Table 2 Thoracic Oncology HERMES Syllabus
A: General principles of the biology of thoracic cancers
1 Carcinogenesis
2 Tumour immunology
3 DNA damage and repair
4 Epigenetics
5 Oncogenes and tumour suppressor genes
6 Cell cycle and apoptosis
7 Growth factors and signalling pathways
8 Oncogenic driver mutations
9 Tumour microenvironment and angiogenesis
10 Mechanisms involved in metastasis
B: Aetiology and epidemiology
1 Descriptive epidemiology of lung and other thoracic cancers
2 Tobacco
3 Air pollution (outdoor and indoor)
4 Asbestos
5 Other occupational carcinogens
6 Radon decay products
7 Chronic inflammation (COPD, infections)
8 Genetic susceptibility and gene-environment interactions
C: Clinical presentations
1 Performance status
2 Signs and symptoms
 2.1 Cough
 2.2 Haemoptysis
 2.3 Chest pain
 2.4 Dyspnoea
 2.5 Wheezing
 2.6 Stridor
 2.7 Hoarseness
 2.8 Phrenic nerve paralysis
 2.9 Dysphagia
 2.10 Pleural effusion
 2.11 Palpable peripheral lymph nodes
 2.12 Superior vena cava syndrome
 2.13 Pancoast syndrome
 2.14 Pericardial effusion
 2.15 Lymphangitic spread
 2.16 Bone metastases
 2.17 Brain metastases
 2.18 Liver and adrenal metastases
 2.19 Other metastatic sites
3 Paraneoplasic syndromes
 3.1 Cachexia
 3.2 Hypercalcaemia
 3.3 Thromboses and pulmonary embolism
 3.4 Syndrome of inappropriate antidiuretic hormone
 3.5 Ectopic adrenocorticotropin hormone syndrome
 3.6 Other paraneoplastic syndromes
D: Diagnostic Procedures
1 Principles of screening, target population, biases
2 Imaging (Chest radiograph, Computed tomography, PET and PET-CT, Ultrasound, Bone scaning, Magnetic resonance imaging)
3 Imaging guided biopsy
4 Bronchoscopy
5 Medical thoracoscopy
6 Open lung biopsies and VATS
7 Mediastinoscopy
8 Pulmonary nodule: definition and diagnostic algorithm
9 Tumour markers
10 Diagnosis and staging algorithms
11 Fitness for therapy
E: Imaging
1 Methods and indications of thoracic cancer and other thoracic tumours
 1.1 Chest radiographs
 1.2 Computed tomography
 1.3 Bone scanning
 1.4 PET and PET-CT
 1.5 Others (MRI sonography)
2 Interpretation of imaging patterns of thoracic tumours
3 Solitary pulmonary nodule
 3.1 Imaging, Bayesian approach and diagnostic algorithms for solitary nodules
F: Diagnostic and interventional bronchoscopic techniques and medical thoracoscopy
1 Indications and contraindications of bronchoscopy and pleuroscopy
2 Therapeutic endoscopy (stents, cryotherapy, laser techniques, brachytherapy)
3 Therapeutic pleuroscopy
G: Clinical and pathological staging
1 TNM description
2 T description
3 N description
4 M description
5 Stage grouping
H: Pathology of intrathoracic tumours
1 Conditioning of cytological and biopsy specimens for pathology/molecular analysis
2 Preinvasive lesions for lung neoplasms
3 Pathology of lung neoplasms
4 Pathological classification and molecular pathology of nonsmall cell lung cancer
5 Pathology and molecular pathology of neuroendocrine and small cell lung cancer
6 Pathology and molecular pathology of mesothelioma
7 Thymoma and germ cell tumors (“frequent” mediastinal tumours)
8 Rare mediastinal tumors
9 Interpretation of pathological reports
I: Prognostic factors/predictive markers
1 General methodological considerations
2 Clinical factors
3 Histopathological factors
4 Molecular markers
J: Principles of thoracic surgery
1 Oncologic principles of surgery for lung tumours
2 Indications, contraindications and perioperative care for thoracic surgery
3 Surgical techniques
4 Alternatives to lobectomy and pneumonectomy
5 Surgery in the context of multi-modality treatment
6 Palliative surgical procedures
7 Surgery for synchronous and metachronous cancers
8 Surgery for oligo-metastatic lung cancer
9 Diagnostic, curative and palliative surgery for mediastinal tumours
10 Curative and palliative surgery of malignant mesothelioma
11 Pulmonary metastases from other sites and its management
K: Management of surgical complications
1 Pain control after thoracic operations
2 Post-operative pneumonia: diagnosis, treatment and prevention
3 Empyema and bronchial fistula after pneumonectomy/lobectomy
4 Prolonged airleak
5 Post-operative bleeding
6 Acute respiratory distress syndrome (ARDS)
7 Cardiac complications after surgery: infarction, arrhythmia
8 Chronic pain after thoracotomy
9 Chronic complications after pneumonectomy
10 Other chronic complications
L: Principles of radiation therapy
1 Radiotherapy planning and techniques
2 Indications and contraindications for radiotherapy
3 Thoracic radiotherapy with curative intent for lung cancer
4 Thoracic palliative radiotherapy
5 Prophylactic, therapeutic and palliative cranial irradiation
6 Stereotactic ablative radiosurgery
7 Palliative radiotherapy for other metastatic sites
8 Radiotherapy for mesothelioma and thymoma
9 Management of side-effects
M: Principles of systemic therapy
1 Basis of cytotoxic therapy
2 Basis of biological therapy
3 Indications and contraindications for systemic therapy including chemotherapy and targeted agents
4 NSCLC (Nonsmall cell lung carcinoma)
 4.1 First-line induction and maintenance therapy for advanced NSCLC including chemotherapy and targeted agents
 4.2 Second line therapy for NSCLC
 4.3 Further lines of treatment
5 Small cell lung cancer (SCLC)
 5.1 First-line therapy for SCLC
 5.2 Second line therapy for SCLC
 5.3 Further lines of treatment
6 Systemic therapy of mesothelioma
7 Systemic therapy for mediastinal tumours
N: Side effects of systemic therapy and their management
1 Quantification of side-effects
2 Side-effects of chemotherapy
 2.1 Haematological side-effects
  2.1.1 Neutropenia and febrile neutropenia
  2.1.2 Anaemia
  2.1.3 Thrombopenia
 2.2 Mucositis/oesophagitis
 2.3 Alopecia and dermatological toxicity
 2.4 Nausea and vomiting
 2.5 Diarrhoea
 2.6 Neurotoxicity
 2.7 Ototoxicity
 2.8 Hepatic toxicity
 2.9 Nephrotoxicity
 2.10 Cardiovascular toxicity
 2.11 Extravasation
 2.12 Infertility and teratogenesis
 2.13 Electrolyte imbalance
3 Side-effects of molecular therapy
 3.1 Dermatological toxicity
 3.2 Diarrhoea
 3.3 Hepatic toxicity
 3.4 Cardiovascular toxicity
 3.5 Pulmonary toxicity
 3.6 Nephrotoxicity
O: Combined modality treatments
1 Adjuvant chemotherapy for early NSCLC
2 Neo-adjuvant chemotherapy for early NSCLC
3 Combined radio-chemotherapy for locally advanced NSCLC
4 Combined radio-chemotherapy for limited SCLC
5 Combined treatment for mesothelioma
P: Management of particular groups of patients
1 Elderly
2 Poor performance status patient
3 Unfit patients due to comorbidities
4 Patients with HIV
5 Preneoplastic and preinvasive lesions
6 Synchronous, metachronous lung tumours
7 Oligometastatic disease
8 Patients with brain metastases
9 Ischaemic heart disease in potentially operable patients
 9.1 Screening and work up
 9.2 Treatment options and recommendations
10 Atherosclerosis of carotid vessels in the surgical patient
11 Strategy in patients with combined lung and extra-thoracic malignancies (head and neck, bladder, colon, kidney, breast, etc.)
Q: Treatment evaluation and follow-up
1 Survival/progression-free survival
2 Response assessment
3 Other surrogate endpoints
4 Quality of life/symptom improvement
5 Follow-up
R: Supportive care
1 Pain management
2 Management of dyspnoea and respiratory failure
3 Management of malignant airway obstruction
4 Management of superior vena cava syndrome
5 Management of paraneoplastic syndromes
6 Malignant pleural effusion
7 Malignant pericardial effusion
8 Management of bone metastases
9 Nutritional support
10 Intensive care
11 Indications and management of intervascular stent and catheters
12 Psychological support for the patient and family
13 Rehabilitation
14 End-of-life care
15 Communicating with the patient
16 Patient education
17 Smoking cessation
S: Methodologies for clinical practice and research
1 Study design and phases
2 Principles of biobanking
3 Statistical analysis
4 Evidence based decision
5 Guidelines assessment and application
T: Ethics
1 Ethical issues
2 Conflicts of interest
U: Cancer-related immunology
1 Basic principles of cancer-related immunology
2 Specific immunotherapy
V: Economic considerations in lung cancer treatment
1 Principles of quality management in thoracic malignancies
2 Quality-adjusted life-year (QALY)
3 Principles of cost-effectiveness of chemotherapy, targeted therapy, surgical therapy and radiotherapy
4 Cancer registries