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Carme Obiols

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    YI03 - Scientific Mentoring (ID 109)

    • Event: WCLC 2019
    • Type: Young Investigator Session
    • Track: Young Investigators
    • Presentations: 4
    • Now Available
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      YI03.01 - Why to Apply for International Fellowship? (Now Available) (ID 3703)

      10:30 - 12:00  |  Presenting Author(s): Celine Mascaux

      • Abstract
      • Presentation
      • Slides

      Abstract

      First of all, if you aim for an academic career, the international fellowship is a requirement in most countries. If you are not choosing an academic career, the international fellowship will be very useful anyway. This fellowship can be clinical, scientific or both, depending on your wish. Be aware of choosing an appropriate destination and team based on what you are looking for. Depending on the country where you trained and the country that you are choosing for your fellowship, you may or may not be fulfill the requirement for clinical practice. You must make sure that your salary will be funded and that your income is sufficient for leaving in the city of your fellowship. A fellowship needs to be planned several months in advance for the administrative preparation.

      Overall, international fellowship will be a uniquely rich experience. It will open new perspectives in your career. You will learn from the new team and modulate your clinical/scientific interpretations and your decisions. It will diversify your clinical/scientific interests, increase and diversify your knowledge and you expertise. The international fellowship will also allow you to built an international network and collaborations, and increase your visibility.

      In addition of being a very valuable professional experience, it will be a very rich personal challenge, from which you will enjoy and learn as well, by discovering and experiencing a different context of life, different culture and also perhaps a different language.

      Both for the professional and the personal side of your life, the international fellowship will open your mind and will be an unforgettable experience

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      YI03.02 - How to Apply for International Fellowship? (Now Available) (ID 3704)

      10:30 - 12:00  |  Presenting Author(s): Ming Sound Tsao

      • Abstract
      • Presentation
      • Slides

      Abstract

      International fellowship to pursue further training is an important part of career development for junior clinicians and investigators. International fellowship will not only increase the clinical and/or research skill of the fellow, it also offers an important opportunity to establish interaction network with senior investigators and peer young investigators across the world. When applying for international fellowship, several aspects should be considered: (1) choosing the field for further training, (2) application procedure, and (3) funding availability. The choice of field for further training will largely determine the future career of the candidate and should be in line with one’s scientific or career passion and clinical/research interest. Prior experience with a role model and mentorship during earlier formative years usually has great influence on one’s decision to pursue career choice. Fellowship training can be limited to clinical only, research only or combined clinical and research training; the latter for a candidate who wishes to pursue clinician-scientist career. Once a decision to pursue further training is made, the candidate should look for fellowship opportunities. This is often through discussion with local mentors or colleagues with prior international fellowship experience, or via familiarity with potential mentors who have published extensively in the area of candidate’s interest or have lectured at international meetings. On-line searches for institutions with established fellowship program may also be useful, but many training programs may not be openly advertised, thus personal approaches and recommendations are often more fruitful. Writing an application letter that demonstrates strong background, qualification, prior track record, commitment and clear post-fellowship career pathway are key elements to win an opportunity for further interview. Availability of secured partial/full funding from local Institution or independent funding agency is a great asset for an application. While one year fellowship that involves only clinical training may be sufficient, training that involves laboratory research will usually require a minimum of 2 years tenure, as the latter usually requires more time to accomplish specific research projects. In such case, preliminary data obtained during first fellowship year may greatly contribute to applications for fellowship offered by international societies (e.g., IASLC, ASCO, AACR) or funding agencies.

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      YI03.03 - Scientific Mentorship: What Should You Expect? (Now Available) (ID 3705)

      10:30 - 12:00  |  Presenting Author(s): Rafael Rosell

      • Abstract
      • Presentation
      • Slides

      Abstract

      Scientific Mentorship: What Should You Expect?

      I am honored to speak to young investigators on mentorship. Over several decades I have had the opportunity to serve as mentor of many clinical investigators, both local and worldwide. Throughout the years, most of my mentors have been involved in translational research and laboratory work, which, on many occasions, has resulted in fruitful research, culminating in theses and publications in relevant journals. One of the key points in assuming the responsibility of training is to work very closely, as friends, standing side by side, studying the relevant research project and its progress. There are several emotions among the mentor and young investigators. The mentor feels joy and delights in seeing the young investigators progress, converting in an overall happiness at the project accomplishment. The mentors joy comes once every young investigator achieves the main objective of his/her work in process.

      Transparency is the fuel of friendship between the mentor and young investigator. The mentor should be fully involved and open, in order to build a strong mentor/investigator relationship. The mentor must show emotional honesty, even if there is the possibility of someone taking advantage of his/her vulnerabilities. Unmasking oneself is the only means to building successful scientific relationships. The mentor should apply an open policy of collaboration, assuming the young investigators could have an even greater capacity for research, than the mentor himself. Most of the time, this behavior will be a benefit for the investigators. There have been many examples of investigators contributing to important findings in a plethora of different research areas. Cancer biology was recognized as an important cancer field in the late 90’s, and many investigators have made exciting contributions in tumors, such as, non-Hodgkin’s lymphomas (Calvo et al JNCI 1998), gastric cancer (Wei et al JNCI 2011) and many others, culminating in salient publications in the field of lung cancer (Karachaliou et al JAMA Oncol 2015). The principal contributions will be included in the presentation.

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      YI03.04 - Oncology Fellows' Career Plans and Expectations (Now Available) (ID 3706)

      10:30 - 12:00  |  Presenting Author(s): Masaoki Ito

      • Abstract
      • Presentation
      • Slides

      Abstract

      I will discuss how I planned my fellow career and tips for achieving based on my own experience. My own career is short, at around 10 years, but I would be glad if my presentation could be of some service to fellows in the same position.

      If you want to achieve something different than your current situation for your own career, then you gain qualifications, earn achievements such as publishing papers, participate in the academic community, or organize projects, but it is difficult to decide on the ultimate goal at an early stage. For young fellows to build a career, the process is more crucial than setting the outcome, therefore it is essential to know oneself, in addition to learning the latest information on thoracic oncology. Read articles, participate in academic conferences and train at other facilities as a means of understanding your own knowledge and competencies, rather than simply as a means of learning about thoracic oncology.

      Although training at special facility will provide the smallest amount of information about thoracic oncology at one time, I believe it is the most efficient means of learning about oneself. This type of learning enables you to directly and simultaneously understand your disadvantages, advantages and characteristics. I have worked and researched at several hospitals and research institutes both in Japan and overseas. I made use of the scholarship system in the past to conduct clinical training in Spain, which enabled me to gain a wealth of clinical experience that I would not have been able to experience in Japan. I am currently affiliated with a research institute in Barcelona and have been involved in research there since 2017 under world-renowned supervisors. I contribute to joint research between Japan and Spain, and Spain and the US, and this, among other opportunities, has enabled me to learn a great deal at my current facility. This experience has not only strengthened my resolve about the new goals I want to achieve, it has also made me fully aware of areas where I am lacking.

      For the training at a special facility, getting the grant is crucial. I have received some grant support from several academic associations including IASLC. The financial supports allowed me to gain and achieve ambitious aims. Through the project, I have been inspired and it brought me new ambitions. Although there are more and more opportunities of the grant in these days, winning is getting more competitive. Fortunately, I could receive grant support several times. However, I failed many times to get the support. To get the grant, I will show tips based on my own experience at my presentation.

      If training at a special facility or getting the grant is difficult, I recommend continuing to participate at international conferences. This is also particularly important for learning the latest information about thoracic oncology. I have participated 13 times in international conferences to date, and have participated in the World Conference on Lung Cancer (WCLC) since the 13th congress held in 2009. I strongly recommend checking all the abstracts before attending the conference, preparing questions and discussing matters with as many people as possible during the conference. WCLC has research in all fields related to thoracic oncology, so it is relatively easy to make new acquaintances and partnership in your own field of research or interest. In this instance also, it is important to make presentations and receive as much input as possible, to clarify areas where you may be lacking and you have advantage, thus using this opportunity as efficiently as you can. Attending congress also gives you chances to get informed the grant opportunity and which facility is attractive for you to make training.

      In summary, it is not easy to make decisions about your career, and often we are unaware when we are at a turning point. No one knows the correct answer. Building a career involves not only your own intentions, but also your situation and funds. The important thing is to focus on the quality of the process to ensure that you do not waste time, and to always be aware of your own strengths and weaknesses, and using or supplementing these characteristics to discover what you want to achieve and what you can achieve in your career.

      Training at a special facility and keeping to join academic congress clearly enhance our academic career. It will give you new confidence to find or continue on your mission for thoracic oncology.

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Author of

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    MA08 - Pawing the Way to Improve Outcomes in Stage III NSCLC (ID 127)

    • Event: WCLC 2019
    • Type: Mini Oral Session
    • Track: Treatment of Locoregional Disease - NSCLC
    • Presentations: 1
    • Now Available
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      MA08.09 - Results of Trimodality Therapy for Patients with cN2 Lung Cancer Diagnosed by Video-Assisted Mediastinoscopic Lymphadenectomy (VAMLA) (Now Available) (ID 1295)

      15:15 - 16:45  |  Author(s): Carme Obiols

      • Abstract
      • Presentation
      • Slides

      Background

      After a properly performed transcervical lymphadenectomy, invasive restaging of the mediastinum is unnecessary because 
there is no material left for a new biopsy. Therefore, when video-assisted mediastinoscopic lymphadenectomy (VAMLA) is used at primary staging, the only parameters to select patients for lung resection after induction therapy are: the stability of the primary tumor and the absence of extrathoracic disease assessed by PET-CT. The aim of this study is to analyze the results of those patients with cN2 NSCLC diagnosed by VAMLA who underwent trimodality treatment in terms of feasibility and survival.

      Method

      Prospective observational single-center study of 250 patients (206 men; median age, 65.7; range, 42-86) with NSCLC cN0-1 (by PET-CT) who underwent VAMLA from 01-2010 to 12-2017. Patients with cN2 diagnosed by VAMLA who underwent trimodality treatment (cisplatin-based chemotherapy concomitant with radical radiotherapy [mean 54Gy, range 40-70Gy] plus lung resection) were analyzed. Follow-up was completed in March 2019. Median follow-up for surviving patients was 39.5 months (range, 8-108). Survival analysis was performed by the Kaplan-Meier method; the log-rank test was used for comparisons. Patients who died within 90 days after resection were excluded from survival analyses. A p-value of less than 0.05 was considered significant. The IBM SPSS Statistics for Mac, version 20.0 was used.

      Result

      The rate of unsuspected N2-3 disease in the whole series was 14.5% (35 patients). 28 patients out of 35 were considered for trimodality treatment. The results of restaging based on the PET-CT were: disease progression in 8 (28.5%) (mostly distant metastases), and stability of the primary tumor or partial response in 20 patients (71.5%). Of 20 patients without progression, 13 (46.5%) underwent lung resection; the remaining 7 were considered unfit for surgery. Three- and 5-year survival rates for those candidates for chemoradiotherapy (n=28) were: 91.7% and 80.2%, respectively, for patients in whom complete lung resection was achieved; 34.3% and 0%, respectively, for those considered unfit for surgery; and 19% and 0%, respectively, for those with progression after chemoradiotherapy (p < 0.0001)(Figure 1).

      figure1.jpg

      Conclusion

      The use of VAMLA to select patients for trimodality treatment is feasible. Based on the results obtained (high rate of unsuspected cN2 diagnosed by VAMLA and prolonged survival of those patients in whom the trimodality treatment was accomplished), VAMLA should be included in the current staging algorithms, especially for those tumors with intermediate risk of N2 and normal mediastinum by PET-CT.

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    OA12 - Profiling the Multidisciplinary Management of Stage III NSCLC (ID 144)

    • Event: WCLC 2019
    • Type: Oral Session
    • Track: Treatment of Locoregional Disease - NSCLC
    • Presentations: 1
    • Now Available
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      OA12.07 - Radicality of Lymphadenectomy in Lung Cancer According to Surgical Approach. Results from the Spanish Group of Video-Assisted Thoracic Surgery (Now Available) (ID 1062)

      15:45 - 17:15  |  Presenting Author(s): Carme Obiols

      • Abstract
      • Presentation
      • Slides

      Background

      The minor standard of systematic nodal dissection (SND) in lung cancer surgery, which is the minimum recommended by the Union for International Cancer Control, requires the resection/sampling of, at least, 3 mediastinal (including subcarinal station) and 3 hilar/intrapulmonary lymph nodes (LN). The objective of this study is to analyze differences in intraoperative LN assessment in patients with surgically treated non-small cell lung cancer (NSCLC) according to surgical approach (open vs VATS), from the results of the Spanish Group of Video-Assisted Thoracic Surgery (GEVATS) database.

      Method

      Prospective multicenter cohort study of anatomic pulmonary resections (n=3533) performed from 20/12/16 to 20/03/18. Exclusions criteria were: indications different from NSCLC, previous lung cancer, synchronous tumors and induction therapy. Patients who did not meet the criteria for SND but had no nodal involvement were coded as pathologic (p)Nx (instead of pN0). Corresponding tests for homogeneity were performed. Multiple logistic regression analysis was used to determine the odds ratio (OR) and 95% confidence interval (95%CI). Stata/SE vs 13 statistical package was used for data analysis. Significance was considered when p<0.05.

      Result

      2532 patients were analyzed (1801 men [71.1%]; median age: 67 years). SND was performed in 65%, with a median of LN resected/sampled of 7 (IQR 4-12) and a rate of pN2 of 9.5%. Table1 summarizes results from bivariate analysis.Independent risk factors for thoracotomy at multivariate analysis (OR; 95%CI) were: squamous cell carcinoma vs adenocarcinoma (1.3; 1.04-1.68), staging mediastinoscopy (2.8; 1.83-4.22), LN resected (1.02; 1.00-1.04), SND (1.4; 1.07-1.8), tumour >3cm (1.8; 1.5-2.2), central tumour (2.5; 2.0-3.1); pN1 (1.5; 1.1-2.1) and pN2 (1.6; 1.1-2.3). A significantly higher proportion of nodal upstaging was observed in thoracotomy group: from cN0 to pN1/pN2, and from cN1 to pN2 (table1).

      figure1.jpg

      Conclusion

      The intensity of lymphadenectomy in GEVATS was superior in the thoracotomy approach. Therefore, intraoperative lymph node evaluation performed at VATS should improve to have better prognostic information and indicate adjuvant therapy.

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