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Objective: Describe characteristics, treatment patterns and clinical outcomes of patients with small-cell lung cancer (SCLC)., Design: Retrospective chart review study defining several cohorts: (1) limited-stage disease (LD) SCLC initiating 1L therapy (1 L LD-SCLC), (2) extensive-stage disease (ED) SCLC initiating 1L therapy (1L ED-SCLC) and (3) patients initiating 2L therapy., Setting: 39 physicians (medical oncologists, thoracic oncologists and/or pulmonologists) from France, Italy and the UK., Participants: Patients >18 years of age with a confirmed diagnosis of LD-SCLC or ED-SCLC and a full oncology medical history. Patients included initiated a 1L (2013-2015) or 2L (2013-2016) treatment (chemotherapy and/or radiotherapy-RT)., Primary and Secondary Outcome Measures: Overall survival (OS) and progression-free survival (PFS)., Results: 231 patients in 1L LD-SCLC, 308 in 1L ED-SCLC and 225 with relapse/refractory SCLC initiating 2L treatment were included. The proportion of men was higher across all groups (56.8% to 68.5%) and mean age at time of diagnosis was 66.0 and 65.4 years in 1L LD-SCLC and 2L ED-SCLC cohorts. The majority of patients in LD-SCLC 1L group received chemotherapy with RT (76.2%). Patients initiating 2L therapy predominantly received chemotherapy alone (79.6%).Median OS in 1 L patients was 17.3 months in LD-SCLC and 8.8 months in ED-SCLC. Median PFS was 11.6 months in LD-SCLC and 6.1 months in ED-SCLC patients. Median OS in patients initiating 2L treatment was 6.6 months. OS from start of 2L treatment was lower in patients initially diagnosed with ED (5.1 months) than in patients initially diagnosed with LD (9.3 months) (p<0.0001). OS and PFS were assessed from the start of 1L or 2L therapy, depending on the cohort., Conclusions: Despite the availability of a high number of treatments and combinations, the prognosis of SCLC is still unsatisfactory, especially for those patients diagnosed with ED-SCLC, indicating high unmet need in this patient population., Competing Interests: Competing interests: FB reports personal fees from Abbvie, Amgen, Bayer, Cellgene, CellMedica, Ipsen, Mediation, Pfizer, Regeneron, Roche, and Takeda; grants from Amgen, Pfizer, and Novartis; and non-financial support from Amgen, and AstraZeneca; outside the submitted work. NG reports personal fees from Lilly, Pharmamar and BMS; and grants from Lilly, and BMS; during the conduct of the study. AL does not report personal fees, grants or non-financial support during the conduct of the study. LM and AJG report BMS employment. MR and NL report IQVIA employment., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Rare cancers are defined by an incidence of <6 out of 100 000 cases per year. They are under-represented in clinical research including tumour molecular analysis. The aim of Arcagen is to generate a multinational database integrating clinical and molecular information of patients with rare cancers., Patients and Methods: We present the retrospective feasibility cohort of patients with rare cancers, with previously collected tumour samples available from any stage. Molecular analysis was performed using FoundationOne CDx for all histologies except for sarcoma where FoundationOne Heme was used. Clinical data including demographic data, medical history, malignant history, treatment and survival data were collected., Results: Eighty-seven patients from three centres were screened; molecular data were obtained for 77 patients (41 sarcomas, 9 yolk sac tumours, 14 rare head and neck cancers, 13 thymomas). The median age at the time of diagnosis was 48 (range 28-85). Most patients had reportable genomic alterations (89%). The most common alterations were linked to cell cycle regulation (TP53, RB1, CDKN2A/B deletions and MDM2 amplification). Multiple activating single-nucleotide variants (SNVs) could be detected in the RAS/RAF family. The tumour mutational burden status was globally low across all samples with a median of 3 Muts/MB (range 0-52). Only 4 cases (ie, 4.7% of tumours) had direct actionable mutations for a treatment approved in Europe within the patient's tumour type., Conclusion: The Arcagen project aims to bridge the gap and improve knowledge of the molecular landscape of rare cancers by prospectively recruiting up to 1000 patients., Competing Interests: Competing interests: IR-C has Honoraria (self) from AbbVie, Agenus, Advaxis, BMS, PharmaMar, Genmab, Pfizer, AstraZeneca, Roche, GSK, MSD, Deciphera, Mersena, Merck Sereno, Novartis, Amgen, Tesaro and Clovis; honoraria (institution) from GSK, MSD, Roche and BMS; advisory/consulting fees from AbbVie, Agenus, Advaxis, BMS, PharmaMar, Genmab, Pfizer, AstraZeneca, Roche/Genentech, GSK, MSD, Deciphera, Mersena, Merck Sereno, Novartis, Amgen, Tesaro and Clovis; research grant/funding (self) from MSD, Roche and BMS; research grant/funding (institution) from MSD, Roche, BMS, Novartis, AstraZeneca and Merck Sereno and travel support from Roche, AstraZeneca and GSK. JF has Honoraria (self) from BMS, AstraZeneca, Roche, MSD, Merck Sereno; advisory/consulting fees from Servier, BMS, AstraZeneca, Innate Pharma, Roche/Genentech; research grant/funding (self) from AstraZeneca; research grant/funding (institution) from MSD, Roche, BMS, Novartis, AstraZeneca and Merck Sereno and travel support from BMS, MSD, AstraZeneca. J-YB has research support and honoraria from Roche Genentech. DJ, OH and RE are employees of FMI/Roche and Roche shareholders., (© Author (s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ on behalf of the European Society for Medical Oncology.)

We established an international consortium to review and discuss relevant clinical evidence in order to develop expert consensus statements related to cancer management during the severe acute respiratory syndrome coronavirus 2-related disease (COVID-19) pandemic. The steering committee prepared 10 working packages addressing significant clinical questions from diagnosis to surgery. During a virtual consensus meeting of 62 global experts and one patient advocate, led by the European Society for Medical Oncology, statements were discussed, amended and voted upon. When consensus could not be reached, the panel revised statements until a consensus was reached. Overall, the expert panel agreed on 28 consensus statements that can be used to overcome many of the clinical and technical areas of uncertainty ranging from diagnosis to therapeutic planning and treatment during the COVID-19 pandemic., Competing Interests: Disclosures AA reports personal fees from BMS, AstraZeneca, MSD, Pfizer, Roche, Takeda and Boehringer outside the submitted work. LA reports other from BMS, MSD, Novartis, Amgen, Ipsen, Roche, Pfizer, Merck, AstraZeneca, Exelixis, Peloton Therapeutics and Corvus Pharmaceuticals outside the submitted work. PAA reports grants and personal fees from BMS, Roche Genentech and Array outside the submitted work; personal fees from MSD, Novartis, Merck Serono, Pierre Fabre, Incyte, MedImmune, AstraZeneca, Syndax, Sun Pharma, Sanofi, Idera, Ultimovacs, Sandoz, Immunocore, 4SC, Alkermes, Italfarmaco, and Eisai outside the submitted work; advisory role with Boehringer Ingelheim outside the submitted work. SB reports grants and personal fees from AstraZeneca/MedImmune and GSK/Tesaro outside the submitted work; personal fees from Amgen, Clovis, Mersana, Seattle Genetics, Genmabs, Merck Serono, Roche and Immunogen outside the submitted work. FB reports personal fees from AstraZeneca, Bayer, BMS, Boehringer Ingelheim, Eli Lilly Oncology, F. Hoffmann-La Roche Ltd., Novartis, Merck, MSD, Pierre Fabre, Pfizer and Takeda outside the submitted work. CCa is a member of AstraZeneca's IMED External Science Panel, a member of Illumina's Scientific Advisory Board and a recipient of research grants (administered by the University of Cambridge) from Genentech, Roche, AstraZeneca and Servier. FC reports personal fees from Amgen, Astellas/Medivation, AstraZeneca, Celgene, Daiichi Sankyo, Eisai, GE Oncology, Genentech, GSK, MacroGenics, Medscape, MSD, Merus BV, Mylan, Mundipharma, Novartis, Pfizer, Pierre Fabre, prIME Oncology, Roche, Samsung Bioepis, Sanofi, Seattle Genetics and Teva outside the submitted work. AC reports grants, personal fees and other from Merck Serono, Servier, Roche, Lilly, Novartis, Takeda, Astellas and Bayer outside the submitted work; personal fees and other from Pierre Fabre, Amgen and Foundation Medicine outside the submitted work; grants from Genentech, FibroGen, Amcure, Sierra Oncology, AstraZeneca, MedImmune, BMS, MSD, AbbVie, Theradex, Array, Tesaro and Johnson & Johnson outside the submitted work. TKC reports grants, personal fees, non-financial support and other from BMS, Exelixis, Pfizer, (during the conduct of the study), Merck, BMS, Exelixis, AstraZeneca, Lilly, Eisai, Novartis, GSK, Lilly, Pfizer and EMD Serono outside the submitted work; has a patent null pending and stock ownership in Pionyr and Tempest; has received travel, accommodations and expenses in relation to consulting, advisory roles and clinical trials; medical writing and editorial assistance support may have been provided by communications companies funded by pharmaceutical companies; the institution (Dana Farber Cancer Institute) may have received additional independent funding from drug companies and/or royalties potentially involved in research around the subject matter; is a member of the NCCN kidney panel. MLKC reports personal fees from Janssen, Astellas, MSD Oncology, Bayer and Illumina outside the submitted work; personal fees and non-financial support from AstraZeneca and Varian outside the submitted work; non-financial support from PV Med and Decipher Biosciences outside the submitted work. CC reports personal fees from Pfizer, Novartis, Eli Lilly and Roche outside the submitted work. GC reports grants from Roche and Pfizer outside the submitted work; personal fees from Daiichi Sankyo, MSD and AstraZeneca outside the submitted work. EdA reports personal fees from Roche/Genentech, Novartis, Seattle Genetics and Zodiac; other from Roche/Genentech and GSK/Novartis; grants from AstraZeneca, GSK/Novartis, Roche/Genentech and Servier outside the submitted work. DDR reports advisory boards and grants from BMS, AstraZeneca, Boehringer Ingelheim, Celgene, Seattle Genetics, Roche/Genentech and Merck/Pfizer outside the submitted work; other from Philips and Olink outside the submitted work. EDV reports institutional financial support for her advisory role from Daiichi Sankyo, Merck, NSABP, Pfizer, Sanofi and Synthon outside the submitted work; institutional financial support for clinical trials or contracted research from Amgen, AstraZeneca, Bayer, Chugai Pharma, CytomX Therapeutics, G1 Therapeutics, Genentech, Nordic Nanovector, Radius Health, Regeneron, Roche and Synthon outside the submitted work. RDe reports personal fees from AstraZeneca, Roche, MSD, Eisai, Pfizer and Novartis outside the submitted work. RDz reports personal fees and non-financial support from Roche and AstraZeneca outside the submitted work; personal fees from Novartis, Pfizer, Takeda, Seattle Genetics, Foundation Medicine and MSD outside the submitted work. CF-F reports grants and other from AstraZeneca and Elekta outside the submitted work. EF reports personal fees from AbbVie, AstraZeneca, Blueprint Medicines, Boehringer Ingelheim, BMS, Eli Lilly, Guardant Health, Janssen, Medscape, Merck KGaA, MSD, Novartis, Pfizer, prIME Oncology, Roche, Samsung, Takeda, TouchIME, GSK and Bayer outside the submitted work; grants from Grant For Oncology Innovation (GOI) and Fundación Merck Salud outside the submitted work; is an independent board member of Grifols. MG reports grants and personal fees from Eli Lilly, Otsuka Pharma, AstraZeneca, Novartis, BMS, Roche, Pfizer, Celgene, Incyte, Bayer, MSD, GSK, Spectrum Pharmaceuticals, Blueprint Medicine and Boehringer Ingelheim outside the submitted work; personal fees from Seattle Genetics, Daiichi Sankyo, Janssen, Inivata, Takeda and Sanofi Aventis outside the submitted work; grants from United Therapeutics Corporation, Merck KGaA, Turning Point, Ipsen, MedImmune, Exelisis, Tiziana Sciences, Clovis and Merck Serono outside the submitted work; non-financial support from MSD, Pfizer and Eli Lilly outside the submitted work. PG reports personal fees from Roche, from MSD, BMS, Boehringer Ingelheim, Pfizer, AbbVie, Novartis, Lilly, AstraZeneca, Janssen, Blueprint Medicines, Takeda, Gilead and ROVI outside the submitted work. JH reports grants and other from BMS, MSD, Novartis, BioNTech and Amgen outside the submitted work; other from Achilles Therapeutics, GSK, Immunocore, Ipsen, Merck Serono, Molecular Partners, Pfizer, Roche/Genentech, Sanofi, Seattle Genetics, Third Rock Ventures and Vaximm outside the submitted work; personal fees from Neogene Therapeutics outside the submitted work. EH reports grants, non-financial support and other from Lilly, Roche/Genentech, Daiichi Sankyo, AstraZeneca, Eisai and Novartis outside the submitted work; grants and non-financial support from Tesaro, Radius Health, Clovis, Medivation and EMD Serono outside the submitted work; grants and other from Puma Biotechnology, Pfizer, Mersana, Boehringer Ingelheim, Cascadian Therapeutics, Silverback and Black Diamond outside the submitted work; grants from Hutchinson MediPharma, OncoMed, MedImmune, Stem CentRx, Curis, Verastem, Zymeworks, Syndax, Lycera, Rgenix, Millenium, TapImmune, BerGenBio, H3 Biomedicine, Acerta Pharma, Takeda, MacroGenics, AbbVie, Immunomedics, Fujifilm, eFFECTOR Therapeutics, Merus, NuCana, Regeneron, Leap Therapeutics, Taiho Pharmaceutical, EMD Serono, Syros, Clovis, CytomX, InventisBio, Deciphera, ArQule, Sermonix Pharmaceuticals, Sutro Biopharma, Zenith Epigenetics, Arvinas, Torque Therapeutics, Harpoon Therapeutics, Fochon Pharmaceuticals, Orinove, Molecular Templates, Unum Therapeutics, Aravive, Compugen, Dana Farber Cancer Institute, G1 Therapeutics, Karyopharm Therapeutics and Torque Therapeutics outside the submitted work; other from Nanostring; non-financial support from Amgen, Bayer, BMS, Genzyme, Helsinn Therapeutics, HERON, Lexicon, Merck, Roche, Sysmex, Guardant Heallth and Foundation Medicine outside the submitted work. PAJ reports grants and personal fees from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Daiichi Sankyo and Takeda Oncology outside the submitted work; personal fees from Pfizer, Roche/Genentech, Merrimack Pharmaceuticals, Chugai Pharmaceuticals, Araxes Pharma, Ignyta, Mirati Therapeutics, Novartis, Voronoi, SFJ Pharmaceuticals, Biocartis and LOXO Oncology outside the submitted work; grants from Puma and Astellas Pharmaceuticals outside the submitted work; receives post-marketing royalties from DFCI owned intellectual property on EGFR mutations licensed to Lab Corp. KJ reports personal fees from MSD, Merck (USA), Amgen, Helsinn, Riemser, Tesaro, Kreussler, Voluntis, Pfizer, Pomme-med, PharmaMar, ClinSol Research, Hexal, G1 Therapeutics, Shire, prIME Oncology, medupdate, art tempi and UpToDate outside the submitted work. RK reports grants and personal fees from MSD, Janssen, Astellas, Bayer and Pfizer outside the submitted work. SBK has received research funding from Novartis, Sanofi-Aventis, Kyowa-Kirin Inc and DongKook Pharm Co.; has participated as a consultant in advisory boards for Novartis, AstraZeneca, Lilly, Enzychem, Dae Hwa Pharmaceutical Co. Ltd., ISU Abxis and Daiichi-Sankyo. FL reports personal fees from Amgen, Astellas, AstraZeneca, BioNTech, Eli Lilly, Elsevier, Excerpta Medica, Imedex, Infomedica, medupdate, Merck Serono, MSD, Corvus, proMedicis, Springer Nature, streamedup!, Zymeworks, Bayer and Roche outside the submitted work; grants and personal fees from Iomedico and BMS outside the submitted work. JPM reports personal fees from Roche, AstraZeneca, Bayer, Innate, Merck Serono, Boehringer Ingelheim, Novartis, Janssen, Incyte, Cue Biopharma, ALX Oncology and Pfizer outside the submitted work; grants and personal fees from BMS outside the submitted work; other from Amgen, MSD, PsiOxus, Debio and Nanobiotix outside the submitted work. TSKM reports grants, personal fees and other from AstraZeneca outside the submitted work; grants and personal fees from Roche/Genentech, Pfizer, MSD, Novartis, SFJ Pharmaceutical and BMS outside the submitted work; grants from Clovis Oncology, XCovery and G1 Therapeutics Inc. outside the submitted work; non-financial support from GeneDecode outside the submitted work; personal fees from Boehringer Ingelheim, Lilly, Merck Serono, Vertex Pharmaceuticals, Oncogenex, Celgene, Ignyta, Cirina, Fishawack Facilitate, Takeda Oncology, Janssen, OrigiMed, Hengrui Therapeutics, Sanofi-Aventis R&D, Yuhan Corporation, PrIME Oncology, Amoy Diagnostics, Loxo-Oncology, ACEA Pharma, Alpha Biopharma Co. Ltd., CStone Pharmaceuticals, IQVIA, MoreHealth, InMed Medical Communication, Virtus Medical Group, Biolidics Ltd., Bayer, Daiichi Sankyo, Incyte Corporation, Lunit Inc., Mirati Therapeutics Inc. and Gritstone Oncology Inc. outside the submitted work; other from Hutchison ChiMed, Sanomics, ASCO and CSCO outside the submitted work. AP reports honoraria for consulting, advisory role or lectures from AstraZeneca, Agilent/Dako, BMS, Eli Lilly, MSD and Roche Genentech. GP reports grants, personal fees and non-financial support from Merck outside the submitted work; grants and non-financial support from AstraZeneca outside the submitted work; grants and personal fees from Roche, BMS, MSD and Novartis outside the submitted work; grants from Amgen and Lilly outside the submitted work. SP has received educational grants, provided consultation, attended advisory boards and/or provided lectures for AbbVie, Amgen, AstraZeneca, Bayer, Biocartis, BioInvent, Blueprint Medicines, Boehringer Ingelheim, BMS, Clovis, Daiichi Sankyo, Debiopharm, Eli Lilly, F. Hoffmann-La Roche, Foundation Medicine, Illumina, Janssen, MSD, Merck Serono, Merrimack, Novartis, PharmaMar, Pfizer, Regeneron, Sanofi, Seattle Genetics, Takeda and Vaccibody, from whom she has received honoraria (all fees to institution). MR reports personal fees from Amgen, AstraZeneca, BMS, Boehringer Ingelheim, GSK, Lilly, Merck, MSD, Novartis, Pfizer, Roche and Samsung Bioepis outside the submitted work. RSS reports attending advisory boards for VCN-BCN, Agendia, Guardant Health, Roche Diagnostics, Ferrer, Pfizer, Novartis, Ipsen, Amgen, Merck, Roche Pharma, Lilly and MSD; speaker's fees from Pfizer, Amgen, Novartis, Merck, MSD, AstraZeneca and Celgene; leadership role and stocks or ownership interest with Sace Medhealth. FS reports financial interests, honoraria for speaker, consultancy or advisory role, royalties and/or direct research funding from Tesaro, Helsinn, Vifor, MSD, Roche, Amgen, Pierre Fabre Oncology, Pfizer, Leo Pharma, Arrow BMS, Mylan and Mundi-Pharma outside of the submitted work. SS reports grants and personal fees from AstraZeneca outside the submitted work; grants from Varian Medical Systems and ViewRay Inc. outside the submitted work; personal fees from MSD and Celgene, outside the submitted work. ES reports personal fees from Astellas, AstraZeneca, BMS, Celgene, Five Prime Therapeutics, Gritstone Oncology, Merck, Servier and Zymeworks outside the submitted work. RS reports grants and personal fees from AstraZeneca and Boehringer Ingelheim outside the submitted work; personal fees from BMS, Eli Lilly, MSD, Novartis, Pfizer, Taiho Pharmaceutical, Takeda, Yuhan and Amgen outside the submitted work. JCS reports personal fees from Abbvie, AstraZeneca, Bayer, Blend Therapeutics, Boeringher Ingelheim, Cytomix, Daiichi Sankyo, Eli Lilly, Genmab, Guardiant Health, Inivata, Merck, Netcancer, Roche, Servier, PharmaMar and Tarveda outside the submitted work; was a full time employee of AstraZeneca from September 2017 to December 2019. FS reports unrestricted research grants from Celgene, Fresenius and Helsinn; participation in company-led clinical trials with Novartis; advisory boards for Helsinn, Mundipharma, Novartis, Fresenius and Kaiku Health. JT reports personal fees from Array Biopharma, AstraZeneca, Bayer, BeiGene, Boehringer Ingelheim, Chugai, Genentech Inc., Genmab A/S, Halozyme, Imugene Limited, Inflection Biosciences Limited, Ipsen, Kura Oncology, Lilly, MSD, Menarini, Merck Serono, Merrimack, Merus, Molecular Partners, Novartis, Peptomyc, Pfizer, Pharmacyclics, ProteoDesign SL, Rafael Pharmaceuticals, F. Hoffmann-La Roche Ltd., Sanofi, SeaGen, Seattle Genetics, Servier, Symphogen, Taiho, VCN Biosciences, Biocartis, Foundation Medicine, HalioDX SAS and Roche Diagnostics outside the submitted work. EVC reports grants from Amgen, Bayer, Boehringer Ingelheim, BMS, Celgene, Ipsen, Lilly, MSD, Merck KGaA, Novartis, Roche and Servier; advisory boards for Array, AstraZeneca, Bayer, Biocartis, BMS, Celgene, Daiichi, Halozyme, GSK, Pierre Fabre, Incyte, Ipsen, Lilly, MSD, Merck KGaA, Novartis, Pierre Fabre, Roche, Servier, Sirtex and Taiho outside the submitted work. PEvS reports IASLC board member; treasurer BACTS; external expert for AstraZeneca, MSD and Institut National du Cancer, France (institutional fees). GV reports grants from Associazione Italiana per la Ricerca sul Cancro (AIRC), Ministry of Health and Istituto Nazionale Assicurazione Infortuni sul Lavoro outside the submitted work; honoraria from Ab Medica SpA, Medtronic and Verb Medical. JY reports personal fees from Boehringer Ingelheim, Eli Lilly, Bayer, Roche/Genentech, Chugai Pharmaceutical, MSD, Pfizer, Novartis, BMS, Ono Pharmaceuticals, AstraZeneca, Merck Serono, Celgene, Yuhan Pharmaceuticals, Daiichi Sankyo, Hansoh Pharmaceuticals, Takeda Oncology, Blueprint Medicines and Amgen outside the submitted work. IFC, NIC, JYD, DDU, NG, RGJ, VG, UG, OAM, GM, RO, KP, CS, DSW, JS, DT and HvH have declared no significant conflict of interest., (Copyright © 2020 European Society for Medical Oncology. Published by Elsevier Ltd. All rights reserved.)

Introduction: Mediastinal lesions are uncommon; studies on their distribution are, in general, small and from a single institution. Furthermore, these studies are usually based on pathology or surgical databases and, therefore, miss many lesions that did not undergo biopsy or resection. Our aim was to identify the distribution of lesions in the mediastinum in a large international, multi-institutional cohort., Methods: At each participating institution, a standardized retrospective radiology database search was performed for interpretations of computed tomography, positron emission tomography-computed tomography, and magnetic resonance imaging scans including any of the following terms: "mediastinal nodule," "mediastinal lesion," "mediastinal mass," or "mediastinal abnormality" (2011-2014). Standardized data were collected. Statistical analysis was performed., Results: Among 3308 cases, thymomas (27.8%), benign mediastinal cysts (20.0%), and lymphomas (16.1%) were most common. The distribution of lesions varied among mediastinal compartments; thymomas (38.3%), benign cysts (16.8%), and neurogenic tumors (53.9%) were the most common lesions in the prevascular, visceral, and paravertebral mediastinum, respectively (p < 0.001). Mediastinal compartment was associated with age; patients with paravertebral lesions were the youngest (p < 0.0001). Mediastinal lesions differed by continent or country, with benign cysts being the most common mediastinal lesions in the People's Republic of China, thymomas in Europe, and lymphomas in North America and Israel (p < 0.001). Benign cysts, thymic carcinomas, and metastases were more often seen in larger hospitals, whereas lymphomas and thymic hyperplasia occurred more often in smaller hospitals (p < 0.01)., Conclusions: Our study confirmed that the spectrum and frequency of mediastinal lesions depend on mediastinal compartment and age. This information provides helpful demographic data and is important when considering the differential diagnosis of a mediastinal lesion., (Copyright © 2019 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.)

Objectives: The International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee-Thymic Domain conducted a web-based cross-sectional survey to assess the acceptance of the TNM thymic staging system in the thoracic community., Methods: A 50-item, web-based questionnaire was circulated among the members of the major thymic organizations worldwide from September to December 2018. The survey consisted of six sections (general information; overall perception of the TNM system; pretreatment staging; T category; N category; and perioperative treatments)., Results: In total, 217 responses were collected from 37 countries in four continents. The TNM classification was considered useful by 78% of the responders (N = 169); the Masaoka-Koga staging system was being used by 87% of the responders (N = 189). With regard to the T category, most responders (mostly surgeons) felt that the capsular and mediastinal pleural involvements should be considered separate T categories. As for the N category, 48% of the responders (N = 105) used the International Thymic Malignancies Interest Group/International Association for the Study of Lung Cancer thymic nodal map, and lymph node dissection (N1/N2) was performed for 50%/21% thymomas and 66%/41% thymic carcinomas. While analyzing the results by the three continents (Europe, Asia, and Americas), responders in Asia were found to report the largest use of the TNM system, the greatest attention to the N category, and the best participation in international thymic databases., Conclusions: The survey indicates that the Union for International Cancer Control/American Joint Committee on Cancer TNM stage classification of thymic tumors is gaining acceptance among the scientific community. The present results will guide the work of the Staging and Prognostic Factors Committee-Thymic Domain for the revision of the ninth edition of the TNM stage classification of thymic tumors., (Copyright © 2019 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.)

The management of patients with mesothelioma and thymic malignancy requires continuous multidisciplinary expertise at any step of the disease. A dramatic improvement in our knowledge has occurred in the last few years, through the development of databases, translational research programs, and clinical trials. Access to innovative strategies represents a major challenge, as there is a lack of funding for clinical research in rare cancers and their rarity precludes the design of robust clinical trials that could lead to specific approval of drugs. In this context, patient-centered initiatives, such as the establishment of dedicated networks, are warranted. International societies, such as IMIG (International Mesothelioma Interest Group) and ITMIG (International Thymic Malignancy Interest Group) provide infrastructure for global collaboration, and there are many advantages to having strong regional groups working on the same issues. There may be regional differences in risk factors, susceptibility, management and outcomes. The ability to address questions both regionally as well as globally is ideal to develop a full understanding of mesothelioma and thymic malignancies. In Europe, through the integration of national networks with EURACAN, the collaboration with academic societies and international groups, the development of networks in thoracic oncology provides multiplex integration of clinical care and research, ultimately ensuring equal access to high quality care to all patients, with the opportunity of conducting high level clinical and translational research projects., (Copyright © 2018 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

Background: Brain metastases (BM) are frequent in non-small cell lung cancer (NSCLC) patients, but there is a lack of evidence-based management of this patient group. We aimed to capture a snapshot of routine BM management in Europe to identify relevant research questions for future clinical trials., Methods: An EORTC Lung Cancer Group (LCG) online survey containing questions on NSCLC BM screening and treatment was distributed between 16/02/17 and 15/06/17 to worldwide EORTC LCG members, and through several European scientific societies in the thoracic oncology field., Results: A total of 462 European physician responses (394 institutions) were analysed (radiation oncologist: 53% [n = 247], pulmonologist: 26% [n = 119], medical oncologist: 18% [n = 84]; 84% with >5 years' experience in NSCLC). Italy (18%, n = 85), Netherlands (15%, n = 68), UK (14%, n = 66), and France (12%, n = 55) contributed most. 393 physicians (85%) screened neurologically asymptomatic patients for BM at diagnosis (52% using magnetic resonance imaging). Most often screened patients were those with a driver mutation (MUT+; 51%, n = 234), stage III (63%, n = 289), and IV (43%, n = 199). 158 physicians (34%) used a prognostic classification to guide initial treatment decisions, and in 50%, lowest prognostic-score threshold to receive treatment differed between MUT+ and non-driver mutation (MUT-) patients. MUT+ patients with >4 BM were more likely to receive stereotactic radiosurgery (SRS) compared with MUT- (27% versus. 21%; p < 0.01). Most physicians (90%) had access to SRS. After single BM surgery, 50% systematically prescribed SRS or WBRT, and 45% only in case of incomplete resection. The preferred treatment in neurologically asymptomatic treatment-naive patients diagnosed with >5 BM was systemic treatment (79%). Of all, 45%/49% physicians stated that all tyrosine kinase inhibitors and immune checkpoint blockers were discontinued (timing varied) during SRS/WBRT, respectively. Drugs most often continued during SRS/WBRT were erlotinib (44%/40%), gefitinib (39%/34%), afatinib (29%/25%), crizotinib (33%/26%) and anti-PD-(L)-1 (28%/22%)., Conclusion: BM management is highly variable in Europe: screening is not uniform, prognostic classifications are not often used and MUT+ NSCLC patients generally receive more intensive local treatment. Prospective assessment of BM management in MUT+ NSCLC patients is required., (Copyright © 2018 Elsevier Ltd. All rights reserved.)