Integration of radiomic, genomic and clinical data to support decision making for lung cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e14607-e14607 ◽  
Author(s):  
Thierry Colin
Keyword(s):  
Lung Cancer ◽  
Decision Making ◽  
Medical Information ◽  
Lung Metastases ◽  
Imaging Techniques ◽  
Early Response ◽  
Tumor Board ◽  
Base Line ◽  
Full Potential ◽  
Therapeutic Decisions

e14607 Background: Medical imaging techniques play a central role in the evaluation of lung cancer and proper images analysis is essential for determining the location and stage of tumors, for diagnosis and prognosis assessment, guiding therapeutic decisions and for monitoring tumor response during and after treatment. It also supports interventional radiology acts (i.e. biopsies, thermo-ablations or embolization). Yet, this source of information, which is critical for the decision-making process, is not being used to its full potential. Besides, NGS technics allow the precise characterization of the genomic profile of a tumor by detecting mutations, evaluating the TMB and providing additional information such as the PD-L1 status. Methods: We have used an AI-based strategy to improve the stratification of cohorts of patients suffering from lung cancer. Using an advanced segmentation technology, we were able to quickly and precisely extract 3D Radiomic characteristics from the images. We then combined extracted heterogeneity and texture indicators with the biology information thanks to a machine learning based methodology. Results: We have applied this strategy to stage 4 NSCLC with EGFR mutation treated with TKI and have shown that stratification of the cohort with respect to the OS can be delivered using the base-line CT-scan and the first two exams used for the evaluation of the early response to the treatment. The same strategy was developed for the monitoring of lung metastases in order to help scheduling thermo-ablation by providing a prediction of the growth of the lesion in oligo-metastatic cases. Conclusions: This study paves the way to a near future when Artificial Intelligence will provide precise evaluation of lung tumors and full integration of all the medical information available for each patient to support the decision making within the tumor board.

A REVIEW ON COMPUTER AIDED DETECTION AND DIAGNOSIS OF LUNG CANCER NODULES

2012 ◽  
Vol 3 (3) ◽  
pp. 393-400 ◽  
Author(s):  
S.Shaik Parveen ◽  
Dr. C Kavitha
Keyword(s):  
Lung Cancer ◽  
Medical Information ◽  
Imaging Techniques ◽  
Computer Aided Detection ◽  
Ultrasound Diagnostics ◽  
Computer Aided ◽  
Detection And Diagnosis ◽  
Diagnosis Of Lung Cancer ◽  
Short Time ◽  
Early Detection And Diagnosis

In this paper, a attempt has been made to summarize some of the information about CAD and CADx for the purpose of early detection and diagnosis of lung cancer. Computer Aided Detection (CADe) and Computer Aided Diagnosis (CADx), are procedures in medical information that assist doctors in the interpretation of medical images. Imaging techniques in X-ray, MRI, and Ultrasound diagnostics yield a great deal of information, which the radiologist has to analyze and evaluate comprehensively in a short time. Thus, the use of digital computers to assist practitioners and physicians in diagnosing diseases and to offer a rapid access to medical information gained importance. CAD systems help scan digital images, e.g. from Computed Tomography (CT), for typical appearances and to highlight conspicuous sections, such as focal areas of lung nodules.

Effect of a multidisciplinary cancer conference for thoracic malignancies on patient care management.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 112-112
Author(s):  
Henner M. Schmidt ◽  
John M. Roberts ◽  
Artur M. Bodnar ◽  
Steven H. Kirtland ◽  
Sonia H. Kunz ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Decision Making ◽  
Esophageal Cancer ◽  
Cancer Patients ◽  
Treatment Plan ◽  
Treatment Decision ◽  
Primary Treatment ◽  
Prior Treatment ◽  
Tumor Board ◽  
Treatment Decision Making

112 Background: Treatment of thoracic cancers frequently involve multiple subspecialties thus treatment decisions are typically best facilitated in multidisciplinary tumor boards (MTB). This approach should facilitate and improve treatment decision making, standardize staging and therapeutic decisions and improve outcomes. In this study we analyze the evolution in staging and treatment decision making associated with presentation at MTB. Methods: Retrospective review of all patients with lung or esophageal cancer presented at our weekly MTB from June 1, 2010 to September 30, 2012. All providers submitting patients to tumor board recorded their current treatment plan prior to presentation. The physician’s plan was then compared to the tumor board’s final recommendation. Changes made were graded according to degree of magnitude as minor, moderate or major change. Minor changes included changes in diagnostic imaging. Moderate changes involved modifications in the type of invasive staging or biopsy procedures. Major changes were defined as changes to final therapeutic plans such as surgery, chemotherapy, or radiation therapy. Results: 435 patients with esophageal or lung cancer were discussed in the MTB. 86 patients having no prior treatment plan available were excluded. In the remaining 347 patients there were 163 patients with esophageal cancer (47%) and 184 patients with lung cancer (53%). In the esophageal cancer patients a change to the physician’s prior treatment plan was recommended in 33 cases (21%). For lung cancer patients a change in the treatment plan was recommended in 50 cases (27%). Overall a recommendation for change in treatment occurred in 83 cases (24 %). Changes were major 13%, moderate 6% and minor 5%. Follow-up in 249 patients confirmed that MTB recommendations were followed in 97% of cases. Conclusions: MTB recommendations frequently differs from the physician’s primary treatment plan. MTB reviews have previously been documented to improve patient’s outcome. The study demonstrates that in one quarter of patients MTB recommendation will be different from the primary treatment plan. Complex cancer patients should be considered for presentation at MTB whenever feasible.

Impact of multidisciplinary discussion on therapeutic decision in cancer patients: a prospective observational study.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18243-e18243
Author(s):  
Carla Pires Amaro ◽  
Larissa Gomes ◽  
Daniel Almeida ◽  
Kelly Reiner ◽  
Gustavo Fernandes Godoy Almeida ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Decision Making ◽  
Cancer Patients ◽  
Rate Of Change ◽  
Tumor Board ◽  
Cancer Center ◽  
Final Decision ◽  
Main Theme ◽  
Number Of Patients ◽  
The Impact

e18243 Background: Continued and rapid evolution of diagnosis and staging methods along with the development of new treatments has changed decision-making process of cancer patient into a more complex task. We evaluated the impact of multidisciplinary tumor board meetings (MTM) in the final decision of cancer patients approach in comparison to the initial decision based on clinical oncologist’s individual choice. Methods: Between April 2016 and January 2017, data were collected prospectively during the MTM held daily at the Antônio Ermírio de Moraes Cancer Center, Sao Paulo, Brazil. Data were gathered by filling out a questionnaire. The therapeutic plan initialy proposed by the physician was compared to the proposal offered by the multidisciplinary team. We evaluated data from breast, gastrointestinal (GI) and lung cancer MTM. Results: We evaluated 100 questionnaires: 39% GI tumors, 34% lung cancer, 27% breast cancer. The main theme for discussion was selection of systemic therapy (65%). The rate of change in therapy choice was 24.6%. The recommendation suggested by the MTM surgeons and radio-oncologists showed disagreement with the one initially proposed in 21 cases. The majority of discordant cases was related to the choice of therapeutic method (57%) with 42% changes in the chemotherapy protocol. Eight patients were submitted to genetic test and mutations search. Only two cases were recommended for clinical trial enrollment. Conclusions: The rate of therapy plan change after MTM is in accordance with international studies. The largest volume of discussions on systemic therapies reflects the large number of new therapies as well as new treatment strategies. This research highlights the potential of multidisciplinary discussions in changing decision-making in cancer cases, allowing a more comprehensive care with the patient. In addition, a MTM allows the access of more patients to new medications made available through clinical trials and protocols. The small number of patients referred to a clinical study reflects the lack of clinical protocols available in Brazil, a problem that needs to be acknowledged and become a priority for Brazilian medical societies and regulatory agencies.

Clinical Judgment Revisited

1999 ◽  
Vol 38 (04/05) ◽  
pp. 279-286 ◽  
Author(s):  
L. L. Weed
Keyword(s):  
Decision Making ◽  
Medical Practice ◽  
Clinical Judgment ◽  
Medical Information ◽  
Patient Records ◽  
Practice Of Medicine ◽  
The Way

AbstractIt is widely recognised that accessing and processing medical information in libraries and patient records is a burden beyond the capacities of the physician’s unaided mind in the conditions of medical practice. Physicians are quite capable of tremendous intellectual feats but cannot possibly do it all. The way ahead requires the development of a framework in which the brilliant pieces of understanding are routinely assembled into a working unit of social machinery that is coherent and as error free as possible – a challenge in which we ourselves are among the working parts to be organized and brought under control.Such a framework of intellectual rigor and discipline in the practice of medicine can only be achieved if knowledge is embedded in tools; the system requiring the routine use of those tools in all decision making by both providers and patients.

Virtual Clinical and Precision Medicine Tumor Boards: A Cloud-based Platform-mediated Implementation of Multidisciplinary Reviews among Oncology Centers in the Covid-19 Era. (Preprint)

2020 ◽  
Author(s):  
Livio Blasi ◽  
Roberto Bordonaro ◽  
Vincenzo Serretta ◽  
Dario Piazza ◽  
Alberto Firenze ◽  
...  
Keyword(s):  
Decision Making ◽  
Health Professionals ◽  
Clinical Pathways ◽  
Prospective Trial ◽  
Banking System ◽  
Outcome Data ◽  
Tumor Board ◽  
Time Saving ◽  
Tumor Boards ◽  
Multidisciplinary Tumor Board

BACKGROUND Multidisciplinary tumor boards play a pivotal role in the patients -centered clinical management and in the decision-making process to provide best evidence -based, diagnostic and therapeutic care to cancer patients. Among the barriers to achieve an efficient multidisciplinary tumor board, lack of time and geographical distance play a major role. Therefore the elaboration of an efficient virtual multidisciplinary tumor board (VMTB) is a key-point to reach a successful oncology team and implement a network among health professionals and institutions. This need is stronger than ever in a Covid-19 pandemic scenario. OBJECTIVE This paper presents a research protocol for an observational study focused on exploring the structuring process and the implementation of a multi-institutional VMTB in Sicily. Other endpoints include analysis of cooperation between participants, adherence to guidelines, patients’ outcomes, and patients satisfaction METHODS This protocol encompasses a pragmatic, observational, multicenter, non-interventional, prospective trial. The study's programmed duration is five years, with a half-yearly analysis of the primary and secondary objectives' measurements. Oncology care health-professionals from various oncology subspecialties at oncology departments in multiple hospitals (academic and general hospitals as well as tertiary centers and community hospitals) are involved in a non-hierarchic fashion. VMTB employ an innovative, virtual, cloud-based platform to share anonymized medical data which are discussed via a videoconferencing system both satisfying security criteria and HIPAA compliance. RESULTS The protocol is part of a larger research project on communication and multidisciplinary collaboration in oncology units and departments spread in the Sicily region in Italy. Results of this study will particularly focus on the organization of VMTB involving oncology units present in different hospitals spread in the area and create a network to allow best patients care pathways and a hub and spoke relationship. Results will also include data concerning organization skills and pitfalls, barriers, efficiency, number and type con clinical cases, and customers’ satisfaction. CONCLUSIONS VMTB represents a unique opportunity to optimize patient’s management in a patient centered approach. An efficient virtualization and data banking system is potentially time-saving, a source for outcome data, and a detector of possible holes in the hull of clinical pathways. The observations and results from this VMTB study may hopefully useful to design nonclinical and organizational interventions that enhance multidisciplinary decision-making in oncology.

scholarly journals Making the Most of Complexity to Create Opportunities: Comprehensive Genomic Profiling and Molecular Tumor Board for Patients with Non-Small Cell Lung Cancer (NSCLC)

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 609
Author(s):  
Caterina Fumagalli ◽  
Elena Guerini-Rocco ◽  
Massimo Barberis
Keyword(s):  
Lung Cancer ◽  
Small Cell ◽  
Tumor Board ◽  
Genomic Profiling ◽  
Small Cell Lung ◽  
Molecular Alterations ◽  
Comprehensive Genomic Profiling ◽  
Molecular Tumor Board ◽  
Personalized Cancer Therapy ◽  
Personalized Cancer

Personalized cancer therapy matches the plan of treatment with specific molecular alterations [...]

scholarly journals Predictive value of 3′-deoxy-3′-18F-fluorothymidine PET in the early response to anti-programmed death-1 therapy in patients with advanced non-small cell lung cancer

2021 ◽  
Vol 9 (7) ◽  
pp. e003079
Author(s):  
Masayuki Sato ◽  
Yukihiro Umeda ◽  
Tetsuya Tsujikawa ◽  
Tetsuya Mori ◽  
Miwa Morikawa ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Treatment Initiation ◽  
Early Response ◽  
Small Cell ◽  
Small Cell Lung ◽  
Flt Pet ◽  
Programmed Death ◽  
Programmed Death 1

BackgroundAnti-programmed death-1 (anti-PD-1) therapy has shown clinical success in patients with advanced non-small cell lung cancer (NSCLC). However, it is difficult to evaluate the early response to anti-PD-1 therapy. We determined whether changes in 3′-deoxy-3′-[18F]-fluorothymidine (18F-FLT) PET parameters before and soon after treatment initiation predicted the therapeutic effect of anti-PD-1 antibody.MethodsTwenty-six patients with advanced NSCLC treated with anti-PD-1 antibody were enrolled prospectively and underwent 18F-FLT PET before and at 2 and 6 weeks after treatment initiation. Changes in maximal standardized uptake value (ΔSUVmax), proliferative tumor volume (ΔPTV) and total lesion proliferation (ΔTLP) of the lesions were calculated and evaluated for their associations with the clinical response to therapy.ResultsThe disease control rate was 64%. Patients with non-progressive disease (non-PD) had significantly decreased TLP at 2 weeks, and decreased SUVmax, PTV, and TLP at 6 weeks, compared with those with PD, while three of eight (37.5%) patients who responded had increased TLP from baseline at 2 weeks (ie, pseudoprogression). Among the parameters that changed between baseline and 2 weeks, ΔPTV0-2 and ΔTLP0-2 had the highest accuracy (76.0%) to predict PD. Among the parameters that changed between baseline and 6 weeks, ΔSUVmax0-6, ΔPTV0-6 and ΔTLP0-6 had the highest accuracy (90.9%) to predict PD. ΔTLP0-2 (≥60%, HR 3.41, 95% CI 1.34–8.65, p=0.010) and ΔTLP0-6 (≥50%, HR 31.4, 95% CI 3.55 to 276.7, p=0.0019) were indicators of shorter progression-free survival.ConclusionsChanges in 18F-FLT PET parameters may have value as an early predictive biomarker for the response to anti-PD-1 therapy in patients with NSCLC. However, it should be noted that pseudoprogression was observed in 18F-FLT PET imaging at 2 weeks after treatment initiation.Trial registration numberjRCTs051180147.

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