1
|
Walter J, Moeller C, Resuli B, Kauffmann-Guerrero D, Manapov F, Dinkel J, Neumann J, Kovacs J, Schneider C, Huber RM, Tufman A. Guideline adherence of tumor board recommendations in lung cancer and transfer into clinical practice. J Cancer Res Clin Oncol 2023; 149:11679-11688. [PMID: 37402967 PMCID: PMC10465379 DOI: 10.1007/s00432-023-05025-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/26/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE Evaluating patients and treatment decisions in a multidisciplinary tumor board has led to better quality of care and longer survival in cancer patients. The aim of this study was to evaluate tumor board recommendations for thoracic oncology patients regarding guideline adherence and transferal of recommendations into clinical practice. METHODS We evaluated tumor board recommendations of the thoracic oncology tumor board at Ludwig-Maximilians University (LMU) Hospital Munich between 2014 and 2016. We compared patient characteristics between guideline-adherent and non-guideline-adherent recommendations, as well as between transferred and non-transferred recommendations. We used multivariate logistic regression models to evaluate factors associated with guideline adherence. RESULTS Over 90% of recommendations by the tumor board were either adherent to the guidelines (75.5%) or over fulfilling guidelines (15.6%). Almost 90% of recommendations were transferred to clinical practice. If a recommendation was not according to the guidelines, the reason was mostly associated with the general condition (age, Charlson comorbidity index, ECOG) of the patient or due to the patients' request. Surprisingly, sex also had a significant influence on the guideline adherence of recommendations, with females being more likely to get recommendations not according to the guidelines. CONCLUSION In conclusion, the results of this study are promising, as the guideline adherence of recommendations as well as the transferal of recommendations into clinical practice were high. In the future, a special focus should be put on fragile patients as well as female patients.
Collapse
Affiliation(s)
- Julia Walter
- Department of Medicine V-Pneumology, University Hospital, Ludwig-Maximilians-University Hospital (LMU) Munich, Munich, Germany.
- German Center for Lung Research (DZL), Giessen, Germany.
| | - Caroline Moeller
- Department of Medicine V-Pneumology, University Hospital, Ludwig-Maximilians-University Hospital (LMU) Munich, Munich, Germany
| | - Blerina Resuli
- Department of Medicine V-Pneumology, University Hospital, Ludwig-Maximilians-University Hospital (LMU) Munich, Munich, Germany
| | - Diego Kauffmann-Guerrero
- Department of Medicine V-Pneumology, University Hospital, Ludwig-Maximilians-University Hospital (LMU) Munich, Munich, Germany
- German Center for Lung Research (DZL), Giessen, Germany
| | - Farkhad Manapov
- German Center for Lung Research (DZL), Giessen, Germany
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Julien Dinkel
- German Center for Lung Research (DZL), Giessen, Germany
- Department of Radiology, Asklepios Clinic Gauting, Gauting, Germany
| | - Jens Neumann
- Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Julia Kovacs
- German Center for Lung Research (DZL), Giessen, Germany
- Department of Thoracic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Christian Schneider
- German Center for Lung Research (DZL), Giessen, Germany
- Department of Thoracic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Rudolf M Huber
- Department of Medicine V-Pneumology, University Hospital, Ludwig-Maximilians-University Hospital (LMU) Munich, Munich, Germany
- German Center for Lung Research (DZL), Giessen, Germany
| | - Amanda Tufman
- Department of Medicine V-Pneumology, University Hospital, Ludwig-Maximilians-University Hospital (LMU) Munich, Munich, Germany
- German Center for Lung Research (DZL), Giessen, Germany
| |
Collapse
|
2
|
Safai Zadeh E, Görg C, Prosch H, Horn R, Jenssen C, Dietrich CF. The Role of Thoracic Ultrasound for Diagnosis of Diseases of the Chest Wall, the Mediastinum, and the Diaphragm-Narrative Review and Pictorial Essay. Diagnostics (Basel) 2023; 13:767. [PMID: 36832255 PMCID: PMC9956010 DOI: 10.3390/diagnostics13040767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/29/2023] [Accepted: 02/08/2023] [Indexed: 02/22/2023] Open
Abstract
The diagnostic capabilities of ultrasound extend far beyond the evaluation of the pleural space and lungs. Sonographic evaluation of the chest wall is a classic extension of the clinical examination of visible, palpable, or dolent findings. Unclear mass lesions of the chest wall can be differentiated accurately and with low risk by additional techniques such as color Doppler imaging, contrast-enhanced ultrasound, and, in particular, ultrasound-guided biopsy. For imaging of mediastinal pathologies, ultrasound has only a complementary function but is valuable for guidance of percutaneous biopsies of malignant masses. In emergency medicine, ultrasound can verify and support correct positioning of endotracheal tubes. Diaphragmatic ultrasound benefits from the real-time nature of sonographic imaging and is becoming increasingly important for the assessment of diaphragmatic function in long-term ventilated patients. The clinical role of thoracic ultrasound is reviewed in a combination of narrative review and pictorial essay.
Collapse
Affiliation(s)
- Ehsan Safai Zadeh
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany
| | - Christian Görg
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna General Hospital, 1090 Vienna, Austria
| | - Rudolf Horn
- Center da Sandà Val Müstair, 7536 Sta. Maria, Switzerland
| | - Christian Jenssen
- Medical Department, Krankenhaus Maerkisch-Oderland, 15344 Strausberg, Germany
- Brandenburg Institute of Clinical Ultrasound, Medical University Brandenburg, 16816 Neuruppin, Germany
| | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Bern, Beau Site, Salem und Permanence, 3018 Bern, Switzerland
| |
Collapse
|
3
|
Neugebauer S, Griesinger F, Dippel S, Heidenreich S, Gruber N, Chruscz D, Lempfert S, Kaskel P. Use of algorithms for identifying patients in a German claims database: learnings from a lung cancer case. BMC Health Serv Res 2022; 22:834. [PMID: 35765059 PMCID: PMC9241287 DOI: 10.1186/s12913-022-07982-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/08/2022] [Indexed: 12/04/2022] Open
Abstract
Background The analysis of statutory health insurance (SHI) data is a little-used approach for understanding treatment and care as well as resource use of lung cancer (LC) patients in Germany. The aims of this observational, retrospective, longitudinal analysis of structured data were to analyze the healthcare situation of LC patients in Germany based on routine data from SHI funds, to develop an algorithm that sheds light on LC types (non-small cell / NSCLC vs. small cell / SCLC), and to gain new knowledge to improve needs-based care. Methods Anonymized billing data of approximately four million people with SHI were analyzed regarding ICD-10 (German modification), documented medical interventions based on the outpatient SHI Uniform Assessment Standard Tariff (EBM) or the inpatient Operations and Procedure Code (OPS), and the dispensing of prescription drugs to outpatients (ATC classification). The study included patients who were members of 64 SHI funds between Jan-1st, 2015 and Dec-31st, 2016 and who received the initial diagnosis of LC in 2015 and 2016. Results The analysis shows that neither the cancer type nor the cancer stage can be unambiguously described by the ICD-10 coding. Furthermore, an assignment based on the prescribed medication provides only limited information: many of the drugs are either approved for both LC types or are used off-label, making it difficult to assign them to a specific LC type. Overall, 25% of the LC patients were unambiguously identifiable as NSCLC vs SCLC based on the ICD-10 code, the drug therapy, and the billing data. Conclusions The current coding system appears to be of limited suitability for drawing conclusions about LC and therefore the SHI patient population. This makes it difficult to analyze the healthcare data with the aim of gathering new knowledge to improve needs-based care. The approach chosen for this study did not allow for development of a LC differentiation algorithm based on the available healthcare data. However, a better overview of patient specific needs could make it possible to modify the range of services provided by the SHI funds. From this perspective, it makes sense, in a first step, to refine the ICD-10 system to facilitate NSCLC vs. SCLC classification. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07982-8.
Collapse
Affiliation(s)
- Sina Neugebauer
- MSD SHARP & DOHME GmbH, Levelingstrasse 4A, 81673, Munich, Germany
| | - Frank Griesinger
- Department of Hematology and Oncology, Internal Medicine-Oncology, Pius Hospital, Medical Campus University of Oldenburg, Cancer Center Oldenburg, Georgstrasse 12, 26121, Oldenburg, Germany
| | - Sabine Dippel
- Organon GmbH, Weystrasse 20, 6006, Lucerne, Switzerland
| | | | - Nina Gruber
- MSD SHARP & DOHME GmbH, Levelingstrasse 4A, 81673, Munich, Germany
| | - Detlef Chruscz
- CONVEMA Versorgungsmanagement GmbH, Karl-Marx-Allee 90A, 10243, Berlin, Germany
| | - Sebastian Lempfert
- HCSL Healthcare Consulting Sebastian Lempfert e.K., Bekwisch 32, 22848, Norderstedt, Germany
| | - Peter Kaskel
- MSD SHARP & DOHME GmbH (former address of MSD), Lindenplatz 1, 85540, Haar, Germany.
| |
Collapse
|
4
|
Moeller M, Schaedlich F, Schuette W. Retrospective Data Analysis of Patients With Metastatic Lung Adenocarcinoma With or Without KRAS-Mutation or TTF1-Expression. Cancer Control 2022; 29:10732748221126949. [PMID: 36355617 PMCID: PMC9661558 DOI: 10.1177/10732748221126949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction Patients with lung adenocarcinoma not expressing TTF1 and those with a KRAS mutation have worse prognosis. However, available data are limited and sometimes contradictory. Therefore, this retrospective cohort analysis aimed to clarify whether there was a difference in overall survival and progression-free survival between these groups of patients. Methods In total, data derived from 181 patients with metastatic lung adenocarcinoma treated at the Martha-Maria Halle-Dölau Hospital from 2016 to 2019 were analyzed. Kaplan-Meier curves were generated, and associated values, such as median survival and its confidence intervals, were determined using the log-rank test. Results A benefit in overall survival (OS) (8.4 vs 5.8 months; HR, .8; 95% CI, .53-1.19; P = .267) was associated with positive TTF1 expression, but this was not statistically significant. The same trend was shown with the progressive free survival (PFS) (6.5 vs 4.6 months; HR, .76; 95% CI, .51-1.20; P = .162). In patients with a KRAS mutation, there was no difference in OS compared to those with a wildtype KRAS. The median survival was almost identical at 7.5 months (KRAS mutation, 95% CI, 3.32-11.74) and 7.0 months (KRAS wildtype, 95% CI, 3.59-10.41). Additionally, in PFS, there was no difference between the 2 groups (5.8 vs 6.3 months). Conclusions Our analysis did not show a worse prognosis in patients with a KRAS mutation or in those with missing TTF1 expression, which is most likely related to the new therapeutic options. As a result of the administration of immunotherapy in patients with a KRAS mutation and the change from a regimen containing pemetrexed to a regimen containing no pemetrexed, the corresponding patients no longer seem to have a worse prognosis.
Collapse
Affiliation(s)
- Miriam Moeller
- Clinic of Internal Medicine, Hospital Martha-Maria Halle-Dölau, Halle, Germany
| | | | - Wolfgang Schuette
- Clinic of Internal Medicine, Hospital Martha-Maria Halle-Dölau, Halle, Germany
| |
Collapse
|
5
|
Messerli M, Liberini V, Grünig H, Maurer A, Skawran S, Lohaus N, Husmann L, Orita E, Trinckauf J, Kaufmann PA, Huellner MW. Clinical evaluation of data-driven respiratory gating for PET/CT in an oncological cohort of 149 patients: impact on image quality and patient management. Br J Radiol 2021; 94:20201350. [PMID: 34520673 DOI: 10.1259/bjr.20201350] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To evaluate the impact of fully automatic motion correction by data-driven respiratory gating (DDG) on positron emission tomography (PET) image quality, lesion detection and patient management. MATERIALS AND METHODS A total of 149 patients undergoing PET/CT for cancer (re-)staging were retrospectively included. Patients underwent a PET/CT on a digital detector scanner and for every patient a PET data set where DDG was enabled (PETDDG) and as well as where DDG was not enabled (PETnonDDG) was reconstructed. All PET data sets were evaluated by two readers which rated the general image quality, motion effects and organ contours. Further, both readers reviewed all scans on a case-by-case basis and evaluated the impact of PETDDG on additional apparent lesion, change of report, and change of management. RESULTS In 85% (n = 126) of the patients, at least one bed position was acquired using DDG, resulting in mean scan time increase of 4:37 min per patient in the whole study cohort (n = 149). General image quality was not rated differently for PETnonDDG and PETDDG images (p = 1.000) while motion effects (i.e. indicating general blurring) was rated significantly lower in PETDDG images and organ contours, including liver and spleen, were rated significantly sharper using PETDDG as compared to PETnonDDG (all p < 0.001). In 27% of patients, PETDDG resulted in a change of the report and in a total of 12 cases (8%), PETDDG resulted in a change of further clinical management. CONCLUSION Deviceless DDG provided reliable fully automatic motion correction in clinical routine and increased lesion detectability and changed management in a considerable number of patients. ADVANCES IN KNOWLEDGE DDG enables PET/CT with respiratory gating to be used routinely in clinical practice without external gating equipment needed.
Collapse
Affiliation(s)
- Michael Messerli
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Virginia Liberini
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Hannes Grünig
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Alexander Maurer
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Stephan Skawran
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Niklas Lohaus
- University of Zurich, Zurich, Switzerland.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Lars Husmann
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Erika Orita
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Josephine Trinckauf
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Martin W Huellner
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| |
Collapse
|
6
|
Hoffmann H, Passlick B, Ukena D, Wesselmann S. [Surgical Therapy for Lung Cancer: Why it Should be Performed in High Volume Centres]. Pneumologie 2020; 74:670-677. [PMID: 33059373 DOI: 10.1055/a-1172-5675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Data on surgical lung cancer cases were extracted from the German Federal Statistics on Diagnosis-related groups (DRG) and a possible association between hospital volume and surgical mortality was explored. All treatment cases documented between 2005 and 2015 with the main diagnosis of lung cancer (International Classification of Disease code C34) and the German Operations and Procedure Key (OPS) codes 5-323 to 5-328 for anatomical lung resections were analysed. The treatment cases were assigned to hospital groups, defined according to the number of procedures performed per year. The total number of anatomical lung resections for the diagnosis of lung cancer increased by 24 % from 9376 resections in 2005 to 11,614 resections in 2015. In 2015, 57 % of anatomical lung resections in patients with lung cancer were performed in 47 high volume centres (hospitals with ≥ 75 resections/year); the remaining 43 % of the resections were distributed among 271 hospitals performing fewer than 75 resections per year. In hospitals performing fewer than 25 procedures/year, hospital mortality was almost twice as high as in large centres with ≥ 75 resections per year (5.7 vs. 3.0 %, mean value 2005 to 2015). In summary, our data indicate that a small number of high-volume hospitals perform the major part of lung resections of lung cancer in Germany with better survival as compared to low-volume hospitals. Based on current nationwide data a clear association between hospital volume and surgical mortality could be demonstrated.
Collapse
Affiliation(s)
- H Hoffmann
- Sektion Thoraxchirurgie, Klinikum rechts der Isar der Technischen Universität München.,Zertifizierungskommission "Lungenkrebszentrum" der Deutschen Krebsgesellschaft, Berlin
| | - B Passlick
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg
| | - D Ukena
- Klinik für Pneumologie, Klinikum Bremen-Ost gGmbH, Bremen.,Zertifizierungskommission "Lungenkrebszentrum" der Deutschen Krebsgesellschaft, Berlin
| | | |
Collapse
|
7
|
Weinhold I, Schindler C, Kossack N, Berndt B, Häckl D. Economic impact of disease prevention in a morbidity-based financing system: does prevention pay off for a statutory health insurance fund in Germany? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:1181-1193. [PMID: 31317353 DOI: 10.1007/s10198-019-01086-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 07/01/2019] [Indexed: 06/10/2023]
Abstract
Preventable chronic diseases account for the greatest burden in the German health system and statutory health insurance (SHI) funds play a crucial role in implementing and financing prevention strategies. On the contrary, the morbidity-based scheme to distribute financial resources from the Central Reallocation Pool among the different sickness funds may counteract efforts of effective prevention from an economic perspective. We assessed financial impacts of prevention from a sickness funds perspective in a retrospective controlled study. Claims data of 6,247,275 persons were analyzed and outcomes between two propensity-matched groups (n = 852,048) of prevention users and non-users were compared in a 4-year follow-up. Using a difference-in-differences approach, we analyzed healthcare expenditures, the development of morbidity, financial transfers from the Central Reallocation Pool, and contribution margins. The group of prevention users develops less morbidity (incidences and disease aggravations) compared to the control group. Healthcare expenditures increase in both groups within 4 years, whereas the increase is lower for prevention users compared to non-users (€568.04 vs. €640.60, p < 0.0001). Taking morbidity-based financial transfers into account, the decrease in contribution margins is stronger for prevention users (- €188.44 vs. - €138.73, p < 0.0001). This study demonstrates an economic disincentive from a sickness funds' perspective. In the semi-competitive SHI market, sickness funds will be discouraged from effective prevention strategies if investments are not worth it financially. Their efforts and knowledge are, however, crucial for joint action to foster prevention over cure in the health system.
Collapse
Affiliation(s)
- Ines Weinhold
- WIG2 Scientific Institute for Health Economics and Health System Research, Leipzig, Germany
| | - Christian Schindler
- WIG2 Scientific Institute for Health Economics and Health System Research, Leipzig, Germany.
| | - Nils Kossack
- WIG2 Scientific Institute for Health Economics and Health System Research, Leipzig, Germany
| | - Benjamin Berndt
- WIG2 Scientific Institute for Health Economics and Health System Research, Leipzig, Germany
| | - Dennis Häckl
- WIG2 Scientific Institute for Health Economics and Health System Research, Leipzig, Germany
| |
Collapse
|
8
|
"Age matters"-German claims data indicate disparities in lung cancer care between elderly and young patients. PLoS One 2019; 14:e0217434. [PMID: 31188861 PMCID: PMC6561547 DOI: 10.1371/journal.pone.0217434] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/28/2019] [Indexed: 12/25/2022] Open
Abstract
Background Although lung cancer is most commonly diagnosed in elderly patients, evidence about tumor-directed therapy in elderly patients is sparse, and it is unclear to what extent this affects treatment and care. Our study aimed to discover potential disparities in care between elderly patients and those under 65 years of age. Methods We studied claims from 13 283 German patients diagnosed with lung cancer in 2009 who survived for at least 90 days after diagnosis. We classified patients as “non-elderly” (≤ 65), “young-old” (65–74), “middle-old” (75–84), and “old-old” (≥ 85). We compared receipt of tumor-directed therapy (6 months after diagnosis), palliative care, opioids, antidepressants, and pathologic diagnosis confirmation via logistic regression. We used generalized linear regression (gamma distribution) to compare group-specific costs of care for 3 months after diagnosis. We adjusted all models by age, nursing home residency, nursing care need, comorbidity burden, and area of residence (urban, rural). The age group “non-elderly” served as reference group. Results Compared with the reference group “non-elderly”, the likelihood of receiving any tumor-directed treatment was significantly lower in all age groups with a decreasing gradient with advancing age. Elderly lung cancer patients received significantly fewer resections and radiotherapy than non-elderly patients. In particular, treatment with antineoplastic therapy declined with increasing age (“young-old” (OR = 0.76, CI = [0.70,0.83]), “middle-old” (OR = 0.45, CI = [0.36,0.50]), and “old-old” (OR = 0.13, CI = [0.10,0.17])). Patients in all age groups were less likely to receive structured palliative care than “non-elderly” (“young-old” (OR = 0.84, CI = [0.76,0.92]), “middle-old” (OR = 0.71, CI = [0.63,0.79]), and “old-old” (OR = 0.57, CI = [0.44,0.73])). Moreover, increased age was significantly associated with reduced quotas for outpatient treatment with opioids and antidepressants. Costs of care decreased significantly with increasing age. Conclusion This study suggests the existence of age-dependent care disparities in lung cancer patients, where elderly patients are at risk of potential undertreatment. To support equal access to care, adjustments to public health policies seem to be urgently required.
Collapse
|
9
|
Eichhorn F, Klotz LV, Bischoff H, Thomas M, Lasitschka F, Winter H, Hoffmann H, Eichhorn ME. Neoadjuvant anti-programmed Death-1 immunotherapy by Pembrolizumab in resectable nodal positive stage II/IIIa non-small-cell lung cancer (NSCLC): the NEOMUN trial. BMC Cancer 2019; 19:413. [PMID: 31046714 PMCID: PMC6498462 DOI: 10.1186/s12885-019-5624-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 04/18/2019] [Indexed: 12/25/2022] Open
Abstract
Background Immunotherapies targeting the PD1/PD-L1 pathway have had a large impact on the treatment of advanced NSCLC. Concerning multimodality tumor therapy, only few trials until today have been performed investigating neoadjuvant treatment with anti PD-1 immunotherapy prior to curative intent surgery. Aim of the NEOMUN investigator initiated trial (EudraCT-Number: 2017–000105-20; ClinicalTrials.gov Identifier: NCT03197467) is to assess feasibility and safety of pre-surgical anti PD-1 treatment in order to improve long term survival. Methods The study is designed as an open-label, single arm, prospective, monocenter, phase II study including 30 patients with NSCLC stage II/IIIA suitable for curative intent surgery. Investigational drug is Pembrolizumab. After 2 cycles of immunotherapy (à 200 mg q3w i.v.), tumor resection with lobectomy or bilobectomy will be performed. Primary objectives are to assess the feasibility and safety of a neoadjuvant immunotherapy and to assess antitumor activity of Pembrolizumab with regard to clinical and pathological tumor response. Secondary objective is disease free and overall survival. Exploratory objective is to analyze potential predictive biomarkers and to evaluate the therapeutic efficacy of Pembrolizumab by extended immune cell and cytokine analysis of tumor tissue. The study protocol was approved by the local ethics committee and the federal authority. Start of patient enrollment is scheduled for June 2018. Discussion The NEOMUN trial will be one of the first clinical trials investigating a multimodal treatment strategy including neoadjuvant immunotherapy using Pembrolizumab as an investigational drug. Assessing the safety and therapeutic potential of neoadjuvant immunotherapy in connection with lung surgery will be of great interest for thoracic surgeons. Trial registration Prospectively, the NEOMUN study has been registered on www.clinicaltrials.gov; NCT03197467 (first post: June 23rd, 2017).
Collapse
Affiliation(s)
- Florian Eichhorn
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University, Roentgenstraße 1, 69126, Heidelberg, Germany.,Translational Lung Research Center (TLRC), Member of German Center for Lung Research (DZL), Heidelberg, Germany
| | - Laura V Klotz
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University, Roentgenstraße 1, 69126, Heidelberg, Germany.,Translational Lung Research Center (TLRC), Member of German Center for Lung Research (DZL), Heidelberg, Germany
| | - Helge Bischoff
- Department of Thoracic Oncology, Thoraxklinik, Heidelberg University, Heidelberg, Germany
| | - Michael Thomas
- Translational Lung Research Center (TLRC), Member of German Center for Lung Research (DZL), Heidelberg, Germany.,Department of Thoracic Oncology, Thoraxklinik, Heidelberg University, Heidelberg, Germany
| | - Felix Lasitschka
- Institute of Pathology, Heidelberg University, Heidelberg, Germany.,Translational Lung Research Center (TLRC), Member of German Center for Lung Research (DZL), Heidelberg, Germany
| | - Hauke Winter
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University, Roentgenstraße 1, 69126, Heidelberg, Germany.,Translational Lung Research Center (TLRC), Member of German Center for Lung Research (DZL), Heidelberg, Germany
| | - Hans Hoffmann
- Divison of Thoracic Surgery, Technical University of Munich, Munich, Germany
| | - Martin E Eichhorn
- Department of Thoracic Surgery, Thoraxklinik, Heidelberg University, Roentgenstraße 1, 69126, Heidelberg, Germany. .,Translational Lung Research Center (TLRC), Member of German Center for Lung Research (DZL), Heidelberg, Germany.
| |
Collapse
|
10
|
Heldwein M, Michel M, Doerr F, Hekmat K. Meticulous lymph node dissection and gross pathological examination improves survival in non-small cell lung cancer patients. J Thorac Dis 2018; 10:S3951-S3953. [PMID: 30631524 DOI: 10.21037/jtd.2018.09.53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Matthias Heldwein
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | | | - Fabian Doerr
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - Khosro Hekmat
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| |
Collapse
|
11
|
Deckert K, Walter J, Schwarzkopf L. Factors related to and economic implications of inhospital death in German lung cancer patients - results of a Nationwide health insurance claims data based study. BMC Health Serv Res 2018; 18:793. [PMID: 30340487 PMCID: PMC6194570 DOI: 10.1186/s12913-018-3599-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 10/02/2018] [Indexed: 12/04/2022] Open
Abstract
Background When patients die in a hospital their quality of life is lower than when they die at home or in a hospice. Despite efforts to improve palliative care supply structures, still about 60% of lung cancer patients die in a hospital. Studies have examined factors related to inhospital death in lung cancer patients, yet none used data of a representative German population, additionally including economic aspects. This study aimed to identify factors related to inhospital death in German lung cancer patients and analysed resulting costs. Methods We analysed a dataset of health insurance claims of 17,478 lung cancer patients (incident 2009) with 3 year individual follow-up. We grouped patients into inhospital death and death elsewhere. Studied factors were indicators of healthcare utilization, palliative care, comorbidities and disease spread. We used logistic regression models with LASSO selection method to identify relevant factors. We compared all-cause healthcare expenditures for the last 30 days of life between both groups using generalized linear models with gamma distribution. Results Twelve thousand four hundred fifty-seven patients died in the observation period, thereof 6965 (55.9%) in a hospital. The key factors for increased likelihood of inhospital death were receipt of inpatient palliative care (OR = 1.85), chemotherapeutic treatments in the last 30 days of life (OR = 1.61) and comorbid Congestive Heart Failure (OR = 1.21), and Renal Disease (OR = 1.19). In contrast, higher care level (OR = 0.16), nursing home residency (OR = 0.25) and receipt of outpatient palliative care (OR = 0.25) were associated with a reduced likelihood. All OR were significant (p-values< 0.05). Expenditures in the last 30 days of life were significantly higher for patients with inhospital death (€ 6852 vs. € 33,254, p-value< 0.0001). Conclusion Findings suggest that factors associated with inhospital death often relate to previous contact with hospitals like prior hospitalizations, and treatment of the tumour or comorbidities. Additionally, factors associated with dying elsewhere relate to access to care settings which are more focused on palliation than hospitals. From these results, we can derive that implementing tools like palliative care into tumour-directed therapy might help patients make self-determined decisions about their place of death. This can possibly be achieved at reduced economic burden for SHIs. Electronic supplementary material The online version of this article (10.1186/s12913-018-3599-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Karina Deckert
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377, Munich, Germany. .,Helmholtz Zentrum München GmbH, German Center for Environmental Health, Institute of Health Economics and Health Care Management, Member of Comprehensive Pneumology Center Munich (CPC-M), Member of German Center for Lung Research (DZL), Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany.
| | - Julia Walter
- Helmholtz Zentrum München GmbH, German Center for Environmental Health, Institute of Health Economics and Health Care Management, Member of Comprehensive Pneumology Center Munich (CPC-M), Member of German Center for Lung Research (DZL), Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany
| | - Larissa Schwarzkopf
- Helmholtz Zentrum München GmbH, German Center for Environmental Health, Institute of Health Economics and Health Care Management, Member of Comprehensive Pneumology Center Munich (CPC-M), Member of German Center for Lung Research (DZL), Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany
| |
Collapse
|
12
|
Messerli M, Stolzmann P, Egger-Sigg M, Trinckauf J, D'Aguanno S, Burger IA, von Schulthess GK, Kaufmann PA, Huellner MW. Impact of a Bayesian penalized likelihood reconstruction algorithm on image quality in novel digital PET/CT: clinical implications for the assessment of lung tumors. EJNMMI Phys 2018; 5:27. [PMID: 30255439 PMCID: PMC6156690 DOI: 10.1186/s40658-018-0223-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 07/29/2018] [Indexed: 12/25/2022] Open
Abstract
Background The aim of this study was to evaluate and compare PET image reconstruction algorithms on novel digital silicon photomultiplier PET/CT in patients with newly diagnosed and histopathologically confirmed lung cancer. A total of 45 patients undergoing 18F-FDG PET/CT for initial lung cancer staging were included. PET images were reconstructed using ordered subset expectation maximization (OSEM) with time-of-flight and point spread function modelling as well as Bayesian penalized likelihood reconstruction algorithm (BSREM) with different β-values yielding a total of 7 datasets per patient. Subjective and objective image assessment with all image datasets was carried out, including subgroup analyses for patients with high dose (> 2.0 MBq/kg) and low dose (≤ 2.0 MBq/kg) of 18F-FDG injection regimen. Results Subjective image quality ratings were significantly different among all different reconstruction algorithms as well as among BSREM using different β-values only (both p < 0.001). BSREM with a β-value of 600 was assigned the highest score for general image quality, image sharpness, and lesion conspicuity. BSREM reconstructions resulted in higher SUVmax of lung tumors compared to OSEM of up to + 28.0% (p < 0.001). BSREM reconstruction resulted in higher signal-/ and contrast-to-background ratios of lung tumor and higher signal-/ and contrast-to-noise ratio compared to OSEM up to a β-value of 800. Lower β-values (BSREM450) resulted in the best image quality for high dose 18F-FDG injections, whereas higher β-values (BSREM600) lead to the best image quality in low dose 18F-FDG PET/CT (p < 0.05). Conclusions BSREM reconstruction algorithm used in digital detector PET leads to significant increases of lung tumor SUVmax, signal-to-background ratio, and signal-to-noise ratio, which translates into a higher image quality, tumor conspicuity, and image sharpness.
Collapse
Affiliation(s)
- Michael Messerli
- Department of Nuclear Medicine, University Hospital Zurich/University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
| | - Paul Stolzmann
- Department of Nuclear Medicine, University Hospital Zurich/University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Michèle Egger-Sigg
- Department of Pathology and Molecular Pathology, University Hospital Zurich/University of Zurich, Zurich, Switzerland
| | - Josephine Trinckauf
- Department of Nuclear Medicine, University Hospital Zurich/University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | | | - Irene A Burger
- Department of Nuclear Medicine, University Hospital Zurich/University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Gustav K von Schulthess
- Department of Nuclear Medicine, University Hospital Zurich/University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich/University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Martin W Huellner
- Department of Nuclear Medicine, University Hospital Zurich/University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| |
Collapse
|
13
|
Yang J, Zhang Q, Wang X. Role of nutritional support for postoperative recovery of respiratory function in patients with primary lung cancer. Oncol Lett 2018; 16:5978-5982. [PMID: 30333868 PMCID: PMC6176417 DOI: 10.3892/ol.2018.9348] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 08/10/2018] [Indexed: 11/08/2022] Open
Abstract
This study explored the role of nutritional support for postoperative recovery of respiratory function in patients with primary lung cancer. Clinical data of 182 patients with primary lung cancer who were admitted to Weifang People's Hospital from January 2013 to December 2015 and underwent lung cancer surgery, were collected and retrospectively analyzed. According to the postoperative diet plan, patients were divided into two groups: General diet group (n=80) and nutrition therapy group (n=102). Patients in the general diet group were given a general diet without any nutritional instruction, whereas the patients in the nutrition therapy group were given an enteral nutritional supplement in addition to a general diet. The changes of nutritional indices, recovery status of respiratory function and incidence of adverse events for patients in the two groups were observed, and the data were analyzed statistically. At day 14 after the therapy started, the body mass index, mid-arm circumference and triceps skinfold of patients in the nutrition therapy group were significantly better than those in the general diet group (P<0.05). More significant improvements in levels of hemoglobin, serum albumin and prealbumin were observed in the nutrition therapy group, and the differences in comparison with levels in the general diet group were statistically significant (P<0.05). The respiratory function was more significantly improved for patients in the nutrition therapy group as well, compared to patients in the general diet group (P<0.05). At the end of 1-year follow-up, incidences of malnutrition, lung infection and mortality in the nutrition therapy group were lower than that of the general diet group (P<0.05). The positive impact of appropriate nutritional support on recovery of postoperative respiratory function improved overall outcomes of patients with lung cancer and reduced mortality as well. The nutrition therapy is worth further clinical study.
Collapse
Affiliation(s)
- Jinhong Yang
- Department of Medical Oncology, Weifang People's Hospital, Weifang, Shandong 261000, P.R. China
| | - Qianqian Zhang
- Department of Medical Oncology, Weifang People's Hospital, Weifang, Shandong 261000, P.R. China
| | - Xiaoli Wang
- Department of Radiotherapy, Weifang People's Hospital, Weifang, Shandong 261000, P.R. China
| |
Collapse
|
14
|
Hofer F, Kauczor HU, Stargardt T. Cost-utility analysis of a potential lung cancer screening program for a high-risk population in Germany: A modelling approach. Lung Cancer 2018; 124:189-198. [PMID: 30268459 DOI: 10.1016/j.lungcan.2018.07.036] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Lung cancer is the leading cause of cancer death in Germany. Although several randomized trials in Europe have evaluated the effectiveness of lung cancer screening programs, evidence on the cost-effectiveness of lung cancer screening is scarce. OBJECTIVE To evaluate the cost-effectiveness of a population-based lung cancer screening program from the perspective of a German payer. METHODS We conducted a cost-effectiveness analysis from the public payer perspective for a high-risk population defined as heavy former and current smokers (≥20 cigarettes per day) between 55 and 75 years of age. The underlying model consisted of two Markov models. We differentiated between a population-based annual screening program and standard clinical care. Depending on stage at diagnosis, simulated patients were assigned to one of five treatment paths according to the German clinical guideline for the diagnosis and treatment of lung cancer. Costs, life years saved, and quality adjusted life years (QALYs) were used as outcomes. Values for input parameters were taken from the literature. The model was run for 60 cycles with a cycle length of three months. Deterministic and probabilistic sensitivity analyses were conducted. RESULTS In the base case, annual lung cancer screening led to an increase in incremental costs (€ 1,153 per person) compared to standard clinical care. However, the screening approach was associated with an incremental gain in life years (0.06 per person) and QALYs (0.04 per person). Thus, the incremental cost-effectiveness ratio (ICER) was € 19,302 per life year saved and € 30,291 per QALY. A probabilistic sensitivity analysis with 10,000 draws resulted in average ICERs of € 22,118 per life year and € 34,841 per QALY. CONCLUSION We provide evidence that lung cancer screening for a high-risk population may be more effective, but also more costly, than standard clinical care from the perspective of a German payer.
Collapse
Affiliation(s)
- Florian Hofer
- Hamburg Center for Health Economics (HCHE), University of Hamburg, Esplanade 36, 20354 Hamburg, Germany.
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
| | - Tom Stargardt
- Hamburg Center for Health Economics (HCHE), University of Hamburg, Esplanade 36, 20354 Hamburg, Germany
| |
Collapse
|
15
|
Baumann R, Chan MKH, Pyschny F, Stera S, Malzkuhn B, Wurster S, Huttenlocher S, Szücs M, Imhoff D, Keller C, Balermpas P, Rades D, Rödel C, Dunst J, Hildebrandt G, Blanck O. Clinical Results of Mean GTV Dose Optimized Robotic-Guided Stereotactic Body Radiation Therapy for Lung Tumors. Front Oncol 2018; 8:171. [PMID: 29868486 PMCID: PMC5966546 DOI: 10.3389/fonc.2018.00171] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/01/2018] [Indexed: 12/24/2022] Open
Abstract
Introduction We retrospectively evaluated the efficacy and toxicity of gross tumor volume (GTV) mean dose optimized stereotactic body radiation therapy (SBRT) for primary and secondary lung tumors with and without robotic real-time motion compensation. Materials and methods Between 2011 and 2017, 208 patients were treated with SBRT for 111 primary lung tumors and 163 lung metastases with a median GTV of 8.2 cc (0.3–174.0 cc). Monte Carlo dose optimization was performed prioritizing GTV mean dose at the potential cost of planning target volume (PTV) coverage reduction while adhering to safe normal tissue constraints. The median GTV mean biological effective dose (BED)10 was 162.0 Gy10 (34.2–253.6 Gy10) and the prescribed PTV BED10 ranged 23.6–151.2 Gy10 (median, 100.8 Gy10). Motion compensation was realized through direct tracking (44.9%), fiducial tracking (4.4%), and internal target volume (ITV) concepts with small (≤5 mm, 33.2%) or large (>5 mm, 17.5%) motion. The local control (LC), progression-free survival (PFS), overall survival (OS), and toxicity were analyzed. Results Median follow-up was 14.5 months (1–72 months). The 2-year actuarial LC, PFS, and OS rates were 93.1, 43.2, and 62.4%, and the median PFS and OS were 18.0 and 39.8 months, respectively. In univariate analysis, prior local irradiation (hazard ratio (HR) 0.18, confidence interval (CI) 0.05–0.63, p = 0.01), GTV/PTV (HR 1.01–1.02, CI 1.01–1.04, p < 0.02), and PTV prescription, mean GTV, and maximum plan BED10 (HR 0.97–0.99, CI 0.96–0.99, p < 0.01) were predictive for LC while the tracking method was not (p = 0.97). For PFS and OS, multivariate analysis showed Karnofsky Index (p < 0.01) and tumor stage (p ≤ 0.02) to be significant factors for outcome prediction. Late radiation pneumonitis or chronic rip fractures grade 1–2 were observed in 5.3% of the patients. Grade ≥3 side effects did not occur. Conclusion Robotic SBRT is a safe and effective treatment for lung tumors. Reducing the PTV prescription and keeping high GTV mean doses allowed the reduction of toxicity while maintaining high local tumor control. The use of real-time motion compensation is strongly advised, however, well-performed ITV motion compensation may be used alternatively when direct tracking is not feasible.
Collapse
Affiliation(s)
- Rene Baumann
- Department of Radiation Oncology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany.,Saphir Radiochirurgie Zentrum Frankfurt und Norddeutschland, Güstrow, Germany
| | - Mark K H Chan
- Department of Radiation Oncology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Florian Pyschny
- Department of Radiation Oncology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Susanne Stera
- Department of Radiation Oncology, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Bettina Malzkuhn
- Department of Radiation Oncology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Stefan Wurster
- Saphir Radiochirurgie Zentrum Frankfurt und Norddeutschland, Güstrow, Germany.,Department of Radiation Oncology, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Stefan Huttenlocher
- Saphir Radiochirurgie Zentrum Frankfurt und Norddeutschland, Güstrow, Germany
| | - Marcella Szücs
- Department of Radiation Oncology, Universitätsmedizin Rostock, Rostock, Germany
| | - Detlef Imhoff
- Department of Radiation Oncology, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Christian Keller
- Saphir Radiochirurgie Zentrum Frankfurt und Norddeutschland, Güstrow, Germany.,Department of Radiation Oncology, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Panagiotis Balermpas
- Saphir Radiochirurgie Zentrum Frankfurt und Norddeutschland, Güstrow, Germany.,Department of Radiation Oncology, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Dirk Rades
- Department of Radiation Oncology, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Claus Rödel
- Department of Radiation Oncology, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Jürgen Dunst
- Department of Radiation Oncology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany.,Department of Radiation Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Guido Hildebrandt
- Department of Radiation Oncology, Universitätsmedizin Rostock, Rostock, Germany
| | - Oliver Blanck
- Department of Radiation Oncology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany.,Saphir Radiochirurgie Zentrum Frankfurt und Norddeutschland, Güstrow, Germany
| |
Collapse
|
16
|
Li Y, Jin G, Su D. Comparison of Gadolinium-enhanced MRI and 18FDG PET/PET-CT for the diagnosis of brain metastases in lung cancer patients: A meta-analysis of 5 prospective studies. Oncotarget 2018; 8:35743-35749. [PMID: 28415747 PMCID: PMC5482613 DOI: 10.18632/oncotarget.16182] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 03/06/2017] [Indexed: 11/25/2022] Open
Abstract
Objective We undertook this meta-analysis to compare the significance of Gadolinium-enhanced MRI and 18FDG PET/PET-CT for diagnosing brain metastases of lung cancer patients. Results Five articles comprising 941 patients were included for analysis. The sensitivities with 95% confidence interval for PET/PET-CT and MRI were 0.21 (0.13 − 0.32) and 0.77 (95% CI = 0.60 − 0.89), specificities were 1.00 (0.99 − 1.00) and 0.99 (0.97 − 1.00), and the areas under curve were 0.98 (0.96 − 0.89) and 0.97 (0.96 − 0.98). Materials and Methods A computerized literature search of studies was conducted in the Pubmed and Embase databases. Meta-analysis methods were used to calculate the sensitivities, specificities, likelihood ratios ratios, diagnostic odd ratios, and areas under summary receiver operating characteristic curves for PET/PET-CT and MRI, respectively. Conclusions The analysis suggested Gadolinium-enhanced MRI had higher sensitivity than 18FDG PET/PET-CT for the diagnosis of brain metastases in lung cancer. MRI may provide additional information to PET-CT for diagnosing brain metastatic lesions.
Collapse
Affiliation(s)
- Ye Li
- Department of Radiology, Cancer Hospital of Guangxi Medical University, Nanning, People's Republic of China.,Department of Radiation Oncology, Cancer Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Guanqiao Jin
- Department of Radiology, Cancer Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Danke Su
- Department of Radiology, Cancer Hospital of Guangxi Medical University, Nanning, People's Republic of China
| |
Collapse
|
17
|
Heydt C, Michels S, Thress KS, Bergner S, Wolf J, Buettner R. Novel approaches against epidermal growth factor receptor tyrosine kinase inhibitor resistance. Oncotarget 2018; 9:15418-15434. [PMID: 29632655 PMCID: PMC5880615 DOI: 10.18632/oncotarget.24624] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 02/21/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The identification and characterization of molecular biomarkers has helped to revolutionize non-small-cell lung cancer (NSCLC) management, as it transitions from target-focused to patient-based treatment, centered on the evolving genomic profile of the individual. Determination of epidermal growth factor receptor (EGFR) mutation status represents a critical step in the diagnostic process. The recent emergence of acquired resistance to "third-generation" EGFR tyrosine kinase inhibitors (TKIs) via multiple mechanisms serves to illustrate the important influence of tumor heterogeneity on prognostic outcomes in patients with NSCLC. DESIGN This literature review examines the emergence of TKI resistance and the course of disease progression and, consequently, the clinical decision-making process in NSCLC. RESULTS Molecular markers of acquired resistance, of which T790M and HER2 or MET amplifications are the most common, help to guide ongoing treatment past the point of progression. Although tissue biopsy techniques remain the gold standard, the emergence of liquid biopsies and advances in analytical techniques may eventually allow "real-time" monitoring of tumor evolution and, in this way, help to optimize targeted treatment approaches. CONCLUSIONS The influence of inter- and intra-tumor heterogeneity on resistance mechanisms should be considered when treating patients using resistance-specific therapies. New tools are necessary to analyze changes in heterogeneity and clonal composition during drug treatment. The refinement and standardization of diagnostic procedures and increased accessibility to technology will ultimately help in personalizing the management of NSCLC.
Collapse
Affiliation(s)
- Carina Heydt
- Molecular Pathological Diagnostics, Institute of Pathology, University Hospital Cologne, Cologne, Germany
- Center of Integrated Oncology Köln-Bonn, University Hospital Cologne, Cologne, Germany
| | - Sebastian Michels
- Center of Integrated Oncology Köln-Bonn, University Hospital Cologne, Cologne, Germany
- Department I of Internal Medicine, Center for Integrated Oncology Köln-Bonn, University Hospital of Cologne, Cologne, Germany
| | | | - Sven Bergner
- Medical Affairs, AstraZeneca Oncology, Wedel, Germany
| | - Jürgen Wolf
- Center of Integrated Oncology Köln-Bonn, University Hospital Cologne, Cologne, Germany
- Department I of Internal Medicine, Center for Integrated Oncology Köln-Bonn, University Hospital of Cologne, Cologne, Germany
| | - Reinhard Buettner
- Molecular Pathological Diagnostics, Institute of Pathology, University Hospital Cologne, Cologne, Germany
- Center of Integrated Oncology Köln-Bonn, University Hospital Cologne, Cologne, Germany
| |
Collapse
|
18
|
Walter J, Tufman A, Leidl R, Holle R, Schwarzkopf L. Rural versus urban differences in end-of-life care for lung cancer patients in Germany. Support Care Cancer 2018; 26:2275-2283. [DOI: 10.1007/s00520-018-4063-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 01/22/2018] [Indexed: 10/18/2022]
|
19
|
Krüger S, Mottaghy FM, Buck AK, Maschke S, Kley H, Frechen D, Wibmer T, Reske SN, Pauls S. Brain metastasis in lung cancer. Nuklearmedizin 2017; 50:101-6. [PMID: 21165538 DOI: 10.3413/nukmed-0338-10-07] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Accepted: 11/25/2010] [Indexed: 11/20/2022]
Abstract
SummaryFDG-PET/CT is increasingly used in staging of lung cancer as single „one stop shop” method. Aim, patients, methods: We prospectively included 104 neurological asymptomatic patients (65 years, 26% women) with primary diagnosis of lung cancer. In all patients PET/CT including cerebral imaging and cerebral MRI were performed. Results: Diagnosis of brain metastases (BM) was made by PET/CT in 8 patients only (7.7%), by MRI in 22 (21.2%). In 80 patients both PET/CT and MRI showed no BM. In 6 patients (5.8%) BM were detectable on PET/CT as well as on MRI. Exclusive diagnosis of BM by MRI with negative finding on PET/CT was present in 16 patients (15.4%). 2 patients (1.9%) had findings typical for BM on PET/CT but were negative on MRI. With MRI overall 100 BM were detected, with PET/CT only 17 BM (p < 0.01). For the diagnosis of BM PET/CT showed a sensitivity of 27.3%, specificity of 97.6%, positive predictive value of 75% and negative predictive value of 83.3%. BM diameter on PET/CT and MRI were consistent in 43%, in 57% BM were measured larger on MRI. Discussion: Compared to the gold standard of MRI for cerebral staging a considerable number of patients are falsely diagnosed as free from BM by PET/CT. MRI is more accurate than PET/CT for detecting multiple and smaller BM. Conclusion: In patients with a curative option MRI should be performed additionally to PET/CT for definitive exclusion of brain metastases.
Collapse
Affiliation(s)
- S Krüger
- Medical Clinic II, Medical Faculty, University of Ulm, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Flockerzi FA, Roggia C, Langer F, Holleczek B, Bohle RM. FGFR1 gene amplification in squamous cell carcinomas of the lung: a potential favorable prognostic marker for women and for patients with advanced cancer. Virchows Arch 2017; 472:759-769. [PMID: 29270870 DOI: 10.1007/s00428-017-2282-0] [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: 09/27/2017] [Revised: 11/30/2017] [Accepted: 12/11/2017] [Indexed: 12/01/2022]
Abstract
In squamous cell carcinoma (SCC) of the lung, mutations within the genes of fibroblast growth factor receptors (FGFR) such as K660N/K660E in FGFR2 and R248C/S249C in FGFR3 and FGFR1 gene amplification have been described, but their prognostic relevance still remains unclear. In order to detect the mutation frequencies and to define their prognostic value for associated clinicopathologic features and survival of patients, resected ΔNp63/p40-positive SCC of the lung (n = 101) were screened for FGFR1 gene amplification by fluorescence in situ hybridization performed on formalin-fixed paraffin embedded tissues and for the presumed driver mutations in genes of FGFR2 and FGFR3 by PCR and Sanger sequencing. Twenty-two of 101 SCCs (22%) were positive for amplification based on a FGFR1/centromere (chromosome 8) ratio > 2.0 or higher. In advanced tumor stages (III-IV), the overall survival of patients carrying FGFR1 gene amplification was significantly higher (p = 0.006). Among women, FGFR1 gene amplification was significantly associated with longer overall survival (p = 0.023). The presence of FGFR1 gene amplification was associated with patient age (65 versus 69 years, p = 0.046), but not with gender, tumor stage, histologic subtype, tumor grade, or ΔNp63/p40 immunoreactivity. The S249C mutation in the FGFR3 gene was identified in one out of 101 SCCs (1%); the K600N, K660E, or R248C mutations were not identified. These results suggest that FGFR1 gene amplification is a frequent alteration in SCC of the lung and appears not to be a negative but rather a favorable prognostic marker for women and particularly for patients with advanced SCC of the lung (stage III-IV).
Collapse
Affiliation(s)
- Fidelis Andrea Flockerzi
- Department of Pathology, Saarland University Medical Center, Homburg, Building 26, 66421, Homburg, Germany.
| | - Cristiana Roggia
- Department of Pathology, Saarland University Medical Center, Homburg, Building 26, 66421, Homburg, Germany.,Department of Interdisciplinary Division of Neuro-Oncology, University Hospital Tübingen, Tübingen, Germany
| | - Frank Langer
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Germany
| | | | - Rainer M Bohle
- Department of Pathology, Saarland University Medical Center, Homburg, Building 26, 66421, Homburg, Germany.,Cancer Center Saarland, Saarland University Medical Center, Homburg, Germany
| |
Collapse
|
21
|
Schmidt K, Damm K, Vogel A, Golpon H, Manns MP, Welte T, Graf von der Schulenburg JM. Therapy preferences of patients with lung and colon cancer: a discrete choice experiment. Patient Prefer Adherence 2017; 11:1647-1656. [PMID: 29033552 PMCID: PMC5630067 DOI: 10.2147/ppa.s138863] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES There is increasing interest in studies that examine patient preferences to measure health-related outcomes. Understanding patients' preferences can improve the treatment process and is particularly relevant for oncology. In this study, we aimed to identify the subgroup-specific treatment preferences of German patients with lung cancer (LC) or colorectal cancer (CRC). METHODS Six discrete choice experiment (DCE) attributes were established on the basis of a systematic literature review and qualitative interviews. The DCE analyses comprised generalized linear mixed-effects model and latent class mixed logit model. RESULTS The study cohort comprised 310 patients (194 with LC, 108 with CRC, 8 with both types of cancer) with a median age of 63 (SD =10.66) years. The generalized linear mixed-effects model showed a significant (P<0.05) degree of association for all of the tested attributes. "Strongly increased life expectancy" was the attribute given the greatest weight by all patient groups. Using latent class mixed logit model analysis, we identified three classes of patients. Patients who were better informed tended to prefer a more balanced relationship between length and health-related quality of life (HRQoL) than those who were less informed. Class 2 (LC patients with low HRQoL who had undergone surgery) gave a very strong weighting to increased length of life. We deduced from Class 3 patients that those with a relatively good life expectancy (CRC compared with LC) gave a greater weight to moderate effects on HRQoL than to a longer life. CONCLUSION Overall survival was the most important attribute of therapy for patients with LC or CRC. Differences in treatment preferences between subgroups should be considered in regard to treatment and development of guidelines. Patients' preferences were not affected by sex or age, but were affected by the cancer type, HRQoL, surgery status, and the main source of information on the disease.
Collapse
Affiliation(s)
- Katharina Schmidt
- Leibniz University of Hannover, Center for Health Economics Research (CHERH), Hannover, Germany
| | - Kathrin Damm
- Leibniz University of Hannover, Center for Health Economics Research (CHERH), Hannover, Germany
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Heiko Golpon
- Department of Pneumology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Tobias Welte
- Department of Pneumology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - J-Matthias Graf von der Schulenburg
- Leibniz University of Hannover, Center for Health Economics Research (CHERH), Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| |
Collapse
|
22
|
Abstract
Zusammenfassung. Dieser Artikel bietet eine Übersicht zum Forschungsstand zu Tanztherapie bei Krebs. Der erste Teil widmet sich der theoretischen Fundierung der Tanztherapie im onkologischen Setting. Der zweite Teil fasst wissenschaftliche Erkenntnisse aus Tanztherapie Studien in der onkologischen Behandlung zusammen. Abschließend werden Einsatzmöglichkeiten während verschiedener Phasen der Behandlung mit entsprechenden tanztherapeutischen Behandlungszielen aus den Studienergebnissen abgeleitet. Die Literaturrecherche ergab, dass Tanztherapie in allen Phasen der Krebsbehandlung eingesetzt wird mit dem Ziel, den emotionalen, sozialen, physischen und spirituellen Zustand der Patientinnen und Patienten zu verbessern. Zukünftige randomisierte kontrollierte Trials könnten die Wirksamkeit spezifischer tanztherapeutischer Interventionen während unterschiedlicher Behandlungsphasen auf Symptome und bei Männern und Kindern untersuchen.
Collapse
|
23
|
Affiliation(s)
- L Kintzelé
- Diagnostische und Interventionelle Radiologie, Radiologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
| | - M-A Weber
- Diagnostische und Interventionelle Radiologie, Radiologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| |
Collapse
|
24
|
Abstract
Lung cancer is a frequently occurring disease, particularly in the elderly; however, within the last 10 years the pharmaceutical treatment of lung cancer has been significantly improved. Due to a better understanding of the pathophysiological events and the identification of molecular subgroups of lung tumors, new therapeutic drugs have been developed that significantly prolong survival of patients with the respective molecular pattern. In particular immunotherapeutic agents, such as programmed death-ligand 1 (PD-L1) and programmed death 1 (PD1) antibodies have shown promising clinical results in a subgroup of lung cancer patients. Due to the high incidence of both lung cancer and rheumatic diseases they often occur together, which necessitates an interdisciplinary management. The success of improved therapy of lung cancer has led to a greater focus on the treatment of comorbidities; however, interventions into the immune system by immune checkpoint inhibitors can lead to new challenges when an autoimmune disease is simultaneously present. The possibility of an effective screening for lung cancer in the future also presents the prospect of an improvement in mortality, which raises the question of the optimal monitoring of patients with rheumatoid arthritis (RA) under immunosuppressive therapy. The aim of this review is to discuss the interaction between lung cancer and RA with respect to the currently available data.
Collapse
|
25
|
Hoffmann H, Junker K, Kugler C, Schnabel PA, Warth A. Anwendung und Interpretation der R‑Klassifikation beim Lungenkarzinom. DER PATHOLOGE 2016; 37:258-68. [DOI: 10.1007/s00292-016-0141-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
26
|
Luzak A, Schnell-Inderst P, Bühn S, Mayer-Zitarosa A, Siebert U. Clinical effectiveness of cancer screening biomarker tests offered as self-pay health service: a systematic review. Eur J Public Health 2016; 26:498-505. [PMID: 26733629 DOI: 10.1093/eurpub/ckv227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Biomarker tests are increasingly being offered by laboratories and clinicians as self-pay health services to screen asymptomatic individuals; however, sufficient evidence may not be available to support this practice. We investigated the benefit-harm tradeoffs associated with 11 biomarkers currently offered in Germany as self-pay tests to screen for cancer. METHODS We systematically searched bibliographic databases for health technology assessments, systematic reviews and randomized-controlled trials (RCTs) through September 2015. We included publications that analysed cancer screening biomarkers and reported patient-relevant outcomes (mortality, morbidity, quality of life), and potential harms of screening, among asymptomatic individuals in screening and non-screening arms. Language was restricted to English and German. Two reviewers independently screened references; data were extracted and quality of included studies was evaluated by a reviewer and validated by a second reviewer. RESULTS Six publications of secondary literature and four publications reporting results from two RCTs were included. For 10 cancer screening biomarkers, no direct evidence on patient-relevant outcomes was available. Only one trial, which simultaneously assessed cancer antigen 125 (CA125) and vaginal ultrasound for ovarian cancer screening, provided the outcome of interest. Screening compared with usual care did not reduce ovarian cancer mortality. Patient harms included overdiagnosis and false-positive results. CONCLUSION Although ovarian cancer screening with CA125 showed no benefit, false-positive tests, overdiagnosis and overtreatment were reported. Physicians and laboratories should provide patients with comprehensive information about the lack of evidence and potential harms caused by biomarker screening tests offered as a self-pay health service.
Collapse
Affiliation(s)
- Agnes Luzak
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i. T, Austria Division of Health Technology Assessment and Bioinformatics, Oncotyrol - Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - Petra Schnell-Inderst
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i. T, Austria Division of Health Technology Assessment and Bioinformatics, Oncotyrol - Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - Stefanie Bühn
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i. T, Austria Division of Health Technology Assessment and Bioinformatics, Oncotyrol - Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - Anja Mayer-Zitarosa
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i. T, Austria Division of Health Technology Assessment and Bioinformatics, Oncotyrol - Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i. T, Austria Division of Health Technology Assessment and Bioinformatics, Oncotyrol - Center for Personalized Cancer Medicine, Innsbruck, Austria Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
27
|
Kloke M, Cherny N. Treatment of dyspnoea in advanced cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol 2015; 26 Suppl 5:v169-73. [PMID: 26314777 DOI: 10.1093/annonc/mdv306] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Affiliation(s)
- M Kloke
- Department of Palliative Medicine and Institute for Palliative Care, Kliniken Essen-Mitte, Academic Teaching Hospital University Essen-Duisburg, Essen, Germany
| | - N Cherny
- Department of Medical Oncology, Shaare Zedek Medical Center, Jerusalem, Israel
| |
Collapse
|
28
|
ten Haaf A, Pscherer S, Fries K, Barth S, Gattenlöhner S, Tur MK. Phage display-based on-slide selection of tumor-specific antibodies on formalin-fixed paraffin-embedded human tissue biopsies. Immunol Lett 2015; 166:65-78. [DOI: 10.1016/j.imlet.2015.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 05/22/2015] [Accepted: 05/25/2015] [Indexed: 10/24/2022]
|
29
|
Skaug K, Eide GE, Gulsvik A. What is the minimum number of patients for quality control of lung cancer management in Norway? CLINICAL RESPIRATORY JOURNAL 2015; 10:707-713. [PMID: 25620395 DOI: 10.1111/crj.12274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 10/17/2014] [Accepted: 01/20/2015] [Indexed: 12/01/2022]
Abstract
INTRODUCTION There are few data available on the optimal number of lung cancer patients needed to generate and compare estimates of quality between units managing lung cancer. The number of lung cancer patients per management unit varies considerably in Norway, where there are 42 hospitals that treated between 1 and 454 lung cancer patients in 2011. AIMS To estimate the differences in quality indicators that are of sufficient importance to change a pulmonary physician's lung cancer management program, and to estimate the size of the patient samples necessary to detect such differences. METHOD Twenty-six physicians were asked about the relative differences from a national average of quality indicators that would change their own lung cancer management program. Sample sizes were calculated to give valid estimates of quality of a management unit based on prevalence of quality indicators and minimally important differences (MID). RESULTS The average MID in quality indicators that would cause a change in management varied from 18% to 24% among 26 chest physicians, depending on the indicator. CONCLUSIONS To generate precise estimates for quality control of lung cancer care in Norway, the number of management units must be reduced. Given the present willingness of chest physicians to change their procedures for management of lung cancer according to the results of quality control indicators, we recommend a maximum of 10 units with a minimum of 200 incident lung cancer patients per year for each management center.
Collapse
Affiliation(s)
- Knut Skaug
- Department of Medicine, NO-5504 Haugesund Hospital, Health Region of Fonna, Haugesund, Norway. .,Section of Thoracic Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway.
| | - Geir E Eide
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway.,Research Group for Lifestyle Epidemiology, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Amund Gulsvik
- Section of Thoracic Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway
| |
Collapse
|
30
|
Schmidt B, Beyer J, Dietrich D, Bork I, Liebenberg V, Fleischhacker M. Quantification of cell-free mSHOX2 Plasma DNA for therapy monitoring in advanced stage non-small cell (NSCLC) and small-cell lung cancer (SCLC) patients. PLoS One 2015; 10:e0118195. [PMID: 25675432 PMCID: PMC4326280 DOI: 10.1371/journal.pone.0118195] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 01/06/2015] [Indexed: 11/19/2022] Open
Abstract
Purpose Most patients suffering from advanced lung cancer die within a few months. To exploit new therapy regimens we need better methods for the assessment of a therapy response. Material and Methods In a pilot study we prospectively enrolled 36 patients with advanced NSCLC and SCLC (34 stage IV, 2 stage IIIB) of whom 34 received standard platinum-based chemo/radiotherapy and two were treated with a tyrosine kinase inhibitor. We measured the levels of extracellular methylated SHOX2 DNA (mSHOX2) in plasma before and during therapy until re-staging. The mSHOX2 analysis was blinded with respect to the clinical data making it an observational study. Results According to the re-staging of 31 first-line patients, 19 patients were classified as non-responders while 12 patients were in the responder group. We observed a tight correlation between radiological data and the change of plasma mSHOX2 level as the equivalent for a therapy response. A ROC analysis showed a high discriminatory power for both patient groups already one week after therapy start (AUC 0.844). Additionally, a Kaplan-Meier and Cox Proportional Hazards analyses revealed a strong relationship between survival and plasma mSHOX2 value p≤0.001 (hazard ratio 11.08) providing some evidence for mSHOX2 also being a predictive marker. Conclusion The longitudinal measurement of extracellular plasma mSHOX2 DNA yields information about the response to cytotoxic treatment and allows an early assessment of treatment response for lung cancer patients. If confirmed in a larger study this would be a valuable tool for selecting and guiding a cytotoxic treatment.
Collapse
Affiliation(s)
- Bernd Schmidt
- Clinic for Internal Medicine I, Department of Pneumology, UKH, Halle/Saale, Germany
| | - Julia Beyer
- Clinic for Internal Medicine I, Department of Pneumology, UKH, Halle/Saale, Germany
| | - Dimo Dietrich
- University Hospital Bonn, Institute of Pathology, Bonn, Germany
| | - Ines Bork
- Clinic for Internal Medicine I, Department of Pneumology, UKH, Halle/Saale, Germany
| | | | - Michael Fleischhacker
- Clinic for Internal Medicine I, Department of Pneumology, UKH, Halle/Saale, Germany
- * E-mail:
| |
Collapse
|
31
|
Poschenrieder F, Beyer L, Rehbock B, Diederich S, Wormanns D, Stroszczynski C, Hamer OW. [Management of solid pulmonary nodules]. Radiologe 2015; 54:436-48. [PMID: 24824378 DOI: 10.1007/s00117-013-2601-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The increasing availability of computed tomography has meant that the number of incidentally detected solitary pulmonary nodules (SPN) has greatly increased in recent years. A reasonable management of these SPN is necessary in order to firstly be able to detect malignant lesions early on and secondly to avoid upsetting the patient unnecessarily or carrying out further stressful diagnostic procedures. This review article shows how the dignity of SPNs can be estimated and based on this how the management can be accomplished taking established guidelines into consideration.
Collapse
Affiliation(s)
- F Poschenrieder
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93042, Regensburg, Deutschland
| | | | | | | | | | | | | |
Collapse
|
32
|
Blum T, Schönfeld N. The lung cancer patient, the pneumologist and palliative care: a developing alliance. Eur Respir J 2014; 45:211-26. [DOI: 10.1183/09031936.00072514] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Considerable evidence is now available on the value of palliative care for lung cancer patients in all stages and at all times during the course of the disease. However, pneumologists and their institutions seem to be widely in arrears with the implementation of palliative care concepts and the development of integrated structures.This review focuses on the available evidence and experience of various frequently unmet needs of lung cancer patients, especially psychological, social, spiritual and cultural ones. A PubMed search for evidence on these aspects of palliative care as well as on barriers to the implementation, on outcome parameters and effectiveness, and on structure and process quality was performed with a special focus on lung cancer patients.As a consequence, this review particularly draws pneumologists’ attention to improving their skills in communication with the patients, their relatives and among themselves, and to establish team structures with more far-reaching competences and continuity than existing multilateral cooperations and conferences can provide. Ideally, any process of structural and procedural improvement should be accompanied by scientific evaluation and measures for quality optimisation.
Collapse
|
33
|
Wielpütz MO, Heußel CP, Herth FJ, Kauczor HU. Radiological diagnosis in lung disease: factoring treatment options into the choice of diagnostic modality. DEUTSCHES ARZTEBLATT INTERNATIONAL 2014; 111:181-7. [PMID: 24698073 PMCID: PMC3977441 DOI: 10.3238/arztebl.2014.0181] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 01/06/2014] [Accepted: 01/06/2014] [Indexed: 01/02/2023]
Abstract
BACKGROUND Chest X-ray, computed tomography (CT), and magnetic resonance imaging (MRI) each have characteristic advantages and disadvantages that need to be considered in clinical decision-making. This point is discussed in reference to the main types of lung disease that are encountered in practice. METHOD A selective literature search was performed in the PubMed and Google Scholar databases. Existing clinical guidelines on the main types of lung disease and studies concerning radiological diagnosis were also con - sidered in this review. RESULTS There have been no more than a few large-scale, controlled comparative trials of different radiological techniques. Chest X-ray provides general orientation as an initial diagnostic study and is especially useful in the diagnosis of pneumonia, cancer, and chronic obstructive pulmonary disease (COPD). Multi-detector CT affords nearly isotropic spatial resolution at a radiation dose of only 0.2-5 mSv, much lower than before. Its main indications, according to current guidelines, are tumors, acute pulmonary embolism, pulmonary hypertension, pulmonary fibrosis, advanced COPD, and pneumonia in a high-risk patient. MRI is used in the diagnosis of cystic fibrosis, pulmonary embolism, pulmonary hypertension, and bronchial carcinoma. The positive predictive value (PPV) of a chest X-ray in outpatients with pneumonia is only 27% (gold standard, CT); in contrast, an initial, non-randomized trial of MRI in nosocomial pneumonia revealed a PPV of 95%. For the staging of mediastinal lymph nodes in bronchial carcinoma, MRI has a PPV of 88% and positron emission tomography with CT (PET/CT) has a PPV of 79%, while CT alone has a PPV of 41% (gold standard, histology). CONCLUSION The choice of radiologicalal technique for the detection, staging, follow-up, and quantification of lung disease should be based on the individual clinical options, so that appropriate treatment can be provided without excessive use of diagnostic testing.
Collapse
Affiliation(s)
- Mark O Wielpütz
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital
- Translational Lung Research Center (TLRC) Heidelberg, German Centre for Lung Research (DZL), Heidelberg
| | - Claus P Heußel
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital
- Translational Lung Research Center (TLRC) Heidelberg, German Centre for Lung Research (DZL), Heidelberg
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Thoraxklinik at Heidelberg University Hospital
| | - Felix J.F Herth
- Translational Lung Research Center (TLRC) Heidelberg, German Centre for Lung Research (DZL), Heidelberg
- Department of Pneumology and Respiratory Critical Care Medicine, Thoraxklinik at Heidelberg University Hospital
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital
- Translational Lung Research Center (TLRC) Heidelberg, German Centre for Lung Research (DZL), Heidelberg
| |
Collapse
|
34
|
Reinmuth N, Meyer A, Hartwigsen D, Schaeper C, Huebner G, Skock-Lober R, Bier A, Gerecke U, Held CP, Reck M. Randomized, double-blind phase II study to compare nitroglycerin plus oral vinorelbine plus cisplatin with oral vinorelbine plus cisplatin alone in patients with stage IIIB/IV non-small cell lung cancer (NSCLC). Lung Cancer 2014; 83:363-8. [PMID: 24462464 DOI: 10.1016/j.lungcan.2014.01.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 12/20/2013] [Accepted: 01/01/2014] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Adding nitroglycerin to the combination of vinorelbine plus cisplatin has been reported to improve the overall survival (OS) of Asian patients with stage IIIB/IV non-small cell lung cancer (NSCLC) probably due to better drug delivery based on changed vascular tonus. The main objective of our study was to evaluate the effect of adding nitroglycerin to vinorelbine and cisplatin in a Caucasian population. METHODS 66 chemonaïve patients with stage IIIB/IV NSCLC received oral vinorelbine (first cycle 60 mg/m(2), subsequent cycles: 80 mg/m(2) in the absence of any hematological toxicity ≥ grade 3 in cycle 1) once daily on days 1 and 8 of each cycle and cisplatin (80 mg/m(2) i.v.) on day 1 of each cycle (q3w). Nitroglycerin (arm A, n=34) or placebo patches (arm B, n=32) were administered once daily from day -3 to day 2 of each cycle and were removed about 12h after administration. One nitroglycerin patch contained 25mg nitroglycerin. RESULTS Median age was 62.5 (33-82) years. In the overall population (n=66), the objective response rate (ORR) was 27.3% (all PR; 95%CI: 17.0-39.6), with a disease control rate (DCR) of 57.6% (95%CI: 44.8-69.7), a median time to progression (TTP) of 4.8 months (n=58; 95%CI: 3.4-5.9) and a median overall survival (OS) of 11.5 months (95%CI: 7.9-13.6). ORR and DCR were numerically higher in arm A than in arm B (35.3% vs. 18.8% and 61.8% vs. 53.1%, respectively), whereas TTP and OS were comparable. The main hematological and non-hematological toxicities grade ≥ 3 were moderate with no significant differences between the two treatment arms. CONCLUSIONS Overall, oral vinorelbine plus cisplatin showed a high level of efficacy and adequate tolerability in first line treatment of NSCLC. Despite the low sample size per group the results seem to confirm the previous results reported in Asian patients.
Collapse
Affiliation(s)
- N Reinmuth
- LungenClinic Grosshansdorf, Department of Thoracic Oncology, member of the German Center for Lung Research, Grosshansdorf, Germany
| | - A Meyer
- Kliniken Maria Hilf, Pneumology, Moenchengladbach, Germany
| | - D Hartwigsen
- Malteser Krankenhaus St. Franziskus, Internal Medicine, Flensburg, Germany
| | - C Schaeper
- Universitaetsklinikum, Internal Medicine, Greifswald, Germany
| | - G Huebner
- Sana Kliniken Ostholstein, Internal Medicine, Oldenburg, Germany
| | | | - A Bier
- Universitaetsklinikum, Pneumology, Rostock, Germany
| | - U Gerecke
- Hanse-Klinikum, Oncology, Stralsund, Germany
| | - C-P Held
- Gesellschaft für medizinische Innovation Hämatologie und Onkologie mbH, Berlin, Germany
| | - M Reck
- LungenClinic Grosshansdorf, Department of Thoracic Oncology, member of the German Center for Lung Research, Grosshansdorf, Germany.
| |
Collapse
|
35
|
Andreas S, Rittmeyer A, Hinterthaner M, Huber RM. Smoking cessation in lung cancer-achievable and effective. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:719-24. [PMID: 24222790 DOI: 10.3238/arztebl.2013.0719] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 08/05/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Lung cancer is the leading cause of death from cancer in Germany. 90% of cases are due to the inhalation of tobacco smoke. About 40% of patients with newly diagnosed lung cancer are still smokers. A structured smoking cessation program is medically reasonable in this situation but is only rarely offered. METHODS This review is based on a selective search in the PubMed database combined with a manual search for current publications. RESULTS Many cross-sectional and longitudinal studies have shown that patients with lung cancer benefit from smoking cessation. After resection with curative intent, second tumors are 2.3 times more common, and recurrent tumors 1.9 times more common, in patients who continue to smoke than in those who stop. The overall mortality in smokers is 2.9 times higher. Smoking cessation also lowers the rate of radiation pneumonitis and infection during radiotherapy and prolongs the median survival after chemoradiotherapy for small-cell lung cancer (18.0 vs. 13.6 months). For patients with non-small-cell lung cancer, smoking cessation is associated with a better general state of health (77.5% vs. 57.6%). For the many patients with lung cancer who are treated palliatively, smoking cessation offers the advantages of improved pulmonary function, weight gain, and better overall quality of life. CONCLUSION Smoking cessation in patients with lung cancer is an important means of increasing the efficacy of treatment and improving their quality of life.
Collapse
Affiliation(s)
- Stefan Andreas
- Stefan Andreas and Achim Rittmeyer have equally contributed to the manuscript ; Lung Hospital Immenhausen, pneumological training hospital of Göttingen University
| | | | | | | |
Collapse
|
36
|
Schneider T, Heussel CP, Herth FJF, Dienemann H. Thermal ablation of malignant lung tumors. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:394-400. [PMID: 23826028 DOI: 10.3238/arztebl.2013.0394] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 02/18/2013] [Indexed: 01/06/2023]
Abstract
BACKGROUND About 50 000 new cases of non-small-cell carcinoma of the lung are diagnosed in Germany each year. More than 20% of the affected patients cannot be offered radical resection because of comorbidity alone. The lung is also the second most common site of distant metastases of extrathoracic tumors; it is the only site of such metastases in 20% of cases. In recent years, image-guided thermoablation has been used with increasing frequency in patients who are unable to undergo surgery for medical reasons. METHODS The PubMed database was selectively searched for publications on the indications, complications, and results of the thermoablative techniques currently in clinical use, with special attention to radiofrequency ablation (RFA). RESULTS There is only a small evidence base to date concerning the treatment of malignant lung tumors with thermoablation. Retrospective and prospective case series have been published, but no randomized controlled trials have yet been conducted. RFA, the most common technique, involves the image-guided percutaneous placement of one or more probes in the tumor, to which thermal energy is then applied. For peripherally located tumors that measure less than 3 cm in diameter, local control of tumor growth can be achieved in about 90% of cases. The long-term results that are now available from smaller series provisionally indicate 5-year survival rates of 20% to 61%. The most common complication is pneumothorax requiring drainage, which occurs in about 10% of cases. In the intermediate term, thermoablation does not cause any clinically relevant loss of pulmonary function. CONCLUSION Image-guided thermoablation cannot now be considered an alternative to surgery for the treatment of malignant lung tumors with curative intent. It does, however, widen the spectrum of therapeutic options for patients who are medically unable to undergo a surgical procedure.
Collapse
Affiliation(s)
- Thomas Schneider
- Department of Thoracic Surgery, St. Vincentius-Kliniken Karlsruhe.
| | | | | | | |
Collapse
|
37
|
Niemoeller OM, Pöllinger B, Niyazi M, Corradini S, Manapov F, Belka C, Huber RM. Mature results of a randomized trial comparing two fractionation schedules of high dose rate endoluminal brachytherapy for the treatment of endobronchial tumors. Radiat Oncol 2013; 8:8. [PMID: 23289530 PMCID: PMC3599644 DOI: 10.1186/1748-717x-8-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 12/08/2012] [Indexed: 01/25/2023] Open
Abstract
Purpose To determine the efficacy of high dose rate endobronchial brachytherapy (HDR-BT) for the treatment of centrally located lung tumors, two different fractionation schedules were compared regarding local tumor response, side effects and survival. Mature retrospective results with longer follow-up and more patients were analyzed. Initial results were published by Huber et al. in 1995. Methods and materials 142 patients with advanced, centrally located malignant tumors with preferential endoluminal growth were randomized to receive 4 fractions of 3.8 Gy (time interval: 1 week, n = 60, group I) or 2 fractions of 7.2 Gy (time interval: 3 weeks, n = 82, group II) endobronchial HDR-BT. Age, gender, tumor stage, Karnofsky Performance Score and histology were equally distributed between both groups. Results Local tumor response with 2 fractions of 7.2 Gy was significantly higher as compared to 4 fractions of 3.8 Gy (median 12 vs. 6 weeks; p ≤ 0.015). Median survival was similar in both groups (19 weeks in the 4 fractions group vs. 18 weeks in the 2 fractions group). Fatal hemoptysis was less frequent following irradiation with 2 × 7.2 Gy than with 4 × 3.8 Gy, although the difference did not achieve statistical significance (12.2% vs. 18.3%, respectively. p = 0,345). Patients presenting with squamous cell carcinoma were at higher risk of bleeding compared to other histology (21.9% vs. 9%, p = 0,035). Multivariate analysis with regard to overall survival, revealed histology (p = 0.02), Karnofsky Performance Score (p < 0.0001) and response to therapy (p < 0.0001) as significant prognostic factors. For patients showing complete response the median survival was 57 weeks, while for patients with progressive disease median survival time was 8 weeks, p < 0.0001. The KPS at the start of the treatment was significantly correlated with survival. Patients presenting with a KPS ≤ 60 at the start had a significantly (p = 0,032) shorter survival time (10 weeks) than patients with a KPS > 60 (29 weeks). Moreover, the Karnofsky Performance Score of most patients improved during therapy (p = 0,001), suggesting successful palliation of cancer associated symptoms. Multivariate analysis with regard to local tumor control found no significant factors. Conclusion Endobronchial HDR-BT is an effective local treatment for advanced centrally located malignant tumors with endoluminal tumor growth. Local tumor response was significantly higher after HDR-BT with 2 × 7.2 Gy.
Collapse
Affiliation(s)
- Olivier M Niemoeller
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians University Munich, Marchioninistr, 15, 81377 Munich, Germany.
| | | | | | | | | | | | | |
Collapse
|
38
|
Plönes T, Krohn A, Burger M, Veelken H, Passlick B, Müller-Quernheim J, Zissel G. Serum level of CC-chemokine ligand 18 is increased in patients with non-small-cell lung cancer and correlates with survival time in adenocarcinomas. PLoS One 2012; 7:e41746. [PMID: 22848587 PMCID: PMC3404958 DOI: 10.1371/journal.pone.0041746] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 06/25/2012] [Indexed: 02/07/2023] Open
Abstract
CC-chemokine ligand 18 (CCL18) is mainly expressed by alternatively activated macrophages and DCs and plays an important role in lung fibrosis, arthritis and other diseases. Here CCL18 was measured in sera of 31 healthy volunteers and 170 patients with lung cancer and correlated these data with histology, tumor stage and clinical parameters. Mean CCL18 serum level of the patients with non-small-cell lung cancer was 150(857) ng/ml vs. 32(61) ng/ml in the healthy control group. Patient groups differ significantly according their histology (adenocarcinoma 143(528) ng/ml vs squamous cell carcinoma 187(857) ng/ml, p<0.02). In addition, we found a significant difference between patients with lower versus higher T-stage (p<0.003). Receiver operating characteristic (ROC) analyses revealed a cutoff point of 83 ng/ml (area under the curve (AUC): 0.968; p<0.0001) to discriminate between healthy controls and non-small-cell lung cancer patients. ROC analyses to discriminate between patients, who died because of cancer related death and those who died for other reasons did not lead to a valid AUC. To stratify the tumor patients, a criterion value plot was performed leading to a point of equal sensitivity and specificity (54%) of 162 ng/ml. Patients with a CCL18 serum level higher than 160 ng/ml had a mean survival time of 623 days. In contrast, those in patients with a baseline level between 83 ng/ml and 160 ng/ml the mean survival time was 984 days (p<0.005). Survival-analysis revealed in adenocarcinoma a mean survival of 1152 days in the group below 83 ng/ml. In the median group the mean survival time was 788 days and in the group with the highest levels the mean survival time was 388 days (p<0.001). In contrast, we found no correlation between the FEV1 and the CCL18 baseline level. In conclusion, in patients suffering from adenocarcinoma increased serum CCL18 levels predict a diminished survival time.
Collapse
Affiliation(s)
- Till Plönes
- Department of Thoracic Surgery, University Medical Center Freiburg, Freiburg, Germany
| | - Alexander Krohn
- Department of Oncology and Haematology, University Medical Center Freiburg, Freiburg, Germany
| | - Meike Burger
- Department of Oncology and Haematology, University Medical Center Freiburg, Freiburg, Germany
| | - Hendrik Veelken
- Department of Haematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Bernward Passlick
- Department of Thoracic Surgery, University Medical Center Freiburg, Freiburg, Germany
| | | | - Gernot Zissel
- Department of Pneumology, University Medical Center Freiburg, Freiburg, Germany
- * E-mail:
| |
Collapse
|
39
|
Pütz K, Engels M, Vollbrecht C, Heukamp LC, Adam AC, Büttner R. [Indications and limitations of fresh frozen sections in the pulmonary apparatus]. DER PATHOLOGE 2012; 33:402-6. [PMID: 22782501 DOI: 10.1007/s00292-012-1603-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Recommendations for the diagnosis of lung tumors almost limit the use of fresh frozen sections to the evaluation of resection margins. In pathology pretherapeutic methods for assessment of clinically suspected lung cancer are favored over intraoperative frozen section diagnosis. For the interdisciplinary management of uncertain lung findings diagnostic methods, such as cytopathology and examination of biopsy material are available. The use of rapid on-site evaluation (ROSE) in cytopathology is limited due to the lack of necessary personnel. Diagnosis of unclear pulmonary lesions or distinction of metastases from primary lung tumors by intraoperative frozen sections is therefore limited to exceptional cases that were not resolved by preoperative biopsies. Such rare cases require a common consensus strategy between thoracic surgeons and pathologists in a preoperative tumor board.
Collapse
Affiliation(s)
- K Pütz
- Institut für Pathologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | | | | | | | | | | |
Collapse
|
40
|
Gompelmann D, Eberhardt R, Herth FJF. Endobronchial ultrasound. Endosc Ultrasound 2012; 1:69-74. [PMID: 24949340 PMCID: PMC4062211 DOI: 10.7178/eus.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Accepted: 05/02/2012] [Indexed: 01/17/2023] Open
Abstract
Endobronchial ultrasound (EBUS) has emerged as a routinely performed procedure in diagnostic bronchoscopy. Extending the view beyond the airway wall, EBUS provides evaluation of tumor involvement of tracheobronchial wall and mediastinum and plays an essential role as a guidance technique for peripheral pulmonary diseases. The latest development is the EBUS-transbronchial needle aspiration (TBNA) scope that allows performing real-time EBUS-TBNA of enlargerd hilar and mediastinal lymph nodes.
Collapse
|
41
|
Linder A, Ertner C, Steger V, Messerschmidt A, Merk J, Cregan I, Timm J, Walles T. Postoperative chest tube management: snapshot of German diversity. Interact Cardiovasc Thorac Surg 2012; 15:622-6. [PMID: 22753431 DOI: 10.1093/icvts/ivs270] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The management of chest tubes is one of the most critical aspects in patient care in thoracic surgery, and no consensus exists regarding the ideal chest tube management strategy. METHODS Chest tube management protocols and their effects on chest tube therapy were compared at four German specialist thoracic surgery units. Altogether, 79 patients were stratified for underlying disease and type of surgery. A digital chest drainage system was applied to objectify the presence of air leakages. RESULTS In our analysis, the average length of drainage therapy was 4.9 ± 2.8 days. Different chest tube management protocols resulted in a significant degree of scatter between units (P = 0.0348). Higher arbitrary postoperative suction levels (4 kPa) resulted in earlier chest tube removal than lower suction levels (2 kPa) (4.2 ± 2.4 vs 5.4 ± 3.0 days, P = 0.06). Patient discharge following chest tube removal was delayed on average by 3.2 ± 2.9 days. This delay was not correlated with the previous duration of chest tube therapy (Spearman's ρ=-0.15, P = 0.25) in contrast to the total length of hospital stay (ρ = 0.59, P < 0.001).
Collapse
Affiliation(s)
- Albert Linder
- Clinic for Thoracic Surgery, Klinikum Bremen Ost, Bremen, Germany
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Mehnert A, Härter M, Koch U. Langzeitfolgen einer Krebserkrankung. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012; 55:509-15. [DOI: 10.1007/s00103-012-1447-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
43
|
Docetaxel–carboplatin chemotherapy combined with cetuximab in patients with locally advanced or metastatic non small-cell lung cancer (NSCLC)—Results of the nonrandomised phase II study TaxErb. Lung Cancer 2012; 75:348-52. [DOI: 10.1016/j.lungcan.2011.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 07/27/2011] [Accepted: 08/13/2011] [Indexed: 01/22/2023]
|
44
|
Petersen I. The morphological and molecular diagnosis of lung cancer. DEUTSCHES ARZTEBLATT INTERNATIONAL 2011; 108:525-31. [PMID: 21886665 PMCID: PMC3163783 DOI: 10.3238/arztebl.2011.0525] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Accepted: 07/16/2010] [Indexed: 01/15/2023]
Abstract
BACKGROUND In Germany, lung cancer causes more deaths than any other malignant disease. Its main etiology is smoking, but other risk factors need to be considered as well. The morphological, molecular and biological phenotype is complex and should no longer be just categorized as either small-cell or non-small cell lung cancer. METHODS This review article is based on the authors' longstanding involvement in the scientific investigation and diagnostic evaluation of lung cancer, including contributions to the current WHO classification and collaboration in the new interdisciplinary classification of adenocarcinoma. The relevant literature was selectively reviewed. RESULTS Lung cancer is morphologically classified into four main subtypes-small-cell carcinoma, squamous-cell carcinoma, adenocarcinoma, and large-cell carcinoma. Genetic and molecular analyses have revealed distinct differences within subtypes; in particular, adenocarcinomas can be further subdivided. Complex techniques of genomic analysis are now available, but clinicopathological data are still the most important determinants of prognosis and are clearly better for this purpose than molecular classification alone. Nonetheless, the assessment of specific molecular markers is becoming increasingly important. CONCLUSION The morphological and molecular classification of lung cancer is undergoing a re-evaluation which will lead to more accurate assessment of individual prognoses and to improved prediction of the response to specific treatment regimens.
Collapse
Affiliation(s)
- Iver Petersen
- Institut für Pathologie, Universitätsklinikum Jena, Ziegelmühlenweg 1, 07743 Jena, Germany
| |
Collapse
|
45
|
Gompelmann D, Eberhardt R, Herth FJF. Advanced malignant lung disease: what the specialist can offer. ACTA ACUST UNITED AC 2011; 82:111-23. [PMID: 21778793 DOI: 10.1159/000329703] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Lung cancer is not only the most commonly diagnosed cancer worldwide, but it is still the leading cause for cancer-related death. The 5-year survival for lung cancer in Europe and in the USA is totally 16%. Therefore, a palliative therapy regimen is required to control the disease and reduce symptoms with the objective of enhancing quality of life of lung cancer patients. In addition to chemotherapy that is still one of the most important pillars in the treatment of advanced lung cancer, further interventional strategies can be offered to improve a patient's quality of life. A locoregional tumour progression is frequently associated with malignant pleural effusion or pericardial effusion, central airway obstruction, tracheo-oesophageal fistula, severe haemoptysis or superior vena cava (SVC) syndrome threatening life and necessitating urgent palliation. Recurrent pleural effusion causing dyspnoea can be managed by pleurodesis, serial thoracocentesis or insertion of an indwelling catheter. Symptomatic malignant pericardial effusion often requires an urgent pericardiocentesis. Furthermore, surgical procedures, instillation of sclerosing agents or local chemotherapy should be considered in refractory pericardial effusion. The therapy regimen of central airway stenosis includes mechanical and thermic endoscopic procedures providing rapid relief of symptoms. To prevent recurrence of airway obstruction, the insertion of a stent or palliative brachytherapy provide re-establishment of the patency of obstructed airways. Haemoptysis can be managed by bronchoscopic interventions as well as by arterial embolization or palliative thoracic radiotherapy. The therapy of SVC syndrome is dependent of histology. In small-cell lung cancer, chemotherapy is recommended. In non-small-cell lung cancer, stent insertion and/or radiotherapy are the therapeutic pillars.
Collapse
Affiliation(s)
- Daniel Gompelmann
- Pneumology and Respiratory Care Medicine, Thoraxklinik at the University of Heidelberg, Heidelberg, Germany.
| | | | | |
Collapse
|
46
|
|
47
|
[Interdisciplinary treatment of non-small cell lung cancer]. Internist (Berl) 2011; 52:158-66. [PMID: 21267533 DOI: 10.1007/s00108-010-2700-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
At the time of diagnosis of non-small cell lung cancer, about two thirds of the patients manifest tumor disease limited to the lungs without distant metastases. In this group localized tumor spread (stages I and II) can be distinguished from locally advanced spread including lymph node metastases (stages IIIA and B). In stages I and II with sufficient cardiopulmonary function, surgical resection is considered the standard treatment approach. If lobe resection is not possible due to comorbidities or limited pulmonary function, parenchyma-sparing resection or definitive radiotherapy is advocated. Postoperative adjuvant chemotherapy is recommended for individual cases in stage IB and as the standard treatment in stage II. In stages IIIA and IIIB interdisciplinary consultation involving pneumologists/oncologists, surgeons, and radiation oncologists is necessary to reach decisions on treatment recommendations. Generally multiple treatment modalities are employed in these stages, such as induction chemotherapy followed by surgery and subsequent irradiation or simultaneous chemoradiotherapy. These treatment combinations with curative intent should be differentiated from the numerous treatment methods with palliative intent.
Collapse
|
48
|
Abstract
In previous years numerous advances in diagnostics, staging and therapy of lung cancer have been achieved. Nevertheless, it remains the most frequent cause of death from cancerous diseases. Early diagnosis and exact staging enable multimodal therapy regimens adjusted to age and comorbidities, which result in complete remission in a few and in prolonged survival and good quality of life in most patients. Curative surgery is possible in stage I non-small cell lung cancer (NSCLC) and results in a 5-year survival rates of up to approximately 75%. Using multimodal therapy approaches long-term survival can even be achieved in 40-50% of patients with advanced T4 tumors. However, in NSCLC with distant metastases median survival time is only 8-12 months. In elderly patients with no surgical options low cytotoxic monotherapy can be employed with a palliative intent. In the limited disease stage of small cell lung cancer (SCLC) long lasting remission after polychemotherapy has been observed in a minority of patients. However, in the extensive disease stage polychemotherapy prolongs the survival time of SCLC patients from 1-2 months to approximately 12 months.
Collapse
|
49
|
Hintze C, Dinkel J, Biederer J, Heussel CP, Puderbach M. [New procedures. Comprehensive staging of lung cancer by MRI]. Radiologe 2011; 50:699-705. [PMID: 20628723 DOI: 10.1007/s00117-009-1959-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Lung cancer staging according to the TNM system is based on morphological assessment of the primary cancer, lymph nodes and metastases. All aspects of this important oncological classification are measurable with MRI. Pulmonary nodules can be detected at the clinically relevant size of 4-5 mm in diameter. The extent of mediastinal, hilar and supraclavicular lymph node affection can be assessed at the same time. The predominant metastatic spread to the adrenal glands and spine can be detected in coronal orientation during dedicated MRI of the lungs. Search focused whole body MRI completes the staging. Various additional MR imaging techniques provide further functional and clinically relevant information during a single examination. In the oncological context the most important techniques are imaging of perfusion and tumor motion. Functional MRI of the lungs complements the pure staging and improves surgical approaches and radiotherapy planning.
Collapse
Affiliation(s)
- C Hintze
- Klinik für Diagnostische Radiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (Haus 23), 24105, Kiel, Deutschland.
| | | | | | | | | |
Collapse
|
50
|
[Lung cancer staging]. Radiologe 2011; 51:135-44. [PMID: 21253686 DOI: 10.1007/s00117-010-2112-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Lung cancer is the third most frequent new cancer diagnosis in Germany. An elaborate clinical diagnosis is essential for successful therapy planning. The necessary examinations are defined in the current S3 guideline on lung cancer diagnosis and therapy. A compilation of diagnostic reports has led to the current 7th edition of the TNM system. According to this update staging is carried out in terms of tumor extent, lymph node status and distant metastases. The resultant tumor stage forms the basis for individual therapy planning. Current guidelines as well as the current TNM system are presented. The usefulness of modern cross-sectional imaging and the possible modalities in this system is reported.
Collapse
|