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Masuda T, Hirano C, Horimasu Y, Nakashima T, Miyamoto S, Iwamoto H, Ohshimo S, Fujitaka K, Hamada H, Hattori N. The extent of ground-glass attenuation is a risk factor of chemotherapy-related exacerbation of interstitial lung disease in patients with non-small cell lung cancer. Cancer Chemother Pharmacol 2017; 81:131-139. [PMID: 29143072 DOI: 10.1007/s00280-017-3476-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 11/07/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Chemotherapy-related acute exacerbation (AE) of interstitial lung disease (ILD) is observed in certain patients with non-small cell lung cancer (NSCLC) who have ILD. Although the prognosis of AE-ILD is extremely poor, there are no established risk factors for its occurrence. Therefore, we retrospectively investigated whether high-resolution computed tomography (HRCT) findings could identify risk factors for AE-ILD. MATERIALS AND METHODS Between January 2005 and December 2016, 35 patients with NSCLC who received chemotherapy at Hiroshima University Hospital and were diagnosed with ILD on HRCT were enrolled. The extent of ground-glass attenuation (GGA), reticulation, honeycomb appearance, and emphysema, as well as the presence of micronodules, traction bronchiectasis, and consolidation were evaluated in five levels of the lung bilaterally. The HRCT scores of GGA, reticulation, honeycomb appearance, and emphysema were determined by the following formula: 100 × sum of the extent of the HRCT findings/lung area. RESULTS Thirty-five patients underwent various first- to fifth-line chemotherapy regimens. Nine patients (25.7%) developed AE-ILD. The median HRCT scores of GGA and reticulation were significantly higher in patients with AE-ILD than in those without. On univariate analysis, a GGA area score ≥ 24.8, reticulation area score ≥ 19.5, and KL-6 level ≥ 946 U/mL were significant risk factors. Multivariate logistic analysis revealed that only a GGA area score ≥ 24.8 was an independent risk factor of AE-ILD. CONCLUSIONS The GGA area on HRCT is a risk factor for chemotherapy-related AE-ILD. Therefore, this parameter can be used to predict the risk of AE-ILD before administering chemotherapy.
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Affiliation(s)
- Takeshi Masuda
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Chihiro Hirano
- Hiroshima Atomic Bomb Casualty Council, 3-8-6 Sendamachi, Naka-ku, Hiroshima, 730-0052, Japan
| | - Yasushi Horimasu
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Taku Nakashima
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shintarou Miyamoto
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hiroshi Iwamoto
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shinichiro Ohshimo
- Department of Emergency and Critical Care Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kazunori Fujitaka
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hironobu Hamada
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Noboru Hattori
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Miyajima M, Watanabe A, Sato T, Teramukai S, Ebina M, Kishi K, Sugiyama Y, Kondo H, Kobayashi S, Takahashi Y, Ito H, Yamamoto R, Sawada S, Fujimori H, Okabe K, Arikura J, Shintani Y, Nakamura H, Toyooka S, Hasumi T, Watanabe T, Hata Y, Iwata H, Aoki M, Funai K, Inoue S, Kawashima O, Iida T, Date H. What factors determine the survival of patients with an acute exacerbation of interstitial lung disease after lung cancer resection? Surg Today 2017; 48:404-415. [DOI: 10.1007/s00595-017-1605-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 10/04/2017] [Indexed: 11/28/2022]
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Miura Y, Saito T, Tanaka T, Takoi H, Yatagai Y, Inomata M, Nei T, Saito Y, Gemma A, Azuma A. Reduced incidence of lung cancer in patients with idiopathic pulmonary fibrosis treated with pirfenidone. Respir Investig 2017; 56:72-79. [PMID: 29325685 DOI: 10.1016/j.resinv.2017.09.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 07/13/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is a disease with a worse prognosis than some types of cancer. In patients with IPF, lung cancer is critical because of the associated high mortality rate from its progression and fatal complications from anticancer treatments. Therefore, preventing lung cancer in patients with IPF is primordial. Pirfenidone is an anti-fibrotic agent that reduces the decline in forced vital capacity. This study aimed to assess the effect of pirfenidone in the development of lung cancer in patients with IPF. METHODS Data from 261 patients with IPF with and without pirfenidone were retrospectively reviewed, and the incidence of lung cancer was analyzed. RESULTS In the pirfenidone group, the incidence of lung cancer was significantly lower than in the non-pirfenidone group (2.4% vs. 22.0%, P < 0.0001). Multivariate Cox proportional hazards regression analysis demonstrated that pirfenidone decreased the risk of lung cancer (hazard ratio, 0.11; 95% confidence interval, 0.03 to 0.46; P = 0.003), whereas coexisting emphysema increased the incidence of lung cancer (hazard ratio, 3.22; 95% confidence interval, 1.35 to 7.70; P = 0.009). CONCLUSIONS Pirfenidone might correlate with a decreased risk of lung cancer in patients with IPF. However, no definite conclusion can be drawn from this retrospective study, and a multicenter, prospective cohort study is still warranted to confirm the effect of pirfenidone on lung cancer in patients with IPF.
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Affiliation(s)
- Yukiko Miura
- Department of Respiratory medicine, National Hospital Organization Ibarakihigashi Hospital, 825, Terunuma, Tokai-mura, Naka-gun, Ibaraki 3191113, Japan; Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo 1138603, Japan.
| | - Takefumi Saito
- Department of Respiratory medicine, National Hospital Organization Ibarakihigashi Hospital, 825, Terunuma, Tokai-mura, Naka-gun, Ibaraki 3191113, Japan.
| | - Toru Tanaka
- Department of Respiratory medicine, National Hospital Organization Ibarakihigashi Hospital, 825, Terunuma, Tokai-mura, Naka-gun, Ibaraki 3191113, Japan.
| | - Hiroyuki Takoi
- Department of Respiratory medicine, National Hospital Organization Ibarakihigashi Hospital, 825, Terunuma, Tokai-mura, Naka-gun, Ibaraki 3191113, Japan.
| | - Yohei Yatagai
- Department of Respiratory medicine, National Hospital Organization Ibarakihigashi Hospital, 825, Terunuma, Tokai-mura, Naka-gun, Ibaraki 3191113, Japan.
| | - Minoru Inomata
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo 1138603, Japan.
| | - Takahito Nei
- Department of Infection Control and Prevention, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo 1138603, Japan.
| | - Yoshinobu Saito
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo 1138603, Japan.
| | - Akihiko Gemma
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo 1138603, Japan.
| | - Arata Azuma
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo 1138603, Japan.
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Yasuda Y, Nomizo T, Ozasa H, Funazo T, Tsuji T, Yoshida H, Sakamori Y, Nagai H, Handa T, Kubo T, Kim YH. Retrospective analysis of acute exacerbation of interstitial lung diseases with nanoparticle albumin-bound paclitaxel in patients with advanced lung cancer with preexisting interstitial lung disease. Mol Clin Oncol 2017; 7:677-680. [PMID: 29046799 DOI: 10.3892/mco.2017.1373] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 07/12/2017] [Indexed: 11/06/2022] Open
Abstract
Lung cancer with preexisting interstitial lung disease (ILD) is difficult to treat due to the risk of acute exacerbation of ILD. Nanoparticle albumin-bound (nab-) paclitaxel improves the overall response rate and reduces neuropathy more efficiently compared with conventional solvent-based (sb-) paclitaxel in patients with advanced non-small-cell lung cancer. However, it is not known whether the risk of acute exacerbation of ILD with nab-paclitaxel is higher compared with that with sb-paclitaxel. Advanced lung cancer patients with ILD treated with nab-paclitaxel (n=14) or sb-paclitaxel (n=14) were retrospectively reviewed. Acute exacerbation of ILD developed in 1/14 patients (7.7%) receiving nab-paclitaxel and 3/14 patients (21.4%) receiving sb-paclitaxel; the difference was not statistically significant. To the best of our knowledge, this is the first study to compare the incidence of acute exacerbation of ILD with nab-paclitaxel with that of sb-paclitaxel in patients with advanced lung cancer with preexisting ILD. The results of the present study support conducting a prospective clinical trial to confirm the clinical benefit of this agent.
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Affiliation(s)
- Yuto Yasuda
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Takashi Nomizo
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Hiroaki Ozasa
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Tomoko Funazo
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Takahiro Tsuji
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Hironori Yoshida
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Yuichi Sakamori
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Hiroki Nagai
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Tomohiro Handa
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Takeshi Kubo
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Young Hak Kim
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
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Niwa H, Nakahara Y, Yokoba M, Mitsufuji H, Sasaki J, Masuda N. Safety and efficacy of carboplatin plus nab-paclitaxel for treating advanced non-small-cell lung cancer with interstitial lung disease. Mol Clin Oncol 2017; 7:604-608. [PMID: 28855994 DOI: 10.3892/mco.2017.1359] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 06/30/2017] [Indexed: 12/26/2022] Open
Abstract
There are few established treatments for patients with non-small-cell lung cancer (NSCLC) with interstitial lung disease (ILD). The safety and efficacy of albumin-bound paclitaxel (nab-paclitaxel) in combination with carboplatin is uncertain, although the combination of carboplatin and paclitaxel is the most common regimen for treating NSCLC patients with ILD. A total of 9 NSCLC patients with ILD, treated between April 2013 and March 2016, were retrospectively investigated. Carboplatin (AUC 5-6) was administered on day 1 and nab-paclitaxel on days 1, 8 and 15, every 4-6 weeks. The median age of the patients upon initiating chemotherapy was 67 years. The pathological examination revealed 6 patients with squamous cell carcinoma, and 6 patients exhibited the typical pattern of ILD. The response rate was 55.6%, and the median progression-free and overall survival time was 174 and 344 days, respectively. Acute exacerbation of ILD was not observed in any of the patients, and febrile neutropenia developed in 3 patients (3/9, 33.3%). Thus, treatment with carboplatin plus nab-paclitaxel was found to be safe and effective for NSCLC patients with ILD, although management of hematological adverse events, such as febrile neutropenia, was required. However, these encouraging results require confirmation by a large-scale clinical trial.
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Affiliation(s)
- Hideyuki Niwa
- Department of Respiratory Medicine, Kitasato University Hospital, Sagamihara, Kanagawa 252-0374, Japan
| | - Yoshiro Nakahara
- Department of Respiratory Medicine, Kitasato University Hospital, Sagamihara, Kanagawa 252-0374, Japan
| | - Masanori Yokoba
- Department of Respiratory Medicine, Kitasato University Hospital, Sagamihara, Kanagawa 252-0374, Japan
| | - Hisashi Mitsufuji
- Department of Respiratory Medicine, Kitasato University Hospital, Sagamihara, Kanagawa 252-0374, Japan
| | - Jiichiro Sasaki
- Department of Respiratory Medicine, Kitasato University Hospital, Sagamihara, Kanagawa 252-0374, Japan
| | - Noriyuki Masuda
- Department of Respiratory Medicine, Kitasato University Hospital, Sagamihara, Kanagawa 252-0374, Japan
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Taniguchi D, Yamasaki N, Miyazaki T, Tsuchiya T, Matsumoto K, Hatachi G, Kakugawa T, Sakamoto N, Mukae H, Nagayasu T. The surgical outcomes of lung cancer combined with interstitial pneumonia: a single-institution report. Surg Today 2017; 47:1397-1404. [DOI: 10.1007/s00595-017-1551-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 03/23/2017] [Indexed: 11/29/2022]
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Kobayashi H, Omori S, Nakashima K, Wakuda K, Ono A, Kenmotsu H, Naito T, Murakami H, Endo M, Takahashi T. Modified GAP index for prediction of acute exacerbation of idiopathic pulmonary fibrosis in non-small cell lung cancer. Respirology 2017; 22:1379-1385. [DOI: 10.1111/resp.13075] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 04/05/2017] [Accepted: 04/05/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Haruki Kobayashi
- Division of Thoracic Oncology; Shizuoka Cancer Center; Shizuoka Japan
| | - Shota Omori
- Division of Thoracic Oncology; Shizuoka Cancer Center; Shizuoka Japan
| | | | - Kazushige Wakuda
- Division of Thoracic Oncology; Shizuoka Cancer Center; Shizuoka Japan
| | - Akira Ono
- Division of Thoracic Oncology; Shizuoka Cancer Center; Shizuoka Japan
| | | | - Tateaki Naito
- Division of Thoracic Oncology; Shizuoka Cancer Center; Shizuoka Japan
| | - Haruyasu Murakami
- Division of Thoracic Oncology; Shizuoka Cancer Center; Shizuoka Japan
| | - Masahiro Endo
- Division of Diagnostic Radiology; Shizuoka Cancer Center; Shizuoka Japan
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Leduc C, Antoni D, Charloux A, Falcoz PE, Quoix E. Comorbidities in the management of patients with lung cancer. Eur Respir J 2017; 49:49/3/1601721. [PMID: 28356370 DOI: 10.1183/13993003.01721-2016] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 11/25/2016] [Indexed: 12/13/2022]
Abstract
Lung cancer represents a major public health issue worldwide. Unfortunately, more than half of them are diagnosed at an advanced stage. Moreover, even if diagnosed early, diagnosis procedures and treatment can be difficult due to the frequent comorbidities observed in these patients. Some of these comorbidities have a common major risk factor, i.e. smoking, whereas others are unrelated to smoking but frequently observed in the general population. These comorbidities must be carefully assessed before any diagnostic and/or therapeutic decisions are made regarding the lung cancer. For example, in a patient with severe emphysema or with diffuse lung fibrosis, transthoracic needle biopsy can be contraindicated, meaning that in some instances a precise diagnosis cannot be obtained; in a patient with chronic obstructive pulmonary disease, surgery may be impossible or should be preceded by intensive rehabilitation; patients with interstitial lung disease are at risk of radiation pneumonitis and should not receive drugs which can worsen the respiratory insufficiency. Patients who belong to what are called "special populations", e.g. elderly or HIV infected, should be treated specifically, especially regarding systemic treatment. Last but not least, psychosocial factors are of great importance and can vary from one country to another according to health insurance coverage.
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Affiliation(s)
- Charlotte Leduc
- Pneumology Dept, Nouvel Hôpital Civil, Strasbourg Cedex, France
| | - Delphine Antoni
- Radiotherapy Dept, Centre Paul Strauss, Strasbourg Cedex, France
| | - Anne Charloux
- Physiology and Functional Explorations Dept, Strasbourg Cedex, France
| | | | - Elisabeth Quoix
- Pneumology Dept, Nouvel Hôpital Civil, Strasbourg Cedex, France
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Saijo A, Hanibuchi M, Goto H, Toyoda Y, Tezuka T, Nishioka Y. An analysis of the clinical features of lung cancer in patients with connective tissue diseases. Respir Investig 2017; 55:153-160. [PMID: 28274531 DOI: 10.1016/j.resinv.2016.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/16/2016] [Accepted: 11/18/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with connective tissue diseases (CTDs) are at increased risk for lung cancer (LC); interstitial lung disease (ILD) is a common form of organ dysfunction in cases of CTD. However, the influence of ILD on the treatment and prognosis in LC patients with CTD is unclear. METHODS Between January 2010 and December 2014, 27 patients among all patients with CTD at our institution were diagnosed with primary LC. We retrospectively analyzed the clinical features, treatment modalities, and outcomes of these patients, and evaluated the potential prognostic factors. Forty-four LC patients without CTD were also analyzed as a control cohort. RESULTS LC patients with CTD had a significantly higher incidence of ILD as a complication compared with those without CTD (52% and 14%, respectively). CTD-associated ILD (CTD-ILD) at diagnosis was associated with significantly worse survival in LC patients with CTD. Multivariate analysis demonstrated that the complication of CTD-ILD was an independent poor prognostic factor in LC patients with CTD. The incidence of acute exacerbation (AE) of CTD-ILD was 21% among LC patients with CTD, and all of these patients died despite intensive treatment including high-dose corticosteroids. The restrictions in curative therapy for LC due to the presence of ILD and AE of CTD-ILD were thought to be the major reasons for the poor outcome. CONCLUSIONS LC patients with CTD had a high prevalence of ILD, and the presence of CTD-ILD was significantly associated with poor prognosis.
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Affiliation(s)
- Atsuro Saijo
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan.
| | - Masaki Hanibuchi
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan.
| | - Hisatsugu Goto
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan.
| | - Yuko Toyoda
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan.
| | - Toshifumi Tezuka
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan.
| | - Yasuhiko Nishioka
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan.
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Kakiuchi S, Hanibuchi M, Tezuka T, Saijo A, Otsuka K, Sakaguchi S, Toyoda Y, Goto H, Kawano H, Azuma M, Ogushi F, Nishioka Y. Analysis of acute exacerbation of interstitial lung disease associated with chemotherapy in patients with lung cancer: A feasibility of S-1. Respir Investig 2016; 55:145-152. [PMID: 28274530 DOI: 10.1016/j.resinv.2016.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 10/17/2016] [Accepted: 10/30/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Interstitial lung disease (ILD) is commonly concomitant with lung cancer, and its acute exacerbation (AE) is the most serious complication in patients receiving treatment for lung cancer. METHODS To investigate the incidence and characteristic features of AE of ILD, we conducted a retrospective study of 665 consecutive patients with lung cancer who were treated at our institute between 2008 and 2014. RESULTS Among the 665 patients, 74 (11.1%) had preexisting ILD, and 64 of them received chemotherapy. Four of the 64 patients (6.3%) had experienced AE of ILD, and two (3.1%) died of respiratory failure during first-line chemotherapy. The use of a combination of carboplatin with tegafur-gimeracil-oteracil potassium (S-1) or paclitaxel as a first-line chemotherapy for non-small cell lung cancer led to a lower frequency of AE, at 8.3% (1/12) and 9.1% (1/11), respectively. The incidence of AE rose to 12.8% (5/39) during second-line treatment, and 14 (total: 15 times) of the 64 patients (21.9%) experienced AE from the time of diagnosis to the end of treatment. The incidence of AE was 17.7% (6/34), 15.8% (3/19), 5.0% (2/40), and 4.2% (1/24) in the paclitaxel-, vinorelbine-, etoposide-, and S-1-containing regimens, respectively. No difference in clinical features and laboratory data was detected between the AE and non-AE groups. CONCLUSIONS Although this was a small retrospective study, its findings showed that S-1 and etoposide may be relatively safe options for the treatment of patients with lung cancer and concomitant ILD.
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Affiliation(s)
- Soji Kakiuchi
- Department of Respiratory Medicine and Rheumatology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8503, Japan; Department of Medical Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8503, Japan.
| | - Masaki Hanibuchi
- Department of Respiratory Medicine and Rheumatology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8503, Japan.
| | - Toshifumi Tezuka
- Department of Respiratory Medicine and Rheumatology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8503, Japan.
| | - Atsuro Saijo
- Department of Respiratory Medicine and Rheumatology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8503, Japan.
| | - Kenji Otsuka
- Department of Respiratory Medicine and Rheumatology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8503, Japan.
| | - Satoshi Sakaguchi
- Department of Respiratory Medicine and Rheumatology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8503, Japan.
| | - Yuko Toyoda
- Department of Respiratory Medicine and Rheumatology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8503, Japan.
| | - Hisatsugu Goto
- Department of Respiratory Medicine and Rheumatology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8503, Japan.
| | - Hiroshi Kawano
- Department of Respiratory Medicine and Rheumatology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8503, Japan.
| | - Masahiko Azuma
- Department of Respiratory Medicine and Rheumatology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8503, Japan.
| | - Fumitaka Ogushi
- National Hospital Organization Kochi National Hospital, Kochi 780-8077, Japan.
| | - Yasuhiko Nishioka
- Department of Respiratory Medicine and Rheumatology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8503, Japan.
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The ATS/ERS/JRS/ALAT statement "IPF by HRCT" could predict acute exacerbation of interstitial lung disease in non-small cell lung cancer. TUMORI JOURNAL 2016; 103:60-65. [PMID: 27791236 DOI: 10.5301/tj.5000574] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Patients with non-small cell lung cancer (NSCLC) and interstitial lung disease (ILD) are at high risk of acute exacerbation of ILD (AE-ILD) when treated with systemic chemotherapy. Standard treatment for NSCLC complicated by ILD has not been established. PURPOSE AND METHODS To examine whether the type of ILD categorized by the official ATS/ERS/JRS/ALAT statement as "idiopathic pulmonary fibrosis (IPF) by high-resolution computed tomography (HRCT)" could predict chemotherapy-induced AE-ILD in NSCLC patients with ILD, we retrospectively reviewed all patients with NSCLC complicated by ILD who had received chemotherapy at our institute from January 2007 until December 2013. Patients' characteristics, pathology and clinical staging of lung cancer, chemotherapy, type of ILD and AE-ILD during chemotherapy were evaluated. ILD was classified according to the statement as follows: usual interstitial pneumonia (UIP), possible UIP, and inconsistent with a UIP pattern. RESULTS A total of 46 patients had pre-existing ILD and received chemotherapy. The mean age was 73 years (range 46-83 years). Fifteen (32.6%) of 46 patients with ILD developed chemotherapy-induced AE-ILD, which was seen more frequently in patients with ILD with a UIP pattern or possible UIP pattern than in patients with a pattern inconsistent with UIP (80% versus 9.7%, p<0.001). Multivariate analyses including age, sex, performance status and radiographic patterns of ILD showed that the presence of a UIP or possible UIP pattern was an independent risk factor for chemotherapy-induced AE-ILD. CONCLUSIONS ILD with a UIP pattern or possible UIP pattern by the classification could be a risk factor for AE-ILD in NSCLC patients with ILD.
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Enomoto Y, Inui N, Kato T, Baba T, Karayama M, Nakamura Y, Ogura T, Suda T. Low forced vital capacity predicts cytotoxic chemotherapy-associated acute exacerbation of interstitial lung disease in patients with lung cancer. Lung Cancer 2016; 96:63-7. [DOI: 10.1016/j.lungcan.2016.03.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/24/2016] [Accepted: 03/29/2016] [Indexed: 10/22/2022]
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Nakajima Y, Akiyama H, Kinoshita H, Atari M, Fukuhara M, Sakai H, Uramoto H. The importance of determining surgical indications in cases of lung cancer and interstitial pneumonia with multiple intrapulmonary lymph nodes. Int J Surg Case Rep 2015; 18:5-8. [PMID: 26656149 PMCID: PMC4701854 DOI: 10.1016/j.ijscr.2015.11.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 11/25/2015] [Accepted: 11/25/2015] [Indexed: 11/21/2022] Open
Abstract
It is difficult to determine whether surgery is indicated in patients with lung cancer with multiple nodular shadows in multiple lung lobes. Physicians are reluctant to perform surgery for patients with lung cancer and interstitial pneumonia. However, surgery is the only treatment method that is expected to achieve cure of lung cancer with interstitial pneumonia. ∼10-mm nodular shadows located near the pleura may represent an intrapulmonary lymph node. Even for patients with lung cancer with interstitial pneumonia, a biopsy should be actively performed to determine the indication for surgery.
Introduction When considering treatment for pulmonary cancer complicated by interstitial pneumonia, the greatest problem is acute exacerbation. We report two cases of pulmonary cancer complicated by interstitial pneumonia in which multiple intrapulmonary lymph nodes were noted. Case presentations Cases 1 and 2 were 76- and 62-year-old males, respectively. Both cases were diagnosed as pulmonary cancer complicated by interstitial pneumonia, and upon chest CT, it was noted that, in addition to the primary lesions, there were multiple nodule shadows under the pleura in the lung lobe, which required identification in order to rule out lung metastasis. In Case 1, the pulmonary nodules were first resected during surgery and a swift diagnosis was made, determining them to be intrapulmonary lymph nodes, which were then operated on curatively. In Case 2, the patient underwent thoracoscopic observation during surgery, the shadows were diagnosed visually as intrapulmonary lymph nodes, and curative surgery was implemented. Discussion and conclusions The greatest problem in treating pulmonary cancer complicated with interstitial pneumonia is acute exacerbation, wherein, in the absence of any surgical indications, alternative treatment is limited. Thus, contra-indicating surgery for a patient due to a diagnosis of metastasis within the lungs, based only on nodule images, should be avoided. If nodules are noted in the area of the pleura, the possibility exists that these could be intrapulmonary lymph nodes, along with metastasis within the lung, and thoracoscopic surgery should be implemented proactively while keeping these in mind.
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Affiliation(s)
- Yuki Nakajima
- Division of Thoracic Surgery, Saitama Cancer Center, 780 Komuro, Ina, Kita-adachi-gun, Saitama 362-0806, Japan.
| | - Hirohiko Akiyama
- Division of Thoracic Surgery, Saitama Cancer Center, 780 Komuro, Ina, Kita-adachi-gun, Saitama 362-0806, Japan
| | - Hiroyasu Kinoshita
- Division of Thoracic Surgery, Saitama Cancer Center, 780 Komuro, Ina, Kita-adachi-gun, Saitama 362-0806, Japan
| | - Maiko Atari
- Division of Thoracic Surgery, Saitama Cancer Center, 780 Komuro, Ina, Kita-adachi-gun, Saitama 362-0806, Japan
| | - Mitsuro Fukuhara
- Division of Thoracic Surgery, Saitama Cancer Center, 780 Komuro, Ina, Kita-adachi-gun, Saitama 362-0806, Japan
| | - Hiroshi Sakai
- Division of Thoracic Oncology, Saitama Cancer Center, 780 Komuro, Ina, Kita-adachi-gun, Saitama 362-0806, Japan
| | - Hidetaka Uramoto
- Division of Thoracic Surgery, Saitama Cancer Center, 780 Komuro, Ina, Kita-adachi-gun, Saitama 362-0806, Japan
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Chen YJ, Chen LX, Han MX, Zhang TS, Zhou ZR, Zhong DS. The Efficacy and Safety of Chemotherapy in Patients With Nonsmall Cell Lung Cancer and Interstitial Lung Disease: A PRISMA-Compliant Bayesian Meta-Analysis and Systematic Review. Medicine (Baltimore) 2015; 94:e1451. [PMID: 26356699 PMCID: PMC4616626 DOI: 10.1097/md.0000000000001451] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Chemotherapy plays a critical and venturous role against the co-morbidity of nonsmall cell lung cancer and interstitial lung disease (NSCLC-ILD).We performed a Bayesian meta-analysis and systematic review to evaluate the safety and efficacy of the chemotherapy in NSCLC-ILD patients.EMBASE, PubMed, the Cochrane Central Register of Controlled Trials, and clinicaltrials.gov (up to January 2015).We included all study designs except case reports, all studies with NSCLC-ILD patients and all the possible chemotherapy regimens.Quality was assessed by a components approach. We derived summary estimates using Bayesian method through WinBUGS (version 1.4.3, MRC Biostatistics Unit, Cambridge, UK).Seven studies involving 251 patients with NSCLC-ILD were included in the meta-analysis. The treatment response (complete remission, 0; [partial remission, 39.1%; 95% credible interval [CrI], 32.6-45.7]; [stable disease, 36%; 95% CrI, 29.6-42.2]; [PD, 15.4%; 95% CrI, 11.3-19.8]; [nonevaluable, 6.4%; 95% CrI, 2.7-10.1]; [overall response rate, 41.3%; 95% CrI, 35.3-47.4]; [disease control rate, 77.7%; 95% CrI, 72.2-82.7]) were comparable to that of patients with NSCLC alone; the survival outcomes (median overall survival, median progression-free survival, and 1-year survival rate) were slightly worse, especially the lower 1-year survival rate. Platinum-based doublets as first-line chemotherapy may be related to higher incidence of acute exacerbation-ILD in first line chemotherapy (AE, 8.47%; 95% CrI, 5.04-12.6).The data selection bias and small patient number make the meta-analysis of treatment response and conclusions generated from these data inaccurate.The present meta-analysis suggests that chemotherapy might be an effective therapy for patients with NSCLC-ILD, but it might be associated with higher incidence of acute exacerbation.
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Affiliation(s)
- Yu Jie Chen
- From the Department of Oncology, General Hospital of Tianjin Medical University, Tianjin, P.R. China (YJC, DSZ); Department of Orthopedics, Tianjin Medical University General Hospital, Heping District, P.R. China (LXC); Department of Respiration, General Hospital of Tianjin Medical University, Tianjin, P.R. China (MXH); Internal Medicine of Traditional Chinese Medicine Department, Jing'an District Central Hospital of Shanghai, Shanghai, P.R. China (TSZ); and Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China (ZRZ)
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Omori T, Tajiri M, Baba T, Ogura T, Iwasawa T, Okudela K, Takemura T, Oba MS, Maehara T, Nakayama H, Tsuboi M, Masuda M. Pulmonary Resection for Lung Cancer in Patients With Idiopathic Interstitial Pneumonia. Ann Thorac Surg 2015; 100:954-60. [DOI: 10.1016/j.athoracsur.2015.03.094] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 03/27/2015] [Accepted: 03/30/2015] [Indexed: 10/23/2022]
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Kashiwabara K, Semba H, Fujii S, Tsumura S, Aoki R. The Ratio KL-6 to SLX in Serum for Prediction of the Occurrence of Drug-Induced Interstitial Lung Disease in Lung Cancer Patients with Idiopathic Interstitial Pneumonias Receiving Chemotherapy. Cancer Invest 2015; 33:516-21. [PMID: 26305851 DOI: 10.3109/07357907.2015.1069832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
We retrospectively evaluated whether the ratio KL-6 to SLX in serum (K/S ratio) before chemotherapy was a predictor for the occurrence of drug-induced interstitial lung disease (D-ILD) in lung cancer patients with idiopathic interstitial pneumonias (IIPs). D-ILD occurred in 8 of 20 IIPs-positive cases and in 14 of 100 IIPs-negative cases (40 vs. 14%, p = .015). In IIPs-positive cases, the high K/S ratio (>20) before first-line chemotherapy had a tendency to increase the risk of D-ILD (p = .085). Serum K/S ratio may be a useful predictor for the occurrence of D-ILD in lung cancer patients with IIPs.
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Affiliation(s)
- Kosuke Kashiwabara
- a Department of Respiratory Medicine , Kumamoto Regional Medical Center , Kumamoto , Japan
| | - Hiroshi Semba
- a Department of Respiratory Medicine , Kumamoto Regional Medical Center , Kumamoto , Japan
| | - Shinji Fujii
- a Department of Respiratory Medicine , Kumamoto Regional Medical Center , Kumamoto , Japan
| | - Shinsuke Tsumura
- a Department of Respiratory Medicine , Kumamoto Regional Medical Center , Kumamoto , Japan
| | - Ryota Aoki
- a Department of Respiratory Medicine , Kumamoto Regional Medical Center , Kumamoto , Japan
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67
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Cordeiro CR, Alfaro TM, Freitas S, Cemlyn-Jones J. Idiopathic pulmonary fibrosis. Lung Cancer 2015. [DOI: 10.1183/2312508x.10009414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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68
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Kimura T, Nojiri T, Hosoda H, Shintani Y, Inoue M, Miyazato M, Okumura M, Kangawa K. Exacerbation of bleomycin-induced injury by lipopolysaccharide in mice: establishment of a mouse model for acute exacerbation of interstitial lung diseases. Eur J Cardiothorac Surg 2015. [DOI: 10.1093/ejcts/ezv261] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Safety of topotecan monotherapy for relapsed small cell lung cancer patients with pre-existing interstitial lung disease. Cancer Chemother Pharmacol 2015; 76:499-505. [DOI: 10.1007/s00280-015-2816-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 06/18/2015] [Indexed: 01/15/2023]
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Luppi F, Cerri S, Taddei S, Ferrara G, Cottin V. Acute exacerbation of idiopathic pulmonary fibrosis: a clinical review. Intern Emerg Med 2015; 10:401-11. [PMID: 25672832 PMCID: PMC7089322 DOI: 10.1007/s11739-015-1204-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 01/23/2015] [Indexed: 01/11/2023]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive fibrotic disease limited to the lung, with high variability in the course of disease from one patient to another. Patients with IPF may experience acute respiratory deteriorations; many of these acute declines are idiopathic and are termed acute exacerbations (AE) of IPF. In these cases, the exclusion of alternative causes of rapid deterioration, including heart failure, bilateral pneumonia or pulmonary embolism, is a challenging goal. AE may occur at any time during the course of IPF, although they are more common in patients with more progressive disease and gastroesophageal reflux. Surgical lung biopsy or even surgical procedures in organs other than the lungs may also trigger AE, mainly in rapidly progressive or advanced IPF. Current diagnostic criteria include the presence of new-onset ground glass opacities or airspace consolidation superimposed on an underlying usual interstitial pneumonia pattern seen on high-resolution computed tomography. The outcome is poor with a short-term mortality in excess of 50% despite therapy. Currently, there is no treatment with demonstrated efficacy for AE-IPF: empirical high-dose corticosteroid therapy is generally used, with or without immunosuppressive agents, with limited evidence. On the other hand, there is hope that new treatments to slow down progression of IPF will translate into a reduction of AE-IPF's occurrence. In conclusion, although significant progress in assessing disease severity in IPF has been made, AEs remain unpredictable and are associated with a high risk of death. Improvements in our understanding of the etiology, risk factors, clinical predictors and epidemiology are needed. It is the goal of clinical researchers in the field to provide respiratory physicians with evidence-based guidance to identify patients who may benefit from therapy for preventing or treating AE-IPF.
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Affiliation(s)
- Fabrizio Luppi
- Centre for Rare Lung Disease, University Hospital, Via del Pozzo, 71, 41124, Modena, Italy,
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71
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Watanabe N, Niho S, Kirita K, Umemura S, Matsumoto S, Yoh K, Ohmatsu H, Goto K. Second-line docetaxel for patients with platinum-refractory advanced non-small cell lung cancer and interstitial pneumonia. Cancer Chemother Pharmacol 2015; 76:69-74. [DOI: 10.1007/s00280-015-2775-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 05/08/2015] [Indexed: 10/23/2022]
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Sculier J, Botta I, Bucalau A, Compagnie M, Eskenazi A, Fischler R, Gorham J, Mans L, Rozen L, Speybrouck S, Wang X, Meert A, Berghmans T. Medical anticancer treatment of lung cancer associated with comorbidities: A review. Lung Cancer 2015; 87:241-8. [DOI: 10.1016/j.lungcan.2015.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 01/09/2015] [Indexed: 12/26/2022]
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Rodríguez-Ruiz ME, Arévalo E, Gil-Bazo I, Olarte García A, Valtueña G, Moreno-Jiménez M, Arbea-Moreno L, Aristu J. Pneumomediastinum as a complication of SABR for lung metastases. Radiat Oncol 2015; 10:25. [PMID: 25612575 PMCID: PMC4313462 DOI: 10.1186/s13014-015-0330-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 01/07/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stereotactic ablative body radiation (SABR) is a novel and sophisticated radiation modality that involves the irradiation of extracranial tumors through precise and very high doses in patients with oligometastatic lung disease and primary lung tumors. CASE PRESENTATION A 52-year-old female with subclinical idiopathic interstitial lung disease (ILD) and oligometastatic lung disease from squamous urethral cancer who was treated with SABR for a metastatic lesion located in the right lower pulmonary lobe. The patient received a hypo-fractionated course of SABR. A 3D-conformal multifield technique was used with six coplanar and one non-coplanar statics beams. A 48 Gy total dose in three fractions over six days was prescribed to the 95% of the PTV. The presence of idiopathic ILD and other identifiable underlying lung conditions were not taken into account as a constraint to prescribe a different than standard total dose or fractionation schedule. Six months after the SABR treatment, a CT-scan showed the presence of a pneumomediastinum with air outside the bronchial tree and within the subcutaneous tissue without co-existing pneumothorax. To our knowledge, this is the first case of pneumomediastinum appearing 6 months after SABR treatment for a lung metastasis located in the perihiliar/central tumors region as defined by the RTOG protocols as the proximal bronchial tree. CONCLUSION Radiation oncologist should be aware of the potential risk of severe lung toxicity caused by SABR in patients with ILD, especially when chemotherapy-induced pulmonary toxicity is administered in a short time interval.
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74
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Effect of platinum-based chemotherapy for non-small cell lung cancer patients with interstitial lung disease. Cancer Chemother Pharmacol 2015; 75:521-6. [DOI: 10.1007/s00280-014-2670-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 12/30/2014] [Indexed: 02/02/2023]
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75
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Sakurada T, Kakiuchi S, Tajima S, Horinouchi Y, Okada N, Nishisako H, Nakamura T, Teraoka K, Kawazoe K, Yanagawa H, Nishioka Y, Minakuchi K, Ishizawa K. Characteristics of and risk factors for interstitial lung disease induced by chemotherapy for lung cancer. Ann Pharmacother 2015; 49:398-404. [PMID: 25565405 DOI: 10.1177/1060028014566446] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Drug-induced interstitial lung disease (DILD) is generally a serious adverse effect and almost always necessitates the discontinuation of the offending drug. Cancer pharmacotherapy is strongly associated with DILD, and the risk of DILD has been suggested to be higher in patients with lung cancer because of preexisting pneumonic disease. OBJECTIVE The aim of this retrospective study was to identify the risk factors and prognostic factors for early death from interstitial lung disease (ILD) induced by chemotherapy for lung cancer. METHODS The medical records of 459 patients who underwent chemotherapy for lung cancer between April 2007 and March 2013 were analyzed with regard to patient background and DILD development, initial symptoms, and prognosis. RESULTS A total of 33 patients (7.2%) developed chemotherapy-induced ILD. The most frequently observed initial symptom was dyspnea (94.3%). Preexisting ILD was identified as a risk factor for DILD (odds ratio [OR] = 5.38; 95% CI = 2.47-11.73; P < 0.01). Among the 33 patients who developed DILD, 10 patients suffered an early death despite steroid therapy. Poor prognostic factors included epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) use (OR = 9.26; 95% CI = 1.05-82.0; P < 0.05) and 2 or more prior chemotherapy regimens (OR = 6.95; 95% CI = 1.14-42.3; P < 0.05). CONCLUSIONS Many lung cancer patients have coexisting ILD, and these patients have a high risk of developing chemotherapy-induced ILD. In addition, patients with DILD who underwent EGFR-TKI therapy and 2 or more prior chemotherapy regimens had a higher risk of fatal outcome.
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Affiliation(s)
- Takumi Sakurada
- Department of Pharmacy, Tokushima University Hospital, Tokushima, Japan
| | - Soji Kakiuchi
- Department of Medical Oncology, Institute of Health Biosciences, University of Tokushima Graduate School, Japan Department of Respiratory Medicine and Rheumatology, Institute of Health Biosciences, University of Tokushima Graduate School, Japan
| | - Soichiro Tajima
- Department of Pharmacy, Kyushu University Hospital, Fukuoka, Japan
| | - Yuya Horinouchi
- Department of Pharmacy, Tokushima University Hospital, Tokushima, Japan
| | - Naoto Okada
- Department of Pharmacy, Tokushima University Hospital, Tokushima, Japan
| | | | - Toshimi Nakamura
- Department of Pharmacy, Tokushima University Hospital, Tokushima, Japan
| | - Kazuhiko Teraoka
- Department of Pharmacy, Tokushima University Hospital, Tokushima, Japan
| | - Kazuyoshi Kawazoe
- Department of Pharmacy, Tokushima University Hospital, Tokushima, Japan Department of Clinical Pharmacy, Institute of Health Biosciences, University of Tokushima Graduate School, Japan
| | - Hiroaki Yanagawa
- Clinical Trial Center for Developmental Therapeutics, Tokushima University Hospital, Tokushima, Japan
| | - Yasuhiko Nishioka
- Department of Respiratory Medicine and Rheumatology, Institute of Health Biosciences, University of Tokushima Graduate School, Japan
| | - Kazuo Minakuchi
- Department of Pharmacy, Tokushima University Hospital, Tokushima, Japan Department of Clinical Pharmacy, Institute of Health Biosciences, University of Tokushima Graduate School, Japan
| | - Keisuke Ishizawa
- Department of Pharmacy, Tokushima University Hospital, Tokushima, Japan Department of Clinical Pharmacy, Institute of Health Biosciences, University of Tokushima Graduate School, Japan
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Sato T, Kondo H, Watanabe A, Nakajima J, Niwa H, Horio H, Okami J, Okumura N, Sugio K, Teramukai S, Kishi K, Ebina M, Sugiyama Y, Kondo T, Date H. A simple risk scoring system for predicting acute exacerbation of interstitial pneumonia after pulmonary resection in lung cancer patients. Gen Thorac Cardiovasc Surg 2014; 63:164-72. [PMID: 25352311 DOI: 10.1007/s11748-014-0487-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 10/07/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Lung cancer patients with interstitial lung diseases (ILDs) who have undergone pulmonary resection often develop acute exacerbation of interstitial pneumonia (AE) in the post-operative period. To predict who is at high risk of AE, we propose a scoring system that evaluates the risk of AE in lung cancer patients with ILDs. METHODS We derived a score for 30-day risk of AE onset after pulmonary resection in lung cancer patients with ILDs (n = 1,022; outcome: risk of AE) based on seven risk factors for AE that were identified in a previous retrospective multi-institutional cohort study. A logistic regression model was employed to develop a risk prediction model for AE. RESULTS A risk score (RS) was derived: 5 × (history of AE) + 4 × (surgical procedures) + 4 × (UIP appearance in CT scan) + 3 × (male sex) + 3 × (preoperative steroid use) + 2 × (elevated serum sialylated carbohydrate antigen, KL-6 level) + 1 × (low vital capacity). The RS was shown to be moderately discriminatory with a c-index of 0.709 and accurate with the Hosmer-Lemeshow goodness-of-fit test (p = 0.907). The patients were classified into three groups: low risk (RS: 0-10; predicted probability <0.1; n = 439), intermediate risk (RS: 11-14; predicted probability 0.1-0.25; n = 559), and high risk (RS: 15-22; predicted probability >0.25; n = 24). CONCLUSION Although further validation and refinement are needed, the risk score can be used in routine clinical practice to identify high risk individuals and to select proper treatment strategies.
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Affiliation(s)
- Toshihiko Sato
- Department of Thoracic Surgery, Kyoto University, 54 Kawaharacho, Shogoin, Sakyoku, Kyoto, Japan,
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Takiguchi Y, Sekine I, Iwasawa S, Kurimoto R, Tatsumi K. Chronic obstructive pulmonary disease as a risk factor for lung cancer. World J Clin Oncol 2014; 5:660-6. [PMID: 25300704 PMCID: PMC4129530 DOI: 10.5306/wjco.v5.i4.660] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 01/27/2014] [Accepted: 05/16/2014] [Indexed: 02/06/2023] Open
Abstract
The association between chronic obstructive pulmonary disease (COPD) and lung cancer has long been a subject of intense debate. The high prevalence of COPD in elderly smokers inevitably strengthens their coincidence. In addition to this contingent coincidence, recent studies have revealed a close association between the two diseases that is independent of the smoking history; that is, the existence of COPD is an independent risk factor for the development of lung cancer. Molecular-based evidence has been accumulating as a result of the efforts to explain the underlying mechanisms of this association. These mechanisms may include the following: the retention of airborne carcinogens followed by the activation of oncogenes and the suppression of tumor suppressor genes; the complex molecular mechanism associated with chronic inflammation in the distal airways of patients with COPD; the possible involvement of putative distal airway stem cells; and genetic factors that are common to both COPD and lung cancer. The existence of COPD in patients with lung cancer may potentially affect the process of diagnosis, surgical resection, radiotherapy, chemotherapy, and end-of-life care. The comprehensive management of COPD is extremely important for the appropriate treatment of lung cancer. Surgical resections with the aid of early interventions for COPD are often possible, even for patients with mild-to-moderate COPD. New challenges, such as lung cancer CT screening for individuals at high risk, are now in the process of being implemented. Evaluating the risk of lung cancer in patients with COPD may be warranted in community-based lung cancer screening.
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78
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Sanchez JF, Ghamande SA, Midturi JK, Arroliga AC. Invasive diagnostic strategies in immunosuppressed patients with acute respiratory distress syndrome. Clin Chest Med 2014; 35:697-712. [PMID: 25453419 DOI: 10.1016/j.ccm.2014.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Immunosuppression predisposes the host to development of pulmonary infections, which can lead to respiratory failure and the development of acute respiratory distress syndrome (ARDS). There are multiple mechanisms by which a host can be immunosuppressed and each is associated with specific infectious pathogens. Early invasive diagnostic modalities such as fiber-optic bronchoscopy with bronchoalveolar lavage, transbronchial biopsy, and open lung biopsy are complementary to serologic and noninvasive studies and assist in rapidly establishing an accurate diagnosis, which allows initiation of appropriate therapy and may improve outcomes with relative safety.
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Affiliation(s)
- Juan F Sanchez
- Pulmonary and Critical Care Medicine Division, Baylor Scott and White Healthcare, 2401 South 31st street, Temple, TX 76508, USA
| | - Shekhar A Ghamande
- Pulmonary and Critical Care Medicine Division, Baylor Scott and White Healthcare, 2401 South 31st street, Temple, TX 76508, USA
| | - John K Midturi
- Pulmonary and Critical Care Medicine Division, Baylor Scott and White Healthcare, 2401 South 31st street, Temple, TX 76508, USA
| | - Alejandro C Arroliga
- Pulmonary and Critical Care Medicine Division, Baylor Scott and White Healthcare, 2401 South 31st street, Temple, TX 76508, USA.
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The safety and efficacy of paclitaxel and carboplatin with or without bevacizumab for treating patients with advanced nonsquamous non-small cell lung cancer with interstitial lung disease. Cancer Chemother Pharmacol 2014; 74:1159-66. [DOI: 10.1007/s00280-014-2590-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 09/10/2014] [Indexed: 12/24/2022]
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Lung Cancer in Combined Pulmonary Fibrosis and Emphysema: A Series of 47 Western Patients. J Thorac Oncol 2014; 9:1162-70. [DOI: 10.1097/jto.0000000000000209] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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81
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Minegishi Y, Kokuho N, Miura Y, Matsumoto M, Miyanaga A, Noro R, Saito Y, Seike M, Kubota K, Azuma A, Kida K, Gemma A. Clinical features, anti-cancer treatments and outcomes of lung cancer patients with combined pulmonary fibrosis and emphysema. Lung Cancer 2014; 85:258-63. [DOI: 10.1016/j.lungcan.2014.05.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 04/08/2014] [Accepted: 05/13/2014] [Indexed: 10/25/2022]
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82
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Sato T, Teramukai S, Kondo H, Watanabe A, Ebina M, Kishi K, Fujii Y, Mitsudomi T, Yoshimura M, Maniwa T, Suzuki K, Kataoka K, Sugiyama Y, Kondo T, Date H. Impact and predictors of acute exacerbation of interstitial lung diseases after pulmonary resection for lung cancer. J Thorac Cardiovasc Surg 2014; 147:1604-1611.e3. [DOI: 10.1016/j.jtcvs.2013.09.050] [Citation(s) in RCA: 157] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 09/16/2013] [Accepted: 09/25/2013] [Indexed: 10/26/2022]
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Yamaguchi S, Ohguri T, Matsuki Y, Yahara K, Oki H, Imada H, Narisada H, Korogi Y. Radiotherapy for thoracic tumors: association between subclinical interstitial lung disease and fatal radiation pneumonitis. Int J Clin Oncol 2014; 20:45-52. [DOI: 10.1007/s10147-014-0679-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 02/15/2014] [Indexed: 12/25/2022]
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Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic progressive and ultimately fatal disease, the clinical course of which in individual patients is highly variable. Sudden deterioration of a patient's respiratory condition during a stable course is not uncommon. Many cases of uncertain etiology have been called acute exacerbation (AEx) of IPF, under the assumption of sudden acceleration of the underlying disease process. In recent years, several studies have reported the clinical significance of AEx-IPF. In 2007 Collard and colleagues created a Consensus Perspective, which proposed consensus definition and standard diagnostic criteria. This review primarily discusses studies performed after this Consensus Perspective.
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Affiliation(s)
- Dong Soon Kim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea.
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85
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Watanabe A, Miyajima M, Mishina T, Nakazawa J, Harada R, Kawaharada N, Higami T. Surgical treatment for primary lung cancer combined with idiopathic pulmonary fibrosis. Gen Thorac Cardiovasc Surg 2012. [PMID: 23188513 DOI: 10.1007/s11748-012-0180-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Idiopathic pulmonary fibrosis (IPF) is defined as a specific form of chronic, progressive fibrosing interstitial pneumonia of unknown cause. IPF is associated with an increased risk of lung cancer, and lung cancer patients with IPF undergoing pulmonary resection for non-small cell lung cancer have increased postoperative morbidity and mortality. Especially, postoperative acute exacerbation of IPF (AEIPF) causes fatal status and long-term outcomes are worse than for patients without IPF, although certain subgroups have a good long-term outcome. A comprehensive review of the current literature pertaining to AEIPF and the late phase outcome after the context of a surgical intervention was performed.
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Affiliation(s)
- Atsushi Watanabe
- Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, 060-8543, Japan.
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86
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Watanabe N, Taniguchi H, Kondoh Y, Kimura T, Kataoka K, Nishiyama O, Kondo M, Hasegawa Y. Efficacy of chemotherapy for advanced non-small cell lung cancer with idiopathic pulmonary fibrosis. ACTA ACUST UNITED AC 2012; 85:326-31. [PMID: 23171837 DOI: 10.1159/000342046] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 07/17/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is the most common type of idiopathic interstitial pneumonia and is associated with an independent increased risk of lung carcinogenesis. The benefit of chemotherapy for lung cancer in cases of IPF remains unknown. OBJECTIVES This study was conducted to elucidate the efficacy of chemotherapy for advanced non-small cell lung cancer (NSCLC) in patients with IPF. METHODS Advanced (i.e. stage IIIB and IV) NSCLC patients with IPF who received systemic chemotherapy were studied. Response rate, toxicity, overall survival and progression-free survival were investigated. RESULTS Between January 2000 and December 2009, 21 patients were enrolled in this study and treated with chemotherapy. The overall response rate with the 1st regimen was 42.9%. The median overall survival was 11.4 months, the 1-year survival rate was 28.6% and the median PFS was 5.4 months. CONCLUSIONS This study showed that advanced NSCLC patients with IPF may benefit from chemotherapy; well-controlled studies are still needed to clarify the efficacy.
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Affiliation(s)
- Naohiro Watanabe
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
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87
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Nagano T, Kotani Y, Fujii O, Demizu Y, Niwa Y, Ohno Y, Nishio W, Itoh T, Murakami M, Nishimura Y. A case of acute exacerbation of idiopathic pulmonary fibrosis after proton beam therapy for non-small cell lung cancer. Jpn J Clin Oncol 2012; 42:965-9. [PMID: 22826350 DOI: 10.1093/jjco/hys115] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
There have been no reports describing acute exacerbations of idiopathic pulmonary fibrosis after particle radiotherapy for non-small cell lung cancer. The present study describes the case of a 76-year-old Japanese man with squamous cell carcinoma of the lung that relapsed in the left upper lobe 1 year after right upper lobectomy. He had been treated with oral prednisolone 20 mg/day every 2 days for idiopathic pulmonary fibrosis, and the relapsed lung cancer was treated by proton beam therapy, which was expected to cause the least adverse effects on the idiopathic pulmonary fibrosis. Fifteen days after the initiation of proton beam therapy, the idiopathic pulmonary fibrosis exacerbated, centered on the left upper lobe, for which intensive steroid therapy was given. About 3 months later, the acute exacerbation of idiopathic pulmonary fibrosis had improved, and the relapsed lung cancer became undetectable. Clinicians should be aware that an acute exacerbation of idiopathic pulmonary fibrosis may occur even in proton beam therapy, although proton beam therapy appears to be an effective treatment option for patients with idiopathic pulmonary fibrosis.
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Affiliation(s)
- Tatsuya Nagano
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunokicho, Chuo-ku, Kobe, Hyogo, Japan.
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88
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Togashi Y, Masago K, Handa T, Tanizawa K, Okuda C, Sakamori Y, Nagai H, Kim YH, Mishima M. Prognostic Significance of Preexisting Interstitial Lung Disease in Japanese Patients With Small-Cell Lung Cancer. Clin Lung Cancer 2012; 13:304-11. [PMID: 22169479 DOI: 10.1016/j.cllc.2011.11.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Revised: 10/08/2011] [Accepted: 11/09/2011] [Indexed: 11/25/2022]
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89
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Sanuki N, Ono A, Komatsu E, Kamei N, Akamine S, Yamazaki T, Mizunoe S, Maeda T. Association of computed tomography-detected pulmonary interstitial changes with severe radiation pneumonitis for patients treated with thoracic radiotherapy. JOURNAL OF RADIATION RESEARCH 2012; 53:110-6. [PMID: 22302051 DOI: 10.1269/jrr.110142] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
We evaluated associations of interstitial changes with radiation pneumonitis (RP) for patients treated with thoracic radiotherapy. Between 2005 and 2009, patients who received thoracic radiotherapy of 40 Gy or more for lung cancer or thymic tumors and were followed-up for more than 6 months were eligible for this study. Possible risk factors for RP included the presence of interstitial changes on computed tomography before radiotherapy, and elevated C-reactive protein (CRP) and lactate dehydrogenase (LDH) levels; these were compared with the incidences of severe RP. A total of 106 patients were included. The incidences of RP were 4 (4%), 0 (0%), and 5 (5%) for grades 3, 4, and 5, respectively. For those with interstitial changes, the incidence of RP ≥ grade 3 was significantly increased from 3% (2/79) to 26% (7/27) (p < 0.001). CRP and LDH levels were also associated with increased RP, as were pulmonary emphysema and performance status ≥ 2. Among 91 patients with RP ≥ grade 1, RP grade ≥ 3 occurred significantly earlier than grades 1 and 2. In conclusion, pulmonary interstitial changes, LDH and CRP levels, pulmonary emphysema, and performance status ≥ 2 were significantly associated with RP ≥ grade 3. RP grade ≥ 3 occurred significantly earlier than grades 1 and 2. The early appearance of interstitial changes requires careful management due to the possibility of severe RP.
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Affiliation(s)
- Naoko Sanuki
- Department of Radiology, Oita Prefectural Hospital, Japan.
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90
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The risk of cytotoxic chemotherapy-related exacerbation of interstitial lung disease with lung cancer. J Thorac Oncol 2011; 6:1242-6. [PMID: 21623239 DOI: 10.1097/jto.0b013e318216ee6b] [Citation(s) in RCA: 148] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION It is unknown what type of interstitial lung disease (ILD) has high risk for chemotherapy-related exacerbation of ILD. We investigated the risk of exacerbation of ILD for patients with lung cancer with ILD. METHODS One hundred nine patients with lung cancer with ILD treated with cytotoxic chemotherapy at Shizuoka Cancer Center between August 2002 and April 2010 were retrospectively reviewed. RESULTS On pretreatment computed tomography (CT) of the chest, 69 patients (63%) were identified with usual interstitial pneumonia (UIP) pattern, and 40 patients (37%) had non-UIP pattern. Patients with UIP pattern developed cytotoxic chemotherapy-related exacerbation of ILD more frequently than those with non-UIP pattern (30 versus 8%, p = 0.005). The incidence of grade 5 pulmonary toxicities was 9% in patients with UIP pattern, compared with 3% in those with non-UIP pattern. Multivariate analyses demonstrated that age (<70 years) and CT pattern (UIP) were significant independent risk factors for cytotoxic chemotherapy-related exacerbation of ILD. In small cell lung cancer, overall survival (OS) from the start of first-line chemotherapy was significantly shorter in UIP pattern than non-UIP pattern (median OS: 9 versus 16 months, p = 0.0475), whereas there was no significant difference in patients with non-small cell lung cancer (median OS: 12 versus 9 months, p = 0.2529). CONCLUSIONS Our results indicated that the incidence of exacerbation of ILD was significantly higher in patients with lung cancer with UIP pattern on CT findings than in those with non-UIP pattern. Therefore, great care is required when administering cytotoxic chemotherapy agents for patients with lung cancer with UIP pattern.
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91
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Survival After Surgery for Pathologic Stage IA Non-Small Cell Lung Cancer Associated With Idiopathic Pulmonary Fibrosis. Ann Thorac Surg 2011; 92:1812-7. [DOI: 10.1016/j.athoracsur.2011.06.055] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 06/12/2011] [Accepted: 06/14/2011] [Indexed: 11/18/2022]
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92
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The Feasibility Study of Carboplatin Plus Etoposide for Advanced Small Cell Lung Cancer with Idiopathic Interstitial Pneumonias. J Thorac Oncol 2011; 6:801-7. [DOI: 10.1097/jto.0b013e3182103d3c] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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93
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Postoperative Acute Exacerbation of IPF after Lung Resection for Primary Lung Cancer. Pulm Med 2011; 2011:960316. [PMID: 21637373 PMCID: PMC3100115 DOI: 10.1155/2011/960316] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 01/09/2011] [Indexed: 12/17/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is characterized by slowly progressive respiratory dysfunction. Nevertheless, some IPF patients experience acute exacerbations generally characterized by suddenly worsening and fatal respiratory failure with new lung opacities and pathological lesions of diffuse alveolar damage. Acute exacerbation of idiopathic pulmonary fibrosis (AEIPF) is a fatal disorder defined by rapid deterioration of IPF. The condition sometimes occurs in patients who underwent lung resection for primary lung cancer in the acute and subacute postoperative phases. The exact etiology and pathogenesis remain unknown, but the condition is characterized by diffuse alveolar damage superimposed on a background of IPF that probably occurs as a result of a massive lung injury due to some unknown factors. This systematic review shows that the outcome, however, is poor, with postoperative mortality ranging from 33.3% to 100%. In this paper, the etiology, risk factors, pathogenesis, therapy, prognosis, and predictors of postoperative AEIPF are described.
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94
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Minegishi Y. Feasibility Study of Combined Chemotherapy for Advanced Lung Cancer with Idiopathic Interstitial Pneumonias and Proteomic Analysis to Detect Risk Factors for Their Acute Exacerbation. J NIPPON MED SCH 2011. [DOI: 10.1272/jnms.78.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Yuji Minegishi
- Division of Pulmonary Medicine, Infectious Disease, and Oncology, Department of Internal Medicine, Nippon Medical School
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96
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The safety and efficacy of weekly paclitaxel in combination with carboplatin for advanced non-small cell lung cancer with idiopathic interstitial pneumonias. Lung Cancer 2010; 71:70-4. [PMID: 20493578 DOI: 10.1016/j.lungcan.2010.04.014] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2010] [Revised: 03/24/2010] [Accepted: 04/11/2010] [Indexed: 12/16/2022]
Abstract
BACKGROUND Idiopathic interstitial pneumonias (IIPs) are one of the most common complications in patients with lung cancer. In lung cancer patients with IIP, the most serious toxicity is acute exacerbation of IIP caused by anticancer treatment in Japan. However, there has been no consensus and no evidence presented, regarding optimal treatment for advanced lung cancer with IIP. PATIENTS AND METHODS Chemotherapy-naïve patients of inoperable stage, or post-operative recurrent non-small cell lung cancer (NSCLC) with IIPs were enrolled. Patients received paclitaxel at a dose of 100mg/m(2) on Days 1, 8, 15, and carboplatin every 28 days at a target dose of area under the curve (AUC) 5.0 on Day 1. RESULTS Between May 2004 and October 2008, 18 patients, including 6 with idiopathic pulmonary fibrosis (IPF), were enrolled and treated for a median of four cycles (range, 1-6). One patient (5.6%; 95% confidence interval (CI), 0-17%) with histologically confirmed IPF had acute exacerbation of IIPs associated with the treatment. The overall response rate was 61% (95% CI, 36-86%). The median progression-free survival, median survival time, and 1-year survival rate were 5.3 months, 10.6 months, and 22%, respectively. CONCLUSION This is the first report indicating that advanced NSCLC patients with IIP may benefit from chemotherapy. Weekly paclitaxel and carboplatin combination chemotherapy was as effective as conventional regimens in advanced NSCLC patients without IIP and was safer than previously reported for NSCLC patients with IIP. The results from this study would support, on ethical grounds, the conduct of a large-scale study to confirm the feasibility of this regimen.
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Shintani Y, Ohta M, Iwasaki T, Ikeda N, Tomita E, Kawahara K, Ohno Y. Predictive factors for postoperative acute exacerbation of interstitial pneumonia combined with lung cancer. Gen Thorac Cardiovasc Surg 2010; 58:182-5. [PMID: 20401711 DOI: 10.1007/s11748-009-0569-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Accepted: 11/10/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE Postoperative acute exacerbation (AE) of usual interstitial pneumonia (UIP) is a serious complication in the surgical treatment for primary lung cancer combined with UIP. The purpose of this study was to determine the predictors of AE of UIP after a major lung resection. METHODS We retrospectively collected data for 40 patients who had been operated on for lung cancer and were diagnosed as UIP based on postoperative histopathological diagnosis. We then evaluated some predictive factors related to the AE of UIP. RESULTS The incidence of postoperative AE of UIP was 15% (6/40 patients). No correlation between patients who developed AE of UIP and those who did not, in terms of preoperative C-reactive protein, white blood cell count, percentage lymphocytes, forced expiratory volume in 1 s, percentage total lung capacity, percentage diffusing capacity of lung for carbon monoxide, and the alveolar partial pressures of oxygen and carbon dioxide. Preoperative serum lactate dehydrogenase (LDH) and serum KL-6 were significantly higher and the percent vital capacity (%VC) was significantly lower in patients who developed AE of UIP than in those who did not. Furthermore, recursive descent partition analysis revealed that %VC (<80.6%) and LDH (>or=241 IU/l) could distinguish patients with AE from those without AE. CONCLUSION Preoperative %VC plus serum LDH values were considered the predictive factors for AE of UIP after surgery for lung cancer.
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Affiliation(s)
- Yasushi Shintani
- Department of Thoracic Surgery, Osaka Prefectural Hospital Organization, Prefectural Medical Center for Respiratory and Allergic Disease, 3-7-1 Habikino, Habikino, Osaka, 583-8588, Japan.
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Kagohashi K, Miyazaki K, Satoh H. Idiopathic interstitial pneumonias associated with lung cancer. Intern Med 2009; 48:1721; author reply 1723. [PMID: 19755786 DOI: 10.2169/internalmedicine.48.2479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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