OTHER PUBLICATIONS

Video-assisted versus open pulmonary metastasectomy: the surgeon's finger or the radiologist's eye?

Synopsis: This study, published in the European Journal of Cardio-Thoracic Surgery, investigates the use of video-assisted thoracoscopic surgery (VATS), a minimally invasive technique, for the removal of lung metastases from colorectal adenocarcinoma. The authors compare the outcomes of VATS with the traditional open-chest surgery. The research addresses the controversy surrounding VATS metastasectomy, particularly its ability to detect and remove tumors that are palpable but not visible on CT scans. The study concludes that the selective use of VATS for therapeutic metastasectomy is justified in cases of metastatic colorectal adenocarcinoma, suggesting that the surgeon's ability to feel for tumors is not always essential with modern imaging techniques.

Tracking the Evolution of Non-Small-Cell Lung Cancer.

 

TRACERx (TRAcking Cancer Evolution through therapy [Rx]) is a landmark research study in the United Kingdom that aims to understand how lung cancer evolves and changes over time. The study, led by Professor Charles Swanton of the Francis Crick Institute and University College London, is the largest single investment in lung cancer research by Cancer Research UK.

The primary goal of TRACERx is to track the genetic changes in non-small cell lung cancer (NSCLC), the most common type of lung cancer, from diagnosis through treatment and, in some cases, to relapse. The study involves taking multiple samples from different parts of a patient's tumor at the time of surgery, as well as blood samples, and analyzing their genetic makeup. This multi-region and longitudinal sampling provides a detailed picture of the genetic diversity within each tumor, a concept known as intratumor heterogeneity.

Key findings and implications of the TRACERx trial so far include:

• Tumor Evolution and Treatment Resistance: The trial has shown that the genetic diversity within a tumor is a major driver of cancer's ability to evolve and develop resistance to treatment. By understanding this evolution, researchers hope to develop new therapies that can target the "trunk" of the evolutionary tree of the cancer—the core genetic mutations present in all cancer cells—rather than just the "branches" that may only be present in some.

• Predicting Relapse: TRACERx researchers have demonstrated that they can use circulating tumor DNA (ctDNA) found in blood samples to detect the presence of residual disease after surgery and predict which patients are at a higher risk of their cancer returning. This could lead to more personalized follow-up care and earlier intervention for those at high risk.

• Metastasis: The study has provided insights into how lung cancer spreads (metastasizes) to other parts of the body. By comparing the genetic makeup of the primary tumor with that of metastatic tumors, researchers can identify the specific subclones of cancer cells that are responsible for metastasis.

• Immunotherapy: TRACERx is also investigating the relationship between tumor evolution and the immune system. The findings could help to predict which patients are most likely to benefit from immunotherapy and could lead to the development of new immunotherapies that are tailored to the specific genetic makeup of a patient's tumor.

In essence, the TRACERx trial is creating a comprehensive map of lung cancer evolution, which is expected to revolutionize how the disease is understood and treated, paving the way for more effective, personalized therapies.