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R. Rami-Porta

Moderator of

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    C - Inaugural Cochrane Workshop (ID 78)

    • Event: WCLC 2013
    • Type: Other Sessions
    • Track: Other Topics
    • Presentations: 16
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      Tea Break (ID 807)

      • Abstract

      Abstract not provided

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      C.00 - Inaugural Cochrane Workshop (ID 4023)

      K. Fong, R. Rami-Porta, F. Macbeth, N. O'Rourke, V. Westeel, N. Pavlakis, C.K. Lee, L. Askie, I. Yang

      • Abstract

      Abstract
      The Cochrane Collaboration is an international, independent, not-for-profit organisation of over 28,000 contributors from more than 100 countries, dedicated to making up-to-date, accurate information about the effects of health care readily available worldwide. Cochrane contributors work together to produce systematic reviews of healthcare interventions, known as Cochrane Reviews, which are published online in The Cochrane Library. Cochrane Reviews are intended to help providers, practitioners and patients make informed decisions about health care, and are the most comprehensive, reliable and relevant source of evidence on which to base these decisions. Over 5,000 Cochrane Reviews have been published so far, online in the Cochrane Database of Systematic Reviews, part of The Cochrane Library. The Collaboration also prepares the largest collection of records of randomised controlled trials in the world, called CENTRAL, published as part of The Cochrane Library. Work from the Cochrane Collaboration is internationally recognised as the benchmark for high quality information about the effectiveness of health care. The Collaboration believes that effective health care is created through equal partnerships between researcher, provider, practitioner and patient. Cochrane Reviews are unique because they are both produced by, and are relevant to, everyone interested in the effects of human health care. Based on the best available evidence, healthcare providers can decide if they should fund production of a particular drug. Practitioners can find out if an intervention is effective in a specific clinical context. Patients and other healthcare consumers can assess the potential risks and benefits of their treatment. The Cochrane Collaboration's contributors are a mix of volunteers and paid staff who are affiliated to the organisation through Cochrane entities: healthcare subject-related review groups, thematic networks (called 'fields'), groups concerned with the methodology of systematic reviews, and regional centres. Many are world leaders in their field of medicine, health policy, research methodology or consumer advocacy, and our entities are situated in some of the world's finest academic and medical institutions. The Cochrane Collaboration is named after Archie Cochrane (1909-1988), a British epidemiologist, who advocated the use of randomised controlled trials as a means of reliably informing healthcare practice. The Collaboration is an independent, not-for-profit organisation, funded by a variety of sources including governments, universities, hospital trusts, charities and personal donations. The Collaboration is registered as a charity in the United Kingdom. To tie the organisation together, there are a number of overarching structures, led by the Steering Group, which provides policy and strategic leadership for the organisation. Members of this group are democratically elected from, and by, contributors. The Cochrane Operations Unit, is based in Oxford, UK, which manages the financial, legal and administrative work of the organisation, led by the Chief Executive Officer of the Collaboration; and a Cochrane Editorial Unit, based in London, UK, which supports Cochrane Review production, editorial processes, and training and methods development, led by the Editor in Chief of The Cochrane Library. There are annual conferences, known as "Colloquia", which are open to everyone. Colloquia are designed to bring people together in one place to discuss, develop and promote our work, and to shape the organisation's future direction In addition to the core mission of producing Cochrane Reviews, contributors are involved in a number of related activities, including advocacy for evidence-based decision-making, providing training in Cochrane Review preparation, developing the methodology for preparing reviews, and translating them from English into a variety of different languages. This session includes providing an introduction to developing a Cochrane Review and is kindly supported by the Cochrane Lung Cancer Review Group, based in Barcelona Spain (website ) and uses high quality training materials developed by the Cochrane Collaboration (grateful acknowledgement of for allowing the use of the training materials) delivered by volunteer Cochrane Collaborators. The session will address topics including; Introduction to systematic reviews, Writing a Cochrane protocol, Searching for studies, Collecting data, Risk of bias, Meta-analysis, Types of data, Heterogeneity, Analysing data and Interpreting results Other training resources include Online Learning Modules as part of a self-directed learning initiative of The Cochrane Collaboration. They provide an introduction to the core skills and methods required for new authors of Cochrane systematic reviews of interventions. The modules are intended to complement other learning opportunities such as face-to-face workshops and webinars, and the guidance provided in the Cochrane Handbook for Systematic Reviews of Interventions.

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      C.01 - Introduction to Writing a Cochrane Review (ID 800)

      F. Macbeth

      • Abstract
      • Presentation
      • Slides

      Abstract
      The Cochrane Collaboration was set up in 1993 with the aim of providing a library of high quality systematic reviews of healthcare interventions. Over the past 20 years it has grown and now involves more than 28,000 people from around the world in its work. The Cochrane Library [1] is now published by Wiley as part of their Online system and includes the following databases: the Cochrane Database of Systematic Reviews (CDSR), the Database of Abstracts of Reviews of Effects (DARE), the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Methodology Register (Methodology Register), the Health Technology Assessment Database (HTA), and the NHS Economic Evaluation Database (NHS EED). The CDSR now contains over 5520 systematic reviews and it impact factor was 5.912 in 2011. Although the great majority of reviews address questions of therapy based on evidence from controlled trials, there are also reviews of diagnostic interventions. The Cochrane Lung Cancer Group (LCG) is one of over 50 Cochrane Review Groups and is dedicated to conducting systematic reviews on all aspects of primary prevention, therapy, supportive care, psychological interventions, biological therapy, and complementary therapy for the prevention, treatment and care of people with lung cancer and other intra-thoracic tumours. Established in 1998 it was originally hosted by the Ibero American Cochrane Centre (IACC) in Barcelona but has recently moved to the University of Besançon, France. Prof Virginie Westeel and Dr Fergus Macbeth are the Coordinating Editors, supported by an international group of clinical and methodological editors. There are currently 37 lung cancer reviews either published or being worked on, with topics ranging from screening to chemotherapy and palliative radiotherapy. The authors of new reviews have to submit a title proposal and a protocol to the Managing Editor. These are peer reviewed, formally approved, and published in The Cochrane Library allowing opportunity for anyone interested to comment on the proposed content and methods. The review process requires: · a thorough literature search · careful selection of the relevant publications · assessing each publication’s Methods for any sources of bias and completing a ‘Risk of Bias’ table · extracting the key data · carrying out a meta-analysis if appropriate · summarising the findings · writing conclusions including a summary in non-technical language for patients and public After the draft review is submitted, it is refereed by three editors with the appropriate expertise. An external peer review is also obtained. This process is designed to maintain the rigour and quality of the reviews to the level expected by The Cochrane Library. Before publication, there is a second review for language, style, and clarity. Carrying out a systematic review to the required standards is therefore a demanding and rigorous process and should be regarded as a research project in itself. This session explains the process in more detail and will I hope engender enthusiasm and lead to the recruitment of new authors. 1. http://www.thecochranelibrary.com

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      C.02 - Writing a Protocol (ID 801)

      N. O'Rourke

      • Abstract
      • Presentation
      • Slides

      Abstract
      The Cochrane Collaboration is an international network of more than 28,000 dedicated people in over 100 countries. Our vision is that healthcare decision-making throughout the world will be informed by high-quality, timely research evidence. We prepare, update and promote the accessibility of Cochrane Systematic Reviews. The Lung Cancer Group editorial team oversees the process of review development from title registration through publishing a protocol to completion of the final systematic review. The scope of topics covered includes prevention, early detection, diagnostic test, all modalities of treatment for both lung cancer and mesothelioma and complementary therapies. The first stage in preparing a review is to identify the topic and register this as a title with the Cochrane group. From this point the authors have a six month time frame to develop a protocol which is essentially the outline plan for the full review. The protocol defines the question to be addressed and specifies the process for identifying, assessing and analysing studies in the review. This will include the inclusion criteria for studies, the search strategy used, the comparisons to be made, any sub-group analyses and their justification and the outcomes to be reported. Once the protocol has been reviewed by the editorial team and confirmed as appropriate for development to a full systematic review, it will be published by Cochrane as a public record of an intended review. This registration helps to minimize bias in the subsequent conduct and reporting of the review and also reduces duplication of effort between groups. This presentation will describe the process of protocol development for a Cochrane review.

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      C.03 - Defining a Review Question (ID 803)

      K. Fong

      • Abstract
      • Slides

      Abstract not provided

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      C.04 - Searching for Studies and Selecting Studies (ID 805)

      V. Westeel

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      C.05 - Collecting Data (ID 806)

      N. Pavlakis

      • Abstract
      • Slides

      Abstract not provided

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      C.06 - Analysing Dichotomous Data (ID 808)

      C.K. Lee

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      C.07 - Analysing Continuous Data (ID 810)

      C.K. Lee

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      C.08 - Analysing Non-Standard Data and Designs (ID 812)

      C.K. Lee

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      C.09 - Assessing Bias in Included Studies (ID 813)

      L. Askie

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      C.10 - Introduction to Meta-Analysis (ID 811)

      L. Askie

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      C.11 - Assessing Small Study Effects and Reporting Bias (ID 814)

      L. Askie

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      C.12 - Introduction to RevMan (ID 815)

      I.A. Yang

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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      C.13 - Feedback and Closing Remarks (ID 816)

      R. Rami-Porta

      • Abstract
      • Presentation
      • Slides

      Abstract
      The Cochrane Collaboration celebrates its 20th anniversary this year. (1, 2) With around 28,000 people involved in 53 Cochrane Review Groups in about 100 countries and more than 5,000 systematic reviews, the Cochrane Collaboration has assisted clinicians, patients, researchers, policy makers and other health professionals to make decisions on a large number of health-related topics. Around 400 systematic reviews are on screening, prevention or treatment of different cancers, and they collectively analyse nearly 5,000 studies. (2) Forty-one systematic reviews are on lung cancer and mesothelioma: 21 of them deal with non-small cell lung cancer and 8, on small cell lung cancer; 7 are related to general aspects of treatment; 3 are about prevention and early detection; and 2 are about mesothelioma. (3) A Cochrane systematic review is the final product of a highly elaborated process. Today’s Workshop has gone through all this process starting with the definition of a question that needs to be answered with the highest certainty. The question is reflected in the TITLE of the review, the first submission to the review group editors that the potential authors do. Once the title has been approved, potential authors have to write and submit a PROTOCOL, a larger document that includes the background of the topic, the methodology to be used, with inclusion and exclusion criteria of studies and patients, the therapeutic interventions that will be included, the search strategy, and relevant references. After approval of this second phase of the process by the review group editors, the authors have to write the final document, the SYSTEMATIC REVIEW, which is internally and externally reviewed. Most systematic reviews analyse randomised clinical trials only, because this is the best research instrument we have in clinical practice. The conclusions derived from these reviews have a high level of evidence - that can even be increased if meta-analyses can be done combining data from the different studies. (4) The meticulous search of published and unpublished data, the careful identification of biases and the sound methodology provide reliable information on the effectiveness of a certain therapeutic intervention, that can be recommended to patients with similar characteristics to those of the patients included in the reviewed studies. (5) Many questions need to be answer in lung cancer therapy. However, randomized clinical trials are relatively few, especially in my specific field: thoracic surgery. We all should feel the responsibility to participate and include patients in clinical trials. No doubt, participation demands an extra effort from us: selecting patients, taking the time to explain the trial to the patients, abiding by randomization rules, sticking to the protocol and so on. But the effort pays off, because the conclusions we draw from randomized clinical trials are the most reliable and solid we can now have on therapeutic interventions. I would like to encourage the audience to participate in clinical trials. The more randomized clinical trials we complete, the more systematic reviews and greater the level of evidence on specific issues of lung cancer and other health-related problems. References 1. Friedrich MJ. The Cochrane Collaboration turns 20: assessing the evidence to inform clinical care. JAMA 2013;309:1881-1882. 2. Tovey D, Maclehose H, Clarke M. The Cochrane Collaboration, its mission and the value of systematic reviews. Cancer Control 2013;155-159. http://globalhealthdynamics.co.uk/cc2013/wp-content/uploads/2013/04/155-159-David-Tovey_2012.pdf Accessed on 27th July 2013. 3. The Cochrane Library. http://www.thecochranelibrary.com/view/0/browse.html Accessed on 27th July 2013. 4. OCEBM Levels of Evidence Working Group. “The Oxford 2011 Levels of Evidence”. Oxford Centre for Evidence-Based Medicine. http://www.cebm.net/index.aspx?o=5653. Accessed on 27[th] July 2013. 5. Cochrane Consumer Network. http://consumers.cochrane.org/what-systematic-review Accessed on 27th July 2013.

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      C.14 - Feedback and Closing Remarks (ID 817)

      F. Macbeth

      • Abstract

      Abstract not provided



Author of

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    C - Inaugural Cochrane Workshop (ID 78)

    • Event: WCLC 2013
    • Type: Other Sessions
    • Track: Other Topics
    • Presentations: 2
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      C.00 - Inaugural Cochrane Workshop (ID 4023)

      R. Rami-Porta

      • Abstract

      Abstract
      The Cochrane Collaboration is an international, independent, not-for-profit organisation of over 28,000 contributors from more than 100 countries, dedicated to making up-to-date, accurate information about the effects of health care readily available worldwide. Cochrane contributors work together to produce systematic reviews of healthcare interventions, known as Cochrane Reviews, which are published online in The Cochrane Library. Cochrane Reviews are intended to help providers, practitioners and patients make informed decisions about health care, and are the most comprehensive, reliable and relevant source of evidence on which to base these decisions. Over 5,000 Cochrane Reviews have been published so far, online in the Cochrane Database of Systematic Reviews, part of The Cochrane Library. The Collaboration also prepares the largest collection of records of randomised controlled trials in the world, called CENTRAL, published as part of The Cochrane Library. Work from the Cochrane Collaboration is internationally recognised as the benchmark for high quality information about the effectiveness of health care. The Collaboration believes that effective health care is created through equal partnerships between researcher, provider, practitioner and patient. Cochrane Reviews are unique because they are both produced by, and are relevant to, everyone interested in the effects of human health care. Based on the best available evidence, healthcare providers can decide if they should fund production of a particular drug. Practitioners can find out if an intervention is effective in a specific clinical context. Patients and other healthcare consumers can assess the potential risks and benefits of their treatment. The Cochrane Collaboration's contributors are a mix of volunteers and paid staff who are affiliated to the organisation through Cochrane entities: healthcare subject-related review groups, thematic networks (called 'fields'), groups concerned with the methodology of systematic reviews, and regional centres. Many are world leaders in their field of medicine, health policy, research methodology or consumer advocacy, and our entities are situated in some of the world's finest academic and medical institutions. The Cochrane Collaboration is named after Archie Cochrane (1909-1988), a British epidemiologist, who advocated the use of randomised controlled trials as a means of reliably informing healthcare practice. The Collaboration is an independent, not-for-profit organisation, funded by a variety of sources including governments, universities, hospital trusts, charities and personal donations. The Collaboration is registered as a charity in the United Kingdom. To tie the organisation together, there are a number of overarching structures, led by the Steering Group, which provides policy and strategic leadership for the organisation. Members of this group are democratically elected from, and by, contributors. The Cochrane Operations Unit, is based in Oxford, UK, which manages the financial, legal and administrative work of the organisation, led by the Chief Executive Officer of the Collaboration; and a Cochrane Editorial Unit, based in London, UK, which supports Cochrane Review production, editorial processes, and training and methods development, led by the Editor in Chief of The Cochrane Library. There are annual conferences, known as "Colloquia", which are open to everyone. Colloquia are designed to bring people together in one place to discuss, develop and promote our work, and to shape the organisation's future direction In addition to the core mission of producing Cochrane Reviews, contributors are involved in a number of related activities, including advocacy for evidence-based decision-making, providing training in Cochrane Review preparation, developing the methodology for preparing reviews, and translating them from English into a variety of different languages. This session includes providing an introduction to developing a Cochrane Review and is kindly supported by the Cochrane Lung Cancer Review Group, based in Barcelona Spain (website ) and uses high quality training materials developed by the Cochrane Collaboration (grateful acknowledgement of for allowing the use of the training materials) delivered by volunteer Cochrane Collaborators. The session will address topics including; Introduction to systematic reviews, Writing a Cochrane protocol, Searching for studies, Collecting data, Risk of bias, Meta-analysis, Types of data, Heterogeneity, Analysing data and Interpreting results Other training resources include Online Learning Modules as part of a self-directed learning initiative of The Cochrane Collaboration. They provide an introduction to the core skills and methods required for new authors of Cochrane systematic reviews of interventions. The modules are intended to complement other learning opportunities such as face-to-face workshops and webinars, and the guidance provided in the Cochrane Handbook for Systematic Reviews of Interventions.

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      C.13 - Feedback and Closing Remarks (ID 816)

      R. Rami-Porta

      • Abstract
      • Presentation
      • Slides

      Abstract
      The Cochrane Collaboration celebrates its 20th anniversary this year. (1, 2) With around 28,000 people involved in 53 Cochrane Review Groups in about 100 countries and more than 5,000 systematic reviews, the Cochrane Collaboration has assisted clinicians, patients, researchers, policy makers and other health professionals to make decisions on a large number of health-related topics. Around 400 systematic reviews are on screening, prevention or treatment of different cancers, and they collectively analyse nearly 5,000 studies. (2) Forty-one systematic reviews are on lung cancer and mesothelioma: 21 of them deal with non-small cell lung cancer and 8, on small cell lung cancer; 7 are related to general aspects of treatment; 3 are about prevention and early detection; and 2 are about mesothelioma. (3) A Cochrane systematic review is the final product of a highly elaborated process. Today’s Workshop has gone through all this process starting with the definition of a question that needs to be answered with the highest certainty. The question is reflected in the TITLE of the review, the first submission to the review group editors that the potential authors do. Once the title has been approved, potential authors have to write and submit a PROTOCOL, a larger document that includes the background of the topic, the methodology to be used, with inclusion and exclusion criteria of studies and patients, the therapeutic interventions that will be included, the search strategy, and relevant references. After approval of this second phase of the process by the review group editors, the authors have to write the final document, the SYSTEMATIC REVIEW, which is internally and externally reviewed. Most systematic reviews analyse randomised clinical trials only, because this is the best research instrument we have in clinical practice. The conclusions derived from these reviews have a high level of evidence - that can even be increased if meta-analyses can be done combining data from the different studies. (4) The meticulous search of published and unpublished data, the careful identification of biases and the sound methodology provide reliable information on the effectiveness of a certain therapeutic intervention, that can be recommended to patients with similar characteristics to those of the patients included in the reviewed studies. (5) Many questions need to be answer in lung cancer therapy. However, randomized clinical trials are relatively few, especially in my specific field: thoracic surgery. We all should feel the responsibility to participate and include patients in clinical trials. No doubt, participation demands an extra effort from us: selecting patients, taking the time to explain the trial to the patients, abiding by randomization rules, sticking to the protocol and so on. But the effort pays off, because the conclusions we draw from randomized clinical trials are the most reliable and solid we can now have on therapeutic interventions. I would like to encourage the audience to participate in clinical trials. The more randomized clinical trials we complete, the more systematic reviews and greater the level of evidence on specific issues of lung cancer and other health-related problems. References 1. Friedrich MJ. The Cochrane Collaboration turns 20: assessing the evidence to inform clinical care. JAMA 2013;309:1881-1882. 2. Tovey D, Maclehose H, Clarke M. The Cochrane Collaboration, its mission and the value of systematic reviews. Cancer Control 2013;155-159. http://globalhealthdynamics.co.uk/cc2013/wp-content/uploads/2013/04/155-159-David-Tovey_2012.pdf Accessed on 27th July 2013. 3. The Cochrane Library. http://www.thecochranelibrary.com/view/0/browse.html Accessed on 27th July 2013. 4. OCEBM Levels of Evidence Working Group. “The Oxford 2011 Levels of Evidence”. Oxford Centre for Evidence-Based Medicine. http://www.cebm.net/index.aspx?o=5653. Accessed on 27[th] July 2013. 5. Cochrane Consumer Network. http://consumers.cochrane.org/what-systematic-review Accessed on 27th July 2013.

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    E07 - Staging in the Molecular Era (ID 7)

    • Event: WCLC 2013
    • Type: Educational Session
    • Track: Imaging, Staging & Screening
    • Presentations: 1
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      E07.3 - IASLC Staging Projects Update (ID 405)

      R. Rami-Porta

      • Abstract
      • Slides

      Abstract
      Background The origin of the International Association for the Study of Lung Cancer (IASLC) Lung Cancer Staging Project took place during an international workshop on intrathoracic staging organized at the Royal Brompton Hospital, London, UK, in 1996. (1) At that time, the 6[th] edition of the tumour, node and metastasis (TNM) classification was in press, but its limitations and weaknesses were discussed in an international and multidisciplinary forum. The main conclusion was the need for a large international database that could be used to refine and update the TNM classification of lung cancer. Two years later, the IASLC Board approved the creation of an International Staging Committee (ISC), whose first co-chairs were Mr. Peter Goldstraw and the late Dr. Robert Ginsberg. An international call was made to promote participation and data sharing, and potential participants were summoned to subsequent meetings and workshops. Data on lung cancer patients diagnosed from 1990 to 2000 were collected from 46 different sources in 20 countries around the world. Data were stored, managed and analysed at Cancer Research And Biostatistics (CRAB), a biostatistics agency based in Seattle, WA, USA. By the end of 2005, 100,869 cases had been registered and 81,495 were analyzable: 68,463 non-small cell lung cancers (NSCLC) and 13,032 small cell lung cancers (SCLC). (2) The analyses of these cases allowed the IASLC to issue recommendations for changes to the 6[th] edition of the TNM classification. The recommendations were accepted by the Union for International Cancer Control (UICC) and by the American Joint Committee on Cancer (AJCC), and were introduced in the 7[th] edition of the TNM classification. (3, 4, 5) With the revision undertaken for the 7[th] edition, a new period of data-based revisions started, with the IASLC leading the revision process and informing the UICC and the AJCC of the potential changes in the classification based on the analyses of its growing international databases. The analyses of the retrospective IASLC database showed that a more detailed database, containing specific information on T, N and M descriptors, would be necessary to continue the revision process. Therefore, in 2009, a call was made for international participation in the prospective collection of data to inform the 8[th] edition of the TNM classification of lung cancer, due to be published in 2016. (6) The IASLC Prospective Phase of the Lung Cancer Staging Project This prospective phase of the project included a new retrospective collection of data from 1999 to 2010. 94,684 patients were collected: 78,640 analyzable cases of NSCLC and 5,912 analyzable cases of SCLC. These cases will be used to inform the 8[th] edition of the TNM classification and are now being analysed at CRAB. Expansion to Other Thoracic Malignancies The ISC incorporated mesothelioma in 2008 and thymic malignancies and oesophageal cancer in 2009. The structure of the ISC was modified to accommodate more tumours and members. Four domains were created: lung cancer domain (chaired by this writer), mesothelioma domain (chaired by Dr. Valerie Rusch), thymic malignancies domain (chaired by Dr. Frank Detterbeck) and oesophageal cancer domain (chaired by Dr. Tom Rice). To increase the participation of more specialists without increasing the number of ISC members and the budget, advisory boards for mesothelioma, thymic malignancies and oesophageal cancer were created. The retrospective database of mesothelioma contains 3,101 surgically treated patients, and its first analysis has been already published. (7) The International Mesothelioma Interest Group (IMIG) and the Mesothelioma Applied Research Foundation (MARF) collaborate with the IASLC Mesothelioma Staging Project. The prospective collection of cases is now ongoing, includes surgically and non-surgically treated patients, and is intended to inform the 8[th] edition of the TNM classification. A side-project on volumetric computerized tomography for clinical staging is also underway. The retrospective database of thymic malignancies has data on more than 10,000 cases, and the prospective collection of data is ongoing. The ISC works closely with the International Thymic Malignancies Interest Group (ITMIG) (8) and with thymic working groups of scientific societies, such as the European Society of Thoracic Surgeons, the European Association for Cardiothoracic Surgery, etc. The main objective is to device a data-driven, internationally acceptable TNM classification for thymic malignancies, both thymomas and thymic carinomas. The retrospective database of the oesophageal cancer is kept at the Cleveland Clinic, Cleveland, OH, USA, and contains data on more than 10,000 patients. Cases are provided by members of the Worldwide Esophageal Cancer Collaboration (WECC). (9) The revised 7[th] edition of the TNM classification of oesophageal cancer was based on the analyses of the surgically treated patients of this database. (10) Expansion to Prognostic Factors Given the importance of more precise prognostication, besides that provided by the TNM classification and staging system, the IASLC Board decided to expand the activities of the Committee to prognostic factors. To make this activity more patent, the name of the Committee was changed to Staging and Prognostic Factors Committee in February 2013. References 1. Goldstraw P. Report on the international workshop on intrathoracic staging, London, October 1996. Lung Cancer 1997;18:107-111. 2. Goldstraw P, Crowley JJ . The International Association for the Study of Lung Cancer international staging project on lung cancer. J Thorac Oncol 2006;1:281-286 3. Goldstraw P, ed. Staging manual in thoracic oncology. Orange Park, FL: Editorial Rx Press; 2009. 4. Sobin L, et al., eds. TNM classification of malignant tumours. 7[th] edition. Oxford: Wiley-Blackwell; 2009;138-146. 5. Edge SB et al., eds. Cancer staging manual. 7[th] edition. New York: Springer; 2010;253-270. 6. Giroux DJ et al. The IASLC lung cancer staging project. Data elements for the prospective project. J Thorac Oncol 2009;4:679-683. 7. Rusch VW et al. Initial analysis of the International Association for the Study of Lung Cancer mesothelioma database. J Thorac Oncol 2012;7:1631-1639. 8. Detterbeck FC, Huang J. Overview. J Thorac Oncol 2011;6(Suppl 3):s1689-1690. 9. Rice TW et al. Worldwide esophageal cancer collaboration. Dis Esophagus 2009;22:1-8. 10. Rice TW et al. 7[th] edition of the AJCC Cancer Staging Manual: esophageal and esophagogastric junction. Ann Surg Oncol 2010;17:1721-1724.

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    MS06 - Surgeons as Drivers of NSCLC Research (ID 23)

    • Event: WCLC 2013
    • Type: Mini Symposia
    • Track: Surgery
    • Presentations: 1
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      MS06.1 - How Do I Contribute to the IASLC Staging Projects? (ID 481)

      R. Rami-Porta

      • Abstract
      • Presentation
      • Slides

      Abstract
      The IASLC Staging Projects The International Association for the Study of Lung Cancer (IASLC) now has four staging projects. The first one, for lung cancer, originated during an international workshop on intrathoracic staging organized at the Royal Brompton Hospital, London, UK, in 1996. (1) It is an ongoing project with two phases: a retrospective phase, during which 81,495 analyzable lung cancer patients diagnosed between 1990 and 2000 were registered: 68,463 non-small cell lung cancers (NSCLC) and 13,032 small cell lung cancers (SCLC) (2); and a prospective phase, that includes 78,640 analyzable cases of NSCLC and 5,912 cases of SCLC diagnosed between 1999 and 2010. The retrospective database was used to revise the 6[th] edition of the tumour, node and metastases (TNM) classification and prepare for the 7[th] edition; (3, 4, 5) the data of the prospective phase will be used to inform the 8[th] edition of the TNM classification due to be published in 2016. This writer chairs the Lung Cancer Domain. In 2008, mesothelioma was incorporated into the activities of the IASLC Staging Project lead by Dr. Valerie Rusch as chair of the Mesothelioma Domain. As with lung cancer, a call was made to collect retrospective series from around the world and, at the same time, an online registration system was created for prospective collection of data. The retrospective mesothelioma database contains 3,101 surgically treated patients. This population was first analysed to assess the existing TNM classification and staging system for mesothelioma. (6) These analyses showed that more data are needed to refine the classification beyond what the retrospective database can do. In essence, more detailed data on the T, N and M descritpors is needed. The prospective collection of data is an ongoing project that collects surgically and non-surgically treated patients and is intended to inform the 8[th] edition of the TNM classification. In 2009, thymic malignancies were incorporated into the IASLC Staging and Prognostic Factors Committee (SPFC). So far, more than 10,000 retrospective cases have been collected and are now being analysed by the statistitians at Cancer Research And Biostatistics (CRAB), in Seattle, WA, USA. The main objective of these analyses is to establish a TNM classification for thymomas and thymic carcinomas. The Thymic Domain of the Committee is chaired by Dr. Frank Detterbeck. (7) Finally, also in 2009, oesophageal cancer was incorporated into the activities of the IASLC SPFC under the leadership of Dr. Tom Rice, who is the chair of the Oesophageal Cancer Domain of the SPFC. More than 10,000 cases are registered in a database stored and analysed at the Cleveland Clinic, Cleveland, OH, USA. The surgical cases were used to inform the 7[th] edition. Plans are made to analyse the non-surgical series and validate data to inform the 8[th] edition of the TNM classification. How to contribute Individuals, institutions, cooperative groups and proprietors of registries can contribute by submitting their databases directly to CRAB, provided their databases include the information that is essential for the IASLC Staging Projects, i.e. clinical and pathological data on the different T, N and M descriptors, treatment modality and survival. CRAB statisticians have to be informed about the characteristics of the databases to assess if they are useful for the project prior to submission. This is, indeed, the easiest way to contribute: to submit your database. CRAB accepts databases on lung cancer and mesothelioma. Databases of thymic malignancies can be submitted either to CRAB or to the International Thymic Malignancies Interest Group (ITMIG). ITMIG will assess the data and will forward the specific staging data to CRAB for analysis. Those wishing to contribute oesophageal cancer cases should get in touch with the chair of the Oesophageal Cancer Domain of the SPFC, Dr. Tom Rice, at the Cleveland Clinic, Cleveland, OH, USA. Contribution is best through the Worldwide Esophageal Cancer Collaboration (WECC). Those who want to contribute prospective cases can use the on-line registration system that CRAB has established for lung cancer and mesothelioma. There also is an on-line registration system for thymic tumours provided by the ITMIG. Submitting retrospective databases and on-line registration of prospective cases take time and may cost money. In order to facilitate grant application to those who need the assistance of a data manager, CRAB has prepared a document describing the project that can be used to complete the grant application forms. This document can be accessed through the IASLC website at www.iaslc.org. Go to ‘Staging’ and there you will find all the necessary information about the IASLC Staging Projects. Those who cannot participate submitting cases can participate analysing data not directly related to the main staging projects. An outline of the research project has to be sent to the Chair of the IASLC SPFC stating the objectives and the variables needed for the study. Approval will be granted based on the availability of data, the relevance of the project and the willingness of the applicant to pay for the CRAB statisticians’ work required for the extraction and analysis of data. (9) References 1. Goldstraw P. Report on the international workshop on intrathoracic staging, London, October 1996. Lung Cancer 1997;18:107-111. 2. Goldstraw P, Crowley JJ. The International Association for the Study of Lung Cancer international staging project on lung cancer. J Thorac Oncol 2006;1:281-286 3. Goldstraw P, ed. Staging manual in thoracic oncology. Orange Park, FL: Editorial Rx Press; 2009. 4. Sobin L et al., eds. TNM classification of malignant tumours. 7[th] edition. Oxford: Wiley-Blackwell; 2009;138-146. 5. Edge SB et al., eds. Cancer staging manual. 7[th] edition. New York: Springer; 2010;253-270. 6. Rusch VW et al. Initial analysis of the International Association for the Study of Lung Cancer mesothelioma database. J Thorac Oncol 2012;7:1631-1639. 7. Detterbeck FC, Huang J. Overview. J Thorac Oncol 2011;6(Suppl 3):s1689-1690. 8. Rice TW et al. 7[th] edition of the AJCC Cancer Staging Manual: esophageal and esophagogastric junction. Ann Surg Oncol 2010;17:1721-1724. 9. Goldstraw P et al. We probably have the answer: now what is the question? J Thorac Oncol 2009:4:939-940.

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    O27 - Clinical Trials and Practice (ID 142)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Other Topics
    • Presentations: 1
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      O27.05 - Is primary tumor standardized uptake value (SUV) an independent prognostic factor for non-small cell lung cancer (NSCLC)? A meta-analysis based on individual patients data. (ID 3888)

      R. Rami-Porta

      • Abstract
      • Presentation
      • Slides

      Background
      [18]F-fluoro-2-deoxy-D-glucose positron emission tomography complements conventional imaging for staging lung cancer although its ability to predict outcome is less well established. Two literature-based meta-analyses suggest a prognostic value in univariate analysis. To assess FDG-PET value in predicting survival adjusted for some known prognostic factors, we carried out a meta-analysis based on individual patients data from multiple independent studies.

      Methods
      Following literature search, and after writing of a protocol for the meta-analysis, we contacted the authors of identified studies and requested individual patients data; we also tried to collect some unpublished data. Data analysis used Cox regression models stratified for the study with overall survival as primary outcome. SUV max was used as a binary covariate (median value for each study).

      Results
      Data were collected for 1526 patients (57% of the identified patients) from 11 publications and 1 unpublished series (median age : 64 years, 60% male patients, squamous cell in 34%, adenocarcinoma in 47%, stages I-II in 58%). Combined univariate hazard ratio (HR) was 1.43 (95% CI : 1.22-1.66); no statistically significant interaction between SUV and one of six additional freatures (age, gender, histology,stage, tumors size –in stages I-III patients- and surgical treatment), was found except for stage (p=0.05) with a decreased prognostic value of SUV for stage IV patients. Without considering SUV, multivariate analysis identified, in stage I-III patients, age, stage, tumor size and surgical treatment as independent prognostic factors. The addition of SUV improved that model : HR estimate for SUV effect was 1.58, statistically significant (95% CI : 1.27-1.96), p<0.0001. No interaction was found with SUV. When tumor size was not included in the tested covariates, we found SUV of additional value (adjustment for age, stage, surgical treatment) with a HR of 1.35 (95% CI : 1.15-158). Interaction between SUV and stage was detected, restricting the significant impact of SUV on survival to stage I-III patients.

      Conclusion
      Conclusions : Although suffering from selection bias and lack of homogeneous SUV assessment, these data suggest that SUV at the time of diagnosis is an independent prognostic marker for patients with stage I-III NSCLC. The utility of SUV in predicting survival in stage IV patients requires further studies.

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    P3.09 - Poster Session 3 - Combined Modality (ID 214)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Combined Modality
    • Presentations: 1
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      P3.09-004 - Oligometastatic non-small cell lung cancer: a simulation expert multidisciplinary tumor board. (ID 1122)

      R. Rami-Porta

      • Abstract

      Background
      Series on aggressive local treatment in selected patients with oligometastatic non-small cell lung cancer (NSCLC) are mostly retrospective, and prospective data are scarce (De Ruysscher et al, JTO 7:1547-1555, 2012). Although a precise definition is lacking, ‘oligometastatic NSCLC’ is considered an intermediate biologic state of restricted metastatic capacity with a limited number of metastases. The turning point between oligometastatic and polymetastatic is merely based on personal opinion and situated somewhere between 1 and 5 distant metastases. In the absence of clear definitions or clinical practice recommendations, a treatment decision is mainly driven by the opinion of each local multidisciplinary tumor board (MDTB).

      Methods
      As the consideration of and the treatment modality for oligometastatic NSCLC is a controversial area in respiratory oncology, in preparation of a recent dedicated workshop, we simulated a MDTB with international experts in the field. Multiple disciplines from 7 different centers participated in the MDTB, including pathology (1), nuclear medicine physician (1), thoracic surgery (3), radiation oncology (3), and respiratory oncology (3). Participants were asked to assess an electronic file describing 10 clinical ‘oligometastatic NSCLC’ cases, with 2 simple questions per case: 1. Do you consider this case ‘oligometastatic’ (Yes/No) and 2. What is your preferred treatment proposal.

      Results
      A full response was returned by all 11 specialists taking part in the simulated MDTB. Only 1 case was considered ‘oligometastatic NSCLC’ by all MDTB members. The presented cases were considered by a median of 78% (range 36-100%) of responders as true oligometastatic disease. Despite the fact that each responder gave only one treatment proposal, a median of 4 different treatment proposals (range 2-6) was made per case. Except for brain metastases, most team members would treat the locoregional thoracic disease before the distant metastases. No preference towards neo-adjuvant or adjuvant chemotherapy could be found. The option for surgery or radiation therapy as part of a combined modality treatment was mainly driven by the physicians’ preference.

      Conclusion
      Our simulated MDTB shows that oligometastatic NSCLC is an entity with many unanswered questions, and thus a major challenge for clinicians. Patients with oligometastatic NSCLC are in the need of 1. discussion at an experienced multidisciplinary tumor board to select patients for a radical combined modality approach; 2. multidisciplinary prospective research protocols to set better definitions of oligometastic NSCLC, evaluate the validity of a radical approach, and to optimize therapeutic modalities.