Does Multidisciplinary Team Management Improve Clinical Outcomes in NSCLC? A Systematic Review With Meta-Analysis.

Introduction: The implementation of multidisciplinary teams (MDTs) has been found to be effective for improving outcomes in oncology. Nevertheless, there is still a dearth of robust literature on patients with NSCLC. The aim of this study was to conduct a systematic review regarding the impact of MDTs on patient with NSCLC outcomes. Methods: Databases were systematically searched up to February 2023. Two reviewers independently performed study selection and data extraction. Risk of bias was evaluated using the Newcastle-Ottawa and certainty of evidence by the Grading of Recommendations Assessment, Development and Evaluation approach. Overall survival was the primary outcome. Secondary outcomes included mortality, length of survival, progression-free survival, time from diagnosis to treatment, complete staging, treatment received, and adherence to guidelines. A meta-analysis with a random-effect model was performed. Statistical analysis was performed with the R 3.6.2 package. Results: A total of 22 studies were included in the systematic review. Ten outcomes were identified, favoring the MDT group over the non-MDT group. Pooled analysis revealed that patients managed by MDTs had better overall survival (three studies; 38,037 participants; hazard ratio 0.60, 95% confidence interval [CI]: 0.49-0.75, I2 = 78%), shorter treatment time compared with patients in the non-MDT group (six studies; 15,235 participants; mean difference = 12.20 d, 95% CI: 10.76-13.63, I2 = 63%), and higher proportion of complete staging (four studies; 14,925 participants; risk ratio = 1.36, 95% CI: 1.17-1.57, I2 = 89%). Conclusions: This meta-analysis revealed that MDT-based patient care was associated with longer overall survival and better quality-of-care-related outcomes.

Impact of cranial stereotactic radiotherapy associated with immunotherapy with nivolumab and ipilimumab on overall survival in patients with melanoma brain metastases: a real-world evidence.

PURPOSE: To evaluate the impact of cranial stereotactic radiotherapy (SRT) on overall survival (OS) of melanoma brain metastases (MBM) patients treated with combined nivolumab and ipilimumab (CNI) in a contemporary and real-world setting. METHODS/PATIENTS: The study was performed by using TriNetX, a global health network dataset of electronic medical records from patients in 49 healthcare organizations. We queried for patients with specific terms between January 2016 and December 2020 and run a propensity score matching (PSM) analysis. OS was estimated by Kaplan-Meier and log-rank test was applied. RESULTS: After initial query and PSM, 114 patients were selected in each cohort. Median OS was 327 days in CNI and not reached in the CNI + SRT cohort, with OS probability of 54.4 and 40.9%, respectively (log-rank P = .0057). CNI + SRT was associated with significantly decreased mortality (HR, 0.57; 95% CI 0.377-0.853; proportionality P = .0034). CONCLUSIONS: This real-world analysis showed that CNI + SRT led to an improvement in OS compared to CNI.

Complete Response for More than 4 Years following Neoadjuvant FOLFOX and Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for a Patient with Advanced Gastric Cancer with Extensive Peritoneal Carcinomatosis.

BACKGROUND: Peritoneal carcinomatosis is usually a terminal disease with short median survival in patients with gastric cancer. Systemic FOLFOX is one of the most used regimens in the first-line treatment of metastatic gastric cancer. However, there is scarce evidence that cytoreductive surgery (CRS) and intraperitoneal heated chemotherapy (HIPEC) improves oncological outcomes of patients with advanced gastric cancer. METHODS: Herein we present a case of a young woman with advanced gastric cancer with omental and peritoneal metastases who achieved an excellent response after 6 months of FOLFOX followed by CRS and HIPEC. RESULTS: A 53-year-old woman was diagnosed with advanced gastric carcinoma, with extensive omental caking and several peritoneal implants measuring 2 cm at the largest diameter. The patient received mFOLFOX6 for 6 months with excellent clinical and radiographic response. She was then submitted to a D2 total gastrectomy followed by CRS and HIPEC with mitomycin. The final pathology report showed a focal adenocarcinoma in the stomach measuring 0.4 mm with no residual tumor in the peritoneum (ypT1ypN0). The patient has been well and disease free for more than 4 years. CONCLUSION: While still controversial, CRS followed by HIPEC may be a curative therapeutic option for highly selected patients.