Randomized Phase III Study of Surgery Alone or Surgery Plus Preoperative Cisplatin and Gemcitabine in Stages IB to IIIA Non–Small-Cell Lung Cancer

Purpose

This study aimed to determine whether three preoperative cycles of gemcitabine plus cisplatin followed by radical surgery provides a reduction in the risk of progression compared with surgery alone in patients with stages IB to IIIA non–small-cell lung cancer (NSCLC).

Patients and Methods

Patients with chemotherapy-naive NSCLC (stages IB, II, or IIIA) were randomly assigned to receive either three cycles of gemcitabine 1,250 mg/m2days 1 and 8 every 3 weeks plus cisplatin 75 mg/m2day 1 every 3 weeks followed by surgery, or surgery alone. Randomization was stratified by center and disease stage (IB/IIA v IIB/IIIA). The primary end point was progression-free survival (PFS).

Results

The study was prematurely closed after the random assignment of 270 patients: 129 to chemotherapy plus surgery and 141 to surgery alone. Median age was 61.8 years and 83.3% were male. Slightly more patients in the surgery alone arm had disease stage IB/IIA (55.3% v 48.8%). The chemotherapy response rate was 35.4%. The hazard ratios for PFS and overall survival were 0.70 (95% CI, 0.50 to 0.97; P = .003) and 0.63 (95% CI, 0.43 to 0.92; P = .02), respectively, both in favor of chemotherapy plus surgery. A statistically significant impact of preoperative chemotherapy on outcomes was observed in the stage IIB/IIIA subgroup (3-year PFS rate: 36.1% v 55.4%; P = .002). The most common grade 3 or 4 chemotherapy-related adverse events were neutropenia and thrombocytopenia. No treatment-by-histology interaction effect was apparent.

Conclusion

Although the study was terminated early, preoperative gemcitabine plus cisplatin followed by radical surgery improved survival in patients with clinical stage IIB/IIIA NSCLC.

[Recommendations for sedation during flexible bronchoscopy]

Flexible bronchoscopy is a standard examination today and is conducted not only in nearly every hospital but also in privately owned practices. The vast majority of patients want sedation for this examination. Such a procedure is nearly always necessary in complex and interventional procedures, irrespective of the patient's wish. The recommendation at hand to use sedation measures for flexible bronchoscopy is based on the results of numerous clinical studies and also takes account of individual experiences in this area. The structural and procedural requirements and the requirements for staff training are defined and should describe the minimum standard when it comes to conducting a bronchoscopy under sedation. Furthermore the drugs recommended for sedation are discussed and their methods of application shown. Finally the recommendations also include suggestions for patient clarification, monitoring and discharge. They should provide the examiner with concrete operating options and therefore above all increase patient safety.

[Implementing in-patient smoking cessation interventions. Basic characteristics of smoking patients in a lung health department]

BACKGROUND

Hospitals have a unique key role in promoting smoking cessation. However, cessation interventions are uncommon in clinical routine despite their proven effectiveness. For planning a tailored intervention for hospitalised patients we examined the characteristics of smokers in our department for lung diseases.

METHODS AND PATIENTS

From July to September 2009 we evaluated the smoking status of all admitted patients. The smoking status was validated by measuring the CO-Hb. Smokers admitted for the first time on one of our regular wards received a comprehensive questionnaire. Patients with a duration of stay of 2 days or less and patients with substantial cognitive or linguistic limitations were excluded. Clinical data was collected from the participating smokers.

RESULTS

25% of all admitted patients were smokers. The participation rate was almost 90% of the eligible smokers. Our questionnaire was very well accepted und provided multitude helpful information for a following cessation counselling. Up to 3 or 4 smokers per day should be anticipated for a cessation intervention at an 80-bed-hospital. At least one counselling contact could be enabled. Although 75% of participants had experienced at least one unsuccessful quit attempt, only a minority used any support or help for cessation so far.

CONCLUSIONS

Specific questionnaires to evaluate the smoking history of patients in hospitals are very suitable and facilitate a subsequent bedside-counseling. To come up with their key role in promoting smoking cessation more hospitals as yet should implement cessation interventions.

Ultra-fast vapour-liquid-solid synthesis of Si nanowires using ion-beam implanted gallium as catalyst

The feasibility of gallium as a catalyst for vapour-liquid-solid (VLS) nanowire (NW) growth deriving from an implantation process in silicon by a focused ion beam (FIB) is investigated. Si(100) substrates are subjected to FIB implantation of gallium ions with various ion fluence rates. NW growth is performed in a hot wall chemical vapour deposition (CVD) reactor at temperatures between 400 and 500 °C with 2% SiH(4)/He as precursor gas. This process results in ultra-fast growth of (112)- and (110)-oriented Si-NWs with a length of several tens of micrometres. Further investigation by transmission electron microscopy indicates the presence of a NW core-shell structure: while the NW core yields crystalline structuring, the shell consists entirely of amorphous material.

Cryobiopsy increases the diagnostic yield of endobronchial biopsy: a multicentre trial

Forceps, brushes or needles are currently the standard tools used during flexible bronchoscopy when diagnosing endobronchial malignancies. The new biopsy technique of cryobiopsy appears to provide better diagnostic samples. The aim of this study was to evaluate cryobiopsy over conventional endobronchial sampling. A total of 600 patients in eight centres with suspected endobronchial tumours were included in a prospective, randomised, single-blinded multicentre study. Patients were randomised to either sampling using forceps or the cryoprobe. After obtaining biopsy samples, a blinded histological evaluation was performed. According to the definitive clinical diagnosis, the diagnostic yield for malignancy was evaluated by a Chi-squared test. A total of 593 patients were randomised, of whom 563 had a final diagnosis of cancer. 281 patients were randomised to receive endobronchial biopsies using forceps and 282 had biopsies performed using a flexible cryoprobe. A definitive diagnosis was achieved in 85.1% of patients randomised to conventional forceps biopsy and 95.0% of patients who underwent cryobiopsy (p<0.001). Importantly, there was no difference in the incidence of significant bleeding. Endobronchial cryobiopsy is a safe technique with superior diagnostic yield in comparison with conventional forceps biopsy.

Cryorecanalization of an obstructed bronchial stent in a 12-year-old boy

We report a 12-year-old boy who underwent stent implantation into the left main bronchus at the age of 9.5 years for palliation of severe bronchial stenosis. He had developed complete obstruction of the stent by granulation tissue resulting in respiratory deterioration and the requirement of mechanical ventilation. The stent obstruction was treated at the age of 11.5 years by cryorecanalization. In this technique, cooling of the tip of the cryoprobe is used to induce adherence of the obstructing tissue allowing the subsequent removal of tissue particles by retraction of the probe. Under general anesthesia, a miniaturized cryoprobe was advanced via the working channel of a flexible bronchoscope. Repeat maneuvers of freezing and retraction resulted in complete recanalization of the stent. Repeat bronchoscopies 4 and 12 weeks later revealed recurrent formation of some granulation tissue which was removed by repeat cryorecanalization. Seven months after the initial procedure there was a complete patency of the stent. According to our experience, cryorecanalization is a safe and effective alternative for the treatment of stent obstruction by granulation tissue. Due to the introduction of a miniaturized probe, this method is well applicable in children since it can be performed via the working channel of a flexible pediatric bronchoscope.