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Zhao Y, Mei T, Na F, Tian X, Ao R, Long X, Luo Q, Duan P, Zhu J, Wang Y, Huang M, Liu Y, Gong Y. First-line treatment of driver gene-negative metastatic lung adenocarcinoma with malignant pleural effusion: Should chemotherapy be combined with an immune checkpoint inhibitor or bevacizumab? Invest New Drugs 2024; 42:196-206. [PMID: 38386170 PMCID: PMC10944392 DOI: 10.1007/s10637-024-01424-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 01/22/2024] [Indexed: 02/23/2024]
Abstract
Patients with metastatic lung adenocarcinoma (MLA) and malignant pleural effusion (MPE) without driver gene mutations have a poor prognosis. None of the standard treatment strategies is recommended for such patients. We retrospectively analyzed the efficacy of the first-line treatment for this specific population: standard platinum-based doublet chemotherapy (CT), CT plus an immune checkpoint inhibitor (CT plus ICI), and CT plus bevacizumab (CT plus Bev). A total of 323 eligible patients were enrolled: CT alone (n = 166), CT plus Bev (n = 72), and CT plus ICI (n = 85). Treatment efficacy assessments were performed every two cycles according to the RECIST guidelines. The endpoints were overall survival (OS) and progression-free survival (PFS). Kaplan-Meier (K‒M) curves and the log-rank test were used to compare OS and PFS. p < 0.05 was the threshold of significance (statistical software: SPSS). The median follow-up was 11.4 months (range, 2.1-49.6 months). PFS and OS in the CT plus ICI/CT plus Bev cohort were significantly longer than those in the CT group (PFS: 7.8/6.4/3.9 months, p < 0.0001; OS: 16.4/15.6/9.6 months, p < 0.0001, respectively). CT plus Bev had better PFS and OS than CT plus ICI/CT in PD-L1 < 1% patients (PFS: 8.4/5.0/3.8 months, p < 0.0001; OS: 15.6/12.9/9.3 months, p < 0.0001). Among patients with PD-L1 1-49%, CT plus ICI led to a longer PFS and OS (PFS: 8.9/5.8/4.2 months, p = 0.009; OS: 24.2/18.8/11.5 months, p = 0.03). In the cohort with PD-L1 ≥ 50%, CT plus ICI was still the best first-line treatment (PFS: 19.7/13.8/9.6 months, p = 0.033; OS: 27.2/19.6/14.9 months, p = 0.047). In driver gene-negative MLA with MPE, CT plus Bev or ICI better controlled MPE and significantly prolonged survival compared to CT alone. PD-L1 expression (negative/positive) may be a key factor influencing the choice of CT plus Bev or ICI.
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Affiliation(s)
- Yuanyuan Zhao
- Division of Thoracic Tumor Multidisciplinary Treatment, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
- Department of Oncology, Chengdu Pidu District Hospital of Traditional Chinese Medicine, Chengdu, 611730, People's Republic of China
| | - Ting Mei
- Lung Cancer Center, West China Tianfu Hospital, Sichuan University, Chengdu, 610213, People's Republic of China
| | - Feifei Na
- Division of Thoracic Tumor Multidisciplinary Treatment, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Xiaoman Tian
- Department of Oncology, Chengdu Jinniu District People's Hospital, Chengdu, 610031, People's Republic of China
| | - Rui Ao
- Department of Oncology, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, 610072, People's Republic of China
| | - Xiangyu Long
- Department of Oncology, Sichuan Provincial Guang'An People's Hospital, Guang'An, 638500, People's Republic of China
| | - Qiang Luo
- Department of Oncology, Chengdu Xinjin District Hospital of Traditional Chinese Medicine, Chengdu, 611430, People's Republic of China
| | - Ping Duan
- Department of Oncology, Chengdu First People's Hospital, Chengdu, 610095, People's Republic of China
| | - Jiang Zhu
- Department of Oncology, West China Shangjin Hospital, Sichuan University, Chengdu, 611730, People's Republic of China
| | - Yongsheng Wang
- Division of Thoracic Tumor Multidisciplinary Treatment, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Meijuan Huang
- Division of Thoracic Tumor Multidisciplinary Treatment, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yongmei Liu
- Division of Thoracic Tumor Multidisciplinary Treatment, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
| | - Youling Gong
- Division of Thoracic Tumor Multidisciplinary Treatment, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
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Mansur A, Garg T, Camacho JC, Habibollahi P, Edward Boas F, Khorshidi F, Buethe J, Nezami N. Image-Guided Percutaneous and Transarterial Therapies for Primary and Metastatic Lung Cancer. Technol Cancer Res Treat 2023; 22:15330338231164193. [PMID: 36942407 PMCID: PMC10034348 DOI: 10.1177/15330338231164193] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
Lung cancer is the leading cause of cancer mortality in the world. A significant proportion of patients with lung cancer are not candidates for surgery and must resort to other treatment alternatives. Rapid technological advancements in fields like interventional radiology have paved the way for valid treatment modalities like image-guided percutaneous and transarterial therapies for treatment of both primary and metastatic lung cancer. The rationale of ablative therapies relies on the fact that focused delivery of energy induces tumor destruction and pathological necrosis. Image-guided percutaneous thermal ablation therapies are established techniques in the local treatment of hepatic, renal, bone, thyroid, or uterine lesions. In the lung, the 3 main indications for lung ablation include local curative intent, a strategy to achieve a chemoholiday in oligometastatic disease, and recently, oligoprogressive disease. Transarterial therapies include a set of catheter-based treatments that involve delivering embolic and/or chemotherapeutic agents directed into the target tumor via the supplying arteries. This article provides a comprehensive review of the various techniques available and discusses their applications and associated complications in primary and metastatic lung cancer.
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Affiliation(s)
| | - Tushar Garg
- Division of Vascular and Interventional Radiology, Russell H Morgan Department of Radiology and Radiological Science, The 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Juan C Camacho
- Vascular and Interventional Radiology, Radiology Associates of Florida, Sarasota, FL, USA
| | - Peiman Habibollahi
- Department of Interventional Radiology, 4002University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - F Edward Boas
- Department of Radiology, 20220City of Hope Cancer Center, Duarte, CA, USA
| | - Fereshteh Khorshidi
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, 12264University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ji Buethe
- Division of Vascular and Interventional Radiology, Russell H Morgan Department of Radiology and Radiological Science, The 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nariman Nezami
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, 12264University of Maryland School of Medicine, Baltimore, MD, USA
- Experimental Therapeutics Program, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
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3
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Li X, Gu W, Liu Y, Wen X, Tian L, Yan S, Chen S. A novel quantitative prognostic model for initially diagnosed non-small cell lung cancer with brain metastases. Cancer Cell Int 2022; 22:251. [PMID: 35948974 PMCID: PMC9367158 DOI: 10.1186/s12935-022-02671-2] [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: 04/27/2022] [Accepted: 08/02/2022] [Indexed: 11/27/2022] Open
Abstract
Background The prognosis of non-small cell lung cancer (NSCLC) with brain metastases (BMs) had been researched in some researches, but the combination of clinical characteristics and serum inflammatory indexes as a noninvasive and more accurate model has not been described. Methods We retrospectively screened patients with BMs at the initial diagnosis of NSCLC at Sun Yat-Sen University Cancer Center. LASSO-Cox regression analysis was used to establish a novel prognostic model for predicting OS based on blood biomarkers. The predictive accuracy and discriminative ability of the prognostic model was compared to Adjusted prognostic Analysis (APA), Recursive Partition Analysis (RPA), and Graded Prognostic Assessment (GPA) using concordance index (C-index), time-dependent receiver operating characteristic (td-ROC) curve, Decision Curve Analysis(DCA), net reclassification improvement index (NRI), and integrated discrimination improvement index (IDI). Results 10-parameter signature's predictive model for the NSCLC patients with BMs was established according to the results of LASSO-Cox regression analysis. The C-index of the prognostic model to predict OS was 0.672 (95% CI = 0.609 ~ 0.736) which was significantly higher than APA,RPA and GPA. The td-ROC curve and DCA of the predictive model also demonstrated good predictive accuracy of OS compared to APA, RPA and GPA. Moreover, NRI and IDI analysis indicated that the prognostic model had improved prediction ability compared with APA, RPA and GPA. Conclusion The novel prognostic model demonstrated favorable performance than APA, RPA, and GPA for predicting OS in NSCLC patients with BMs. Supplementary Information The online version contains supplementary material available at 10.1186/s12935-022-02671-2.
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Affiliation(s)
- Xiaohui Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, People's Republic of China.,Department of Clinical Laboratory Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
| | - Wenshen Gu
- Department of Laboratory Medicine, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Guangzhou, 510120, People's Republic of China
| | - Yijun Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, People's Republic of China.,Department of Clinical Laboratory Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
| | - Xiaoyan Wen
- Department of Central Sterile Supply, Guanghua School of Stomatology, Affiliated Stomatological Hospital, Guangdong Province Key Laboratory of Stomatology, Sun Yat-Sen University, Guangzhou, Guangdong, 510055, People's Republic of China
| | - Liru Tian
- Research Center for Translational Medicine, the First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, Guangdong, 510080, People's Republic of China
| | - Shumei Yan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, People's Republic of China. .,Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.
| | - Shulin Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, People's Republic of China. .,Department of Clinical Laboratory Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China. .,Guangdong Esophageal Cancer Institute, Guangzhou, 510060, People's Republic of China.
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Pagnotti GM, Trivedi T, Mohammad KS. Translational Strategies to Target Metastatic Bone Disease. Cells 2022; 11:1309. [PMID: 35455987 PMCID: PMC9030480 DOI: 10.3390/cells11081309] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/15/2022] [Accepted: 03/21/2022] [Indexed: 11/16/2022] Open
Abstract
Metastatic bone disease is a common and devastating complication to cancer, confounding treatments and recovery efforts and presenting a significant barrier to de-escalating the adverse outcomes associated with disease progression. Despite significant advances in the field, bone metastases remain presently incurable and contribute heavily to cancer-associated morbidity and mortality. Mechanisms associated with metastatic bone disease perpetuation and paralleled disruption of bone remodeling are highlighted to convey how they provide the foundation for therapeutic targets to stem disease escalation. The focus of this review aims to describe the preclinical modeling and diagnostic evaluation of metastatic bone disease as well as discuss the range of therapeutic modalities used clinically and how they may impact skeletal tissue.
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Affiliation(s)
- Gabriel M. Pagnotti
- Department of Endocrine, Neoplasia and Hormonal Disorders, MD Anderson Cancer Center, University of Texas, Houston, TX 77030, USA; (G.M.P.); (T.T.)
| | - Trupti Trivedi
- Department of Endocrine, Neoplasia and Hormonal Disorders, MD Anderson Cancer Center, University of Texas, Houston, TX 77030, USA; (G.M.P.); (T.T.)
| | - Khalid S. Mohammad
- Department of Anatomy and Genetics, Alfaisal University, Riyadh 11533, Saudi Arabia
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5
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Dual Airway and Esophageal Stenting in Advanced Esophageal Cancer With Lesions Near Carina. J Bronchology Interv Pulmonol 2021; 27:286-293. [PMID: 32966034 DOI: 10.1097/lbr.0000000000000672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tracheobronchial stenting either alone or with esophageal stenting is often required for symptom palliation in obstructive or fistulous lesions of the airway due to esophageal cancer. There is limited evidence regarding dual stenting for lesions near the carina due to esophageal cancer. Hence, this study aims to evaluate the technical feasibility, outcomes, and complications of preplanned dual stenting in these patients. METHODS This is a prospective observational study carried out over a period of 4 years (January 2015 to July 2019). All patients undergoing dual stenting in the airway and esophagus with obstructive or fistulous lesions near the carina were included. The esophageal stent was placed within 24 hours. Prestenting and poststenting symptoms were compared using a symptom-based visual analog scale, Hugh Jones dyspnea scale and dysphagia scale. RESULTS Twenty-nine patients (20 males; mean±SD age, 55.3±12.2 y) underwent dual stenting. Twenty-four patients had central airway obstruction due to: infiltration in 20 (69%) and external compression in 4 (13.7%), respectively. Five (17.3%) patients had tracheoesophageal fistula with no airway obstruction. In 80% of the patients (n=23), silicone stents were placed. There was significant improvement in both dyspnea and dysphagia after dual stenting (P<0.001). Mucus plugging, lower respiratory infection, and granulation tissue were the main complications. Median survival after dual stent was 97 days (range, 17 to 297 d). CONCLUSION Dual stenting within the airway and the esophagus is a safe and viable option for palliative relief of symptoms in patients with advanced esophageal cancer.
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Li X, Qin K, Yuan C, Song S. The effect of enhancing quality of life in patients intervention for advanced lung cancer: Protocol for a randomized clinical study. Medicine (Baltimore) 2020; 99:e23682. [PMID: 33371108 PMCID: PMC7748172 DOI: 10.1097/md.0000000000023682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/13/2020] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE The objective of this present research is to evaluate the effect of the intervention of enhancing quality of life in patients in patients with advanced lung cancer. METHODS Our research is carried out as a randomized clinical trial which will be implemented from December 2020 to October 2021. It was approved by the Ethics Committee of People's Hospital of Chengyang District (03982790). This study includes 90 patients with advanced lung cancer. Patients diagnosed at our oncology clinic are eligible if they are diagnosed within 8 weeks of a novel diagnosis of stage 3 or stage 4 lung cancer. Patients with hepatic insufficiency, renal failure, and respiratory and heart failure, as well as a series of severe mental illness are excluded from our research. Patients are divided randomly into the intervention group and control group, each group is assigned 45 patients. Through utilizing functional assessment of cancer therapy-lung, the measurement of life quality is conducted. And the measurement of mood is carried out with Hospital Anxiety and Depression Scale. RESULTS Table 1 indicates the patient's life quality and Hospital Anxiety and Depression Scale in both groups. CONCLUSION Enhancing quality of life in patient intervention may be beneficial to improve the life quality in advanced lung cancer patients.Trial registration: The protocol was registered in Research Registry (researchregistry6243).
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Affiliation(s)
| | | | - Chunyan Yuan
- Department of Rehabilitation Medicine, People's Hospital of Chengyang District, Qingdao, China
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7
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Sakin A, Sahin S, Atci MM, Sakin A, Yasar N, Geredeli C, Aksaray F, Cihan S. The effect of different treatment modalities on survival in elderly patients with locally advanced non-small cell lung cancer. Pulmonology 2019; 27:26-34. [PMID: 31839507 DOI: 10.1016/j.pulmoe.2019.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/14/2019] [Accepted: 11/22/2019] [Indexed: 12/28/2022] Open
Abstract
PURPOSE The aim of this study is to investigate the effect of treatment modalities on survival among unoperat ed and locally-advanced non-small cell lung cancer (NSCLC) patients aged 70 years and older, representing real-life data. METHODS From 2005 through 2017, medical records of 2259 patients with lung cancer from Okmeydani Training and Research Hospital-Istanbul/Turkey were reviewed retrospectively. Patients with locally advanced NSCLC ≥ 70 years of age who did not undergo surgery for lung cancer were reviewed. In total, 130 patients were eligible for the final analysis. Patients were stratified into four groups as: chemotherapy (CT), concurrent chemoradiotherapy (cCRT), sequential chemoradiotherapy (sCRT), and radiotherapy (RT) only. RESULTS Of the 130 patients included in the analysis; CT, cCRT, sCRT, and RT only were applied to 25(19.2%), 30(23.1%), 31(23.8%), and 44(33.8%) patients, retrospectively. Twelve (9.2%) patients were female. Median age was 72 years (range, 70-88). Sixty (46.2%) patients had stage IIIA disease and 70(53.8%) patients had stage IIIB disease. Median progression-free survival(mPFS) in patients treated with CT, cCRT, sCRT, and RT were 8.0, 15, 10, and 9.0 months, respectively(p = 0.07). Corresponding median overall survival (mOS) were 10, 33, 20, and 15 months (p = 0.04). In multivariate analysis, stage IIIB disease [hazard ratio (HR), 2.8], ECOG-PS 2(HR, 2.10), and ECOG-PS 3-4(HR, 5.13) were found to be the negative factors affecting survival, while cCRT (HR, 0.45) and sCRT (HR, 0.50) were the independent factors associated with better survival. CONCLUSION This study showed that the use of combined treatment modality was associated with better survival in elderly patients with locally advanced NSCLC, with the greatest survival observed in patients treated with cCRT. We therefore suggest that cCRT, when feasible, should be strongly considered in locally advanced NSCLC patients 70 years and over.
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Affiliation(s)
- A Sakin
- Department of Medical Oncology, Yuzuncu Yil University Medical School, 65030, Van, Turkey.
| | - S Sahin
- Department of Medical Oncology, University of Health Sciences, Van Research and Training Hospital, Van, Turkey.
| | - M M Atci
- Department of Medical Oncology, University of Health Sciences, Okmeydani Training and Research Hospital, 34384, Istanbul, Turkey.
| | - A Sakin
- Department of Internal Medicine, University of Health Sciences, Van Research and Training Hospital, Van, Turkey.
| | - N Yasar
- Department of Medical Oncology, University of Health Sciences, Okmeydani Training and Research Hospital, 34384, Istanbul, Turkey.
| | - C Geredeli
- Department of Medical Oncology, University of Health Sciences, Okmeydani Training and Research Hospital, 34384, Istanbul, Turkey.
| | - F Aksaray
- Department of Radiation Oncology, University of Health Sciences, Okmeydani Training and Research Hospital, 34384, Istanbul, Turkey.
| | - S Cihan
- Department of Medical Oncology, University of Health Sciences, Okmeydani Training and Research Hospital, 34384, Istanbul, Turkey.
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Jumeau R, Vilotte F, Durham AD, Ozsahin EM. Current landscape of palliative radiotherapy for non-small-cell lung cancer. Transl Lung Cancer Res 2019; 8:S192-S201. [PMID: 31673524 DOI: 10.21037/tlcr.2019.08.10] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Radiotherapy (RT) is a cornerstone in the management of advanced stage III and stage IV non-small-cell lung cancer (NSCLC) patients. Despite international guidelines, clinical practice remains heterogeneous. Additionally, the advent of stereotactic ablative RT (SABR) and new systemic treatments such as immunotherapy have shaken up dogmas in the approach of these patients. This review will focus on palliative thoracic RT for NSCLC but will also discuss the role of stereotactic radiotherapy, endobronchial brachytherapy (EBB), the interest of concomitant treatments (chemotherapy and immunotherapy), and the role of RT in lung cancer emergencies with palliative intent.
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Affiliation(s)
- Raphael Jumeau
- Department of Radiation-Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Florent Vilotte
- Department of Radiation-Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - André-Dante Durham
- Department of Radiation-Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Esat-Mahmut Ozsahin
- Department of Radiation-Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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9
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[Expert Consensus on the Diagnosis and Treatment of Bone Metastasis in Lung Cancer (2019 Version)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:187-207. [PMID: 31014437 PMCID: PMC6500496 DOI: 10.3779/j.issn.1009-3419.2019.04.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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10
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Larson B, Adler DG. Endoscopic management of esophagorespiratory fistulas. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2019. [DOI: 10.1016/j.tgie.2019.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Youness HA, Harris K, Awab A, Keddissi JI. Bronchoscopic advances in the management of aerodigestive fistulas. J Thorac Dis 2018; 10:5636-5647. [PMID: 30416814 DOI: 10.21037/jtd.2018.05.44] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Malignant aerodigestive fistula (ADF) is an uncommon condition complicating thoracic malignancies. It results in increased morbidity and mortality and warrants therapeutic intervention. The management approach depends on symptoms, configuration, location, and extent of the fistula. This article will discuss the therapeutic considerations in the management of ADF.
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Affiliation(s)
- Houssein A Youness
- Oklahoma City VA Health Care system, Oklahoma City, OK, USA.,University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kassem Harris
- Interventional Pulmonary Section, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Ahmed Awab
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jean I Keddissi
- Oklahoma City VA Health Care system, Oklahoma City, OK, USA.,University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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12
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Evidence-based Palliative Care Approaches to Non-pain Physical Symptom Management in Cancer Patients. Semin Oncol Nurs 2018; 34:227-240. [DOI: 10.1016/j.soncn.2018.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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13
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Adzic-Vukicevic T, Barac A, Blanka-Protic A, Popovic S, Uskokovic-Stefanovic Z, Stojsic J, Ilic AD. Endotracheal stent increased survival length in patients with invasive thymic adenocarcinoma. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2018; 23:30. [PMID: 29887898 PMCID: PMC5961320 DOI: 10.4103/jrms.jrms_831_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 12/20/2017] [Accepted: 01/08/2018] [Indexed: 11/04/2022]
Abstract
We reported the first case of inoperative thymic adenocarcinoma successfully palliative treated by the double-stent procedure. In a patient who expressed stridor, computed tomography was done and necrotic mediastinal mass, which protrudes into a trachea, was demonstrated. Fiberoptic bronchoscopy showed tracheal infiltration and 70% stenosis; therefore, surgical resection was inapplicable. Recanalization with repeated argon plasma coagulation and debridement of necrotic mass was performed, followed by placement of the endotracheal stent, radiotherapy, and chemotherapy. After 1 year, the patient developed gastric aspiration and tracheoesophageal fistula; therefore, the esophageal stent was placed. The outcome was lethal, but the placement of endotracheal stent significantly increased a length of survival for the patient with invasive thymic adenocarcinoma.
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Affiliation(s)
- Tatjana Adzic-Vukicevic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinical Centre of Serbia, Clinic for Pulmonology, Belgrade, Serbia
| | - Aleksandra Barac
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinical Centre of Serbia, Clinic for Infectious and Tropic Diseases, Belgrade, Serbia
| | | | - Spasoje Popovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinical Centre of Serbia, Clinic for Pulmonology, Belgrade, Serbia
| | | | - Jelena Stojsic
- Department for Thoraco-Pulmonary Pathology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Aleksandra Dudvarski Ilic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinical Centre of Serbia, Clinic for Pulmonology, Belgrade, Serbia
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Morin S, Grateau A, Reuter D, de Kerviler E, de Margerie-Mellon C, de Bazelaire C, Zafrani L, Schlemmer B, Azoulay E, Canet E. Management of superior vena cava syndrome in critically ill cancer patients. Support Care Cancer 2017; 26:521-528. [PMID: 28836006 DOI: 10.1007/s00520-017-3860-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 08/16/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE The purpose of this study is to describe the management and outcome of critically ill cancer patients with Superior Vena Cava Syndrome (SVCS). METHODS All cancer patients admitted to the medical intensive care unit (ICU) of the Saint-Louis University Hospital for a SVCS between January 2004 and December 2016 were included. RESULTS Of the 50 patients included in the study, obstruction of the superior vena cava was partial in two-thirds of the cases and complete in one-third. Pleural effusion was reported in two-thirds of the patients, pulmonary atelectasis in 16 (32%), and pulmonary embolism in five (10%). Computed tomography of the chest showed upper airway compression in 18 (36%) cases, while echocardiography revealed 22 (44%) pericardial effusions. The causes of SVCS were diagnosed one (0-3) day after ICU admission, using interventional radiology procedures in 70% of the cases. Thirty (60%) patients had hematological malignancies, and 20 (40%) had solid tumors. Fifteen (30%) patients required invasive mechanical ventilation, seven (14%) received vasopressors, and renal replacement therapy was implemented in three (6%). ICU, in-hospital, and 6-month mortality rates were 20, 26, and 48%, respectively. The cause of SVCS was the only factor independently associated with day 180 mortality by multivariate analysis. Patients with hematological malignancies had a lower mortality than those with solid tumors (27 versus 80%) (odds ratio 0.12, 95% confidence interval (0.02-0.60), p < 0.01). CONCLUSION Airway obstruction and pleural and pericardial effusions contributed to the unstable condition of cancer patients with SVCS. The vital prognosis of SVCS was mainly related to the underlying diagnosis.
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Affiliation(s)
- Sarah Morin
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - Adeline Grateau
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - Danielle Reuter
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - Eric de Kerviler
- Department of Radiology, Saint-Louis University Hospital, AP-HP, Paris, France.,Paris Diderot University-Sorbonne Paris Cité, Paris, France
| | | | - Cédric de Bazelaire
- Department of Radiology, Saint-Louis University Hospital, AP-HP, Paris, France.,Paris Diderot University-Sorbonne Paris Cité, Paris, France
| | - Lara Zafrani
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France.,Paris Diderot University-Sorbonne Paris Cité, Paris, France
| | - Benoit Schlemmer
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France.,Paris Diderot University-Sorbonne Paris Cité, Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France.,Paris Diderot University-Sorbonne Paris Cité, Paris, France
| | - Emmanuel Canet
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France.
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15
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Ozeki T, Asano M, Fujimoto N, Nishimura J, Takada K, Miyamoto Y, Fuchimoto Y, Wada S, Ozaki S, Kishimoto T. Esophagobronchial Fistula in a Patient with Squamous Cell Carcinoma of the Lung: A Case Report. Case Rep Oncol 2017; 10:553-557. [PMID: 28868011 PMCID: PMC5567114 DOI: 10.1159/000477659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 05/22/2017] [Indexed: 01/09/2023] Open
Abstract
A 73-year-old man was referred to our hospital after a 2-week history of bloody sputum and cough. Computed tomography (CT) images of the chest showed a mass grouped with mediastinal lymph nodes, and bronchoscopy showed a projecting mass in the right main bronchus. After a transbronchial biopsy, the patient was diagnosed with squamous cell carcinoma (T4N2M0 stage IIIB). The patient was treated with systemic chemotherapy, consisting of cisplatin (40 mg/m2, days 1 and 8) and docetaxel (30 mg/m2, days 1 and 8), and concurrent thoracic irradiation at a daily dose of 2 Gy. On day 35 of treatment, the patient complained of a sore throat and cough. A CT of the chest showed punctate low-attenuation foci between the esophagus and bronchus. Gastrointestinal endoscopy and bronchoscopy demonstrated a fistula in the middle intrathoracic esophagus and the left main bronchus. The patient's symptoms gradually improved, and the fistula was closed after the suspension of chemoradiotherapy. Radiotherapy was resumed and completed on day 82. However, on day 108, he developed a fever and cough, and a tumor with fistula was revealed in the right main bronchus. He had an esophageal stent inserted, but he later died of sudden hemoptysis.
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Affiliation(s)
- Taichi Ozeki
- Department of Medicine, Okayama Rosai Hospital, Okayama, Japan
| | - Michiko Asano
- Department of Pulmonary Medicine, Okayama Rosai Hospital, Okayama, Japan
| | - Nobukazu Fujimoto
- Department of Medical Oncology, Okayama Rosai Hospital, Okayama, Japan
| | - Jun Nishimura
- Department of Medicine, Okayama Rosai Hospital, Okayama, Japan
| | - Kenji Takada
- Department of Medicine, Okayama Rosai Hospital, Okayama, Japan
| | - Yosuke Miyamoto
- Department of Pulmonary Medicine, Okayama Rosai Hospital, Okayama, Japan
| | - Yasuko Fuchimoto
- Department of Pulmonary Medicine, Okayama Rosai Hospital, Okayama, Japan
| | - Sae Wada
- Department of Pulmonary Medicine, Okayama Rosai Hospital, Okayama, Japan
| | - Shinji Ozaki
- Department of Pulmonary Medicine, Okayama Rosai Hospital, Okayama, Japan
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Elkolaly RM, Korraa EEDA, Ibrahim ISE. Electrocautery and cryotherapy in inoperable malignant lung lesions. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2017. [DOI: 10.4103/ejb.ejb_23_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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17
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Curtin M, Piggott RP, Murphy EP, Munigangaiah S, Baker JF, McCabe JP, Devitt A. Spinal Metastatic Disease: A Review of the Role of the Multidisciplinary Team. Orthop Surg 2017; 9:145-151. [PMID: 28544780 DOI: 10.1111/os.12334] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 03/02/2017] [Indexed: 12/16/2022] Open
Abstract
Historically, a simple approach centered on palliation was applicable to the majority of patients with metastatic spinal disease. With advances in diagnosis and treatment, a more complicated algorithm has devolved requiring a multidisciplinary approach with institutional commitment and support. We performed a database review including pertinent articles exploring the multidisciplinary management of spinal metastatic disease. The wide variation in clinical presentation and tumor response to treatment necessitates a multidisciplinary approach that integrates the diagnosis and treatment of the cancer, symptom management, and rehabilitation for optimal care of patients with spinal metastases. Advances in the field of radiology have led to earlier and more focused diagnosis of spinal metastasis and acts to guide therapy. Advances in surgical techniques, neurophysiologic monitoring, and anesthetic expertise have allowed surgeons to perform more extensive procedures leading to improved outcomes and reduced morbidity. Radiation oncology input that is essential as external beam radiation therapy can provide significant pain relief. Non-operative measures may include bisphosphonate infusions, management of complications (e.g. hypercalcemia of malignancy), monoclonal antibody infusions, and chemotherapy if indicated in the treatment of the primary malignancy. Input from psychology services is necessary to address the biopsychosocial ramifications of spinal metastasis. Allied health professionals in the form of physiotherapists, social workers, and dieticians also contribute in maximizing patients' quality of life and well-being.
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Affiliation(s)
- Mark Curtin
- Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Saolta Hospital Group, Galway, Ireland
| | - Robert P Piggott
- Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Saolta Hospital Group, Galway, Ireland
| | - Evelyn P Murphy
- Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Saolta Hospital Group, Galway, Ireland
| | - Sudarshan Munigangaiah
- Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Saolta Hospital Group, Galway, Ireland
| | - Joseph F Baker
- Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Saolta Hospital Group, Galway, Ireland
| | - John P McCabe
- Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Saolta Hospital Group, Galway, Ireland
| | - Aiden Devitt
- Department of Trauma and Orthopaedic Surgery, University College Hospital Galway, Saolta Hospital Group, Galway, Ireland
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18
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Silon B, Siddiqui AA, Taylor LJ, Arastu S, Soomro A, Adler DG. Endoscopic Management of Esophagorespiratory Fistulas: A Multicenter Retrospective Study of Techniques and Outcomes. Dig Dis Sci 2017; 62:424-431. [PMID: 28012101 DOI: 10.1007/s10620-016-4390-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/22/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS Esophagorespiratory fistulas (ERF) are a devastating complication of benign and malignant etiologies. ERF are associated with high mortality, short survival, and poor quality of life. We performed a multicenter analysis of patients with ERF undergoing endoscopic treatment. METHODS Multicentre retrospective study. RESULTS We analyzed 25 patients undergoing 35 procedures over an 8-year period. Our data showed high technical success rates (97.1% of procedures) and with good, but not ideal, clinical success rates (60% of procedures, 80% of patients), which were defined as fistula closure confirmed by radiographic or repeat endoscopic evaluation and/or a lack of recurrent episodes of clinical aspiration to focus on durable ERF closure as opposed to only initial success. Proximal ERF were the most difficult to manage with the lowest overall clinical success rates, highest rates of recurrent aspiration despite endoscopic therapy, highest adverse events, and shortest survival times. Adverse events occurred in 40.0% of our patients and were all minor. Treatment allowed for diet advancement in 75% of patients. CONCLUSION This represents the largest recent collection of US data and the first multicenter study evaluating the clinical success of multiple treatment modalities while stratifying data by fistula etiology and esophageal location. The endoscopic approaches detailed in this study offer a minimally invasive and safe choice for intervention with the potential to improve quality of life despite overall suboptimal clinical success and survivorship rates for in with ERF.
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Affiliation(s)
- Bryan Silon
- Gastroenterology and Hepatology, Huntsman Cancer Center, University of Utah School of Medicine, 30N 1900E 4R118, Salt Lake City, UT, 84132, USA
| | - Ali A Siddiqui
- Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, PA, USA
| | - Linda Jo Taylor
- Gastroenterology and Hepatology, Huntsman Cancer Center, University of Utah School of Medicine, 30N 1900E 4R118, Salt Lake City, UT, 84132, USA
| | - Sanaa Arastu
- Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, PA, USA
| | - Ammara Soomro
- Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, PA, USA
| | - Douglas G Adler
- Gastroenterology and Hepatology, Huntsman Cancer Center, University of Utah School of Medicine, 30N 1900E 4R118, Salt Lake City, UT, 84132, USA.
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19
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Double stenting for malignant oesophago-respiratory fistula. Wideochir Inne Tech Maloinwazyjne 2016; 11:214-221. [PMID: 27829946 PMCID: PMC5095274 DOI: 10.5114/wiitm.2016.62042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 05/22/2016] [Indexed: 01/05/2023] Open
Abstract
Introduction The close anatomical relationship between the oesophagus and bronchial tree results in formation of an oesophago-respiratory fistula in a subset of patients with advanced oesophageal or lung cancer. In those patients stenting of both the oesophagus and tracheobronchial tree is a valid option of palliative treatment. Aim To determine the effectiveness, tolerance, quality of life, safety and survival after double stenting procedures. Material and methods Retrospective analysis of a prospectively collected database was performed, concerning consecutive patients with oesophago-respiratory fistulas treated with double stenting. In all patients the degree of dysphagia, respiratory function before and after the procedure, and quality of life were evaluated. Partially covered oesophageal self-expanding metallic stents (PCESEMS) were used for oesophageal stenting, and silicone Y-type or partially covered self-expanding bronchial and tracheal stents (PCASEMS) were used to restore airway patency. Results Between 2003 and 2015, 31 patients underwent double stenting due to oesophago-respiratory fistulas. Twenty-nine patients were diagnosed with oesophageal squamous cell carcinoma and 2 with bronchial carcinoma. In all patients, improvement in the general condition and quality of life was observed after airway patency restoration. Two patients required mechanical ventilation due to respiratory failure immediately after the procedure. Seven patients with oesophageal fistulas died because of bleeding in the long-term follow-up. Four patients required endoscopic re-intervention. Mean survival time was 67.1 days. Conclusions Double stenting is an effective procedure improving patients’ quality of life. However, life-threatening complications can occur.
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20
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Airway Covered Metallic Stent Based on Different Fistula Location and Size in Malignant Tracheoesophageal Fistula. Am J Med Sci 2016; 350:364-8. [PMID: 26422803 DOI: 10.1097/maj.0000000000000565] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Malignant tracheoesophageal fistula (MTEF) is a devastating complication of esophageal cancer, lung cancer or other carcinoma with a shorter life-span and poor life quality. The aim of this study was to assess the effect of airway stent insertion on MTEF patients. METHODS A total of 63 MTEF patients were included, 12 patients with lung cancer and 46 patients with esophageal cancers. Eight zones were proposed to classify various fistula locations. Airway stents were selected based on the various zones and fistula size. RESULTS Airway stents were successfully inserted in all patients, and both airway and esophageal stents in 8 patients. Most fistula were located in locations II (18/63, 28.6%), III (22/63, 34.9%), then VII (9/63, 14.3%). The stents included 10 (15.9%) I shaped, 8 (12.7%) L shaped and 45 (71.4%) Y shaped. Different stents were placed based on different locations and sizes of fistulas. Overall, mean survival time was 163 days (2-270 days). Most symptoms relieved after stent insertion. Mean Karnofsky score jumped from 43.0 ± 10.7 before stent placement to 66.7 ± 10.8 after stent insertion (P = 0.000). Complete closure was achieved in 45 patients (71.4%), and incomplete closure and leakage were found in 18 patients. CONCLUSIONS Airway stent insertion provides an effective approach to improve symptoms and quality of life. The choice of stent based on different fistula location and size may be a reasonable way in clinical practice.
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Abstract
BACKGROUND This is an updated version of the original Cochrane review first published in Issue 9, 2010 on "Interventions for cough in cancer". Cough is a common symptom in patients with malignancies, especially in patients with lung cancer. Cough is not well controlled in clinical practice and clinicians have few management options to treat it. OBJECTIVES The primary objective was to determine the effectiveness of interventions, both pharmacological and non-pharmacological, (other than chemotherapy and external beam radiotherapy) in the management of cough in malignant disease (especially in lung cancer). SEARCH METHODS For this update, we searched for relevant studies in CENTRAL and DARE (The Cochrane Library); MEDLINE; EMBASE; PsycINFO; AMED and CINAHL to 9 June 2014. In addition, we searched for ongoing trials via the metaRegister of controlled trials (mRCT), ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) and the UK Clinical Research Network Study Portfolio. SELECTION CRITERIA We selected randomised controlled trials (RCTs) and clinical trials (quasi-experimental trials and trials where there is a comparison group but no mention of randomisation) in participants with primary or metastatic lung cancer or other cancers. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the titles and abstracts of all studies for inclusion, and extracted data from all included studies independently before reaching consensus. A third review author arbitrated on any disagreement. Meta-analysis was not attempted due to the heterogeneity of the studies. MAIN RESULTS For the original version of the review, 17 studies met the inclusion criteria and examined either brachytherapy, laser or photodynamic therapy (eight studies) or a variety of pharmacological therapies (nine studies). Overall, there was an absence of credible evidence and the majority of studies were of low methodological quality and at high risk of bias. Brachytherapy in a variety of doses seemed to improve cough in selected participants, suggesting that possibly the lowest effective dose should be used to minimise side effects. Photodynamic therapy was examined in one study and, while improvements in cough were observed, its role in relationship to other therapies for cough was unclear. Some indication of positive effect was observed with morphine, codeine, dihydrocodeine, levodropropizine, sodium cromoglycate and butamirate citrate linctus (cough syrup), although all studies had significant risk of bias. For this update, we did not identify any additional trials for inclusion. Two ongoing trials were identified but no study results were available. AUTHORS' CONCLUSIONS No new trials were included since the publication of the original version of this review, while 11 new studies that were identified were eventually excluded from this review. Therefore, our conclusions remain unchanged. No practice recommendations could be drawn from this review. There is an urgent need to increase the number and quality of studies evaluating the effects of interventions for the management of cough in cancer.
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Affiliation(s)
- Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
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22
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Farhat AA, Ragab M, Abd-Elzaher AH, Attia GA, Torky MS. Bronchoscopic electrocauterization versus argon plasma coagulation as a palliative management for patients with bronchogenic carcinoma. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2014.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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23
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Zori AG, Jantz MA, Forsmark CE, Wagh MS. Simultaneous dual scope endotherapy of esophago-airway fistulas and obstructions. Dis Esophagus 2014; 27:428-34. [PMID: 23937203 DOI: 10.1111/dote.12120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Management of esophago-airway fistulas (EAF) and obstructions often involves therapy with esophageal and/or airway stents. We present a unique approach for the management of EAF and obstructions with simultaneous upper endoscopy and bronchoscopy (two scopes inserted simultaneously through the mouth). The aim is to assess the efficacy and safety of a simultaneous dual scope approach for management of EAF and obstructions. The endoscopy database at the University of Florida was reviewed from October 2007 to April 2012 to identify adult patients who had undergone simultaneous upper endoscopy and bronchoscopy for EAF and obstructions. Medical records were reviewed for demographics, indication, pathology, imaging, simultaneous endoscopic and bronchoscopic findings/maneuvers, outcomes, and adverse events. Outcomes assessed included: (i) technical success, (ii) fistula occlusion, (iii) dysphagia score, and (iv) adverse events. Thirteen patients with EAF and/or obstruction underwent simultaneous dual scope endoscopy. Dual scope procedures were technically successful in 12/13 (92%) patients. Dysphagia score improved from three to one in both patients with dysphagia without EAF. Fistula occlusion was observed in 7/10 patients (70%) with EAF. With this technique, stents were placed accurately without airway compression, migrated esophageal stents extracted from the tracheal lumen without trauma, and tracheal stents not displaced during esophageal manipulations. EAF not otherwise apparent were identified in two patients. Adverse events occurred in 2/13 (15%) patients, and 5/13 (38%) patients died from advanced cancer during follow up (mean 4.1 months, range 1-8 months). Simultaneous dual scope (two scopes inserted through the mouth at the same time) therapy of EAF and obstructions is feasible, effective, and safe, and may develop to be the preferred approach for the management of complex esophago-airway diseases.
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Affiliation(s)
- A G Zori
- Division of Gastroenterology, University of Florida, Gainesville, Florida, USA
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24
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Ediebah DE, Coens C, Zikos E, Quinten C, Ringash J, King MT, Schmucker von Koch J, Gotay C, Greimel E, Flechtner H, Weis J, Reeve BB, Smit EF, Taphoorn MJB, Bottomley A. Does change in health-related quality of life score predict survival? Analysis of EORTC 08975 lung cancer trial. Br J Cancer 2014; 110:2427-33. [PMID: 24743709 PMCID: PMC4021536 DOI: 10.1038/bjc.2014.208] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/19/2014] [Accepted: 03/24/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Little is known about whether changes in health-related quality of life (HRQoL) scores from baseline during treatment also predict survival, which we aim to investigate in this study. METHODS We analysed data from 391 advanced non-small-cell lung cancer (NSCLC) patients enrolled in the EORTC 08975 study, which compared palliative chemotherapy regimens. HRQoL was assessed at baseline and after each chemotherapy cycle using the EORTC QLQ-C30 and QLQ-LC13. The prognostic significance of HRQoL scores at baseline and their changes over time was assessed with Cox regression, after adjusting for clinical and socio-demographic variables. RESULTS After controlling for covariates, every 10-point increase in baseline pain and dysphagia was associated with 11% and 12% increased risk of death with hazard ratios (HRs) of 1.11 and 1.12, respectively. Every 10-point improvement of physical function at baseline (HR=0.93) was associated with 7% lower risk of death. Every 10-point increase in pain (HR=1.08) was associated with 8% increased risk of death at cycle 1. Every 10-point increase in social function (HR=0.91) at cycle 2 was associated with 9% lower risk of death. CONCLUSIONS Our findings suggest that changes in HRQoL scores from baseline during treatment, as measured on subscales of the EORTC QLQ-C30 and QLQ-LC13, are significant prognostic factors for survival.
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Affiliation(s)
- D E Ediebah
- Quality of Life Department, European Organisation for Research and Treatment of Cancer, Avenue Mounier, 83 b11, 1200 Brussels, Belgium
| | - C Coens
- Quality of Life Department, European Organisation for Research and Treatment of Cancer, Avenue Mounier, 83 b11, 1200 Brussels, Belgium
| | - E Zikos
- Quality of Life Department, European Organisation for Research and Treatment of Cancer, Avenue Mounier, 83 b11, 1200 Brussels, Belgium
| | - C Quinten
- Quality of Life Department, European Organisation for Research and Treatment of Cancer, Avenue Mounier, 83 b11, 1200 Brussels, Belgium
- Department of Biostatistics, European Centre for Disease Prevention and Control, Surveillance and Response Support Unit, Tomtebodavägen 11a, 171 83 Stockholm, Sweden
| | - J Ringash
- Department of Radiation Oncology, The Princess Margaret Hospital and the University of Toronto, 610 University Avenue, Toronto, Ontario, Canada M5G 2M9
| | - M T King
- Department of Psychology, Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, New South Wales NSW 2006, Australia
| | - J Schmucker von Koch
- Department of Ethics, University of Regensburg, Medical Ethics, Universitaetsstrasse 31, D-93040 Regensburg, Germany
| | - C Gotay
- School of Population and Public Health, University of British Columbia, Room 162—2206 East Mall, Vancouver, British Columbia, Canada BC V6T 1Z3
| | - E Greimel
- Department of Obstetrics and Gynecology, Medical University Graz, Auenbruggerplatz 14, AT 8036 Graz, Austria
| | - H Flechtner
- Department of Child and Adolescent Psychiatry, University Magdeburg, Leipziger Str 44, 39120 Magdeburg, Germany
| | - J Weis
- Psychosocial Department, Tumor Biology Center at the University of Freiburg, Breisacher Str. 117, 79106 Freiburg, Germany
| | - B B Reeve
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, 1101-D McGavran-Greenberg Building Chapel Hill, Chapel Hill, NC 27599, USA
| | - E F Smit
- Department of Pulmonology, VU University Medical Centre, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - M J B Taphoorn
- Department of Neurology, VU University Medical Center/Medical Center Haaglanden 2501 CK, The Hague, The Netherlands
| | - A Bottomley
- Quality of Life Department, European Organisation for Research and Treatment of Cancer, Avenue Mounier, 83 b11, 1200 Brussels, Belgium
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Ortega Ruiz F, Díaz Lobato S, Galdiz Iturri JB, García Rio F, Güell Rous R, Morante Velez F, Puente Maestu L, Tàrrega Camarasa J. Oxigenoterapia continua domiciliaria. Arch Bronconeumol 2014; 50:185-200. [DOI: 10.1016/j.arbres.2013.11.025] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 11/22/2013] [Accepted: 11/24/2013] [Indexed: 11/24/2022]
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Bronchoscopic findings and bleeding control predict survival in patients with solid malignancies presenting with mild hemoptysis. Ann Am Thorac Soc 2014; 10:342-9. [PMID: 23952853 DOI: 10.1513/annalsats.201303-056oc] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Regardless of its volume, hemoptysis is a concerning symptom. Mild hemoptysis and its significance in patients with solid malignancies has not been studied. METHODS We conducted a retrospective chart review of patients with solid malignancies who presented for evaluation of mild hemoptysis. In this population, we studied the impact of bronchoscopic findings and endobronchial therapies on overall survival and bleeding recurrence. Patients were categorized into four groups on the basis of the presence or absence of active bleeding and endobronchial disease at the time of initial bronchoscopy: active bleeding with endobronchial lesion (AB/EBL), active bleeding without endobronchial lesion (AB/no-EBL), absence of active bleeding but with endobronchial lesion (no-AB/EBL), and absence of active bleeding and endobronchial lesion (no-AB/no-EBL). MEASUREMENTS AND MAIN RESULTS Ninety-five of the 112 patients with solid malignancies and mild hemoptysis underwent bronchoscopies. There was a significantly lower median survival time for patients with bronchoscopic findings of active bleeding and endobronchial lesion compared with patients with no active bleeding and/or no endobronchial lesion (3.48 mo; 95% confidence interval [CI], 2.14-6.05). On a multivariate analysis, factors independently associated with improved survival were higher hemoglobin values (hazard ratio [HR], 0.78; 95% CI, 0.67-0.91) and cessation of hemoptysis without recurrence at 48 hours (HR, 0.43; 95% CI, 0.22-0.84). Variables independently associated with worse survival were disease stage (HR, 10.8; 95% CI, 2.53-46.08) and AB/EBL (HR, 3.20; 95% CI, 1.74-5.89). CONCLUSIONS In patients with solid malignancies presenting with mild hemoptysis, bronchoscopic findings of AB/EBL are associated with decreased survival. Hemoptysis control without recurrence at 48 hours after endobronchial intervention may improve survival.
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Sun Y, Guan Z, Liao M, Yu X, Wang C, Wang J, Niu X, Shi Y, Zhi X, Liu Y, Liu M, Zhang Y, Yang Y, Shen J, Chen G, Zhou Q, Zhou C, Guo Q, Tang L, Duan J, Liang J, Zhang Y, Cheng Y. [Expert consensus on the diagnosis and treatment of bone metastasis in lung cancer (2014 version)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2014; 17:57-72. [PMID: 24581154 PMCID: PMC6000054 DOI: 10.3779/j.issn.1009-3419.2014.02.01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Yan Sun
- Cancer Hospital, Chinese Aacademy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Zhongzhen Guan
- SunYat-Sen University Cancer Center,Guangzhou 510060, China
| | - Meilin Liao
- Shanghai Chest Hospital, Shanghai, 200030, China
| | - Xin Yu
- Department of psychiatry, Peking University Sixth Hospital, Beijing 100191, China
| | - Changli Wang
- Department of Lung Cancer Surgery, Tianjin Cancer Hospital, Tianjin 300060, China
| | - Jie Wang
- Department of Thoracic Medical Oncology, Beijing Cancer Hospital, Peking University, Beijing 100142, China
| | - Xiaohui Niu
- Department of Orthopedic Oncology Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Yuankai Shi
- Department of Medical Oncology, Cancer Hospital, Chinese Aacademy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xiuyi Zhi
- Department of Thoracic Surgery, Beijing Lung Cancer Center, Beijing Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yunpeng Liu
- Departmentof Medical Oncology, the First Hospital of China Medical University, Shenyang 110001, China
| | - Mengzhong Liu
- Department of Radiotherapy, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China
| | - Yiping Zhang
- Department of Chemotherapy, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Yue Yang
- Department of Thoracic Surgery, Beijing Cancer Hospital, Peking University, Beijing 100142, China
| | - Jingnan Shen
- Department of Orthopedic Oncology Surgery, the First Affiliated Hospital Sun Yat-Sen University, Guangzhou 510080, China
| | - Gongyan Chen
- Department of Medical Oncology, Haerbin Medical University Cancer Hospital, Haerbin 150081, China
| | - Qinghua Zhou
- Department of Thoracic Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Caicun Zhou
- Departmentof Medical Oncology, Shanghai Pulmonary Hospital, Shanghai 200433, China
| | - Qisen Guo
- Department of Medical Oncology, Shandong Province cancer Hospital, Jinan 250117, China
| | - Lili Tang
- Department of rehabilitation, Beijing Cancer Hospital, Peking University, Beijing 100142, China
| | - Jianchun Duan
- Department of Thoracic Medical Oncology, Beijing Cancer Hospital, Peking University, Beijing 100142, China
| | - Jun Liang
- Department of Medical Oncology, the Affiated Hospital of Qingdao University, Qingdao 266003, China
| | - Yingjian Zhang
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Ying Cheng
- Department of Medical Oncology, Jilin Cancer Hospital, Changchun 130012, China
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Wang J, Liang J, Wang W, Ouyang H, Wang L. Malignant thrombosis of the superior vena cava caused by non-small-cell lung cancer treated with radiation and erlotinib: a case with complete and prolonged response over 3 years. Onco Targets Ther 2013; 6:749-53. [PMID: 23836987 PMCID: PMC3702549 DOI: 10.2147/ott.s45660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Most cases of superior vena cava (SVC) syndrome resulting from neoplasm, especially from lung cancer, remain a serious challenge to treat. Here, for the first time as far as we are aware, we report the case of a non-small-cell lung cancer patient with a massive SVC malignant thrombosis who was treated with thoracic irradiation and erlotinib. The treatment regimen consisted of erlotinib 150 mg/day and a total dose of 66 Gy/33 fractions delivered to the tumor, malignant thrombosis, and metastasis mediastinal lymph nodes. The malignant thrombosis responded dramatically and the combined regimen was well tolerated. After discharge, the erlotinib was prescribed as maintenance therapy. The patient was followed closely for the next 3 years. During this time, positron emission tomography/computed tomography scans and serum tumor marker screens were undertaken. By 6 months, the primary tumor showed complete response and by 9 months, the SVC thrombosis had disappeared. No sign of relapse has been found to date.
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Affiliation(s)
- Jianyang Wang
- Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
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Épidémiologie, prise en charge et coût des métastases osseuses des cancers bronchopulmonaires (hors métastases rachidiennes). Rev Mal Respir 2013; 30:309-15. [DOI: 10.1016/j.rmr.2012.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 11/14/2012] [Indexed: 12/25/2022]
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L'espérance S, Vincent F, Gaudreault M, Ouellet JA, Li M, Tosikyan A, Goulet S. Treatment of metastatic spinal cord compression: cepo review and clinical recommendations. ACTA ACUST UNITED AC 2013; 19:e478-90. [PMID: 23300371 DOI: 10.3747/co.19.1128] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Metastatic spinal cord compression (mscc) is an oncologic emergency that, unless diagnosed early and treated appropriately, can lead to permanent neurologic impairment. After an analysis of relevant studies evaluating the effectiveness of various treatment modalities, the Comité de l'évolution des pratiques en oncologie (cepo) made recommendations on mscc management. METHOD A review of the scientific literature published up to February 2011 considered only phase ii and iii trials that included assessment of neurologic function. A total of 26 studies were identified. RECOMMENDATIONS Considering the evidence available to date, cepo recommends that cancer patients with mscc be treated by a specialized multidisciplinary team.dexamethasone 16 mg daily be administered to symptomatic patients as soon as mscc is diagnosed or suspected.high-loading-dose corticosteroids be avoided.histopathologic diagnosis and scores from scales evaluating prognosis and spinal instability be considered before treatment.corticosteroids and chemotherapy with radiotherapy be offered to patients with spinal cord compression caused by myeloma, lymphoma, or germ cell tumour without sign of spinal instability or compression by bone fragment.short-course radiotherapy be administered to patients with spinal cord compression and short life expectancy.long-course radiotherapy be administered to patients with inoperable spinal cord compression and good life expectancy.decompressive surgery followed by long-course radiotherapy be offered to appropriate symptomatic mscc patients (including spinal instability, displacement of vertebral fragment); andpatients considered for surgery have a life expectancy of at least 3-6 months.
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Affiliation(s)
- S L'espérance
- Comité de l'évolution des pratiques en oncologie, Quebec City, QC
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31
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Shehata SM, El-Shora AE, Mazroaa MA, Ragab MI. Outcome of endobronchial electrocautery versus external beam radiotherapy or both together in the palliative management of non-small cell lung cancer. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2013. [DOI: 10.1016/j.ejcdt.2013.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Prognostic factors for patients in postoperative brain metastases from surgically resected non-small cell lung cancer. Int J Clin Oncol 2012; 19:50-6. [PMID: 23239054 DOI: 10.1007/s10147-012-0503-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 11/25/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND Postoperative recurrence in non-small cell lung cancer (NSCLC) reduces the life expectancy of patients. In this retrospective study, we investigated the prognostic factors in patients with postoperative brain metastases from surgical resected non-small cell lung cancer (NSCLC). METHODS We conducted a retrospective chart review of patients who had undergone resection for NSCLC between April 2004 and February 2009 and found 65 had experienced postoperative brain metastases by March 2010. We reviewed these patients for clinicopathological information, treatments and responses to treatment, and overall survival. RESULTS The 5-year survival rate after the diagnosis of brain metastases was 15.4 %. Significantly favorable prognostic factors for patients after a diagnosis of brain metastases included female gender, adenocarcinoma, a small number (1-3) of brain metastases, no extracranial metastasis at the diagnosis of brain metastases, radiation treatment (whole-brain radiation and/or stereotactic irradiation), and local treatment [stereotactic irradiation and/or surgical operation (craniotomy)]. Furthermore, in patients with only brain metastases as the postoperative initial recurrence, the favorable positive prognostic factors included a small number (1-3) of brain metastases, adjuvant chemotherapy, chemotherapy (including adjuvant and other chemotherapy and excluding epidermal growth factor receptor-tyrosine kinase inhibitors), and local treatment. CONCLUSIONS Our study found that the foregoing clinical characteristics in postoperative brain metastases and the administration of treatment contributed to patient life expectancy.
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Chawla RK, Madan A, Chawla K. Tracheo-esophageal fistula: Successful palliation after failed esophageal stent. Lung India 2012; 29:289-92. [PMID: 22919174 PMCID: PMC3424874 DOI: 10.4103/0970-2113.99123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The incidence of tracheo-esophageal (TO) fistula is on the rise, especially after palliative management for esophageal malignancies. We report a case of cancer of esophagus who after chemotherapy and radiotherapy developed TO fistula. Placement of an esophageal stent helped him in taking food orally, but his cough and dyspnoea continued to worsen. Fibreoptic bronchoscopy demonstrated a severely compressed trachea secondary to protrusion of esophageal stent which responded very well to an Ultraflex-covered tracheal stent and the patient achieved relief from cough and dyspnoea.
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Affiliation(s)
- Rakesh K Chawla
- Department of Respiratory Medicine, Critical Care and Sleep Disorders, Jaipur Golden Hospital, Rohini, Delhi, India
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Fernández Vallone VB, Hofer EL, Choi H, Bordenave RH, Batagelj E, Feldman L, La Russa V, Caramutti D, Dimase F, Labovsky V, Martínez LM, Chasseing NA. Behaviour of mesenchymal stem cells from bone marrow of untreated advanced breast and lung cancer patients without bone osteolytic metastasis. Clin Exp Metastasis 2012; 30:317-32. [PMID: 23053744 DOI: 10.1007/s10585-012-9539-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Accepted: 09/17/2012] [Indexed: 12/19/2022]
Abstract
Tumour cells can find in bone marrow (BM) a niche rich in growth factors and cytokines that promote their self-renewal, proliferation and survival. In turn, tumour cells affect the homeostasis of the BM and bone, as well as the balance among haematopoiesis, osteogenesis, osteoclastogenesis and bone-resorption. As a result, growth and survival factors normally sequestered in the bone matrix are released, favouring tumour development. Mesenchymal stem cells (MSCs) from BM can become tumour-associated fibroblasts, have immunosuppressive function, and facilitate metastasis by epithelial-to-mesenchymal transition. Moreover, MSCs generate osteoblasts and osteocytes and regulate osteoclastogenesis. Therefore, MSCs can play an important pro-tumorigenic role in the formation of a microenvironment that promotes BM and bone metastasis. In this study we showed that BM MSCs from untreated advanced breast and lung cancer patients, without bone metastasis, had low osteogenic and adipogenic differentiation capacity compared to that of healthy volunteers. In contrast, chondrogenic differentiation was increased. Moreover, MSCs from patients had lower expression of CD146. Finally, our data showed higher levels of Dkk-1 in peripheral blood plasma from patients compared with healthy volunteers. Because no patient had any bone disorder by the time of the study we propose that the primary tumour altered the plasticity of MSCs. As over 70 % of advanced breast cancer patients and 30-40 % of lung cancer patients will develop osteolytic bone metastasis for which there is no total cure, our findings could possibly be used as predictive tools indicating the first signs of future bone disease. In addition, as the MSCs present in the BM of these patients may not be able to regenerate bone after the tumour cells invasion into BM/bone, it is possible that they promote the cycle between tumour cell growth and bone destruction.
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Affiliation(s)
- Valeria B Fernández Vallone
- Experimental Biology and Medicine Institute, CONICET, 2490 Vuelta de Obligado, Ciudad Autónoma de Buenos Aires, 1428, Buenos Aires, Argentina.
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Dupuy DE, Shulman M. Current status of thermal ablation treatments for lung malignancies. Semin Intervent Radiol 2012; 27:268-75. [PMID: 22550366 DOI: 10.1055/s-0030-1261785] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
About 75% of lung cancer patients are not surgical candidates, either due to advanced disease or medical comorbidities. Furthermore, conventional treatments that can be offered to these patients are beneficial only to a small percentage of them. Thermal ablation is a minimally invasive treatment that is commonly used in this group of patients, and which has shown promising results. Currently, the most widely used ablation techniques in the treatment of lung malignancies are radiofrequency ablation (RFA), microwave ablation, and cryoablation. Although the most studied technique is RFA, recent studies with microwave ablation and cryoablation have shown some advantages over RFA. This article reviews the application of thermal ablation in the thorax, including patient selection, basic aspects of procedure technique, imaging follow-up, treatment outcomes, and comparison of ablation techniques.
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Affiliation(s)
- Damian E Dupuy
- Department of Diagnostic Imaging, Rhode Island Hospital, Alpert Medical School at Brown University, Providence, Rhode Island
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Michael HH, Tsai YY, Hoffe SE. Overview of Diagnosis and Management of Metastatic Disease to Bone. Cancer Control 2012; 19:84-91. [DOI: 10.1177/107327481201900202] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Bone metastases occur frequently in patients with advanced cancer and are a serious complication of cancer. The decision to treat is often individualized, based on each patient's clinical presentation, life expectancy, and quality of life. Methods We reviewed the current literature pertaining to management of metastatic disease to bone, and the medical, radiotherapeutic, and surgical treatment options for management of bone metastasis are discussed. Results Current management of skeletal metastasis includes analgesia, systemic therapy, radiation therapy, and surgery. We propose treatment algorithms for management of vertebral and nonvertebral bone metastases and suggest individualized interventions based on clinical presentation. Conclusions Management of bone metastases is complex and requires a multidisciplinary approach. The goal of treatment is often palliative, and intervention and treatment regimens should be individualized based on the specific clinical presentation of each patient.
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Affiliation(s)
- Hsiang-Hsuan Michael
- Departments of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Ya-Yu Tsai
- Cancer Epidemiology and Genetics at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Sarah E. Hoffe
- Departments of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
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Lee HJ, Oh IJ, Park SW, Ban HJ, Kim YC, Kim SO. A Case of Miliary Brain Metastasis of Lung Cancer Mimicking Neurocysticercosis. Tuberc Respir Dis (Seoul) 2012. [DOI: 10.4046/trd.2012.72.2.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ho-Jun Lee
- Department of Internal Medicine, Chonnam National University Medical School, Hwasun, Korea
| | - In-Jae Oh
- Department of Internal Medicine, Chonnam National University Medical School, Hwasun, Korea
| | - Sang-Woo Park
- Department of Internal Medicine, Chonnam National University Medical School, Hwasun, Korea
| | - Hee-Jung Ban
- Department of Internal Medicine, Chonnam National University Medical School, Hwasun, Korea
| | - Young-Chul Kim
- Department of Internal Medicine, Chonnam National University Medical School, Hwasun, Korea
| | - Soo-Ok Kim
- Department of Internal Medicine, Seonam University College of Medicine, Gwangju, Korea
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Hsu YL, Huang MS, Yang CJ, Hung JY, Wu LY, Kuo PL. Lung tumor-associated osteoblast-derived bone morphogenetic protein-2 increased epithelial-to-mesenchymal transition of cancer by Runx2/Snail signaling pathway. J Biol Chem 2011; 286:37335-46. [PMID: 21885439 DOI: 10.1074/jbc.m111.256156] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Bone is a frequent target of lung cancer metastasis and is associated with significant morbidity and a dismal prognosis. Interaction between cancer cells and the bone microenvironment causes a vicious cycle of tumor progression and bone destruction. This study analyzed the soluble factors secreted by lung tumor-associated osteoblast (TAOB), which are responsible for increasing cancer progression. The addition of bone morphogenetic protein-2 (BMP-2), present in large amounts in TAOB conditioned medium (TAOB-CM) and lung cancer patient sera, mimicked the inductive effect of TAOB-CM on lung cancer migration, invasion, and epithelial-to-mesenchymal transition. In contrast, inhibition of BMP by noggin decreases the inductive properties of TAOB-CM and lung cancer patient sera on cancer progression. Induction of lung cancer migration by BMP-2 is associated with increased ERK and p38 activation and the up-regulation of Runx2 and Snail. Blocking ERK and p38 by a specific inhibitor significantly decreases cancer cell migration by inhibiting Runx2 up-regulation and subsequently attenuating the expression of Snail. Enhancement of Runx2 facilitates Rux2 to recruit p300, which in turn enhances histone acetylation, increases Snail expression, and decreases E-cadherin. Furthermore, inhibiting Runx2 by siRNA also suppresses BMP-2-induced Snail up-regulation and cell migration. Our findings provide novel evidence that inhibition of BMP-2 or BMP-2-mediated MAPK/Runx2/Snail signaling is an attractive therapeutic target for osteolytic bone metastases in lung cancer patients.
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Affiliation(s)
- Ya-Ling Hsu
- Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
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Nakagawa K, Ohkuma K, Yamashita H, Masuda M, Matsumoto Y, Gotoh T. Radiation therapy did not alleviate complete paralysis due to metastasis of lung adenocarcinoma to thoracic vertebrae until four months later. Acta Oncol 2011; 50:606-8. [PMID: 21250927 DOI: 10.3109/0284186x.2010.550314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Dyspnea, nausea and vomiting, anorexia, fatigue, and sleep disturbances are common and distressing in advanced cancer. We updated previous systematic reviews of how these symptoms can be alleviated with targeted literature searches. The approach to these symptoms requires comprehensive symptom assessment; treating underlying causes when benefits exceed risks; prioritizing treatment, as patients usually have many symptoms; and addressing psychosocial and spiritual distress. For dyspnea, evidence supports systemic opioids and nonpharmacological treatments such as a fan. The strongest evidence supports metoclopramide for cancer-related nausea and octreotide for bowel obstruction. For anorexia, enteral or parenteral nutrition is indicated with obstruction and expected prognosis of at least 6 weeks. Evidence supports several drugs for appetite affecting quality of life. For fatigue, evidence supports psychosocial interventions and methylphenidate. For insomnia, evidence supports cognitive-behavioral therapy in cancer; no sleep agents have superior effectiveness.
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Abstract
BACKGROUND Cough is a common symptom in patients with malignancies, especially in patients with lung cancer. Cough is not well controlled in clinical practice and clinicians have few management options to treat it. OBJECTIVES The primary objective of this review was to determine the effectiveness of interventions, both pharmacological and non-pharmacological, (other than chemotherapy and external beam radiotherapy) in the management of cough in malignant disease (especially in lung cancer). SEARCH STRATEGY Databases searched included: The Cochrane Central Register of Controlled Trials (CENTRAL) and the Database of Abstracts of Reviews of Effectiveness (DARE) (The Cochrane Library issue 4, 2009); MEDLINE (1966 to May 2010); EMBASE (1980 to May 2010); CINAHL (1980 to May 2010); PSYCHINFO (1980 to May 2010); AMED (1985 to May 2010); SIGLE (1980 to May 2010); British Nursing Index (1985 to May 2010); CancerLit (1975 to May 2010). We searched for cough suppressants, antitussives and other drugs with antitussive activity as well as non-pharmacological interventions (see Appendices 1-4 for search terms). SELECTION CRITERIA We selected randomised controlled trials (RCTs) and clinical trials (quasi-experimental trials, and trials where there is a comparison group but no mention of randomisation) in participants with primary or metastatic lung cancer or other cancers. DATA COLLECTION AND ANALYSIS Two review authors independently assessed titles and abstracts of all studies, and extracted data from all selected studies before reaching consensus. A third review author arbitrated with any disagreement. Meta-analysis was not attempted due to the heterogeneity of studies. MAIN RESULTS Seventeen studies met inclusion criteria and examined either brachytherapy, laser or photodynamic therapy (eight studies) or a variety of pharmacological therapies (nine studies). Overall, there was absence of credible evidence and the majority of studies were of low methodological quality and high risk of bias. Brachytherapy seemed to improve cough in a variety of doses in selected participants, suggesting that possibly the lowest effective dose should be used to minimise side effects. Photodynamic therapy was examined in one study, and while improvements in cough were observed, its role over other therapies for cough is unclear. Some indication of effect was observed with morphine, codeine, dihydrocodeine, levodropropizine, sodium cromoglycate and butamirate citrate linctus (cough syrup), although all studies had significant risk of bias. AUTHORS' CONCLUSIONS No practice recommendations could be drawn from this review. There is an urgent need to increase the number and quality of studies evaluating the effects of interventions in the management of cough in cancer.
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Affiliation(s)
- Alex Molassiotis
- School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK, M13 9PL
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Chung IH, Park MH, Kim DH, Jeon GS. Endobronchial stent insertion to manage hemoptysis caused by lung cancer. J Korean Med Sci 2010; 25:1253-5. [PMID: 20676346 PMCID: PMC2908804 DOI: 10.3346/jkms.2010.25.8.1253] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 09/17/2009] [Indexed: 11/20/2022] Open
Abstract
Hemoptysis in patients with lung cancer is not uncommon and sometimes have dangerous consequences. Hemoptysis has been managed with various treatment options other than surgery and medicine, such as endobronchial tamponade, transcatheter arterial embolization and radiation therapy. However, these methods can sometimes be used only temporarily or are not suitable for a patient's condition. We present a case in which uncontrollable hemoptysis caused by central lung cancer was successfully treated by inserting a covered self-expanding bronchial stent. The patient could be extubated and was able to undergo further palliative therapy. No recurrent episodes of hemoptysis occurred for the following three months. As our case, airway stenting is a considerable option for the tamponade of a bleeding lesion that cannot be successfully managed with other treatment methods and could be used to preserve airway patency in a select group of patients.
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Affiliation(s)
- In Hee Chung
- Department of Radiology, Dankook University College of Medicine, Cheonan, Korea
| | - Mi-hyun Park
- Department of Radiology, Dankook University College of Medicine, Cheonan, Korea
| | - Doh Hyung Kim
- Division of Pulmonology and Allergy, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Gyeong Sik Jeon
- Department of Radiology, Dankook University College of Medicine, Cheonan, Korea
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Mularski RA, Campbell ML, Asch SM, Reeve BB, Basch E, Maxwell TL, Hoverman JR, Cuny J, Clauser SB, Snyder C, Seow H, Wu AW, Dy S. A Review of Quality of Care Evaluation for the Palliation of Dyspnea. Am J Respir Crit Care Med 2010; 181:534-8. [DOI: 10.1164/rccm.200903-0462pp] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Juszkat R, Kopeć T, Błaszyk M, Borucki Ł, Szyfter W. [Tracheal stenting in patients treated due to carcinoma of the larynx]. Otolaryngol Pol 2010; 63:523-7. [PMID: 20198989 DOI: 10.1016/s0030-6657(09)70173-8] [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
INTRODUCTION Stenosis of the trachea and main bronchia can occur in patients with lung, larynx, thyroid gland, esophagus, in metastatic tumors, can be also caused by trauma and foreign bodies. Treatment in this condition can be difficult. Tracheal stenosis in patients after total removal of the larynx is relatively rare. It can be caused by recidiv tumor and inflammation processes. AIM OF THE STUDY Was to evaluate usefulness of stents in patient with stenosis of the trachea after total laryngectomy due to squamous cell carcinoma. MATERIAL AND METHODS Authors described two cases of patient after total laryngectomy. Nitinol, expandable, tracheal stents were used in both cases. Placement of the stent into the trachea was relatively simple. Patients have undergone this procedure in short general anesthesia. RESULTS After stenting patients exhibited dramatic improvement in their respiratory symptoms and quality of life. CONCLUSIONS Stents are useful in cases of tracheal stenosis and the effect is related to the reason of stenosis.
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Abstract
Palliation of symptoms to optimize QOL is the foundation of cancer care regardless of stage of disease or level of anticancer treatment. Patients commonly experience pain, constipation, nausea, vomiting, dyspnea, fatigue, and delirium. Many valid clinical tools are available to the primary care clinician to screen for symptoms, assess severity, measure treatment response, and elicit the patient's subjective symptom experience. Although there is limited evidence regarding the relative efficacy of symptom interventions from randomized controlled trials, clinical practice guidelines are available.
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Affiliation(s)
- Barbara Reville
- Palliative Care Service, Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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Harris DG, Noble SIR. Management of terminal hemorrhage in patients with advanced cancer: a systematic literature review. J Pain Symptom Manage 2009; 38:913-27. [PMID: 19833478 DOI: 10.1016/j.jpainsymman.2009.04.027] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 04/11/2009] [Accepted: 04/13/2009] [Indexed: 10/20/2022]
Abstract
Although terminal hemorrhage is an infrequent occurrence in advanced cancer patients, it is extremely distressing for patients, their families, and health care professionals when it does occur. By definition, there is a very short time period to support and comfort the patient, and it is vital that the management approach follows the best available evidence base. A systematic literature search was carried out to retrieve relevant publications relating to the management of terminal hemorrhage in patients with advanced cancer in whom invasive or interventional procedures are no longer appropriate. From 3,564 initial citations, 18 were appropriate to include in the final review, many of which focused on patients with head and neck tumors. The reported incidence of significant bleeding in patients with advanced cancer is 6%-14% and incidence of terminal hemorrhage 3%-12%. Key areas arising from the literature were 1) identifying patients at risk, 2) general supportive measures to use, and 3) use of sedative medication. General supportive measures included use of dark towels to camouflage blood loss, use of suction, and applying external pressure. There was variation in the recommended sedative medication (drug, dose, and route). Drugs recommended included diazepam, midazolam, diamorphine, and ketamine at varying doses and routes of administration. Current guidelines are based completely on isolated case reports and expert opinion. Clinical research is needed in this area but is difficult because of practical and ethical limitations.
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Affiliation(s)
- Dylan G Harris
- Department of Palliative Medicine, Velindre Hospital, Cardiff CF14 2TL, Wales, United Kingdom.
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Espiritu O, Schaeffer E, Bhesania N, Perera S, Dickinson E, Nussbaum E, Lai D. Physiotherapy practice and delegation policies in oxygen administration: a survey of ontario hospitals. Physiother Can 2009; 61:163-72. [PMID: 20514179 DOI: 10.3138/physio.61.3.163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE As of 2008, the Regulated Health Professions Act in Ontario stipulates that administration of oxygen is a controlled act, which physiotherapists are not authorized to perform but which may be delegated to physiotherapists by another health professional authorized to perform this act. The aims of this study were (1) to survey physiotherapy practice of oxygen administration in Ontario hospitals and (2) to determine the proportion and characteristics of hospitals with delegation policies for physiotherapists to administer oxygen. METHOD Postal surveys were sent to 208 hospitals. Data were collected on hospital characteristics; the presence of delegation policies; and the practice and training of physiotherapists, physiotherapy assistants, and students in oxygen administration. Data were described by summative statistics. Fisher's exact test and Cramer's V statistic were used to examine associations. Potential prognostic factors were analyzed using logistic regression. RESULTS Response rate was 82.7%. Physiotherapists administered oxygen in 39% of hospitals, and 28% of hospitals had delegation policies. Larger, urban, or teaching hospitals and those with a matrix structure were most likely to have delegation policies and physiotherapists who administered oxygen. Rehabilitation hospitals were also likely to have such policies. CONCLUSION Physiotherapists administer oxygen in less than half of Ontario hospitals, very few of which have delegation policies.
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Affiliation(s)
- Olivia Espiritu
- Olivia Espiritu, MScPT: Graduate of the Department of Physical Therapy, University of Toronto, Toronto, Ontario
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Björk-Eriksson T, Ask A, Glimelius B. The potential of proton beam radiation for palliation and reirradiation. Acta Oncol 2009; 44:918-20. [PMID: 16332602 DOI: 10.1080/02841860500355967] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A group of Swedish oncologists and hospital physicists have estimated the number of patients in Sweden suitable for proton beam therapy. The estimations have been based on current statistics of tumour incidence, number of patients potentially eligible for radiation treatment, scientific support from clinical trials and model dose planning studies and knowledge of the dose-response relations of different tumours and normal tissues. If an estimated 1% of the palliative treatments can be administered by protons with substantial benefits to the patient, almost 100 patients per year in Sweden would be eligible. It is further estimated that around 150 patients per year in need of reirradiation would benefit from radiation with protons compared to photons.
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The role of palliative care in the lung cancer patient: can we improve quality while limiting futile care? Curr Opin Pulm Med 2009; 15:321-6. [DOI: 10.1097/mcp.0b013e32832b8a5d] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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