who received MSR had longer OS (median OS, 40.0 months; 95% confidence interval [CI], 29.6 to 50.4) than those who received SSR (median OS, 28.9 months; 95% CI, 24.3 to 33.5; P=0.031). Thoracic radiotherapy was associated with prolonged median OS (41.7 months, 95% CI, 29.0 to 54.4 vs 27.1 months, 95% CI 22.7 to 31.5; log-rank P< 0.001). Multivariate analysis confirmed that thoracic radiotherapy was independently associated with improved OS (adjusted hazard ratio [HR], 0.514; 95% CI 32.3% to 81.8%; P=0.005).Conclusion: MSR improves survival outcomes in patients with advanced-stage, EGFR-mutant, lung adenocarcinoma, with thoracic radiotherapy having the most significant effect on prognosis.Keywords: advanced-stage lung cancer, adenocarcinomas, radiotherapy, EGFR

Background Metastatic lung cancer is a debilitating disease, but with the advances in immunotherapy, therapeutic options have vastly increased. Numerous complete blood count parameters (CBC) have been described as easily accessible biomarkers that might predict response to immunotherapy. However, to date, no comprehensive study has been performed on the longitudinal changes of these parameters during cancer progression. Methods The clinicopathological variables and CBC parameters of 986 advanced stage lung cancer patients were retrospectively analyzed. Blood tests were performed as part of the routine checkup and the results were recorded at the time of the diagnosis of the primary tumor, the diagnosis of brain or bone metastases, and also during the last available follow‐up. Results In the experimental subcohort, 352 and 466 patients were diagnosed with brain and bone metastases, respectively. The control group consisted of 168 patients without clinically detectable or other distant organ metastases. In our longitudinal analyses, we found significantly decreasing absolute lymphocyte count (ALC: P