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Sousa MJ, Basto R, Magalhães JC, Costa C, Garcia R, Domingues I, Jesus E, Sousa G. P14.81 Brain metastases of lung adenocarcinoma - Clinicopathological profile and outcomes of a single-centre. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Brain metastases (BM) in patients with non-small cell lung cancer (NSCLC) are considered a major determinant of overall survival (OS). Historically, surgical resection (SR), stereotactic radiosurgery (SRS), or/and whole-brain radiation therapy (WBRT) followed by chemotherapy has been the treatment modalities for BM from lung adenocarcinoma. Recent insights into the biology of adenocarcinoma have led to a wealth of novel therapies, including tyrosine kinase inhibitors (TKIs). Here, we review the pattern of brain metastasis in lung adenocarcinoma patients and management strategies in our centre.
MATERIAL AND METHODS
We performed a single-centre retrospective analysis of patients with lung adenocarcinoma and BM between 2017–2020. Data were collected from electronic medical records, including clinical and histopathological features and outcomes. Survival curves were estimated with the Kaplan-Meier method and compared using the log-rank test.
RESULTS
We identified 29 patients, 65% male, median age 65 years (range 38–84); 55% ECOG PS 0–1; 59% smokers; 55% had extracranial metastases (ECM) and 66% were symptomatic, 24% were EGFR mutated, the frequency of ALK rearrangement was 14%, in 14% the molecular testing was not performed. We treated 59% with WBRT, 12% with SRS, 11% with SR+WBRT and 4% with SR+SRS; 14% were referred for palliative care. Clinical deterioration during local therapy was observed in 32% of the patients and, consequently, they haven’t undergone systemic treatment. After local treatment, 26% received chemotherapy (CT) and 28% received TKIs therapy. Median OS (mOS) was 11.3 months (95% CI 2.4–20.3) for the CT subgroup; mOS for the TKIs subgroup was not reached, but the 1-year survival rate was 67%.
CONCLUSION
BM confers a worse prognosis in lung adenocarcinoma patients. Currently, targeted systemic treatments in patients with driver mutations improve survival and have demonstrated efficacy in lung adenocarcinoma metastatic to the brain. Further research is needed to find better treatments for BM in NSCLC patients with no driver mutations.
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Affiliation(s)
- M J Sousa
- Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - R Basto
- Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - J C Magalhães
- Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - C Costa
- Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - R Garcia
- Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - I Domingues
- Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - E Jesus
- Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - G Sousa
- Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
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Basto R, Magalhães JC, de Sousa M, Monteiro J, Domingues I, Jesus E, Sousa G. 87P Impact of chemoradiotherapy on the survival of patients with stage III NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/s1556-0864(21)01929-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Arjona A, Aziz O, Passot G, George S, Jesus E, Van der Speeten K, Piso P, Nedelcut S, Sommariva A, Yonemura Y, Turaga K, Rodriguez-Ortiz L, Sanchez-Hidalgo J, Casado-Adam A, Rufian-Peña S, Briceño-Delgado J, Glehen O. Laparoscopic Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Limited Peritoneal Metastasis. The PSOGI International Collaborative Registry. Eur J Surg Oncol 2021. [DOI: 10.1016/j.ejso.2020.11.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Félix Soares R, Silva R, Rodrigues É, Amaral M, Nabais M, Cunha Pereira T, Peixoto M, Macedo F, Monteiro A, Pontes F, Domingues I, Garcia A, Rêgo I, Cunha Carvalho J, Chaves A, Jesus E, Vilão Ó, Sousa G. 1514P Patient-reported outcomes of early integration palliative care in quality of life and symptom burden in advanced lung cancer – A randomized study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Figueiredo A, Almeida M, Almodovar M, Alves P, Araújo A, Araújo D, Barata F, Barradas L, Barroso A, Brito U, Camacho E, Canário D, Cardoso T, Chaves A, Costa L, Cunha J, Duarte J, Estevinho F, Felizardo M, Fernandes J, Ferreira L, Ferreira L, Fidalgo P, Freitas C, Garrido P, Gil N, Hasmucrai D, Jesus E, Lopes J, de Macedo J, Meleiro A, Neveda R, Nogueira F, Pantorotto M, Parente B, Pego A, Rocha M, Roque J, Santos C, Saraiva J, Silva E, Silva S, Simões S, Soares M, Teixeira E, Timóteo T, Hespanhol V. Real-world data from the Portuguese Nivolumab Expanded Access Program (EAP) in previously treated Non Small Cell Lung Cancer (NSCLC). Pulmonology 2020; 26:10-17. [DOI: 10.1016/j.pulmoe.2019.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/27/2019] [Accepted: 06/10/2019] [Indexed: 11/30/2022] Open
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Sousa JP, Neves C, Jesus E, Chaves A, Lourenco C, Goncalves L, Sousa G. P852 Cancer-associated thrombotic diathesis: one of your worst nightmares. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
A 34-year-old male patient was diagnosed with undifferentiated sarcoma of the right thigh, with lung metastasis. He underwent primary lesion resection surgery and initiated chemotherapy with both doxorubicin and ifosfamide. Though primary tumor burden was substantially reduced, secondary lesions were found to be irresponsive to drug therapy, leading to regimen switching to both gemcitabine and docetaxel. Three months later, patient started complaining of atypical chest pain and palpitations. Electrocardiography revealed very frequent supraventricular ectopic complexes, while a transthoracic echocardiogram unveiled a pulmonary vein thrombus, which extended into the left atrium. This finding, which was further characterized by cardiovascular magnetic resonance imaging, prompted anticoagulation initiation, under the form of enoxaparin 1mg/kg bid. At this time, chemotherapeutic scheme was, again, swapped, and a cycle of both doxorubicin and olaratumab was introduced. A combined episode of inferolateral ST-segment elevation myocardial infarction and peripheral arterial embolism followed shortly thereafter. Emergent invasive coronary angiogram revealed no signs of both epicardial atherosclerosis and thrombus, whereas subsequent transthoracic echocardiography showed a massive left heart thrombus, extending into the aortic valve annulus. Anti-thrombotic approach involved increasing enoxaparin dosage to 1.5mg/kg bid but no fibrinolytic therapy. Despite a rather uneventful immediate clinical course, with no electric or hemodynamic instability and no limb-threatening ischemia, lamentably, patient died two weeks later, before thrombus definitive imaging reassessment. As no autopsy was performed, it is unclear whether a cardiovascular acute event or neoplasm inexorable progression is to blame as the primary cause of death.
Thrombosis is a common, costly and potentially fatal cancer complication. Patients receiving systemic chemotherapy for advanced diseased are at higher risk. Despite major management developments in the past fifteen years, evidence still supports traditional low-molecular-weight heparins as the first-line therapy and prognosis remains dismal.
Abstract P852 Figure.
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Affiliation(s)
- J P Sousa
- University Hospitals of Coimbra, Coimbra, Portugal
| | - C Neves
- Instituto Português de Oncologia de Coimbra, Cardiologia, Coimbra, Portugal
| | - E Jesus
- Instituto Português de Oncologia de Coimbra, Cardiologia, Coimbra, Portugal
| | - A Chaves
- Instituto Português de Oncologia de Coimbra, Cardiologia, Coimbra, Portugal
| | - C Lourenco
- University Hospitals of Coimbra, Coimbra, Portugal
| | - L Goncalves
- University Hospitals of Coimbra, Coimbra, Portugal
| | - G Sousa
- Instituto Português de Oncologia de Coimbra, Cardiologia, Coimbra, Portugal
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Rego I, Pontes F, Chaves A, Jesus E. EP1.04-39 Is Body Mass Index a Prognostic Factor in Patients with Lung Cancer Treated with Immunotherapy? J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.2160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Amaral S, Casal Moura M, Carvalho J, Chaves A, Jesus E, Sousa G. Prognostic significance of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz027.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Domingues I, Carvalho J, Pratas E, Pinheiro S, Amaral S, Bonito N, Jesus E, Ribeiro J, Chaves A, Pais A, Sousa G. A long-term analysis of imatinib palliative treatment in gastrointestinal stromal tumors. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Mariano M, Jesus E, Barradas L, Carvalho L, Gervásio H. 52P PRIMARY EWING'S SARCOMA/PERIPHERAL NEURO- ECTODERMAL TUMORS ARISING FROM THE LUNG OF AN ADULT MALE. Lung Cancer 2011. [DOI: 10.1016/s0169-5002(11)70189-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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