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Editor's Choice

We have traditionally not highlighted review articles in this journal. However, thymic malignancies represent a class of thoracic tumors whose diagnosis, classification and treatment can be confusing for some health care practitioners. Thus, the practice guideline by  Dr  Vella and colleagues, which provides recommendations for the most effective therapy for patients with thymic epithelial tumors, including thymoma, thymic carcinoma, and thymic neuroendocrine tumors according to the TNM 8th edition, will be helpful to readers when managing patients with thymic epithelial tumours.

It has been shown that incorporating smoking cessation into lung cancer screening programs is a successful strategy to improve quit rates. However, this is not commonly done because resources and careful planning is needed to include smoking cessation programs, which can sometimes be complex and resource-intensive into routine low dose CT screening programs. In this issue of the Journal, Pastorino and colleagues report on the Screening and Multiple Intervention on Lung Epidemics (SMILE) trial, an ongoing, single center randomized controlled trial conducted at the Istituto Nazionale dei Tumori in Milan, Italy. Investigators used a plant based compound, cytisine as a pharmacologic agent to enhance smoking cessation.  The investigational agent, cytisine, is a plant-based alkaloid that is a selective partial agonist at nicotinic acetylcholine receptors, and has been used for smoking cessation in eastern Europe since the 1960s. The quit rate of participants using cytisine and counselling was 31% compared to 3% for those using counselling alone. The implications of these important findings are put in perspective by Dr Carolyn Dressler in an excellent accompanying editorial.

Lymph node metastasis is widely accepted as a key prognostic factor in resected early stage non-small cell lung cancer (NSCLC). However, over the years, there has been some debate as to the accepted minimum criteria regarding adequate lymph node sampling in lung cancer surgery. The American College of Surgeons Commission on Cancer has recently updated its sampling recommendations for early-stage NSCLC. The previous recommendation was that at least ten lymph nodes should be sampled at the time of lung surgery. The current recommendation calls for sampling at least one hilar and three mediastinal lymph node stations. In spite of these updates, intraoperative lymph node sampling minimums continue to be a subject of debate. In this issue of the journal, Heiden and colleagues attempt to assess the prognostic impact of these guidelines. Their study included 9749 patients. Count-based and station-based sampling guidelines were achieved in 33.9% and 26.3% patients, respectively.  The most important finding was that adherence to either guideline was associated with improved OS and higher likelihood of pathologic upstaging. Thus, it is important that all surgeons performing curative lung cancer surgery perform adequate intraoperative lymph node sampling to improve survival. Dr Osarogiagbon puts these findings and the complexities of assuring adequate lymph node sampling, particularly in the community setting, in perspective in an insightful accompanying editorial.

Alex A. Adjei, MD, PhD


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Journal of Thoracic Oncology

Cover Image - Journal of Thoracic Oncology, Volume 17, Issue 12

Journal of Thoracic Oncology (JTO), the official journal of the International Association for the Study of Lung Cancer, is the primary educational and informational publication for topics relevant to the prevention, detection, diagnosis, and treatment of all thoracic malignancies. JTO emphasizes a multidisciplinary approach and includes original research reviews and opinion pieces. The audience includes epidemiologists, medical oncologists, radiation oncologists, thoracic surgeons, pulmonologists, radiologists, pathologists, nuclear medicine physicians, and research scientists with a special interest in thoracic oncology. The journal is interested in receiving manuscripts dealing with epidemiology, prevention, screening, early detection, staging, cure, and treatment of thoracic malignancies. More


Logo of the International Association for the Study of Lung Cancer (IASLC)

The International Association for the Study of Lung Cancer (IASLC) is the only global organization dedicated solely to the study of lung cancer and other thoracic malignancies. More

Companion Journal

Cover Image - JTO Clinical and Research Reports, Volume 3, Issue 11

JTO Clinical and Research Reports is the official open access journal of the International Association for the Study of Lung Cancer. More



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