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Background/aim Small cell lung cancer (SCLC) accounts for 13% of all lung cancers. Venous thromboembolism (VTE) is a frequent complication. The purpose of this study was to investigate the incidence and risk factors for VTE in SCLC patients. Patients and methods Retrospective analysis of patients with histologically confirmed SCLC treated between January 2015 and June 2018 at Sotiria General Hospital, Athens, Greece. Results Two hundred and seventeen patients were included in the analysis. The incidence of VTE was 4.1%. Increased body mass index (BMI) was correlated with the development of VTE. Moreover, VTE appeared more frequently in patients with major vessel infiltration and with poor Eastern Cooperative Oncology Group Performance Status. Other factors, including gender, age, stage, presence of metastasis, treatment, immobilization, anticoagulation, comorbidities, and laboratory values did not correlate with the development of VTE. Conclusion Factors associated with the development of VTE were BMI, major vessel infiltration and PS. Identifying factors that predispose to VTE could help physicians detect high-risk patients who would benefit from prophylactic anticoagulation therapy.

BACKGROUND: Accurate mediastinal staging in patients with non-small cell lung cancer (NSCLC) is crucial for the determination of optimal treatment management. METHODS: This was a real-life prospective study enrolling 140 patients between December 2016 and August 2018. We aimed to determine the clinical utility of EBUS/EUS-b in mediastinal staging of patients with NSCLC in comparison with integrated PET/CT. Furthermore, SUV(max) cut-off value with the highest specificity/accuracy was evaluated. Subgroup analysis according to histological type was performed. RESULTS: One hundred and thirty patients were eligible for analysis (mean age ± SD: 67.6±7.6, males 97). Three hundred different lymph node stations were sampled (272 through EBUS-TBNA and 28 through EUS-b FNA). Mean SUV(max) of all malignant lymph nodes was 7.46 (SD =5.54). Sensitivity, specificity, PPV and NPV of EBUS/EUS-b for the identification of mediastinal malignant lymph nodes was 93.8%, 100%, 100%, and 93.4%, respectively. Accordingly, PET/CT yielded 92.2% sensitivity, 43.9% specificity, 64.8% PPV and 83.3% NPV. For adenocarcinoma (n=76) NPV were 86.2% with EBUS/EUS-b and 75% with PET/CT. NPV for squamous cell (n=46) was 100% with EBUS/EUS-b and 90.9% with PET/CT. EBUS/EUS-b staging yielded excellent agreement with final staging (97.5%, Tau 0.94, P

Cancer and COVID-19 are both well-established risk factors predisposing to thrombosis. Both disease entities are correlated with increased incidence of venous thrombotic events through multifaceted pathogenic mechanisms involving the interaction of cancer cells or SARS-CoV2 on the one hand and the coagulation system and endothelial cells on the other hand. Thromboprophylaxis is recommended for hospitalized patients with active cancer and high-risk outpatients with cancer receiving anticancer treatment. Universal thromboprophylaxis with a high prophylactic dose of low molecular weight heparins (LMWH) or therapeutic dose in select patients, is currentlyindicated for hospitalized patients with COVID-19. Also, prophylactic anticoagulation is recommended for outpatients with COVID-19 at high risk for thrombosis or disease worsening. However, whether there is an additive risk of thrombosis when a patient with cancer is infected with SARS-CoV2 remains unclear In the current review, we summarize and critically discuss the literature regarding the epidemiology of thrombotic events in patients with cancer and concomitant COVID-19, the thrombotic risk assessment, and the recommendations on thromboprophylaxis for this subgroup of patients. Current data do not support an additive thrombotic risk for patients with cancer and COVID-19. Of note, patients with cancer have less access to intensive care unit care, a setting associated with high thrombotic risk. Based on current evidence, patients with cancer and COVID-19 should be assessed with well-established risk assessment models for medically ill patients and receive thromboprophylaxis, preferentially with LMWH, according to existing recommendations. Prospective trials on well-characterized populations do not exist.

Lung cancer is the leading cause of cancer-related deaths worldwide, and elucidation of its complicated pathobiology has been traditionally targeted by studies incorporating genomic as well other high-throughput approaches. Recently, a collection of methods used for cancer imaging, supplemented by quantitative aspects leading towards imaging biomarker assessment termed “radiomics”, has introduced a novel dimension in cancer research. Integration of genomics and radiomics approaches, where identifying the biological basis of imaging phenotypes is feasible due to the establishment of associations between molecular features at the genomic–transcriptomic–proteomic level and radiological features, has recently emerged termed radiogenomics. This review article aims to briefly describe the main aspects of radiogenomics, while discussing its basic limitations related to lung cancer clinical applications for clinicians, researchers and patients.

Superior vena cava syndrome (SVCS) is a clinical entity characterized by signs and symptoms arising from the obstruction or occlusion of the thin-walled superior vena cava (SVC) and can result in significant morbidity and mortality. Despite the rise of benign cases of SVCS, as a thrombotic complication of intravascular devices, it is most commonly seen secondary to malignancy as a consequence of thrombosis, direct invasion of tumor cells inside the vessel, or external compression. SVCS can be the initial presentation of a previously undiagnosed tumor in up to 60% of cases. Lung cancer and non-Hodgkin lymphoma (NHL) are responsible for up to 85%-90% of malignancy-related SVCS, while metastatic cancers account for approximately 10%. Herein, we review the pathophysiology, etiology, clinical presentation, diagnosis, and management of malignancy-related SVCS.

To map the patients' journey from symptoms onset to treatment initiation for the most frequent histological types of lung cancer in Greece and describe the initial treatment that patients receive.The primary data source was a Greek hospital-based registry. Demographic, anthropometric, lifestyle, and diagnostic-related characteristics as well as treatment-related data were extracted from the registry for patients diagnosed with Adenocarcinoma, Squamous and Small Cell Lung Cancer (SCLC). The time intervals from symptoms onset to diagnosis (StD), diagnosis to treatment initiation (DtT), symptoms onset to treatment initiation (StT) and surgery to post-surgery treatment (SRGtT) were estimated.231, 120 and 122 patients were diagnosed with Adenocarcinoma, SCLC and Squamous, respectively. The percentage of patients diagnosed at stage III/IV ranged from 75% in Adenocarcinoma to 97.5% in SCLC (p 0.001). The median (IQR) StD was 52 (28-104) days and no difference was detected across the three histological types (p = 0.301). Cough as first symptom was the only determinant of StD (p = 0.001). The median (IQR) DtT was 23 (13-36) days, with this time interval being shorter among patients with SCLC compared to patients with Adenocarcinoma and Squamous (p 0.001). The median (IQR) StT was 81 (51-139) days. Almost one third of patients with Adenocarcinoma and Squamous were subjected first to surgery and the median (IQR) SRGtT was 42 (34-55) days.Our results indicate that time interval from symptoms onset to treatment initiation in Greece is substantially prolonged, highlighting the need for strategies to expedite lung cancer diagnosis and access to evidence-based treatment.

e13531 Background: It is known that malignancies exaggerate the risk of thrombosis up to 20%, while for Lung Cancer (LC) is articulated up to 14%. Likewise, thrombosis amplifies the LC progression, thrombosis-associated lung cancer (TALC). The pathophysiology promoting LCAT & TALC is multifactorial depending on the characteristics of LC, specific anti-cancer modalities, patient features, and biomarkers such as tissue factor, neutrophil extracellular traps released in response to cancer, cancer procoagulant, and cytokines. Low-molecular-weight heparins are used in prophylaxis and treatment for high-burden for thrombosis (HTB) patients, allowing specialists to focus on the cancer disease. Methods: iCaLT is a prospective observational study conducted in Thoracic Diseases General Hospital Sotiria (Athens, Greece) assessing the role of thromboprophylaxis with tinzaparin 10.000 Anti-Xa IU, OD with the systemic anti-cancer therapy (SACT). LC patients with active disease that are currently under treatment are enrolled after signing informed consent and monitored up to six months or until anticoagulation terminates. Results: Results from 106 patients reported, 29 (27%) are still ongoing: 79% were males. Histological results involve: adenocarcinomas 54%, squamous 25%, small cell 15%and others. LC patients received SACT: 55%, 23%, 10%, 6% in 1st, 2nd, 3rdand 4th line. HTB patients with active LC related to 4 factors: disease, treatment, biomarker and patient features are presented in table. On average patients accumulated 3.7±1.1risk factors, 91% of patients accumulated ≥3 risk factors. Median thromboprophylaxis duration was: 4.8 months (1st-3rd quartile: 2.8-6.0 months). One patient experienced thrombotic event in lower extremes and consequently pulmonary embolism (efficacy 99.1%, 95%CI: 94.6-99.8%), five patients experienced minor bleeding adverse events (haemoptysis) (4.7%, 95%CI: 2.0-10.6%), and two patients allergic reactions. Patients with haemoptysis had lower age (60 vs. 67, p=0.1357). Conclusions: Thromboprophylaxis with tinzaparin intermediate dose in high thrombotic burden patients with active lung cancer is effective and safe. Further research is needed.[Table: see text]

Introduction: Accurate mediastinal staging in patients with non-small cell lung cancer (NSCLC) is crucial for the determination of optimal treatment management. Aim: To compare the diagnostic accuracy of EBUS/EUS-b with PET-CT in mediastinal staging of potentially operable NSCLC patients. Methods: This was a prospective study enrolling 140 patients between 1/7/2016 and 31/8/2018. Results: 130 patients were eligible for analysis (mean age ± SD:67,6 ±7,6, males 97). 304 different lymph node (LN) stations were sampled (276 through EBUS and 28 through EUS-b). Sensitivity, specificity, PPV and NPV of EBUS/EUS-b for the identification of mediastinal malignant LN’s was 93,8%, 100%, 100% and 93,4% respectively. Accordingly, PET-CT yielded 92,2% sensitivity, 43,9% specificity, 64,8% PPV and 83,3% NPV. NPV for adenocarcinoma (n=76) was 86,2% with EBUS/EUS-b and 75% with PET-CT. NPV for squamous cell (n=46) was 100% with EBUS/EUS-b and 90,9% with PET-CT. Thoracic endosonography staging yielded excellent agreement with final staging (97,5%, Tau 0,94, p Conclusion: Thoracic endosonography is a safe, minimally invasive procedure with high sensitivity and diagnostic accuracy in patients with potentially operable NSCLC. Implementation of both EBUS/EUS-b and PET-CT is necessary in order to avoid futile thoracotomies.

Immune checkpoint inhibitors (ICIs) are a newly developed component of cancer care that expands the treatment possibilities for patients. Their use has been associated with several immune-related adverse events, including ICI-induced sarcoidosis-like reactions. This article reviews the data concerning ICI-induced sarcoidosis-like reactions currently available in the medical literature. These reactions have been reported in three classes of ICIs: anti-cytotoxic T-lymphocyte associated protein 4 antibodies, programmed death 1 inhibitors and programmed death ligand 1 inhibitors. These reactions are indistinguishable from sarcoidosis with a similar histology, pattern of organ involvement, and pattern of clinical manifestations. The most common locations to observe granulomatous inflammation from these reactions is in intrathoracic locations (the lung and/or mediastinal lymph nodes) and the skin. The median time between initiation of an ICI and the development of a sarcoidosis-like reaction averaged 14 weeks. Clinicians have opted to use corticosteroids and/or discontinue the ICI, or take no action when these reactions have developed. Regardless of whether the clinician performed an intervention or not, these reactions have uniformly improved or resolved after ICI-treatment, which provides additional temporal evidence supporting the presence of a sarcoidosis-like reaction as opposed to sarcoidosis. There is even evidence that the development of an ICI-induced sarcoidosis-like reaction suggests that the ICI is effective as an anti-tumor agent and should be continued. As is the case for sarcoidosis, sarcoidosis-like reactions do not mandate antisarcoidosis therapy, especially if the condition is asymptomatic. When treatment of sarcoidosis-like reaction is required, it may be prudent to continue ICI therapy and add antisarcoidosis therapy because standard antisarcoidosis regimens seem to be effective. Further research into the mechanisms involved in the development of ICI-induced sarcoidosis-like reactions may give insights into the immunopathogenesis of sarcoidosis.

Systematic treatment of advanced non-small cell lung cancer (NSCLC) includes targeted treatment with epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs). The development of skin rash and its intensity have been associated with EGFR TKI’s efficacy. The main purpose of this study was to further investigate the potential value of erlotinib-associated rash as a predictor of prognosis and treatment response in a real-world cohort of patients with advanced NSCLC. The medical records of all NSCLC patients treated with erlotinib at the Oncology Unit of GPP, Sotiria Athens General Hospital between January 1, 2014 and August 31, 2016 were retrospectively reviewed. Seventy-nine patient medical records fulfilled the criteria and were included in the study. Development of erlotinib-associated rash was correlated with clinicopathological characteristics of patients, treatment response, and overall survival (OS) using univariate and multivariate Cox regression analysis. The number of patients with rash was greater in the responders group (90% vs. 46.4%, p = 0.015). In univariate analysis, there was a statistically significant association between rash development and time to progression (TTP) [HR: 0.32 (0.17‐0.57), p p = 0.018) and rash (HR: 0.34, 95% CI: 0.18‐0.63, p = 0.001) were independently associated with TTP and also that the duration of treatment with erlotinib (HR: 0.58, 95% CI: 0.42‐0.80, p = 0.001) and rash (HR: 0.10, 95% CI: 0.20‐0.48, p = 0.004) was an independent predictor of survival. Our results suggest that erlotinib-associated rash may represent a clinically valuable biomarker for the prediction of treatment response and OS in patients with advanced NSCLC.

Malignancy is an important predisposing factor for thromboembolic disease. Patients with malignancy display 4 to 10 times greater risk than the general population. As for lung cancer, that risk seems to further increase and become up to 20 times higher. The aim of this article is to review the International literature in order to highlight for the first time, the correlation between thromboembolic disease and small cell lung cancer. PubMed, Medline and Embase databases were searched from 1990 up to 2016, for retrospective and prospective studies that investigate the correlation between thromboembolic disease and small cell lung cancer. The incidence rate of thromboembolic disease found in these studies ranged between 6.8% and 11.5%. Thromboembolic disease is associated with a reduced survival in patients with small cell lung cancer and six factors seemed to increase the risk of thromboembolism: chemotherapy, cisplatin treatment, smoking, extensive disease, the infiltration of the superior vena cava and multiple concomitant diseases. Thromboembolic disease shows an increased incidence in patients with small cell lung cancer and more research with well-designed studies is required in order to study in detail the anticoagulation treatment and the survival in small cell lung cancer patients.

Introduction – purposeThe aim of this study is to review the results of applying a hypofractionated radiotherapy schedule for locally advanced inoperable lung cancer in patients who have received chemotherapy. Lung cancer and especially non-small-cell lung cancer is prone to accelerated repopulation and shorter treatment schedules in the form of accelerated radiotherapy have been shown to improve treatment outcome.Patients – methodIn total, 29 patients with inoperable lung cancer (stage II, IIIa,b, IV) were treated with accelerated hypofractionated 3D conformal radiotherapy. All patients received a dose of 55 Gy in 20 fractions (daily dose of 2·75 Gy). The median age was 65·5 years, 87% of patients had stage III–IV disease, 93% of patients received sequential chemotherapy with their radiotherapy. Median follow-up of patients was 36 months.ResultsThe median overall survival from time of diagnosis was 16·5 months and the 1 year overall survival was 31%. Complications were present in 44·8% of the patients and the most common complication (20·7%) was pneumonitis alone. The complication rate was not significantly different according to histological type, stage, type of chemotherapy, presence of recurrence or death.ConclusionAlthough our study limitation is the small number of patients, these data suggest that the efficacy of this hypofractionated schedule could be considered as alternative option to the conventional regimen of 66 Gy given in 33 fractions.

To review the use of brachytherapy as an adjuvant therapy to reduce recurrences after sublobar resections and as a palliation to patients with inoperable disease. Α review of all published studies was performed to identify the recurrence rate after brachytherapy adjuvant to sublobar resection and assess the palliation of symptoms and the complications of brachytherapy as a palliative treatment. Most of the studies that we found about brachytherapy as an adjuvant therapy to sublobar resection due to patient's poor cardiopulmonary reserve showed that brachytherapy offered low recurrence rate with low toxicity. Ten studies concerning palliative brachytherapy showed improvement of symptoms with good tolerance and good endoscopic response rates. Literature suggests that brachytherapy for inoperable symptomatic disease can be delivered for symptom improvement with acceptable toxicity. Brachytherapy as an alternative treatment option for lung cancer needs more investigation with more prospective trials.

Introduction and Aim: Previous studies suggest the potential correlation between increased mean platelet volume (MPV) and survival in non-small cell lung cancer (NSCLC), but results are often contradictory. We herein aimed to further evaluate the prognostic value of MPV in patients with advanced-stage NSCLC in the real-world setting of a tertiary referral oncology center. Methods: Demographic, clinicopathological and laboratory data (including complete blood count parameters) of 30 patients with stage IIIB or IV NSCLC were retrieved from the Lung Cancer registry of the Oncology Clinic of Sotiria Athens General Hospital and analyzed. All the above variables (including MPV) were correlated to each other, as well as with overall survival (OS) and progression-free survival (PFS). Results: Mean patients’ age was 68,5 (SD=7,5) years. The majority of patients were male (76.7%), had positive smoking history (90%), squamous cell carcinoma (53.3%), and stage IV disease (76.7%). No statistically significant correlations between survival and sex, age, smoking history or tumor histology (squamous cell carcinoma versus adenocarcinoma), or between MPV and histology were noted. Worse performance status (p=0.004) and higher white blood cell count (p=0.01) were correlated with reduced OS, while increased MPV was strongly correlated both with OS and PFS (p Conclusions: Increased MPV may correlate with improved survival of patients with NSCLC, thus potentially representing a marker of favorable prognosis. Our study findings warrant confirmation in larger prospective series

Introduction and Aim: Patients with malignant central airway obstruction (mCAO) may need endobronchial intervention for symptoms relief but also to manage atelectasis and consequent respiratory failure. We herein aimed to assess quality of life (QoL) in patients with lung cancer after endobronchial intervention for malignant central airway obstruction. Methods: Over an 18-month period, 29 patients with symptomatic malignant central airway obstruction were enrolled in order to re-establish airway patency. QoL and dyspnea were evaluated by the EORTC -C30 and EORTC -LC13 Questionnaire before the intervention, 1 week after and every following month until first relapse or death. Results: Overall, 44.8% of patients (n=13) had poor performance status (PS ≥3) and 51.7% (n=15) of patients had stage IV disease. QoL improved significantly from the first week up to the 6th month (p Conclusions: Interventional management of patients with mCAO results in sustained significant improvement of QoL and decrease of shortness of breath and should be considered as an essential component of a multidisciplinary approach.

Introduction and Aim: Percutaneous computed tomography-guided (CT-guided) thermal ablation is a minimally invasive method for the treatment of adrenal metastases, painful bone metastases and liver metastases originating from non-small cell lung cancer (NSCLC). We aimed to further evaluate the safety and efficacy of CT-guided radiofrequency ablation (RFA) and microwave ablation (MWA) in the management of metastases in a real-life cohort of NSCLC patients. Methods: The medical records of 142 patients with metastatic NSCLC (71, 32 and 40 patients with adrenal metastases, painful bone metastases and liver metastases, respectively) treated with CT-guided RFA or MWA were retrospectively studied. The efficacy of thermal ablation was evaluated by post-ablation imaging. For painful bone metastases, palliation was assessed by the Brief Pain Inventory (BPI) score. Results: Technical success of CT-guided thermal ablation was 100%. No major complications occurred. Among patients with adrenal metastases treated with RFA or MWA, local recurrence was observed in 17.1% and 19.4% of cases at 1-year follow up, respectively. In patients with painful bone metastases, significant pain relief was noted after thermal ablation (p Conclusion: CT-guided RF and MW ablation is a safe and effective local treatment for the management of adrenal, bone and liver metastases from NSCLC. For painful bone metastases RF ablation provides significant pain relief.

Objectives Disturbed sleep is a common complaint of lung cancer patients undergoing active oncologic treatment. We aimed to clarify the extent to which psychological symptoms, coping strategies, and social support interfere with sleep quality and whether they mediate the relationship between sleep quality and fatigue or functional capacity in a sample of chemotherapy treated lung cancer patients. Methods Lung cancer patients attending an oncology unit for scheduled chemotherapy cycles completed questionnaires assessing their sleep quality, fatigue, depression, anxiety, stress, coping, social support, symptoms of pain, dyspnea, and cough, and sleep hygiene practices. Demographic and disease-related characteristics were obtained from patients' medical records and treating physicians rated their functional status. Multivariate regression and mediation analyses were applied to test the study's hypotheses. Results One hundred nineteen patients were enrolled, 58.2% of whom were identified as poor sleepers. After adjusting for age, gender, comorbidities, concomitant medications, cancer stage, prior and ongoing treatment, sleep hygiene, and symptoms, there was a statistically significant association between poor sleep quality and anxiety (odd`s ratio [OR] 1.17 [95% CI, 1.01-1.35]), stress (OR 1.14 [95% CI, 1.04-1.25]), and positive coping (OR 1.15 [95% CI, 1.02-1.31]). Poor sleep quality was an independent correlate of fatigue (B 1.56 [95% CI, 0.61-2.50]) and low performance status (OR 5.17 [95% CI, 1.60-16.72]); stress symptoms partially mediated the relationship between sleep quality and fatigue (P = .030). Conclusions Higher psychological burden predict sleep disturbances and contribute to increased fatigue in lung cancer patients undergoing chemotherapy. Effective psychoeducational interventions may benefit these populations.

The aim of the present study was to further explore the impact of bone metastases (BMs) and their therapeutic management on the overall prognosis of patients with small cell lung carcinoma (SCLC). We performed a retrospective analysis of medical records of 363 patients with histologically or cytologically confirmed SCLC, diagnosed and treated in the Oncology Unit of Sotiria Athens General Hospital, between January 2003 and December 2012. Demographic and clinicopathological features, including BMs, their time point of development (early onset/at diagnosis versus late onset/at a subsequent time point), treatment modality for BMs (radiotherapy, bisphosphonates or both) and the presence of skeletal-related events (SREs), were correlated with overall survival (OS). Survival analysis was performed using the Kaplan-Meier method, log-rank tests and Cox regression analysis. Overall, 130/363 patients (35.8 %) were diagnosed with either early-onset (97/363 cases, 26.7 %) or late-onset BMs (33/363 cases, 9.1 %). Patients with early-onset BMs had a reduced OS as compared to those with late-onset BMs [Hazard ratio (HR) 0.61; 95 % Confidence interval (CI) 0.41-0.91; p = 0.015) or those without BMs (HR 0.76; 95 % CI 0.6-0.96; p = 0.024). SREs and treatment modality of BMs had no impact on OS. Multiple Cox regression analysis showed that increased age, poor performance status (PS), presence of BMs and early onset BMs were independently associated with reduced OS. The results of our single-institution study suggest that the development of early-onset BMs may represent an independent predictor of a worse prognosis among patients with SCLC, in addition to well-established adverse prognostic factors such as poor PS.

e21624 Background: As shown in recent studies, inflammation plays a key role in lung cancer (LC) pathogenesis and evolution, while the potential prognostic and predictive value of various inflammation markers in different disease stages is being extensively studied. We herein aimed to further evaluate the potential prognostic value of a new inflammation marker (ALI, Advanced Lung Cancer Inflammation Index = BMI x Alb / NLR), which combines previous markers of systematic inflammation with markers of nutrition or cachexia at the time of LC diagnosis. Methods: The medical records of 67 patients, diagnosed with LC in Sismanoglio Athens General hospital, within a two-year period (January 2016-January 2017) were retrospectively studied. Demographic, clinicopathological and laboratory features of patients, including pre-treatment ALI, were recorded and correlated with prognosis (overall survival, OS). Results: A total of 67 patients were included with a mean age of 60 (± 8) years. The majority of cases were men (39/67,58.2 %), with positive smoking history (62/67, 92.5%), performance status (PS) 1-2 (43/67, 64.2%) and disease stage IV (54/67, 80.6%). Adenocarcinoma was the commonest histological type observed (19/67, 28.5%). Values of ALI ranged from 7.8 to 37.2 (mean: 21±6). The cut-off point of ALI was 19 (based on ROC curve analysis) and patients were divided into two groups: those with ALI < 19 and those with ALI ≥ 19. In univariate analysis, PS and the presence of metastatic disease, as well as ALI values < 19, were all correlated with reduced survival (p = 0.002, p = 0.028 and p = 0.018, respectively). In multivariate analysis, PS was the only parameter that retained its statistically significant correlation with an adverse prognosis (p = 0.048), although its prognostic significance was increased when combined with ALI. Conclusions: Although failing to confirm an independent prognostic value for ALI, the results of our study suggest that combination of ALI with standard prognostic predictors such as PS may improve prediction of patients’ survival. Additional prospective studies are warranted to validate the prognostic significance of this promising biomarker and expand its use in routine practice.

Aim: To determine whether PET/CT and brain MRI used in staging NSCLC can be accurate, reliable and cost-effective tools. NSCLC represents 80–85% of lung cancer and adequate information on the initial tumor staging is critical for planning an optimal therapeutic strategy. Patients & methods: Data from 30 newly diagnosed NSCLC patients in Greece were collected and prospectively recorded. Patients with potential resectable disease were evaluated to ensure that there are no detectable metastases that would rule out the possibility of a curative surgery. Results: Divergence occurred in 50% of cases of staging with CT or PET/CT alone, while metastases undetectable by the CT were revealed using PET/CT. Unnecessary thoracotomies were avoided by 10% of patients and another 10% was operated on after chemotherapy with a better prognosis. Conclusion: PET/CT and brain MRI combined are reliable for correct staging, reducing avoidable thoracotomies, morbidity rates and costs.

Introduction Epithelioid hemangioenthothelioma (EH) is a rare vascular neoplasm of endothelial origin. It most commonly develops in the lung and liver, but may also arise from any organ, and typically displays an intermediate clinical behavior between haemangioma and angiosarcoma. Because of the rarity of this tumor no standard therapy has been proposed. Targeted antiangiogenic therapy using bevacizumab, a monoclonal antibody against vascular endothelial growth factor, has been previously reported in very few isolated cases with contradictive results. Presentation of cases We herein report a case series of four patients with EH, including two cases of localized lung and pleural EH and two cases of liver and bone EH with pulmonary metastases, which were all treated with bevacizumab. Discussion Among our studied cases, bevacizumab monotherapy was well tolerated and resulted in stable disease in three patients with advanced-stage lung, liver and bone EH, for a period of 11, 7 and 12 months, respectively. Moreover, in one of these cases (primary liver EH with pulmonary metastases), long-term disease stabilization for an additional period of 17 months was observed following administration of chemotherapy with cyclophosphamide, adriamycin and vincristine (CAV) and hepatic arterial chemoembolization combined with thalidomide. Conclusion Bevacizumab monotherapy at 15mg/kg may benefit the outcome of patients with advanced EH. We also report a long-term disease stabilization following treatment with CAV and hepatic arterial chemoembolization combined with thalidomide, in a case of liver EH with pulmonary metastases.

Introduction The continuation of smoking in cancer patients further enhances disease progression. The aim of our study is to relate the intention to quit smoking with demographic and psychological characteristics of the patient. Material and Methods 80 patients with solid organ cancer, were included in the study. They were monitored for the disease in oncology departments independent of the time of diagnosis, stage and type. A self-report questionnaire including a demographic information sheet, a rating scale of intention to quit smoking, a scale for assessing the degree of smoking dependence and the STAI anxiety questionnaire were used. Results 56.3 % of the sample were male. 68.8 % were married, while 78.4% were parents. 93.8% were smokers in the past, while 53% continue smoking after cancer diagnosis and 31.3% smoke 20 cigarettes per day. Above 50% of the smokers are worried about the dangers of smoking. Conclusions The role of personality, the level of education and the degree of smoking dependence, influences the smoker’s intention to quit smoking. Regardless of the severity of the diagnosis and the risks of a disease such as cancer, the patient's attitude is affected by their educational level and the level of trait anxiety.

Although a malignant pleural effusion is considered a manifestation of an advanced stage disease not amenable to curative resection in patients with non-small cell lung cancer, the same is not true in the case of the presence of malignant cells in the pleural cavity without an accompanying effusion, discovered incidentally during the operation with pleural lavage cytology (PLC). PLC is a diagnostic technique used to detect tumor cells and translate this finding to a prognostic index. Various reports have attempted to utilize the results of PLC and draw inferences regarding the origins of malignant cells in the pleural cavity, the association of these results with various disease characteristics and, most importantly, their impact on disease recurrence and survival. However, due to non-consistent techniques and protocols used to acquire the samples for cytological evaluation and assess their significance, results are inhomogeneous. Nevertheless, the entrance of malignant cells in the pleural cavity follows the rules posed by the natural disease process when discovered before pulmonary resection takes place, while surgical manipulations certainly play an important role in the case malignant cells are checked over after pulmonary resection. In addition, although the prognostic significance of a positive PLC result is indisputable and significantly decreases long-term survival in the majority of studies, this factor has not yet been incorporated into the TNM staging system. Lastly, some authors have advocated the use of some form of adjuvant treatment for those patients found with positive PLC results, based on the assumption that a curative resection followed by multiple pleural washings will not remove the entirety of the population of malignant cells present in the pleural space.

Aim: We aimed to explore the prognostic implications of adiponectin (APN) levels in the serum and bronchoalveolar lavage (BAL) of patients with advanced NSCLC. Materials & methods: 29 newly diagnosed patients with stage IV NSCLC were prospectively enrolled. Baseline serum and BAL levels of APN were assayed by ELISA and correlated with various clinicopathological parameters, including overall survival. Results: No statistically significant correlations were observed between the serum or BAL levels of APN and the clinicopathological parameters evaluated. The only prognostic factor identified, both by univariate and multivariate survival analyses, was performance status. Conclusion: The results of our cohort failed to reveal any prognostic significance of serum and BAL levels of APN in stage IV NSCLC.

Although smoking cessation after diagnosis of cancer improves survival and quality of life almost half cancer patients continue to smoke. In this study we analyzed smoking cessation success, using Continuous abstinence Rate (CAR) and the factors affecting cessation in cancer patients in an outpatient clinic. Out of 1020 smokers, 83 had a history of various types of cancer.All smokers attended a 12 weeks program. CAR among cancer patients was 55.47% and in non cancer 67%. Chi-square tests show that at the 5% level of significance severe dependence and number of cigarettes are positively related with failure in smoking cessation. while sex and education were not found significant.The presence of cancer was found significant (p=0.032) with cancer patients having higher rate of failure.To better examine the significance of each factor without the influence of others and estimate its impact on cessation , we conducted logistic regression.Estimates include the odds ratios and marginal probability effects of independent variables.Inserting data of a particular patient into the model, the probability of cessation failure is obtained.The presence of cancer is not important now at 5% level but is important at p=0.076 (OR=1.52 and marginal probability effect=0.098).

Background: Docetaxel (DT) is an extensively used taxane, frequently associated with hypersensitivity reactions. The aim of this study was to record the epidemiological and clinical features of hypersensitivity to DT in non-small cell lung cancer patients in order to obtain useful information concerning the management of these patients. We also developed a desensitization protocol and evaluated its clinical application. Methods: We retrospectively reviewed records of 620 non-small cell lung cancer patients treated with DT-containing regimens in the adjuvant, first-, second- or next-line setting. Data from 102 patients who had exhibited hypersensitivity reactions were analyzed according to the Common Toxicity Criteria for Adverse Events version 3.0. Five patients were chosen for the desensitization protocol. We applied the standard protocol for parenteral desensitization to β-lactam antibiotics, and DT treatment was carried out with a series of 10-fold dilutions in sufficient volume to administer the total dose. Results: One hundred and two patients (16.5%) were recorded as having hypersensitivity to DT. Reactions were observed after approximately 2.5 ± 1.0 cycles. Only 14 patients (14/620, 2%) developed grade 3–4 hypersensitivity. Reactions were more likely in patients during second- or third-line chemotherapy, but no other correlation (age, gender, atopic status) was observed. Five patients completed a parenteral desensitization protocol and continued their treatment uneventfully. Conclusions: Hypersensitivity reactions to DT respond quickly to discontinuation along with appropriate supportive care. Premedication and increased infusion time may allow readministration. The desensitization protocol that we developed provides a reliable alternative to permanent discontinuation of DT.