1
|
An algorithmic approach utilizing CK7, TTF1, beta-catenin, CDX2, and SSTR2A can help differentiate between gastrointestinal and pulmonary neuroendocrine carcinomas. Virchows Arch 2021; 479:481-491. [PMID: 33733343 DOI: 10.1007/s00428-021-03085-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/10/2021] [Accepted: 03/14/2021] [Indexed: 12/21/2022]
Abstract
Primary gastrointestinal neuroendocrine carcinoma (GI-NEC) cannot be distinguished morphologically from pulmonary neuroendocrine carcinoma (P-NEC). This can present a significant diagnostic challenge in cases where site of origin cannot be readily determined. To identify immunohistochemical (IHC) markers that can be used to reliably distinguish between GI-NECs and P-NECs, we constructed 3-mm tissue microarrays, one containing 13 GI-NECs and one containing 20 P-NECs. IHC was performed on both microarrays using 21 stains: AE1/AE3, CK7, CK20, synaptophysin, chromogranin, CD56, INSM1, SSTR2A, CDX2, SATB2, TTF1, Napsin A, PR, GATA3, PAX8, ISL1, beta-catenin, AFP, SMAD4, Rb, and p53. For GI-NEC, the most strongly expressed marker was synaptophysin (mean H-score 248), while AE1/AE3 was the most strongly expressed in P-NEC (mean H-score 230), which was stronger than in GI-NEC (p = 0.011). Other markers that were stronger overall in P-NEC than in GI-NEC included CK7 (p < 0.0001) and TTF1 (p < 0.0001). Markers that were stronger overall in GI-NEC than in P-NEC included SSTR2A (p = 0.0021), SATB2 (p = 0.018), CDX2 (p = 0.019), and beta-catenin (nuclear; p = 0.029). SMAD4, Rb, and p53 showed similar rates of abnormal protein expression. Based on these results, a stepwise algorithmic approach utilizing CK7, TTF1, beta-catenin, CDX2, and SSTR2A had a 91% overall accuracy in distinguishing these GI-NEC from P-NEC. This was tested on a second cohort of 10 metastatic GI-NEC and 10 metastatic P-NEC, with an accuracy in this cohort of 85% and an overall accuracy of 89% for the 53 cases tested. Our algorithm reasonably discriminates GI-NEC from P-NEC using currently available IHC stains.
Collapse
|
2
|
de Groot PM, Chung JH, Ackman JB, Berry MF, Carter BW, Colletti PM, Hobbs SB, McComb BL, Movsas B, Tong BC, Walker CM, Yom SS, Kanne JP. ACR Appropriateness Criteria ® Noninvasive Clinical Staging of Primary Lung Cancer. J Am Coll Radiol 2020; 16:S184-S195. [PMID: 31054745 DOI: 10.1016/j.jacr.2019.02.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 12/19/2022]
Abstract
Lung cancer is the leading cause of cancer-related deaths in both men and women. The major risk factor for lung cancer is personal tobacco smoking, particularly for small-cell lung cancer (SCLC) and squamous cell lung cancers, but other significant risk factors include exposure to secondhand smoke, environmental radon, occupational exposures, and air pollution. Education and socioeconomic status affect both incidence and outcomes. Non-small-cell lung cancer (NSCLC), including adenocarcinoma, squamous cell carcinoma, and large cell carcinoma, comprises about 85% of lung cancers. SCLC accounts for approximately 13% to 15% of cases. Prognosis is directly related to stage at presentation. NSCLC is staged using the eighth edition of the tumor-node-metastasis (TNM) criteria of the American Joint Committee on Cancer. For SCLC the eighth edition of TNM staging is recommended to be used in conjunction with the modified Veterans Administration Lung Study Group classification system distinguishing limited stage from extensive stage SCLC. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Collapse
Affiliation(s)
| | | | - Jeanne B Ackman
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mark F Berry
- Stanford University Medical Center, Stanford, California; The Society of Thoracic Surgeons
| | - Brett W Carter
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | | | - Betty C Tong
- Duke University School of Medicine, Durham, North Carolina; The Society of Thoracic Surgeons
| | | | - Sue S Yom
- University of California San Francisco, San Francisco, California
| | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| |
Collapse
|
3
|
Lee J, Lee J, Choi J, Kim JW, Cho J, Lee CG. Early treatment volume reduction rate as a prognostic factor in patients treated with chemoradiotherapy for limited stage small cell lung cancer. Radiat Oncol J 2015; 33:117-25. [PMID: 26157681 PMCID: PMC4493423 DOI: 10.3857/roj.2015.33.2.117] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 06/03/2015] [Accepted: 06/10/2015] [Indexed: 11/26/2022] Open
Abstract
Purpose To investigate the relationship between early treatment response to definitive chemoradiotherapy (CRT) and survival outcome in patients with limited stage small cell lung cancer (LS-SCLC). Materials and Methods We retrospectively reviewed 47 patients with LS-SCLC who received definitive CRT between January 2009 and December 2012. Patients were treated with systemic chemotherapy regimen of etoposide/carboplatin (n = 15) or etoposide/cisplatin (n = 32) and concurrent thoracic radiotherapy at a median dose of 54 Gy (range, 46 to 64 Gy). Early treatment volume reduction rate (ETVRR) was defined as the percentage change in gross tumor volume between diagnostic computed tomography (CT) and simulation CT for adaptive RT planning and was used as a parameter for early treatment response. The median dose at adaptive RT planning was 36 Gy (range, 30 to 43 Gy), and adaptive CT was performed in 30 patients (63.8%). Results With a median follow-up of 27.7 months (range, 5.9 to 75.8 months), the 2-year locoregional progression-free survival (LRPFS) and overall survival (OS) rates were 74.2% and 56.5%, respectively. The mean diagnostic and adaptive gross tumor volumes were 117.9 mL (range, 5.9 to 447 mL) and 36.8 mL (range, 0.3 to 230.6 mL), respectively. The median ETVRR was 71.4% (range, 30 to 97.6%) and the ETVRR >45% group showed significantly better OS (p < 0.0001) and LRPFS (p = 0.009) than the other group. Conclusion ETVRR as a parameter for early treatment response may be a useful prognostic factor to predict treatment outcome in LS-SCLC patients treated with CRT.
Collapse
Affiliation(s)
- Joohwan Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jeongshim Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jinhyun Choi
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Won Kim
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jaeho Cho
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Geol Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
4
|
Grigore AD, Ben-Jacob E, Farach-Carson MC. Prostate cancer and neuroendocrine differentiation: more neuronal, less endocrine? Front Oncol 2015; 5:37. [PMID: 25785244 PMCID: PMC4347593 DOI: 10.3389/fonc.2015.00037] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 02/03/2015] [Indexed: 12/17/2022] Open
Abstract
Neuroendocrine differentiation (NED) marks a structural and functional feature of certain cancers, including prostate cancer (PCa), whereby the malignant tissue contains a significant proportion of cells displaying neuronal, endocrine, or mixed features. NED cells produce, and can secrete, a cocktail of mediators commonly encountered in the nervous system, which may stimulate and coordinate cancer growth. In PCa, NED appears during advanced stages, subsequent to treatment, and accompanies treatment resistance and poor prognosis. However, the term “neuroendocrine” in this context is intrinsically vague. This article seeks to provide a framework on which a unified view of NED might emerge. First, we review the mutually beneficial interplay between PCa and neural structures, mainly supported by cell biology experiments and neurological conditions. Next, we address the correlations between PCa and neural functions, as described in the literature. Based upon the integration of clinical and basic observations, we suggest that it is legitimate to seek for true neural differentiation, or neuromimicry, in cancer progression, most notably in PCa cells exhibiting what is commonly described as NED.
Collapse
Affiliation(s)
- Alexandru Dan Grigore
- Department of BioSciences, Rice University , Houston, TX , USA ; Center for Theoretical Biological Physics, Rice University , Houston, TX , USA
| | - Eshel Ben-Jacob
- Center for Theoretical Biological Physics, Rice University , Houston, TX , USA ; Sackler School of Physics and Astronomy, Tel Aviv University , Tel Aviv , Israel ; Sagol School of Neuroscience, Tel Aviv University , Tel Aviv , Israel
| | - Mary C Farach-Carson
- Department of BioSciences, Rice University , Houston, TX , USA ; Center for Theoretical Biological Physics, Rice University , Houston, TX , USA ; Department of Bioengineering, Rice University , Houston, TX , USA
| |
Collapse
|
5
|
Ravenel JG, Rosenzweig KE, Kirsch J, Ginsburg ME, Kanne JP, Kestin LL, Parker JA, Rimner A, Saleh AG, Mohammed TLH. ACR Appropriateness Criteria Non-invasive Clinical Staging of Bronchogenic Carcinoma. J Am Coll Radiol 2014; 11:849-56. [DOI: 10.1016/j.jacr.2014.05.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 05/28/2014] [Indexed: 11/15/2022]
|
6
|
GUO ZHANJUN, WANG HONGJING, LI YANTAO, LI BIN, LI CUIQIAO, DING CUIMIN. A microRNA-related single nucleotide polymorphism of the XPO5 gene is associated with survival of small cell lung cancer patients. Biomed Rep 2013; 1:545-548. [PMID: 24648983 PMCID: PMC3917003 DOI: 10.3892/br.2013.92] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 03/20/2013] [Indexed: 01/19/2023] Open
Abstract
MicroRNA (miRNA)-related single nucleotide polymorphisms (miR-SNPs) in miRNA processing machinery genes affect cancer risk, treatment efficacy and patient prognosis. A miR-SNP of rs11077 located in the 3'UTR of miRNA processing machinery gene XPO5 was examined in small cell lung cancer (SCLC) patients to evaluate its association with cancer survival. A total of 42 patients were enrolled in the present study and genotyped for rs11077 and survival was assessed using the Kaplan-Meier method, as well as univariate and multivariate analyses. The AA genotype of rs11077 was identified for its significant association with better survival time (P=0.023). In addition, rs11077 was found to associate independently with overall survival in SCLC patients by multivariate analysis (relative risk 2.469; 95% CI, 1.088-5.603; P=0.031). The findings of this study suggest that although miR-SNP studies for miRNA processing machinery genes are still at an early age, miR-SNPs have an impact on cancer survival. In conclusion, a miR-SNP in the 3'UTR region of the XPO5 gene was identified as an independent prognostic marker for survival of advanced SCLC patients.
Collapse
Affiliation(s)
- ZHANJUN GUO
- Departments of Gastroenterology and Hepatology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011,
P.R. China
| | - HONGJING WANG
- Respiratory Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011,
P.R. China
| | - YANTAO LI
- Respiratory Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011,
P.R. China
| | - BIN LI
- Respiratory Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011,
P.R. China
| | - CUIQIAO LI
- Respiratory Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011,
P.R. China
| | - CUIMIN DING
- Respiratory Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011,
P.R. China
| |
Collapse
|
7
|
DING CUIMIN, LI RUIJUAN, PENG JINGCUI, LI SHENGMIAN, GUO ZHANJUN. A polymorphism at the miR-502 binding site in the 3' untranslated region of the SET8 gene is associated with the outcome of small-cell lung cancer. Exp Ther Med 2012; 3:689-692. [PMID: 22969952 PMCID: PMC3438626 DOI: 10.3892/etm.2012.469] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Accepted: 12/19/2011] [Indexed: 12/11/2022] Open
Abstract
microRNAs (miRNAs) bind to the 3' untranslated regions (UTRs) of messenger RNAs, where they interfere with translation of genes that regulate cell differentiation, apoptosis and tumourigenesis. The histone methyltransferase SET8 has been reported to methylate TP53 and regulate genomic stability. We analysed a single nucleotide polymorphism (rs16917496) within the miR-502 miRNA seed region at the 3' UTR of SET8 in small-cell lung cancer (SCLC) patients. The SET8 CC+CT genotype was identified to be independently associated with longer survival in SCLC patients by multivariate analysis (relative risk, 0.453; 95% CI 0.217-0.944; p=0.035). The analysis of genetic polymorphisms in miRNA binding sites may help to identify patient subgroups at high risk of poor outcome.
Collapse
Affiliation(s)
| | - RUIJUAN LI
- Departments of Respiratory Medicine, and
| | | | | | - ZHANJUN GUO
- Gastroenterology and Hepatology, The Fourth Hospital of Hebei Medical University, Shijiazhuang,
P.R. China
| |
Collapse
|
8
|
Chronic cough: a multidisciplinary approach. The Journal of Laryngology & Otology 2012; 126:441-4. [PMID: 22289161 DOI: 10.1017/s0022215111003409] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND METHODS Chronic cough is defined as a cough persisting for more than eight weeks. This condition generates significant healthcare and economic costs. It is associated with a spectrum of disorders across multiple medical specialties and can provide significant challenges for effective evaluation and management. The current literature was reviewed to gain further insight into chronic cough, including its relationship with sinonasal disease. RESULTS Within the reviewed literature, there was strong emphasis on post-nasal drip syndrome as a major causative factor. CONCLUSION Cough is the most common complaint for which adult patients seek medical consultation in primary care settings. Chronic cough is associated with a deterioration in the quality of patients' lives. Thorough assessment of a patient with a chronic cough relies on a multidisciplinary approach.
Collapse
|
9
|
ACR Appropriateness Criteria® Noninvasive Clinical Staging of Bronchogenic Carcinoma. J Thorac Imaging 2010; 25:W107-11. [PMID: 21042062 DOI: 10.1097/rti.0b013e3181f51e7f] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
10
|
Ichinose Y, Seto T, Nishiwaki Y, Kiura K, Sakai H, Yokoyama A, Segawa Y, Ando M, Watanabe K. Phase I Study of Topotecan and Cisplatin in Patients with Small Cell Lung Cancer. Jpn J Clin Oncol 2010; 41:197-203. [DOI: 10.1093/jjco/hyq177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
11
|
|
12
|
Abstract
BACKGROUND Lung cancer may occur in the lung transplant population because many patients are former smokers. Not much is known about risk factors and outcomes in these patients. METHODS We performed a search of the lung transplant database at our institution to identify patients who had been diagnosed with lung cancer. Records and reports were reviewed for demographics, risk factors for malignancy, lung transplant characteristics, radiographic characteristics, treatment, and outcomes. RESULTS We identified 12 lung transplant patients with bronchogenic carcinoma at our institution [age 47.2 +/- 13.2 years (mean +/- SD); 7 (58%) men and 5 (42%) women]. Eleven patients were transplanted for chronic obstructive pulmonary disease (COPD). Time from transplantation to diagnosis of cancer was 119 (21-416) [mean (range)] weeks. Eleven cancers occurred in the native lung; most common cancer cell types were adenocarcinoma (N = 5). Incidence among patients with COPD, who received single lung transplantation was 5.15%. Time from diagnosis of bronchogenic carcinoma to death was 10.8 (1-60) [mean (range)] weeks with a 75% (9/12) 1-year mortality. CONCLUSIONS Among our patients, almost all cancers occurred in native lung in ex-smokers who received a lung transplant for COPD. The cancer was often an incidental finding on a routine chest radiograph; however, the disease was usually at an advanced stage at diagnosis, limiting therapeutic options.
Collapse
|
13
|
Rossi A, Maione P, Palazzolo G, Sacco PC, Ferrara ML, Falanga M, Gridelli C. New Targeted Therapies and Small-Cell Lung Cancer. Clin Lung Cancer 2008; 9:271-9. [DOI: 10.3816/clc.2008.n.042] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
14
|
|
15
|
Abstract
Cough is the most common presenting complaint in adults seeking medical treatment in an ambulatory setting. Chronic cough (persisting greater than 3 weeks) can be associated with myriad diseases that may overlap multiple medical specialties. For this reason, a thorough assessment of the patient with chronic cough relies on a multidisciplinary approach and close cooperation between pulmonary medicine, gastroenterology, and otolaryngology. Despite this daunting task, success can be achieved in up to 90% of patients with chronic cough if a systematic and thorough approach is used. The purpose of this review is to summarize the state-of-the-art in the diagnosis and treatment of chronic cough for the practicing otolaryngologist.
Collapse
Affiliation(s)
- C Blake Simpson
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas Health Science Center, San Antonio 78229-3900, USA.
| | | |
Collapse
|
16
|
Yilmaz S, Dursun M, Canoruç F, Bayan K, Büyükbayram H. Upper gastrointestinal bleeding caused by small-cell lung cancer: a case report. Dig Dis Sci 2006; 51:788-90. [PMID: 16615004 DOI: 10.1007/s10620-006-3207-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2005] [Accepted: 04/16/2005] [Indexed: 12/17/2022]
Affiliation(s)
- Serif Yilmaz
- Department of Gastroenterology, Dicle University Faculty of Medicine, Diyarbakir, Turkey.
| | | | | | | | | |
Collapse
|
17
|
Myers JN, O'neil KM, Walsh TE, Hoffmeister KJ, Venzon DJ, Johnson BE. The pulmonary status of patients with limited-stage small cell lung cancer 15 years after treatment with chemotherapy and chest irradiation. Chest 2005; 128:3261-8. [PMID: 16304271 DOI: 10.1378/chest.128.5.3261] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES To describe pulmonary symptoms, signs, pulmonary function, and lung imaging studies in patients with limited-stage small cell lung cancer (SCLC) 2 to 15 years after receiving treatment with chemotherapy and chest radiotherapy. DESIGN Retrospective review of clinical records and radiographic studies of patients treated in three different prospective combined-modality studies. SETTING Federal hospital. PATIENTS One hundred fifty-six patients with SCLC who were enrolled between 1974 and 1994. INTERVENTIONS Patients with limited-stage SCLC treated on prospective therapeutic studies of combined chemotherapy and radiation therapy were identified. Pulmonary symptoms, physical findings, pulmonary function tests, arterial blood gas measurements, and chest imaging studies were assessed at baseline, and at 1 to 2 years, at 3 to 5 years, and at > 5 years following the initiation of treatment. MEASUREMENTS AND RESULTS Initial symptoms included cough in 84 (55%), dyspnea in 59 (39%), and sputum production in 26 (17%). Twenty-three patients lived beyond 5 years (15%) without evidence of recurrence. Seven of these 5-year survivors were without pulmonary symptoms. Pulmonary function test results showed no significant changes in percent predicted values for FVC, FEV(1), and FEV(1)/FVC ratio over the time periods reviewed. The percent predicted values for the diffusing capacity of the lung for carbon monoxide decreased from 71% before the start of treatment to 56% (p < 0.032) at 1 to 2 years. Values improved in most patients beyond 5 years after starting treatment. Radiologist interpretations of chest imaging studies were available for 17 of 23 patients surviving > 5 years. Most patients had minimal to no changes in imaging study findings beyond 5 years. CONCLUSIONS Long-term survivors with limited-stage SCLC who were treated with combined chemotherapy and chest radiotherapy have minimal changes in pulmonary symptoms or function from 5 to 15 years after the start of treatment. A concern for late toxicity from combined-modality therapy should not dissuade clinicians from offering therapy with potentially curative result with minimal to no pulmonary dysfunction.
Collapse
Affiliation(s)
- Janet N Myers
- Department of Medicine, Uniformed Services University of the Health Sciences, Pulmonary and Critical Care Division, Bethesda, MD 20814, USA.
| | | | | | | | | | | |
Collapse
|
18
|
Abstract
Small cell lung cancer (SCLC) is generally sensitive to first-line chemotherapy, but limited disease often recurs and extensive disease is rarely curable. The most common first-line therapy regimen is cisplatin (Platinol; Bristol-Myers Squibb; Princeton, NJ) plus etoposide (Etopophos; Bristol-Myers Squibb)--PE, which is associated with overall response rates >80% in patients with limited SCLC. Although it is associated with median survival times of approximately 18-20 months for limited disease, PE yields median survival times of only approximately 8-12 months in patients with extensive disease, and symptom palliation becomes the primary therapeutic goal. The toxicities of PE may undermine quality of life and leave patients more susceptible to adverse events during subsequent therapies. Topotecan (HYCAMTIN; GlaxoSmithKline; Philadelphia, PA), an established treatment for recurrent SCLC, is being investigated in the first-line setting because of its novel mechanism of action; predictable, noncumulative, and manageable toxicities; and potential synergy with other active agents. Several recent phase II trials have generated promising results for topotecan-based combination regimens, including topotecan/paclitaxel (TAXOL; Bristol-Myers Squibb) (overall response rates 45%-100%), topotecan/etoposide (overall response, 95%), and topotecan, paclitaxel, and platinum agent triplets (overall response rates 51%-93%). The most frequent serious toxicity associated with these regimens was reversible and noncumulative neutropenia, which was generally manageable with supportive care. Additional clinical trials to investigate topotecan-based combination regimens and confirm their role in the first-line treatment of SCLC are under way.
Collapse
Affiliation(s)
- David J Stewart
- The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Room FC-9-3062, Houston, Texas 77030, USA.
| |
Collapse
|
19
|
Affiliation(s)
- Abid Irshad
- Department of Radiology, Medical University of South Carolina, Charleston, SC, USA.
| | | |
Collapse
|
20
|
Affiliation(s)
- James G Ravenel
- Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
21
|
Beau-Faller M, Gaub MP, Schneider A, Ducrocq X, Massard G, Gasser B, Chenard MP, Kessler R, Anker P, Stroun M, Weitzenblum E, Pauli G, Wihlm JM, Quoix E, Oudet P. Plasma DNA microsatellite panel as sensitive and tumor-specific marker in lung cancer patients. Int J Cancer 2003; 105:361-70. [PMID: 12704670 DOI: 10.1002/ijc.11079] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The majority of lung cancer patients have tumor-derived genetic alterations in circulating plasma DNA that could be exploited as a diagnostic tool. We used fluorescent microsatellite analysis to detect alterations in plasma and tumor DNA in 34 patients who underwent bronchoscopy for lung cancer, including 11 small cell lung cancer (SCLC) and 23 nonsmall cell lung cancer (NSCLC) (12 adenocarcinomas, 11 squamous cell carcinomas) and 20 controls. Allelotyping was performed with a selected panel of 12 microsatellites from 9 chromosomal regions 3p21, 3p24, 5q, 9p, 9q, 13q, 17p, 17q and 20q. Plasma DNA allelic imbalance (AI) was found in 88% (30 of 34 patients), with a similar sensitivity in SCLC and NSCLC. In the 24 paired available tumor tissues, 83% (20 of 24) presented at least 1 AI. Among these patients, 85% (17 of 20) presented also at least 1 AI in paired plasma DNA, but the location of the allelic alterations in paired plasma and tumor DNA could differ, suggesting the presence of heterogeneous tumor clones. None of the 20 controls displayed plasma or bronchial DNA alteration. A reduced panel of six markers (at 3p, 5q, 9p, 9q) showed a sensitivity of 85%. Moreover, a different panel of microsatellites at 3p and 17p13 in SCLC and at 5q, 9p, 9q and 20q in NSCLC patients could be specifically used. Analysis of plasma DNA using this targeted panel could be a valuable noninvasive test and a useful tool to monitor disease progression without assessing the tumor.
Collapse
Affiliation(s)
- Michèle Beau-Faller
- Laboratoire de Biochimie et de Biologie Moĺculaire, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Chaudhary UB, Taksey JD, Johnson RD, Lewin DN. Small-cell cancers, and an unusual reaction to chemotherapy: Case 3. Small-cell carcinoma of the stomach. J Clin Oncol 2003; 21:2441-2. [PMID: 12805346 DOI: 10.1200/jco.2003.06.165] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Uzair B Chaudhary
- Department of Medicine, Medical University of South Carolina, Charleston, USA
| | | | | | | |
Collapse
|
23
|
Lewiński T, Zuławski M. Small cell lung cancer survival: 3 years as a minimum for predicting a favorable outcome. Lung Cancer 2003; 40:203-13. [PMID: 12711123 DOI: 10.1016/s0169-5002(03)00025-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To define the minimum survival time indicating a significantly reduced risk of recurrence of small cell lung cancer (SCLC) basing on the evaluation of survival of patients (pts) with SCLC who underwent anatomic staging and were exposed to combination chemotherapy (CT) (including combined modality treatment). METHODS Eight pts being our 'historic' group submitted to the NCI Registry for Long Term Survivors with SCLC (est. 1977) and a following 657 unselected pts diagnosed, staged, treated and undergoing life-long follow-up at a single institution between the years 1981 and 1996. For those among our pts who had no evidence of metastatic disease, but had not undergone thorough staging, we have arbitrarily created an intermediate group referred to as 'XD'. RESULTS Of the 657 pts 111 survived 2 years or more. Among these 111 there were 88 pts with LD at presentation, 11 with 'XD' and 12 with ED. Of the 111 pts surviving 2 years 51 (51/111) were re-treated for relapse before 24 months. From this group of 111 2 year-or-more survivors 45 (41%) died between 2 and 3 years. From year 3 onwards mortality decreased substantially-eight pts died in the 3-4 year interval and eight in the 4-5 interval-accounting for 14% of all the 2 year survivors. We did not observe any failure of the primary tumor beyond a period of 5 years-both in our 'historic' and the analyzed group. After 5 years development of a second primary tumor, mainly lung cancer, is one of the major causes of death in pts 'cured' of their primary tumor. CONCLUSION The shortest survival-time which allows predicting a significantly reduced risk of recurrence of SCLC is 3 years. The same landmark was achieved with the estimation of hazard function and allowed to find a remarkably decreased risk of death at the point of 3 years.
Collapse
Affiliation(s)
- Tadeusz Lewiński
- Department of Lung and Thoracic Tumors, The Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, P.O. Box 106, 5 W.K. Roentgen Str., 02-770 Warsaw 130, Poland.
| | | |
Collapse
|
24
|
Jennens RR, Rosenthal MA, Mitchell P, Presneill JJ. Outcome of patients admitted to the intensive care unit with newly diagnosed small cell lung cancer. Lung Cancer 2002; 38:291-6. [PMID: 12445751 DOI: 10.1016/s0169-5002(02)00219-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Patients with newly diagnosed small cell lung cancer (SCLC) may be considered for admission to an intensive care unit (ICU). Even though SCLC is highly responsive to chemotherapy, it is not clear whether patient outcomes justify the resource use of an ICU. This paper reports the results of a retrospective review of 20 newly diagnosed cases of SCLC who were admitted to one of three ICUs in Melbourne, Australia. Patients who had more than one negative prognostic factor did uniformly poorly, with no survivors beyond 4 months. Five patients were treated with chemotherapy whilst intubated and receiving mechanical ventilatory support. Two of these patients responded to chemotherapy and were extubated 4 days later. Both of these patients were alive and free of tumour recurrence 7 months later. In contrast, patients not treated with chemotherapy died early (within 40 days). We conclude that some patients with SCLC achieve a medium to long-term survival following treatment with chemotherapy instituted during or around the time of their admission to an ICU. The admission to an ICU of selected patients with SCLC may be justified, and prognostic indicators may be of benefit in making these difficult treatment decisions.
Collapse
Affiliation(s)
- Ross R Jennens
- Department of Medical Oncology, Clinical Haematology and Palliative Care, The Royal Melbourne Hospital, Parkville 3050, Vic., Australia.
| | | | | | | |
Collapse
|
25
|
Nicholson SA, Beasley MB, Brambilla E, Hasleton PS, Colby TV, Sheppard MN, Falk R, Travis WD. Small cell lung carcinoma (SCLC): a clinicopathologic study of 100 cases with surgical specimens. Am J Surg Pathol 2002; 26:1184-97. [PMID: 12218575 DOI: 10.1097/00000478-200209000-00009] [Citation(s) in RCA: 279] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Separation of small cell lung carcinoma (SCLC) from nonsmall cell lung carcinoma (NSCLC) is a critical distinction to be made in the diagnosis of lung cancer. However, the diagnosis of SCLC is most commonly made on small biopsies and cytologic specimens, and practicing pathologists may not be familiar with all its morphologic guises and frequent combination with NSCLC elements, which may be seen in larger specimens. Following the most recent WHO classification of lung tumors and with the hope of identifying prognostic markers, we examined in detail the histology of 100 surgical biopsies or resections with a diagnosis of SCLC from the AFIP and pathology panel of the International Association for the Study of Lung Cancer (IASLC). Multiple clinical and histologic features were studied by Kaplan-Meier analysis. Neuroendocrine architectural patterns, including nested and trabecular growth, with peripheral palisading and rosette formation were common in SCLC. Necrosis and apoptotic debris was prominent in all cases, but crush artifact was infrequent. Cell size in surgical biopsy specimens appears larger than in bronchoscopic biopsy specimens and occasional cells may show prominent nucleoli and vesicular nuclear chromatin, but this does not preclude the diagnosis of SCLC. A high percentage of cases (28%) showed combinations with NSCLC, with large cell carcinoma the most common, followed by adenocarcinoma and squamous cell carcinoma. Because of the frequency of a few scattered large cells in SCLC, we arbitrarily recommend that at least 10% of the tumor show large cell carcinoma before subclassification as combined SC/LC. However, combined SCLC is easily recognized if the additional component consists of other NSCLC subtypes such as adenocarcinoma or squamous cell carcinoma, so no percentage requirement is needed. Stage remained the only predictor of prognosis.
Collapse
Affiliation(s)
- Siobhan A Nicholson
- Department of Pulmonary and Mediastinal pathology, Armed Forces Institute of Pathology, Washington DC 20306-6000, USA
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Thomas CR, Giroux DJ, Janaki LM, Turrisi AT, Crowley JJ, Taylor SA, McCracken JD, Shankir Giri PG, Gordon W, Livingston RB, Gandara DR. Ten-year follow-up of Southwest Oncology Group 8269: a phase II trial of concomitant cisplatin-etoposide and daily thoracic radiotherapy in limited small-cell lung cancer. Lung Cancer 2001; 33:213-9. [PMID: 11551416 DOI: 10.1016/s0169-5002(01)00181-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To report the long-term follow-up of Southwest Oncology Group-8269, a phase II North American cooperative group trial of concurrent cisplatin, etoposide, vincristine (PEV), and thoracic radiotherapy (TRT) for limited small-cell lung cancer (L-SCLC). METHODS 114 eligible patients from 47 institutions enrolled between April, 1985 and March 1986. Patients had documented L-SCLC. Induction chemotherapy consisted of three cycles of PEV. TRT was administered at 1.8 Gy/fraction in 25 daily fractions to a total dose of 45 Gy, to begin concomitantly. Consolidative chemotherapy included two cycles of vincristine, methotrexate, etoposide, doxorubicin and cyclophosphamide. Prophylactic cranial irradiation (PCI) was concurrent with the 3rd cycle of chemotherapy. The PCI dose was 30 Gy in 15 fractions of 2 Gy/fraction. RESULTS As of May 2000, 5 of 114 remain alive and progression-free with a minimum follow-up interval of 13.2 years, as of May 2000. The median follow-up interval is 14.2 years. Thirty eight patients died of causes other than SCLC and five patients are still alive and progression-free. Of the remaining 71 patients dying of SCLC, local failure (LF) occurred in 24% (17 patients), distant metastasis (DM) occurred in 35% (25 patients), simultaneous LF and DM occurred in 25% (18 patients), and was indeterminate in 16% (11 patients). Thus, LF was a component of failure in 49%. Twenty patients had the CNS as the initial site of failure. Eleven patients (10%) developed fatal second primary cancers, including two with acute myelogenous leukemia, two with squamous cell lung cancer, one each with breast, pancreas, prostate, renal cell, and myelodysplasia. One patient developed both a melanoma and non-Hodgkin's lymphoma. CONCLUSION There are long-term survivors with concomitant TRT and PEV. LF and DM are common. Pattern of failure suggests needs to improve local and systemic control.
Collapse
Affiliation(s)
- C R Thomas
- Department of Radiation Oncology, San Antonio Cancer Institute, University of Texas Health Science Center, San Antonio, TX, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Rowell NP. Prophylactic cranial irradiation in small cell lung cancer: who gets it? Clin Oncol (R Coll Radiol) 2001; 12:324-5. [PMID: 11315719 DOI: 10.1053/clon.2000.9183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
28
|
Väkevä L, Pukkala E, Ranki A. Increased risk of secondary cancers in patients with primary cutaneous T cell lymphoma. J Invest Dermatol 2000; 115:62-5. [PMID: 10886509 DOI: 10.1046/j.1523-1747.2000.00011.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
As putative etiologic factors of primary cutaneous T cell lymphomas may have a general cancerogenic effect, we wanted to assess the risk of secondary malignancies in 319 patients diagnosed with histopathologically verified cutaneous T cell lymphomas and reported to the Finnish Cancer Registry during the years 1953-95. Standardized incidence ratios were defined as the ratio of observed to expected numbers of cases. To obtain the expected numbers of cancer, age-, sex-, and period-specific Finnish incidence rates were applied to the appropriate person-years under observation. Ninety-five percent confidence intervals were calculated assuming a Poisson distribution. For the whole period, we detected 36 secondary cancers whereas 26 were expected (standardized incidence ratios 1.4, 95% confidence intervals 1.0-1.9). The overall risk of lung cancer was significantly increased (standardized incidence ratio was 2.7, 95% confidence intervals were 1.4-4.8); and in particular small-cell lung cancer showed high standardized incidence ratios (standardized incidence ratio was 8.5, 95% confidence intervals were 2.8-20). Also, the risk of lymphomas was elevated (standardized incidence ratios for Hodgkin and non-Hodgkin lymphomas combined were 7.0, 95% confidence intervals were 1.9-18). The incidence of other cancers was similar to the national ratios. An increased risk of secondary cancers and in particular small-cell cancer of the lung and lymphomas among patients with primary cutaneous T cell lymphoma is demonstrated. In clinical practice, lung cancer and lymphomas must be kept in mind when following up patients with cutaneous T cell lymphomas.
Collapse
Affiliation(s)
- L Väkevä
- Helsinki University Central Hospital, Department of Dermatology, Helsinki, Finland.
| | | | | |
Collapse
|
29
|
Bruhn N, Beinert T, Oehm C, Jandrig B, Petersen I, Chen XQ, Possinger K, Fleischhacker M. Detection of microsatellite alterations in the DNA isolated from tumor cells and from plasma DNA of patients with lung cancer. Ann N Y Acad Sci 2000; 906:72-82. [PMID: 10818600 DOI: 10.1111/j.1749-6632.2000.tb06594.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In this paper, we show that the same panel of three microsatellite markers is useful for the detection of alterations in the DNA of tumor cells and plasma from patients diagnosed with SCLC and NSCLC. In 31% of the SCLC patients, we detected a microsatellite alteration(s) or LOH in at least one locus. In the group of patients diagnosed with NSCLC, a microsatellite alteration or LOH was detected in at least one locus in 33% of the patients. In all but 2 patients, the identical alteration observed in the DNA from tumor cells was also detected in the DNA isolated from blood plasma. This work confirms the results described by other groups and it extends the diagnostic possibilities of finding tumor cell-specific DNA alterations also in the DNA freely circulating in plasma and serum of patients with cancer.
Collapse
MESH Headings
- Adult
- Aged
- Carcinoma, Non-Small-Cell Lung/blood
- Carcinoma, Non-Small-Cell Lung/genetics
- Carcinoma, Small Cell/blood
- Carcinoma, Small Cell/genetics
- Chromosomes, Human, Pair 21
- Chromosomes, Human, Pair 6
- DNA, Neoplasm/blood
- DNA, Neoplasm/genetics
- DNA, Neoplasm/isolation & purification
- Female
- Humans
- Lung Neoplasms/blood
- Lung Neoplasms/genetics
- Male
- Microsatellite Repeats/genetics
- Middle Aged
- Polymerase Chain Reaction
- X Chromosome
Collapse
Affiliation(s)
- N Bruhn
- Universitätsklinikum Charité, Medizinische Klinik II m.S. Onkologie und Hämatologie, Berlin, Germany
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Styles JR, Waddell JA, Solimando DA. Topotecan for Ovarian Cancer and Small-Cell Lung Cancer. Hosp Pharm 2000. [DOI: 10.1177/001857870003500303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The increasing complexity of cancer chemotherapy makes it mandatory that pharmacists be familiar with these highly toxic agents. This column reviews various issues related to the preparation, dispensing, and administration of cancer chemotherapy, both commercially available and investigational.
Collapse
|
31
|
Solimando DA, Waddell JA. Carboplatin and Etoposide (CE) Regimen. Hosp Pharm 2000. [DOI: 10.1177/001857870003500202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The increasing complexity of cancer chemotherapy makes it mandatory that pharmacists be familiar with these highly toxic agents. This column reviews various issues related to the preparation, dispensing, and administration of cancer chemotherapy, both commercially available and investigational.
Collapse
Affiliation(s)
- Dominic A. Solimando
- Oncology Drug Information, cancereducation.com, 30 West 21st Street, New York, NY 10010
| | - J. Aubrey Waddell
- Department of Pharmacy, Brooke Army Medical Center, Building 3600, 3851 Roger Brooke Drive, San Antonio, TX 78234
| |
Collapse
|