Thoracic Cancer Journal
type: channel
description: THORAC (Thoracic Cancer Journal) is dedicated to publishing clinical and experimental research in the field of thoracic oncology. As the official journal of the Portuguese Lung Cancer Study Group (Grupo de Estudos de Cancro do Pulmão - GECP), it serves as a vital platform for advancing knowledge and fostering collaboration within the thoracic oncology community.
publisher: Grupo de Estudos de Cancro do Pulmão (GECP)
language: en
publication name: Thoracic Cancer Journal
items: Rethinking Lung Cancer Through Screening, Early Detection and Precision Oncology
items: One Bronchus too Many: A Rare Bronchoscopy Finding
items: Benign yet Suspicious: Sclerosing Pneumocytoma Uncovered in Cancer Staging
items: ESMO 2025 and the Future of EGFRm NSCLC Sequencing: First-line Choices that Preserve Subsequent Therapy Eligibility
items: Will Spatial Transcriptomics Transform Pathology?
items: Revisiting the Role of Adjuvant Radiotherapy in Non-Small Cell Lung Cancer
items: Self-Care for Effective Caregiving
items: Challenges of Staging Lung Cancer with the New TNM Classification (9th edition)
items: Lung cancer study group - 25 years
items: Triple-Dose Furmonertinib for Leptomeningeal Metastases in Advanced EGFR L858R-Mutated Lung Adenocarcinoma: A Case Report
items: Clinical Outcomes of Thoracic Cancer Patients Requiring ICU Admission: A 10-Year Retrospective Study
items: Sequential T790M mutation testing and changes in the therapeutic approach after 2 lines of chemotherapy – clinical case
items: Descriptive analysis of PD-L1 expression in non-small cell lung carcinoma biopsies: two -year experience in a tertiary Hospital
items: LENT score in prognostic assessment of malignant pleural effusion – the impact of target therapy
items: Stereotactic body radiotherapy in primary lung disease: Experience of a portuguese center
items: A importância de publicar
items: Comprehensive Evaluation of Peripheral Immunodynamics in Advanced Non-Small Cell Lung Cancer Associated to Chemotherapy and Immunotherapy
items: Therapeutic Targets in Non-Small Cell Lung Cancer: Current Progress and Future Directions
items: Digital Image Analysis and Artificial Intelligence in Lung Cancer Pathology
items: Operability versus Resectability in Non-Small Cell Lung Cancer: A Multidisciplinary Perspective
items: Investigator-Led Clinical Research in Thoracic Oncology: Are We Able to Do It?
items: Atividades do GECP
items: Two-year treatment with Pembrolizumab monotherapy in advanced non-small cell lung cancer: a reflection based on real-world data
items: A multicentric analysis of prognostic factors in malignant pleural mesothelioma
items: 20 years managing malignant pleural mesothelioma: a review of our experience and the quest for the optimal prognostic marker
items: Editorial
items: Novos desafios
items: Radiation-induced pneumonitis: literature review and clinical case
items: Um caso de Carcinoma do Pulmão de Não Pequenas Células EGFR
items: AT LAST! It was not a progression!

Rethinking Lung Cancer Through Screening, Early Detection and Precision Oncology
type: item
subject: Editorial
  topic: section
creator: M Teresa Almodovar
rights: Copyright (c) 2026 Author(s) (or their employer(s)) and THORAC 2024 https://creativecommons.org/licenses/by-nc/4.0
date: 2026-01-23
publication date: 2026-01-23
starting page: 30
ending page: 31
doi: 10.82582/thorac.84

One Bronchus too Many: A Rare Bronchoscopy Finding
type: item
subject: Images in Thoracic Oncology
  topic: section
subject: Bronchi/abnormalities
  topic: keywords
subject: Bronchoscopy
  topic: keywords
creator: Manuel d'Almeida
creator: Telma Sequeira
creator: Ambrus Szantho
creator: Jorge Dionísio
rights: Copyright (c) 2026 Author(s) (or their employer(s)) and THORAC 2024 https://creativecommons.org/licenses/by-nc/4.0
date: 2026-01-23
publication date: 2026-01-23
starting page: 32
ending page: 35
doi: 10.82582/thorac.79

Benign yet Suspicious: Sclerosing Pneumocytoma Uncovered in Cancer Staging
type: item
subject: Images in Thoracic Oncology
  topic: section
subject: Lung Neoplasms/diagnostic imaging
  topic: keywords
subject: Neoplasm Staging
  topic: keywords
subject: Pulmonary Sclerosing Hemangioma/diagnostic imaging
  topic: keywords
creator: Isabel Eiró
creator: Carlos Alves
creator: Rúben Costa
rights: Copyright (c) 2026 Author(s) (or their employer(s)) and THORAC 2024 https://creativecommons.org/licenses/by-nc/4.0
date: 2026-01-23
publication date: 2026-01-23
starting page: 36
ending page: 39
doi: 10.82582/thorac.78

ESMO 2025 and the Future of EGFRm NSCLC Sequencing: First-line Choices that Preserve Subsequent Therapy Eligibility
type: item
description: The therapeutic landscape for EGFR-mutated non-small-cell lung cancer (NSCLC) has rapidly evolved with the advent of thirdgeneration tyrosine kinase inhibitors (TKIs), bispecific antibodies, and antibody–drug conjugates (ADCs). Despite substantial improvements in first-line efficacy, a significant proportion of patients fail to reach targeted second-line therapies because of rapid clinical decline at progression. This concise review synthesizes evidence from phase II-III clinical trials and recent real-world data to evaluate how current first-line strategies influence the feasibility of subsequent therapies, with particular attention to central nervous system (CNS) risk, co-mutational biology, and treatment tolerability. Osimertinib monotherapy remains the global standard owing to its robust systemic and intracranial efficacy. The addition of chemotherapy, as shown in FLAURA2, further enhances firstline tumor control but may compromise salvage opportunities by reducing the likelihood of preserving actionable resistance. The amivantamab-lazertinib combination provides clear benefit in biomarker-defined high-risk disease but often limits the potential to reuse TKI-based approaches later in the course of treatment. Across studies, approximately 35%-40% of patients are unable to receive a targeted second-line regimen, and real-world survival after osimertinib failure is frequently restricted to 8-12 months. These data collectively suggest that the optimal first-line approach in EGFR-mutated NSCLC is not simply the regimen with the longest progression-free survival but rather the one that preserves access to subsequent effective therapies. Clinical decisions at diagnosis must therefore be made with downstream eligibility in mind, ensuring that patients remain candidates for HER3- and TROP2-directed ADCs and other emerging agents that are likely to shape survival beyond the first-line setting.
subject: Review Article
  topic: section
subject: Carcinoma, Non-Small-Cell Lung/drug therapy
  topic: keywords
subject: Carcinoma, Non-Small-Cell Lung/genetics
  topic: keywords
subject: ErbB Receptors/genetics
  topic: keywords
subject: Osimertinib
  topic: keywords
creator: Arif Hakan Önder
rights: Copyright (c) 2026 Author(s) (or their employer(s)) and THORAC 2024 https://creativecommons.org/licenses/by-nc/4.0
date: 2026-01-23
publication date: 2026-01-23
starting page: 60
ending page: 67
doi: 10.82582/thorac.76

Will Spatial Transcriptomics Transform Pathology?
type: item
description: Spatial transcriptomics (ST) is an emerging technology that maps gene expression directly onto tissue architecture. As it moves toward clinical adoption, ST is poised to become an integral tool in precision diagnostics. Here, we discuss its potential to complement and enhance traditional morphological assessment, reinforcing the pathologist’s central role in the molecular era.
subject: Perspective Article
  topic: section
subject: Gene Expression Profiling
  topic: keywords
subject: Neoplasms/genetics
  topic: keywords
subject: Neoplasms/pathology
  topic: keywords
subject: Transcriptome
  topic: keywords
creator: Miguel Cristovão
creator: Maria Carmo-Fonseca
creator: Catarina Alves-Vale
rights: Copyright (c) 2025 Author(s) (or their employer(s)) and THORAC 2024 https://creativecommons.org/licenses/by-nc/4.0
date: 2025-11-05
publication date: 2025-11-05
starting page: 16
ending page: 20
doi: 10.82582/thorac.75

Revisiting the Role of Adjuvant Radiotherapy in Non-Small Cell Lung Cancer
type: item
description: .
subject: Case Report
  topic: section
subject: Carcinoma, Non-Small-Cell Lung
  topic: keywords
subject: Radiotherapy, Adjuvant
  topic: keywords
creator: Nelson Ferreira
rights: Copyright (c) 2025 Author(s) (or their employer(s)) and THORAC 2024 https://creativecommons.org/licenses/by-nc/4.0
date: 2025-11-05
publication date: 2025-11-05
starting page: 22
ending page: 25
doi: 10.82582/thorac.74

Self-Care for Effective Caregiving
type: item
subject: Perspective Article
  topic: section
subject: Caregiver Burden
  topic: keywords
subject: Caregivers
  topic: keywords
subject: Self Care
  topic: keywords
creator: Ana Rodrigues
rights: Copyright (c) 2025 Author(s) (or their employer(s)) and THORAC 2024 https://creativecommons.org/licenses/by-nc/4.0
date: 2025-11-05
publication date: 2025-11-05
starting page: 12
ending page: 14
doi: 10.82582/thorac.73

Challenges of Staging Lung Cancer with the New TNM Classification (9th edition)
type: item
subject: Perspective Article
  topic: section
subject: Lung Neoplasms
  topic: keywords
subject: Neoplasm Staging
  topic: keywords
creator: Helder Novais Bastos
rights: Copyright (c) 2025 Author(s) (or their employer(s)) and THORAC 2024 https://creativecommons.org/licenses/by-nc/4.0
date: 2025-11-05
publication date: 2025-11-05
starting page: 6
ending page: 11
doi: 10.82582/thorac.72

Lung cancer study group - 25 years
type: item
subject: Editorial
  topic: section
creator: Fernando Barata
rights: Copyright (c) 2025 Author(s) (or their employer(s)) and THORAC 2024 https://creativecommons.org/licenses/by-nc/4.0
date: 2025-11-05
publication date: 2025-11-05
starting page: 4
ending page: 5
doi: 10.82582/thorac.71

Triple-Dose Furmonertinib for Leptomeningeal Metastases in Advanced EGFR L858R-Mutated Lung Adenocarcinoma: A Case Report
type: item
description: Leptomeningeal metastases (LM) are a devastating complication of non-small cell lung cancer (NSCLC), particularly in patients with epidermal growth factor receptor (EGFR) mutations. Despite the success of EGFR tyrosine kinase inhibitors (TKIs), central nervous system (CNS) progression remains common and associated with poor outcomes due to limited drug penetration. We report a 73-year-old woman with EGFR L858R-mutated NSCLC who developed LM after multiple lines of therapy, including gefitinib, osimertinib, chemotherapy, anti-angiogenic therapy, and radiotherapy. Treatment with high-dose furmonertinib (240 mg daily) combined with bevacizumab resulted in symptom relief and additional survival. Remarkably, her overall survival exceeded six years from initial diagnosis. This case highlights the potential role of dose-escalated furmonertinib as salvage therapy in LM after osimertinib resistance and underscores the importance of sequential and multimodal management in advanced EGFR-mutant NSCLC.
subject: Case Report
  topic: section
subject: Adenocarcinoma of Lung/drug therapy
  topic: keywords
subject: Adenocarcinoma of Lung/genetics
  topic: keywords
subject: Carcinoma, Non-Small-Cell Lung/drug therapy
  topic: keywords
subject: Carcinoma, Non-Small-Cell Lung/genetics
  topic: keywords
subject: ErbB Receptors/ genetics
  topic: keywords
subject: Furmonertinib
  topic: keywords
subject: Meningeal Neoplasms/secondary
  topic: keywords
creator: Hong Wu
creator: Lei Li
creator: Jing Yang
creator: Yuan Tian
creator: Hui Wang
rights: Copyright (c) 2024 Author(s) (or their employer(s)) and THORAC 2024 https://creativecommons.org/licenses/by-nc/4.0
date: 2026-04-20
publication date: 2026-04-20
doi: 10.82582/thorac.69

Clinical Outcomes of Thoracic Cancer Patients Requiring ICU Admission: A 10-Year Retrospective Study
type: item
description: Introduction Lung cancer is the most common solid malignancy requiring intensive care unit (ICU) admission, but ICU admission for cancer patients is often denied, being the second most common reason for refusal. This study aimed to evaluate the outcomes of thoracic cancer patients admitted to the ICU and understand the characteristics that may affect these outcomes. Methods This retrospective cohort study analyzed 25 patients with lung cancer admitted to the ICU between 2014 and 2023 at the Multidisciplinary Thoracic Tumors Unit of a tertiary hospital in Portugal. Clinical characteristics and survival outcomes were assessed. Results Patients had a median age of 68 years, were predominantly male (72%), and mostly had stage IV disease (76%). Over 10 years, ICU admissions for thoracic cancer patients increased, with septic shock being the primary reason for admission. Respiratory and cardiovascular dysfunctions were prevalent, requiring frequent respiratory support. Mortality rates were 60% at 28 days, 72% at 6 months, and 76% at 12 months. Higher SOFA and SAPS II scores, hematological dysfunction, and invasive mechanical ventilation were associated with higher 28-day mortality. Conclusion ICU mortality was linked to severity at admission, not oncological disease burden. Survivors maintained functional status and continued treatment. Advancements in lung cancer therapies and rising survival rates emphasize the need to update ICU admission criteria and mortality predictor scores.
subject: Original Article
  topic: section
subject: lung cancer
  topic: keywords
subject: Immune Checkpoint Inhibitors/therapeutic use
  topic: keywords
subject: intensive care unit
  topic: keywords
subject: outcomes
  topic: keywords
creator: Diana Amorim
creator: Adelaide Alves
creator: Ana Rita Salgado
creator: Susana Ferreira
creator: Ana Barroso
rights: Copyright (c) 2026 Author(s) (or their employer(s)) and THORAC 2024 https://creativecommons.org/licenses/by-nc/4.0
date: 2026-01-23
publication date: 2026-01-23
starting page: 50
ending page: 59
doi: 10.82582/thorac.67

Sequential T790M mutation testing and changes in the therapeutic approach after 2 lines of chemotherapy – clinical case
type: item
description: The EGFR mutation is identified in 10-50% of patients with non-small cell lung cancer (NSCLC). After first-line therapy, with 1st or 2nd line tyrosinacinase (TKI) inhibitors, in patients with NSCLC and a sensitizing EGFR mutation the most frequent mechanism of resistance is the acquisition of a T790M mutation, in 50-70%. We present the clinical case of a woman with NSCLC, cT2bN1M1b, stage IV with cerebral and adrenal metastasis at diagnosis and EGFR mutation. She underwent holocranial radiotherapy and treatment with erlotinib. Detection of T790M mutation after 2 chemotherapy regimens, with previous negative result on both liquid and histological biopsy for the detection ofT790M mutation. Eight years after diagnosis, she is functionally autonomous, asymptomatic, under therapy with osimertinib. This case illustrates the importance of knowledge of the resistance mechanism in patients with NSCLC and EGFR mutations, and the role of sequential rebiopsies.
subject: Clinical Case
  topic: section
subject: Carcinoma, non-small-cell lung/drug therapy
  topic: keywords
subject: carcinoma, non-small-cell lung/genetics
  topic: keywords
subject: carcinoma, non-small-cell lung/pathology
  topic: keywords
subject: EGFR mutation
  topic: keywords
subject: lung neoplasms/genetics
  topic: keywords
subject: mutation/genetics
  topic: keywords
subject: rebiopsy
  topic: keywords
subject: targeted therapy
  topic: keywords
subject: TKI -resistance
  topic: keywords
subject: T790M -mutation
  topic: keywords
creator: Fernanda Estevinho
creator: Ana Catarina Silva
creator: Luís Cirnes
creator: Teresina Amaro
rights: Copyright (c) 2025 Author(s) (or their employer(s)) and THORAC 2024 https://creativecommons.org/licenses/by-nc/4.0
date: 2025-01-05
publication date: 2025-01-05
starting page: 37
ending page: 42
doi: 10.32932/gecp.2021.07.015

Descriptive analysis of PD-L1 expression in non-small cell lung carcinoma biopsies: two -year experience in a tertiary Hospital
type: item
description: Introduction: The expression of PD-L1 as a predictive marker of response to treatment of non-small cell lung cancer (NSCLC) allows the identification of patients most likely to benefit from treatment with inhibitors of immune checkpoints. The main objective of this study was to determine the PD-L1 positivity/negativity rates of biopsies diagnosed with NSCLC during the year 2017 and 2018 at CHUPorto and compare with the predicted rates. Materials and methods: All biopsies of lung, bronchus or pleura diagnosed with primary epithelial neoplasia were surveyed and categorized according to the age and sex of patients, the reported diagnosis, the level of expression of PD-L1 and the mutational study. Results: Of the 262 cases identified, 57% were diagnosed with adenocarcinoma, 26% with squamous cell carcinoma, 11% with neuroendocrine neoplasia and 6% with others. PD-L1 expression was evaluated in 215 biopsies out of 229 recorded with the diagnosis of NSCLC. Of these 215 cases, 54% were negative, 26% showed mild to intermediate positivity and 20% high positivity for PD-L1. Discussion and conclusion: The evaluation of PD-L1 expression in lung cancer biopsies is an essential tool for defining the treatment of these patients. The values of PD-L1 expression described here in the clinical practice of CHUPorto tend to be more negative than those described in the original clinical trial, but similar to those described by real-life studies. Given the impact that the expression of PD-L1 has on the management of patients with NSCLC in daily clinical practice, it is important to know our reality. As future perspectives, we consider important the correlation analysis of PD-L1 expression with the results of treatment with inhibitors of immune checkpoints.
subject: Retrospective Article
  topic: section
subject: PD -L1
  topic: keywords
subject: non-small cell carcinoma
  topic: keywords
subject: lung
  topic: keywords
creator: Carolina Estima Fleming
creator: Paula Fidalgo
creator: Hugo Miranda
creator: Raquel Romão
creator: António Araújo
creator: José Ramón Vizcaíno
rights: Copyright (c) 2025 Author(s) (or their employer(s)) and THORAC 2024 https://creativecommons.org/licenses/by-nc/4.0
date: 2025-01-05
publication date: 2025-01-05
starting page: 29
ending page: 35
doi: 10.32932/gecp.2021.07.014

LENT score in prognostic assessment of malignant pleural effusion – the impact of target therapy
type: item
description: Introduction: Malignant pleural effusion (MPE) is a common manifestation in patients with advanced lung cancer. The LENT score was developed as a risk stratification system to predict the survival of these patients. However, following the discovery of molecular markers and a new era of personalized therapy, prognostic estimation became a challenging exercise. The aim of this study was to evaluate the performance of LENT score in predicting MPE survival in EGFR and ALK mutated lung adenocarcinoma. Methods: A retrospective single-center study of patients with MPE from lung adenocarcinoma followed between January 2008 to December 2018. Results: Forty-two patients were included in the study (mean age 76.4 ± 12.6 years, 52% female). Of these patients, 29% exhibited EGFR gene mutation or ALK gene translocation and received tyrosine kinase inhibitor therapy (TKI), in contrast to 71% of patients without identification of mutational factors and receiving conventional chemotherapy. Based on LENT score, in the sub-group treated with conventional chemotherapy, 67% had a moderate-risk category and 33% a high-risk category, with a median overall survival (OS) of 109 (31-406) and 36 (11-77) days, respectively. In the sub-group treated with targeted therapy, 75% were in a moderate-risk category and 25% in a high-risk category with a median OS of 1033 (245-1710) and 238 (27-not available) days, respectively. Patients receiving targeted therapy had a longer survival than patients receiving conventional chemotherapy in all LENT score risk categories (p<0.05). Conclusions: OS in patients with MPE due to lung adenocarcinoma was similar to that predicted by the LENT score, except for patients with EGFR mutation or ALK translocation. In this subgroup, the LENT score seems to underestimate the prognosis. Although this study has limitations regarding sample size, it does reveal, in the present time, some inaccuracy of the LENT score, demonstrating that it needs to be reviewed and revalidate…
subject: Retrospective Article
  topic: section
subject: Malignant pleural effusion
  topic: keywords
subject: LENT score
  topic: keywords
subject: Adenocarcinoma
  topic: keywords
creator: Sofia Sousa
creator: João Caldeira
creator: Ana Figueiredo
creator: Fernando Barata
rights: Copyright (c) 2025 Author(s) (or their employer(s)) and THORAC 2024 https://creativecommons.org/licenses/by-nc/4.0
date: 2025-01-05
publication date: 2025-01-05
starting page: 23
ending page: 27
doi: 10.32932/gecp.2021.07.013

Stereotactic body radiotherapy in primary lung disease: Experience of a portuguese center
type: item
description: Background: Stereotactic body radiation therapy (SBRT) is the primary alternative to surgery for patients with clinical stage I or II non -small cell lung cancer (NSCLC) who have significant comorbidity that precludes safe resection and for those who refuse surgery. Methods: Patients with clinical stage I or II NSCLC treated with SBRT in our institution between January 2015 and December 2019 were retrospectively analyzed. Patient characteristics, treatment -related outcomes and toxicities were analyzed. Control and survival rates were calculated using the Kaplan -Meier method. Acute and late toxicities were graded according to the CTCAE v4.0. Results: 110 patients were identified, 78 men and 32 women, with a median age of 75,5 years (50 -90 years), and a ECOG performance status of 0 or 1 in 73% of these patients. Of the biopsy proven cases (65%), 36% were adenocarcinomas and 21% were squamous cell carcinomas. 65% patients were staged as IA (T1N0), 33% as IB (T2aN0) and 2% as IIB (T3N0), all of which were clinically staged with PET -CT. The majority of the tumors (70%) were peripherally located, with a median size of 24.3mm. 48Gy in 4 fractions was the most prescribed scheme (70%), followed by 50Gy in 5 fractions (17.3%). 110 patients were eligible for assessment of recurrence. With a median follow -up of 53 months (IC95% 42 to 57 months), 32 patients (29.1%) had disease recurrence, of which 10% failed locally, 7.3% had regional failure and 22.7% distant failure. The 2 - and 5 -year local control was 91% and 85%, respectively. The 2 - and 5 -year regional control were both 92%, and the distant metastasis free survival and overall survival (OS) were 80% and 67%; 75% and 45%, respectively. Median OS was 51,3 months. No grade 3 toxicity was reported. Late grade 2 toxicity occurred in 26% of patients (11% pneumonitis, 7% fatigue, 2% rib fracture, 4% chest wall pain, and 2% esophagitis). Prognostic factors correlated with better OS were: age <70 years (p = 0.03), female g…
subject: Review Article
  topic: section
subject: NSCLC
  topic: keywords
subject: Stereotactic Radiotherapy
  topic: keywords
subject: SBRT
  topic: keywords
subject: lung cancer
  topic: keywords
subject: early stage
  topic: keywords
creator: Catarina Travancinha
creator: Nelson Ferreira
creator: Raquel Barroso
creator: Susana Esteves
creator: Miguel Labareda
creator: João Fonseca
creator: Telma Antunes
rights: Copyright (c) 2025 Author(s) (or their employer(s)) and THORAC 2024 https://creativecommons.org/licenses/by-nc/4.0
date: 2025-01-05
publication date: 2025-01-05
starting page: 7
ending page: 22
doi: 10.32932/gecp.2021.07.012

A importância de publicar
type: item
subject: Editorial
  topic: section
creator: Helder Novais e Bastos
rights: Copyright (c) 2025 Author(s) (or their employer(s)) and THORAC 2024 https://creativecommons.org/licenses/by-nc/4.0
date: 2025-01-05
publication date: 2025-01-05
starting page: 5
ending page: 6
doi: 10.32932/gecp.2021.07.011

Comprehensive Evaluation of Peripheral Immunodynamics in Advanced Non-Small Cell Lung Cancer Associated to Chemotherapy and Immunotherapy
type: item
description: Introduction: Immunotherapy, particularly immune checkpoint inhibitors (ICIs), has transformed the treatment landscape for advanced non-small cell lung cancer (NSCLC). Despite significant benefits for some patients, durable responses are limited to 20%–30% of cases, necessitating predictive biomarkers for better therapeutic guidance. While tumor-based markers such as PD-L1 expression and tumor mutational burden offer partial insights, peripheral blood biomarkers have emerged as promising minimally invasive tools for monitoring immune dynamics and predicting outcomes. Methods: This prospective pilot study analyzed the immune profiles of 51 NSCLC patients across three therapy groups—diagnostic (DX), chemotherapy (CT), and ICI-treated (ICB)—using high-dimensional flow cytometry and advanced computational algorithms. Results: Compared to healthy controls, NSCLC patients exhibited significant alterations in immune subsets, including elevated regulatory T cells (Tregs) and myeloid-derived suppressor cells (MDSCs). Therapy-specific changes included increased effector and activated T cells (e.g., HLA-DR+CD38+ Th1 cells) and dendritic cell subtypes, particularly cDC2, in the ICB group. In contrast, chemotherapy was associated with heightened Tc2 and activated CD8 T cells. Importantly, distinct immune signatures correlated with therapeutic outcomes. Non-progressors (stable disease or partial response) under ICB displayed higher levels of switch-memory B cells and cDC1, while progressors showed increased naïve B cells and cDC2. These findings highlight the immunomodulatory effects of different therapies and the potential of peripheral biomarkers for treatment stratification. Results: This study underscores the need for further validation of peripheral blood biomarkers and their integration into clinical decision-making to optimize NSCLC immunotherapy outcomes.
subject: Review Article
  topic: section
subject: Biomarkers, Tumor
  topic: keywords
subject: Carcinoma, Non-Small-Cell Lung/drug therapy
  topic: keywords
subject: Carcinoma, Non-Small-Cell Lung/immunology
  topic: keywords
subject: Immune Checkpoint Inhibitors/pharmacology
  topic: keywords
subject: Immune Checkpoint Inhibitors/therapeutic use
  topic: keywords
subject: Immunotherapy
  topic: keywords
creator: Paulo Rodrigues-Santos
creator: Luana Madalena Sousa
creator: Jani Sofia Almeida
creator: Fernando Barata
creator: Ana Figueiredo
rights: Copyright (c) 2025 Author(s) (or their employer(s)) and THORAC 2024 https://creativecommons.org/licenses/by-nc/4.0
date: 2025-01-03
publication date: 2025-01-03
starting page: 24
ending page: 40
doi: 10.82582/thorac.53

Therapeutic Targets in Non-Small Cell Lung Cancer: Current Progress and Future Directions
type: item
description: Non-small cell lung cancer (NSCLC) accounts for approximately 85% of all lung cancer cases, representing the majority of cancer-related deaths worldwide. Recent advances have shifted treatment paradigms from conventional chemotherapy to precision oncology approaches, particularly molecularly targeted therapies. This review focuses on pivotal molecular drivers such as EGFR, ALK, KRAS, MET, HER2, and RET, synthesizing content from recent studies and editorial perspectives. Targeted therapies, particularly tyrosine kinase inhibitors (TKIs), have redefined patient care by improving progression-free and overall survival. However, resistance mechanisms remain a challenge, necessitating innovative strategies and combination approaches. This article integrates perspectives to provide a comprehensive overview of NSCLC target therapeutic progress and future directions.
subject: Review Article
  topic: section
subject: Carcinoma, Non-Small-Cell Lung/drug therapy
  topic: keywords
subject: Carcinoma, Non-Small-Cell Lung/genetics
  topic: keywords
subject: Molecular Targeted Therapy
  topic: keywords
subject: Precision Medicine
  topic: keywords
subject: Protein Kinase Inhibitors/therapeutic use
  topic: keywords
creator: Sonia Silva
rights: Copyright (c) 2025 Author(s) (or their employer(s)) and THORAC 2024 https://creativecommons.org/licenses/by-nc/4.0
date: 2025-01-03
publication date: 2025-01-03
starting page: 14
ending page: 22
doi: 10.82582/thorac.51

Digital Image Analysis and Artificial Intelligence in Lung Cancer Pathology
type: item
description: .
subject: Review Article
  topic: section
creator: Bárbara Sepodes
creator: Vânia Almeida
rights: Copyright (c) 2025 Author(s) (or their employer(s)) and THORAC 2024 https://creativecommons.org/licenses/by-nc/4.0
date: 2025-01-03
publication date: 2025-01-03
starting page: 10
ending page: 13
doi: 10.82582/thorac.50

Operability versus Resectability in Non-Small Cell Lung Cancer: A Multidisciplinary Perspective
type: item
subject: Perspective Article
  topic: section
subject: Carcinoma, Non-Small-Cell Lung/pathology
  topic: keywords
subject: Carcinoma, Non-Small-Cell Lung/surgery
  topic: keywords
creator: João Maciel
rights: Copyright (c) 2025 Author(s) (or their employer(s)) and THORAC 2024 https://creativecommons.org/licenses/by-nc/4.0
date: 2025-01-03
publication date: 2025-01-03
starting page: 6
ending page: 8
doi: 10.82582/thorac.49

Investigator-Led Clinical Research in Thoracic Oncology: Are We Able to Do It?
type: item
subject: Editorial
  topic: section
creator: Maria Teresa Almodovar
rights: Copyright (c) 2025 Author(s) (or their employer(s)) and THORAC 2024 https://creativecommons.org/licenses/by-nc/4.0
date: 2025-01-03
publication date: 2025-01-03
starting page: 4
ending page: 5
doi: 10.82582/thorac.48

Atividades do GECP
type: item
description: 9.º CONGRESSO PORTUGUÊS DO CANCRO DO PULMÃO Grande Hotel Sta. Eulália – Albufeira 21 a 23 de Outubro de 2021
subject: GECP Activities
  topic: section
rights: Copyright (c) 2024 Author(s) (or their employer(s)) and THORAC 2024 https://creativecommons.org/licenses/by-nc/4.0
date: 2024-12-28
publication date: 2024-12-28
starting page: 39
ending page: 63
doi: 10.32932/

Two-year treatment with Pembrolizumab monotherapy in advanced non-small cell lung cancer: a reflection based on real-world data
type: item
description: Introduction and objectives: Immunotherapy has introduced advances in the treatment of non -small cell lung cancer. However, data from current clinical practice on potential responder groups, optimal duration of treatment and safety issues remain unclear. It is intended to produce a reflection on the population of patients with a favourable response to Pembrolizumab and how they have evolved clinically over time. Materials and methods: Retrospective study of patients who completed at least 2 years/35 cycles of Pembrolizumab was conducted, with descriptive analysis of clinicopathological characteristics and medical results obtained during the follow -up period. Results: Twenty -three patients were identified, mostly men (95.7%), diagnosed with adenocarcinoma (78.3%) at an average age of 62.0 -year -old, with good functional status. During treatment, 69.6% of cases achieved an objective response. At the time of the study, with a median follow -up of 35.2 months, 17 patients were alive and in remission (73.9%), 7 of which (41.1%) with disease controlled for more than 32.6months (maximum observed of 48.7) months; among those who progressed (13.0%), only 1 achieved a partial response again within 5.1 months of reintroduction of immunotherapy. Grade >2 adverse events occurred in 9 patients (39%), leading to different clinical outcomes; of these, 44% showed recurrence even after suspension of immunotherapy. Discussion and conclusions: The data seem to support the potential lasting benefit of Pembrolizumab described in recent studies, with a manageable, although not negligible, safety profile. In the absence of relevant toxicity and in the face of disease progression, a second course may be considered. However, more prospective, and multicenter studies, with a larger sample and a longer follow -up period, are needed to support these data.
subject: Original Article
  topic: section
subject: Non -small cell lung cancer
  topic: keywords
subject: immunotherapy
  topic: keywords
subject: pembrolizumab
  topic: keywords
subject: follow-up
  topic: keywords
subject: prognosis
  topic: keywords
creator: Sara Costa-Martins
creator: Salete Valente
creator: Alice Pêgo
creator: Ana Figueiredo
creator: Fernando Barata
rights: Copyright (c) 2024 Author(s) (or their employer(s)) and THORAC 2024 https://creativecommons.org/licenses/by-nc/4.0
date: 2024-12-28
publication date: 2024-12-28
starting page: 29
ending page: 38
doi: 10.32932/gecp.2022.02.020

A multicentric analysis of prognostic factors in malignant pleural mesothelioma
type: item
description: Background: Malignant pleural mesothelioma is a rare entity with poor prognosis, linked to previous asbestos exposure. The main goal of this study was to analyse the impact of clinical factors on mesothelioma prognosis. Methods: Retrospective cohort study of patients with malignant pleural mesothelioma in three Portuguese institutions, from 1999 to 2020. Statistical analysis was performed with Kaplan–Meier method and Cox regression using IBM SPSS® v25. Results: 60 patients were included, with male predominance (70%) and a median age of 69 years old. At diagnosis, 61% had advanced TNM stage (TNM III-IV) and 18% had an ECOG-PS ≥ 2. Asbestos exposure was stated in 48%. Epithelioid mesothelioma was the most prevalent histological subtype (81%). The majority received first line chemotherapy, in 10% combined with surgery, and two patients received immunotherapy after progression. Median overall survival (OS) was 13 months and median progression free survival was 10 months. A lower OS was observed in patients with ECOG-PS ≥ 2, age ≥ 70 years, TNM stage III-IV, anaemia, and hypoalbuminemia. Applying the decision tree model proposed by Brims et al. in our population, a significant difference in median OS was observed between the risk groups. In a multivariate analysis using Cox regression, Brims risk group 4, older age and advanced TNM stage were identified as independent negative prognostic factors. Conclusion: Recognition of these prognostic factors at diagnosis and use of specific prognostic models can help guide malignant pleural mesothelioma management.
subject: Original Article
  topic: section
subject: Malignant mesothelioma
  topic: keywords
subject: pleural tumours
  topic: keywords
subject: prognosis
  topic: keywords
subject: survival analysis
  topic: keywords
subject: asbestos
  topic: keywords
creator: Mafalda Batista
creator: Juliana Barata
creator: Sara Costa-Martins
creator: Maria Jesus Valente
creator: Maria Gabriela Oliveira Fernandes
creator: Sandra Saleiro
creator: Madalena Souto Moura
creator: Conceição Souto Moura
creator: Adriana Magalhães
creator: Maria Salete Valente
rights: Copyright (c) 2024 Author(s) (or their employer(s)) and THORAC 2024 https://creativecommons.org/licenses/by-nc/4.0
date: 2024-12-28
publication date: 2024-12-28
starting page: 19
ending page: 28
doi: 10.32932/gecp.2022.02.019

20 years managing malignant pleural mesothelioma: a review of our experience and the quest for the optimal prognostic marker
type: item
description: Introduction: Malignant pleural mesothelioma (MPM) is a rare, but aggressive incurable cancer. A variety of prognostic tools have been developed to guide clinicians and patients in the management of MPM regarding the most appropriate therapy and survival time. Objectives: To evaluate the usefulness of the Brims’ decision tree analysis, the EORTC prognostic score, the CALGB prognostic groups, the modified Glasgow Prognostic Score (mGPS), and the LENT prognostic score in our MPM patients. Methods: Local retrospective database analysis of patients with MPM diagnosed between 2000 and 2020. The different prognostic scores were applied and MPM group risks’ evolution was analyzed. Statistical analysis was performed with IBM® SPSS® Statistics 25. Results: A total of 67 patients were evaluated (55 males, 82.1%). Epithelioid MPM was the commonest histological type (51 patients, 76.1%). Median overall survival (OS) was 11 months (IQR 23) and median progression free-survival (PFS) was 7 months (IQR 12.5). Survival distributions were statistically significantly different for the Brims’ and the mGPS’ groups (respectively, χ2 = 7.188, p = .027, and χ2 = 6.46, p = .04). For EORTC, CALGB and LENT score, there were not statistically significant differences in survival distributions (respectively, χ2 =.57, p = .811; χ2 = 7.978, p = .157; and χ2 = 1.23, p = .267). Brims’ model and mGPS statistically significantly predicted OS (respectively, F(1,57) = 11.1, p < 0.01, and F(1,32) = 6.846, p = .01). EORTC, CALGB and LENT failed to statistically significantly predict OS (respectively, F(1,44) = .003, p = .955; F(1.43) = .722, p = 0.4; and F(1,14) = 1.193, p = .293). Conclusion: The small number of patients included and missing data for some parameters are limitations of our analysis. However, to our knowledge, this was the first study and the largest cohort to address MPM prognostic scores in our country. In our cohort, the Brims’ model and mGPS were useful in predicting survival. Both are…
subject: Review Article
  topic: section
subject: Mesothelioma
  topic: keywords
subject: malignant
  topic: keywords
subject: survival analysis
  topic: keywords
subject: prognosis
  topic: keywords
creator: João Nunes Caldeira
creator: Sofia Rodrigues Sousa
creator: Ana Maria Figueiredo
creator: Alice Pêgo
creator: Fernando Barata
rights: Copyright (c) 2024 Author(s) (or their employer(s)) and THORAC 2024 https://creativecommons.org/licenses/by-nc/4.0
date: 2024-12-28
publication date: 2024-12-28
starting page: 9
ending page: 17
doi: 10.32932/gecp.2022.02.018

Editorial
type: item
subject: Editorial
  topic: section
creator: Fernando Barata
rights: Copyright (c) 2024 Author(s) (or their employer(s)) and THORAC 2024 https://creativecommons.org/licenses/by-nc/4.0
date: 2024-12-28
publication date: 2024-12-28
starting page: 7
ending page: 7
doi: 10.32932/gecp.2022.02.017

Novos desafios
type: item
subject: Steering Page
  topic: section
creator: Paulo Costa
rights: Copyright (c) 2024 Author(s) (or their employer(s)) and THORAC 2024 https://creativecommons.org/licenses/by-nc/4.0
date: 2024-12-28
publication date: 2024-12-28
starting page: 5
ending page: 5
doi: 10.32932/gecp.2022.02.016

Radiation-induced pneumonitis: literature review and clinical case
type: item
description: Introduction and Objectives: Most cancer patients need radiotherapy treatments. In chest irradiation, a possible serious complication is Radiation-Induced lung Injury, an entity that encompasses radiation-induced pneumonitis and radiation fibrosis. Radiation-induced pneumonitis occurs in 5-20% of patients and may be asymptomatic or symptomatic, which can affect the quality of life of patients. Materials and Methods: Literature review and brief clinical case description. Clinical Case: A 35-year-old woman with a history of asthma who underwent tumorectomy for breast carcinoma, followed by external radiotherapy, hormone therapy and chemical castration. Following a persistent and aggravated respiratory condition, a diagnosis of radiation pneumonitis was established, documented by imaging exams and with histological confirmation. The subsequent initiation of corticoid therapy resulted in a frank clinical improvement of the patient with resolution of the condition. Conclusion: Radiation-induced pneumonitis is a non-negligible adverse effect of chest irradiation and has a multi-factorial origin. Several risk factors have been associated with this entity, both related to the treatment itself and related to patient characteristics. The institution of targeted therapy as early as possible allows for a possible resolution of the condition.
subject: Review Article
  topic: section
subject: Radiation-induced pneumonitis
  topic: keywords
subject: radiotherapy
  topic: keywords
subject: radiation fibrosis
  topic: keywords
creator: Diana Correia
creator: Inês Nobre Góis
creator: André Abreu
creator: Margarida Borrego
rights: Copyright (c) 2024 Author(s) (or their employer(s)) and THORAC 2024 https://creativecommons.org/licenses/by-nc/4.0
date: 2024-12-28
publication date: 2024-12-28
starting page: 41
ending page: 50
doi: 10.32932/gecp.2022.09.028

Um caso de Carcinoma do Pulmão de Não Pequenas Células EGFR
type: item
description: Background: EGFR mutation is the most frequent in Non-Small Cell Lung Cancer and occurs mainly in women and non-smoking patients. Clinical case: We present the case of a 51-year-old female, former light smoker, diagnosed with lung adenocarcinoma in 2014, in stage IB. She underwent surgery and adjuvant therapy. She recurred after two years with metas-tatic lung and bone disease, with EGFR exon 21 mutation. Therapy with tyrosine-kinase inhibitor (TKI) gefitinib was started and later, osimertinib. She maintained TKI therapy for three years until clinical progression. Subsequently, several lines of chemotherapy and immunotherapy were sequenced (without alteration of molecular profile and/or histological transformation). Discussion: Resistance to TKIs is inevitable and its mechanisms are not always known; however, maintenance should be considered if there is clinical benefit, despite imaging progression. Currently chemotherapy is the subsequent therapy that is used, but new drugs are under development to be used after resistance to osimertinib.
subject: Clinical Case
  topic: section
subject: non-small cell lung carcinoma
  topic: keywords
subject: adenocarcinoma
  topic: keywords
subject: EGFR
  topic: keywords
subject: therapeutic sequencing
  topic: keywords
subject: TKI
  topic: keywords
creator: Sofia Campos
creator: Catarina Custódio
creator: Margarida Felizardo
creator: Jaime Calha
creator: Rosa Maria Madureira
creator: José Alberto Teixeira
rights: Copyright (c) 2024 Author(s) (or their employer(s)) and THORAC 2024 https://creativecommons.org/licenses/by-nc/4.0
date: 2024-12-28
publication date: 2024-12-28
starting page: 35
ending page: 40
doi: 10.32932/gecp.2022.09.027

AT LAST! It was not a progression!
type: item
description: Introduction: Nivolumab is approved in Portugal for non-small cell metastatic lung cancer, as one of the indications, after progressing on chemotherapy. As an immune checkpoint inhibitor (ICI) immune-related adverse events (irAE) are possible reactions. Case report: A 64-year-old man with stage III lung adenocarcinoma who progressed after chemoradiotherapy and first line metastatic chemotherapy started nivolumab. Approximately 16 months after starting treatment he is admitted to the hospital with suspected brain metastasis due to vomiting, prostration and altered mental state. Brain-CT showed no abnormalities, but analyses showed decreased levels of ACTH and cortisol, which supported the diagnosis of hypophysitis. Nivolumab was stopped and high-dose hydrocortisone was initiated with good response. After discharge, patient showed disease stability and maintained vigilance. Discussion: Hypophysitis is an uncommon endocrine irAE of nivolumab. It appears on average 6 months after starting treatment and shows nonspecific symptoms often misjudged as disease progression. Only a high degree of suspicion can lead to appropriate investigation and treatment.
subject: Clinical Case
  topic: section
subject: adenocarcinoma
  topic: keywords
subject: hypophysitis
  topic: keywords
subject: nivolumab
  topic: keywords
creator: Raquel Paulinetti Camara
creator: Kelly Lopes
creator: Miguel Barbosa
creator: Inês Sucena
creator: Carla Simão
creator: Paulo Mota
creator: Dina Matias
creator: Telma Sequeira
creator: Teresa Almodovar
rights: Copyright (c) 2024 Author(s) (or their employer(s)) and THORAC 2024 https://creativecommons.org/licenses/by-nc/4.0
date: 2024-12-28
publication date: 2024-12-28
starting page: 29
ending page: 34
doi: 10.32932/gecp.2022.09.026