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This survey, conducted in Rhône-Alpes region (France), aims to better understand the actual conditions of practice in thoracic oncology. A questionnaire was distributed to all oncologists, pulmonologists, radiotherapy physicians and thoracic surgeons in the region. Of 401 questionnaires, the response rate was 56%. Among the responders 46% reported exercising the Thoracic Oncology (TO). Most physicians practicing TO are pulmonologists (62%). The majority (45%) are engaged in secondary hospital or university hospital (27%). However, practitioners with the most important activity exerts in university hospitals and cancer centre (71% of physicians practicing in secondary hospitals and 75% of those in private practice reported to manage fewer than 80 new NSCLC cases per year in structure). Furthermore, 91% are regularly involved in a multidisciplinary team. Radiation oncologist, pulmonologists and thoracic surgeons are assiduous to these meeting; however radiologists and, to a lesser extent, pathologists are less attentive. Moreover, 92% of practitioners belong to cancer networks. Similarly, over one third of working together in a cooperative clinical research institution and nearly half are involved in clinical trials (with nearly half in secondary hospital). These results highlight the reality of practice in Rhône-Alpes and will serve as the basis for coordinating authorities to correct dysfunctions or monitor certain activities of interest (clinical trials)., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

The first-line treatment of non-small cell bronchial cancers at the metastatic stage relies on chemotherapy, the impact of which, in terms of survival in comparison with palliative care alone, has been confirmed by several meta-analyses. The recent development of new drugs (vinorelbine, gemcitabine, paclitaxel, docetaxel) that benefit from an improved efficacy-toxicity ratio, has led to the individualisation, as treatment standard in patients in a general state of good health, of bitherapies based on the combination of a platinum salt and recent active drugs. The latter exhibit similar efficacy, in terms of response and survival, providing PS 0 or 1 patients with a median survival of around 8 months and, at 1 year, nearing 35%. The choice of the first-line therapy in a given patient will be based essentially on the differences in toxicity profiles among the therapeutic regimens, taking into account the frequent co-morbidities in this population, the modalities of administration and the perspectives of second-line therapy. The patients with an altered general state of health (PS 2) will benefit from adapted treatment based on active monotherapy or bitherapy without cisplatin. The prolongation of the first-line therapy over and above 4 cycles following maximal reduction of the tumour does not provide enhanced survival and considerably increases toxicity. The recent cytotoxic agents appear to provide a real progress, although modest in the treatment of metastatic NSCBC, progress which is visible considering the proportion of patients still living in the long term.

Meta-analysis is a statistical method allowing an evaluation of the direction and quantitative importance of a treatment effect observed in randomized trials which have tested the treatment but have not provided a definitive conclusion. In the present review, we discuss the methodology and the contribution of meta-analyses to the treatment of advanced-stage or metastatic non-small-cell lung cancer. In this area of cancerology, meta-analyses have provided determining information demonstrating the impact of chemotherapy on patient survival. They have also helped define a two-drug regimen based on cisplatin as the gold standard treatment for patients with a satisfactory general status. Recently, the meta-analysis method was used to measure the influence of gemcitabin in combination with platinium salts and demonstrated a small but significant benefit in survival, confirming that gemcitabin remains the gold standard treatment in combination with cisplatin.

We report a case of sarcoidosis with mediastinal and pulmonary localizations associated with diffuse antineutrophil cytoplasmic antibodies (c-ANCA). This led to discuss the differential diagnosis with vascularitis and the specificity of c-ANCA in Wegener's granulocytosis.

Radiation-induced cancer is a rare complication of radiotherapy. The diagnosis relies on chronological, topographical and histological data distinguishing the lesion from tumoural relapse. We report the case of a second cancer, meeting the criteria of radiation-induced malignancy, and attempt to define the frequency, clinical situations and risk man. In addition to gentic mechanisms, other factors appear to play a role in the genesis of radiation-induced cancer.