Immunotherapy has revolutionized oncology care, improving patient outcomes in several cancers. However, these therapies are also associated with typical immune-related adverse events due to the enhanced inflammatory and immune response. These toxicities can arise at any time during treatment but are more frequent within the first few months. Any organ and tissue can be affected, ranging from mild to life-threatening. While some manifestations are common and more often mild, such as dermatitis and colitis, others are rarer and more severe, such as myocarditis. Management depends on the severity, with treatment being held for >grade 2 toxicities. Steroids are used in more severe cases, and immunosuppressive treatment may be considered for non-responsive toxicities, along with specific organ support. A multidisciplinary approach is mandatory for prompt identification and management. The diagnosis is primarily of exclusion. It often relies on imaging features, and, when possible, cytologic and/or pathological analyses are performed for confirmation. In case of clinical suspicion, imaging is required to assess the presence, extent, and features of abnormalities and to evoke and rule out differential diagnoses. This imaging-based review illustrates the diverse system-specific toxicities associated with immune checkpoint inhibitors and chimeric antigen receptor T-cells with a multidisciplinary perspective. Clinical characteristics, imaging features, cytological and histological patterns, as well as the management approach, are presented with insights into radiological tips to distinguish these toxicities from the most important differential diagnoses and mimickers—including tumor progression, pseudoprogression, inflammation, and infection—to guide imaging and clinical specialists in the pathway of diagnosing immune-related adverse events.

A double-lumen tube or bronchial blocker positioning using flexible bronchoscopy for lung isolation and one-lung ventilation requires specific technical competencies. Training to acquire and retain such skills remains a challenge in thoracic anesthesia. Recent technological and innovative developments in the field of simulation have opened up exciting new horizons and possibilities. In this narrative review, we examine the latest development of existing training modalities while investigating, in particular, the use of emergent techniques such as virtual reality bronchoscopy simulation, virtual airway endoscopy, or the preoperative 3D printing of airways. The goal of this article is, therefore, to summarize the role of existing and future applications of training models/simulators and virtual reality simulators for training flexible bronchoscopy and lung isolation for thoracic anesthesia.

Introduction: Stereotactic body radiation therapy (SBRT) is an alternative treatment for early stage lung cancer. Metallic fiducial markers (FMs) allow tumor tracking by CyberKnife®, increasing precision. Transthoracic FMs insertion is at high risk for pneumothorax, endovascular insertion is time consuming, and endobronchial linear-gold FMs frequently dislocate. The endobronchial insertion of spiral microcoil FMs (m-FMs), commonly used for endovascular procedures, will be assessed. Methods: We retrospectively evaluated all patients from 10.2015 to 11.2019 with at least one peripheral pulmonary lesion (PPL) < 25 mm treated at our center by m-FMs (Cook-Medical or Terumo) endobronchial placement. Transbronchial biopsies (TBB) were performed if the PPL was visible by the radial-endobronchial ultrasound (R-EBUS). In patients deemed too fragile by the local multidisciplinary meeting, we performed m-FMs insertion only. The m-FMs tracking rate for Cyberknife®, the migration rate at planification CT-scan before SBRT delivery, complications and procedure duration were analyzed. Results: 52 patients were treated during 55 procedures and 207 m-FMs were placed for 68 PPL. At least one m-FM was not in the expected segment for 9 PPL (16 m-FMs, migration rate 8%). Among 7/16 migrated m-FMs, the target was in a previously irradiated area. R-EBUS was used for 33/68 PPL, TBB could be performed in 9 cases. Target tracking by Cyberknife® was possible for 64/68 PPL (tracking rate 94%). No complication occurred; median procedure duration was 31.5 minutes. Conclusion: Endobronchial m-FMs insertion for PPL is rapid and safe with a low migration rate. In previously irradiated areas, larger m-FMs may be a more appropriate option.