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Advances in Thoracic Oncology Research

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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (1 February 2026) | Viewed by 5528

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Dr. Domenico Galetta

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Guest Editor

Division of Thoracic Surgery, European Institute of Oncology, Via Giuseppe Ripamonti, 435, 20141 Milano, Italy
Interests: lung cancer; mediastinal neoplasms; mesothelioma; pleural disease; less invasive techniques; induction therapies
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Special Issue Information

Dear Colleagues,

The last decade has been characterized by significant changes in the diagnosis and therapy in the field of thoracic oncology, with medical oncologists and thoracic surgeons approaching the treatment of thoracic malignancies with new diagnostic and therapeutic tools. The wide and diffuse use of biomarker tests led medical oncologists to provide targeted and personalized therapies (i.e., tyrosine kinase inhibitors and/or immune checkpoint inhibitors) both for early and advanced lung cancer stages, which led to promising results in terms of long-term survival. From a surgical point of view, new emerging tools in both surgical practice (less invasive techniques, robotic approaches, etc.) and in postoperative management have demonstrated large benefits for the patients. Radiation therapy has also played an important role in the treatment of chest tumors more often within a multidisciplinary program.

This Special Issue of Cancers will focus on advances in thoracic oncology research, providing an overview of recent advances in the diagnosis and treatment of lung cancer (from early stages to advanced non-small-cell lung cancer and neuroendocrine tumors), mediastinal tumors (including thymic neoplasms—thymoma, thymic carcinoma, rare thymic tumors, and endothoracic neurogenic neoplasms), neoplasm of the pleura (primary one, as mesothelioma, or secondary) and tumors of the chest wall.

We encourage all colleagues (surgeons, medical oncologists, radiation oncologists and radiologists) to contribute original research articles and reviews to this Special Issue.

We look forward to receiving your contributions.

Dr. Domenico Galetta
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

lung cancer
mediastinal
thymic
neuroendocrine
robotic
VATS
chest wall
chemotherapy
immunotherapy
radiotherapy

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Published Papers (4 papers)

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Research

16 pages, 686 KB

Open AccessArticle

Segmentectomy Versus Lobectomy in Patients with Stage IA Lung Adenocarcinoma: Long-Term Survival in a Propensity Score-Matched Cohort

by Zhangfeng Huang, Tenglong Luo, Zuhan Geng, Qi Gao and Yongde Liao

Cancers 2026, 18(8), 1202; https://doi.org/10.3390/cancers18081202 - 9 Apr 2026

Viewed by 532

Abstract

Background: Whether there are differences in clinical outcomes between segmentectomy and lobectomy in patients with early-stage lung adenocarcinoma (LUAD) remains uncertain. This study aimed to compare all-cause mortality and lung cancer-specific mortality in patients with lung tumors ≤ 20 mm undergoing these two procedures. Methods: Patients with stage IA lung adenocarcinoma (≤20 mm) who underwent segmentectomy or lobectomy were identified from the SEER database (2008–2022). Propensity score matching (PSM) was applied to balance baseline characteristics. Kaplan–Meier curves depicted overall survival and lung cancer-specific survival. Multivariable Cox proportional hazards models were used to evaluate associations between surgical procedures and mortality, reporting hazard ratios (HRs) with 95% confidence intervals (CIs). Results: Among 9641 patients, 1065 (11.0%) underwent segmentectomy. After 1:1 PSM, 2028 patients had well-balanced covariates. The median follow-up was 43.0 months. In the lobectomy group, 158 all-cause deaths (35.1 per 1000 person-years) and 66 lung cancer-specific deaths (14.7 per 1000 person-years) occurred, compared with 176 and 80 events in the segmentectomy group (39.9 and 18.1 per 1000 person-years, respectively). Multivariable Cox regression demonstrated that segmentectomy, compared with lobectomy, was not associated with a higher risk of all-cause mortality (adjusted HR [aHR], 1.07, 95% CI 0.86–1.34) or lung cancer-specific mortality (aHR, 1.18, 95% CI 0.84–1.64). The results were consistent across tumor differentiation subgroups. Conclusions: Among patients with early-stage (≤20 mm) LUAD, segmentectomy was not associated with an increased risk of all-cause or lung cancer-specific mortality compared with lobectomy. Further studies with larger sample sizes are warranted to validate these findings. Full article

(This article belongs to the Special Issue Advances in Thoracic Oncology Research)

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17 pages, 766 KB

Open AccessArticle

Real-World Data on the Safety and Efficacy of SBRT for Central and Ultra-Central Lung Tumors: A Retrospective Multi-Center Cohort

by Anna Zygogianni, Andromachi Kougioumtzopoulou, Kalliopi Platoni, Maria Protopapa, Zoi Liakouli, Ioannis M. Koukourakis, Despoina Alexiou, Theodoros Stroubinis, Christina Armpilia, Christos Antypas, Michalis Psarras, Despoina Stasinou, Ioannis Georgakopoulos and Vasileios Kouloulias

Cancers 2026, 18(4), 653; https://doi.org/10.3390/cancers18040653 - 17 Feb 2026

Viewed by 878

Abstract

Background/Objectives: The use of stereotactic body radiotherapy (SBRT) for centrally and ultra-centrally located early-stage non-small cell lung cancer (NSCLC) remains clinically challenging due to the proximity of critical mediastinal organs at risk and the limited prospective evidence, particularly for ultra-central disease. Real-world data are needed to better define the safety and efficacy of SBRT when delivered according to contemporary protocol-based planning principles. Methods: This retrospective cohort study included patients treated at two radiotherapy centers, with centralized follow-up and outcome adjudication at a single academic institution. We evaluated patients with centrally or ultra-centrally located, early-stage NSCLC treated with SBRT according to dose-fractionation and planning principles derived from the NRG Oncology/RTOG 0813 protocol. Tumors were classified as central or ultra-central according to the International Association for the Study of Lung Cancer and HILUS definitions, respectively. The prescribed dose was 50 Gy in five fractions. Primary endpoints were treatment-related toxicity and local progression-free survival (LPFS). Secondary endpoints included overall survival (OS), progression-free survival (PFS), and dosimetric outcomes. Survival endpoints were analyzed using the Kaplan–Meier method. Results: Seventy-eight patients were included, of whom 52 had centrally located and 26 ultra-centrally located tumors. Median follow-up was 57 months. The overall objective response rate was 92.3%. The estimated 4-year LPFS was 97.4% for the entire cohort, with rates of 100% for central and 91.6% for ultra-central tumors (p < 0.001). Four-year OS was 98.7%, with no treatment-related deaths observed. Treatment-related toxicity was minimal, with grade ≥ 2 events occurring in only one patient (1.3%) and no grade ≥ 3 toxicity. All treatment plans met predefined organ-at-risk dose constraints. Conclusions: In this real-world cohort, SBRT delivered according to RTOG 0813 planning principles achieved excellent local control with minimal clinically relevant toxicity in patients with centrally and ultra-centrally located early-stage NSCLC. These findings support the safe implementation of SBRT in carefully selected patients when stringent organ-at-risk constraints and conservative treatment planning are employed. Full article

(This article belongs to the Special Issue Advances in Thoracic Oncology Research)

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12 pages, 6655 KB

Open AccessArticle

Initial Experience with Correlation Object–Based DRR Targeting Using Stereoscopic X-Ray Imaging in Lung SBRT

by Marlies Boussaer, Cristina Teixeira, Kajetan Berlinger, Selma Ben Mustapha, Anne-Sophie Bom, Sven Van Laere, Mark De Ridder and Thierry Gevaert

Cancers 2026, 18(2), 316; https://doi.org/10.3390/cancers18020316 - 20 Jan 2026

Viewed by 668

Abstract

Background/Objectives: Despite significant advances in imaging technology, real-time intra-fraction monitoring of moving targets remains a challenge in markerless radiotherapy. This retrospective study investigates the use of ExacTrac Dynamic by Brainlab as an intra-fraction monitoring tool for stereotactic body radiotherapy (SBRT) in both early-stage NSCLC and oligometastatic disease. Methods: A total of 63 X-ray pairs from 21 patients were analyzed to evaluate tumor visualization with and without a surrogate approach. Statistical analysis was conducted to determine whether failures could be attributed to tumor size or localization using the Mann–Whitney U-test and Fisher’s exact test. The accuracy of the X-ray/digitally reconstructed radiograph (DRR) surrogate-based fusion was assessed by calculating and comparing the corresponding 3D vectors according to the linear mixed effects model, with a random slope effect for size of surrogate and a random intercept per patient. Results: Surrogates enhanced tumor visualization on X-ray/DRR fusions from 14.3% to 75.5%. Tumor size and lung affected (left or right) did not predict visualization success. Tumor location, however, tended to influence visibility, with lesions in the upper lobes being more readily visualized (88%) than those in the lower lobes (48.1%), although no statistical significance was reported (p > 0.05). Regarding geometric accuracy, 76% of the analyzed data points deviated less than 5 mm in the 3D vector measurements, the mean values were around 4 mm (±3 mm), and the medians were within 3 mm across all conditions. No statistically significant differences (p > 0.05) were found based on the surrogate size or the triggering time of the X-ray during the breathing cycle. Conclusions: Surrogate-based DRRs, referred to as Correlation Objects, demonstrate consistent geometric accuracy across multiple surrogate sizes and X-ray acquisitions, supporting the clinical translation of markerless lung targeting workflows for lung SBRT. Full article

(This article belongs to the Special Issue Advances in Thoracic Oncology Research)

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17 pages, 1105 KB

Open AccessArticle

Plasmatic Inactive IL-18 Predicts a Worse Overall Survival for Advanced Non-Small-Cell Lung Cancer with Early Metabolic Progression after Immunotherapy Initiation

by Serena Janho dit Hreich, Olivier Humbert, Tanguy Pacé-Loscos, Renaud Schiappa, Thierry Juhel, Marius Ilié, Victoria Ferrari, Jonathan Benzaquen, Paul Hofman and Valérie Vouret-Craviari

Cancers 2024, 16(12), 2226; https://doi.org/10.3390/cancers16122226 - 14 Jun 2024

Cited by 6 | Viewed by 2239

Abstract

The aim of this study was to assess the potential value of circulating active and inactive IL-18 levels in distinguishing pseudo and true tumor progression among NSCLC patients receiving immune checkpoint inhibitor treatments (ICIs). Methods: This ancillary study includes 195 patients with metastatic non-small-cell lung cancer (NSCLC) treated with ICI in monotherapy, either pembrolizumab or nivolumab. Plasmatic levels of IL-18-related compounds, comprising the inhibitor IL-18 binding protein (IL-18BP), the inactive IL-18 (corresponding to IL-18/IL-18BP complex), and the active free IL-18, were assayed by ELISA. Objective tumoral response was analyzed by ¹⁸FDG PET-CT at baseline, 7 weeks, and 3 months post treatment induction, using PERCIST criteria. Results: Plasmatic IL-18BP and total IL-18 levels are increased at baseline in NSCLC patients compared with healthy controls, whereas IL-18/IL-18BP complexes are decreased, and free IL-18 levels remain unchanged. Neither of the IL-18-related compounds allowed to discriminate ICI responding to nonresponding patients. However, inactive IL-18 levels allowed to discriminate patients with a first tumor progression, assessed after 7 weeks of treatment, with worse overall survival. In addition, we showed that neutrophil concentration is also a predictive indicator of patients’ outcomes with OS (HR = 2.6, p = 0.0001) and PFS (HR = 2.2, p = 0.001). Conclusions: Plasmatic levels of inactive IL-18, combined with circulating neutrophil concentrations, can effectively distinguish ICI nonresponding patients with better overall survival (OS), potentially guiding rapid decisions for therapeutic intensification. Full article

(This article belongs to the Special Issue Advances in Thoracic Oncology Research)

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