Predictors and survival of cardiomyopathy determined by echocardiography in Thai patients with early systemic sclerosis: an inception cohort study

Available data including the incidence, predictors and long-term outcome of early systemic sclerosis patients associated with suspected cardiomyopathy(SSc-CM) is limited. Therefore, we aimed to study the incidence, predictors and survival of SSc-CM. An inception cohort study was conducted for early SSc patients seen at the Rheumatology Clinic, Maharaj Nakorn Chiang Mai Hospital, Thailand, from January 2010 to December 2019. All patients were determined for clinical manifestations and underwent echocardiography and HRCT at enrollment and then annually. SSc-CM was determined and classified using echocardiography. 135 early SSc patients (82 female,108 DcSSc) were enrolled. With the mean follow-up period of 6.4 years, 32 patients developed SSc-CM. The incidence of SSc-CM was 5.3 per 100-person years. The multivariate Cox regression analysis showed that baseline anti-topoisomerase I-positive (Hazard ratio[HR] 4.86, p = 0.036), dysphagia (HR 3.35, p = 0.001), CK level ≥ 500 U/L(HR 2.27, p = 0.045) and low oxygen saturation (HR 0.82, p = 0.005) were predictors of SSc-CM. The survival rates after SSc-CM diagnosis at 1, 5 and 10 years were 90.3%, 73.1%, and 56.1%, respectively. In this study cohort, the incidence of SSc-CM was 5.3 per 100-person years, and tended to have low survival. The presence of anti-topoisomerase I antibody, dysphagia, CK level ≥ 500 U/L, and low oxygen saturation were independent baseline predictors for developing SSc-CM.

Correlation of Air Pollution and Prevalence of Acute Pulmonary Embolism in Northern Thailand

BACKGROUND

The relationship between the level of air pollution and acute pulmonary embolism (APE) has had inconsistent results.

OBJECTIVE

This study aimed to analyze the relationship between the high level of air pollution exposure and APE.

METHODS

A ten-year retrospective cohort, single-center study was performed on patients diagnosed with APE from October 2010 to December 2020. The association between air pollution and monthly APE case diagnosis was analyzed.

RESULTS

A total number of 696 patients was included. The effect of every 10 µg/m³ increment of particulate matters with an aerodynamic diameter < 10 µm (PM₁₀) on total monthly APE cases (unprovoked PE and provoked PE) was increased significantly at lag 4, 5 and 6 months with adjusted RR (95% CI) of 1.06 (1.01, 1.12), p = 0.011, 1.07 (1.01, 1.13), p = 0.021 and 1.06 (1.01, 1.12), p = 0.030, respectively. Adjusted RR for APE was significantly increased for PM₁₀ in the second tertile ((adjusted RR (95% CI) 1.76 (1.12, 2.77)), p = 0.014.

CONCLUSIONS

We conclude that PM₁₀ is associated with an increased prevalence of APE cases. The policy for tighter control of air pollution in our country is needed to reduce the impact of air pollutants on people's health.

Elevated baseline serum creatine kinase in Thai early systemic sclerosis patients is associated with high incidence of cardiopulmonary complications and poor survival: an inception cohort study

BACKGROUND

Inception cohort data regarding the incidence of cardiopulmonary complications in early systemic sclerosis (SSc) patients comparing those with and without elevated baseline creatine kinase (CK) are limited. This study aimed to compare the incidence of cardiopulmonary complications and survival between the two subgroups.

METHODS

We used an inception cohort study of early SSc patients seen at the Rheumatology Clinic, Maharaj Nakorn Chiang Mai Hospital, Thailand, from January 2010 to December 2019. All patients were assessed for clinical manifestations and CK levels and underwent echocardiography and HRCT at the study entry and annually thereafter.

RESULTS

A total of 144 SSc patients (84 female, 115 diffuse cutaneous SSc (DcSSc)) with a mean disease duration of 11.9 ± 9.2 months were enrolled. At cohort entry, their mean ± SD CK levels were 364.3 ± 598.0 U/L. The participants were then divided into two subgroups: (i) 29 SSc with elevated CK (baseline CK ≥ 500 U/L); (ii) 115 SSc with non-elevated CK. At enrollment, the elevated CK group was characterized by a higher proportion of male gender, DcSSc subtype, arthritis, and weakness; shorter disease duration; and higher MRSS compared with non-elevated CK. At the last visit, with a mean ± SD follow-up duration of 6.2 ± 2.7 years, the elevated CK group showed a higher cumulative prevalence of weakness, dysphagia, LVEF < 50%, and suspected myocardial disease; higher incidence of LVEF < 50%, suspected myocardial disease, and ILD; and shorter survival time.

CONCLUSION

It was found in our study cohort that elevated baseline serum CK in early SSc, of which majority were DcSSc subtype, is associated with more severe clinical presentation, higher incidence of cardiopulmonary complications, and shorter survival time compared with the non-elevated CK subgroup. Key Points • In early SSc patients, elevated baseline serum creatine kinase was confirmed to be associated with a high incidence of cardiac and ILD complications, and poor long-term survival time. • Careful evaluation of baseline serum CK levels in all early-diagnosed SSc patients is crucial in general clinical practice.

AB0644 Incidence of cardiopulmonary complications and survival in early systemic sclerosis (SSc) patients comparing between those with and without elevated serum creatine kinase (CK): inception cohort study

Background

There has been no prior inception cohort data regarding incidence of cardiopulmonary complications and survival in early SSc patients comparing between those with elevated creatine kinase (baseline CK ≥ 500 U/L) and without elevated CK (baseline CK < 500 U/L).

Objectives

The aims of this study were to compare: (1) the prevalence of clinical manifestations; (2) incidence rate (IR) of cardiopulmonary complications and (3) survival, between early SSc patients with and without elevated serum CK levels, using inception cohort study.

Methods

We used an inception cohort of early SSc patients (disease duration from first Non-Raynaud’s phenomenon≤ 3 years) seen at the Rheumatology clinic, Maharaj Nakorn Chiang Mai Hospital, Thailand, between January 1st 2010 and 31 December 2019. All patients were assessed for clinical manifestations, creatine kinase (CK) levels and underwent electrocardiography (ECG), echocardiography and high-resolution computed tomography (HRCT) at the study entry and every 12 months thereafter. Interstitial lung disease (ILD) was determined by HRCT. Myocardial disease was defined as presence of dilated cardiomyopathy, non-specific cardiomyopathy or suspected primary right ventricular dysfunction assessed by echocardiography.

Results

One hundred and forty-four patients (84 females, 115 diffuse cutaneous SSc [DcSSc] and 111 anti-topoisomerase I antibody-positive) with mean ± SD age of 53.3 ± 8.9 years, mean disease duration of 11.9 ± 9.2 months and mean follow-up duration of 6.2 ± 2.7 years were recruited. There were 29 early SSc patients with elevated CK (20.1%). Comparing with patients without elevated CK, SSc with elevated CK had significantly higher proportion of clinical manifestations as followings: male gender (58.6% vs. 37.4%, p = 0.038), DcSSc subtype (93.1% vs. 76.5%, p = 0.047) and shorter disease duration (8.2 ± 6.3 vs.12.8 ± 9.5 months, p = 0.009). At enrollment, the elevated CK group had significantly higher prevalence of arthritis (44.8% vs. 25.2%, p = 0.038), weakness (55.2% vs. 10.4%, p < 0.001) and higher modified Rodnan skin score (MRSS) (23.5 ± 10.1 vs. 17.5 ± 10.6, p = 0.005); At last visit, the elevated CK group had significantly higher cumulative prevalence of weakness (58.6% vs. 11.3%, p < 0.001), dysphagia (75.9% vs. 43.5%, p = 0.002), LVEF < 50% (48.3% vs. 12.2%, p < 0.001) and myocardial disease (55.2% vs. 21.7%, p < 0.001). The elevated CK group had significantly higher incidence rate (IR) of: LVEF < 50% (14.24 vs. 2.03 per 100 person-year; incidence rate ratio (IRR) 7.03, p < 0.001), myocardial disease (19.74 vs. 3.87 per 100 person-year; IRR 5.09, p < 0.001) and ILD (60.40 vs. 31.49 per 100 person-year; IRR 1.92, p = 0.006); compared to the non-elevated CK group. The survival rate of early SSc with elevated CK group at 1, 3 and 5 year were 86.2% and 82.5% and 74.3%, respectively. The median survival time of the elevated CK group was lower than those without elevated CK group (6.98 vs. 8.56 years, p = 0.012).

Conclusion

Our study cohort found that early SSc patients with elevated baseline CK levels are predominant in male gender, DcSSc subtype with shorter disease duration. The elevated CK group has more severe clinical presentations including higher MRSS, arthritis and weakness compared to the non-elevated CK group. In addition, significantly higher incidence rate of: LVEF < 50%, myocardial disease, ILD; and poorer survival are also obviously detected in the elevated CK group.

Disclosure of Interests

None declared

Optimal landmark for chest compression during cardiopulmonary resuscitation derived from a chest computed tomography in arms-down position

Funding Acknowledgements

Type of funding sources: Private hospital(s). Main funding source(s): The Faculty of Medicine, Chiang Mai University Fund

Background

Recently evidence, compression at the maximal left ventricular diameter on sternum (LVmax) maximises cardiac output, stroke volume and rate of return of spontaneous circulation. However, there is insufficient evidence for the specific landmark on the chest for high-quality chest compression. Although cardiac arrest patients are usually in the arms-down position, previous studies used chest computed tomography (CCT) of the patient with arms-up position. It might alter the left ventricular position.

Purpose

This study aimed to identify the landmark of LVmax and to propose the new hand placement to optimise the chest compression by using CCT in arms-down position.

Methods

A retrospective, cross-sectional study conducted at a university-based, tertiary care hospital between September 2016 and November 2020. We included adult patients who underwent CCT in arms-down position. We measured healthcare providers’ hand heel width and the cardiothoracic parameters in CCT to establish a new optimal landmark of chest compression. We defined the sternal notch as a reference point and measured the distance from the sternal notch to LVmax (DLVmax), to the lower half of sternum (DLH), and to the point of maximal force of hand which placed the palmar margin of the reference hand at the xiphisternal junction (lower end of the sternum).

Results

A total of 39 patients were enrolled to measure the cardiothoracic parameters. There were 22 male (56.4%) and the median age was 67 years. DLVmax was neither different in inspiratory-hold nor expiratory-hold (mean ± standard deviation: 12.1 ± 1.9 cm and 12.9 ± 2.7 cm, p = 0.386). LVmax was located lower than the lower half of the sternum (Figure 1); the median of DLVmax and DLH were 12.6 cm (interquartile range: 10.6, 13.5 cm) and 10.0 cm (9.5, 11.0 cm), respectively (p &lt;0.001). We found that the distance from the sternal notch to the point of maximal force of the left hand which the ulnar border located at the xiphisternal junction (DLU) was not significantly different from DLVmax (Figure 2); the median of DLVmax and DLU were 12.6 cm (10.6, 13.5 cm) and 11.3 cm (10.6, 12.5 cm), respectively (p 0.076).

Conclusions

The maximal left ventricular diameter on sternum (DLVmax) in the arms-down position was located lower than the lower half of the sternum (lower than the standard guideline recommendation). We propose that the new hand placement for chest compression is placing the left hand down and the hand’s border located at the xiphisternal junction while approach at left side of the patient. Abstract Figure.  Abstract Figure.

The effects of dapagliflozin on hepatic and visceral fat in type 2 diabetes patients with non-alcoholic fatty liver disease

BACKGROUND AND AIM

Sodium-glucose cotransporter 2 inhibitors have shown excellent results in glucose control in type 2 diabetes mellitus (T2DM) patients, while also promoting weight loss. These mechanisms may be beneficial in the treatment of non-alcoholic fatty liver disease (NAFLD). Our study aims to investigate the effect of dapagliflozin on hepatic and visceral fat contents and related biochemical markers in T2DM with NAFLD patients.

METHODS

This is a double-blinded placebo-controlled randomized, single-center study. Non-insulin-dependent T2DM patients with NAFLD were prospectively enrolled and randomly assigned to receive either dapagliflozin (10 mg/day) or placebo for 12 weeks. The primary end-point was the changes in intrahepatic lipid contents, evaluated by the liver attenuation index.

RESULTS

Of 40 patients enrolled, 38 patients completed the study (dapagliflozin group, n = 18; placebo group, n = 20). Baseline demographic and laboratory findings were similar in both groups. After 12 weeks of treatment, dapagliflozin significantly decreased intrahepatic lipid contents demonstrated by an increase in liver attenuation index in comparison with the placebo treatment (5.8 ± 5.1 vs 0.5 ± 6.1 Hounsfield units, P = 0.006). Significant reduction in bodyweight, bodyfat, visceral fat/subcutaneous fat ratio, hemoglobin A1c, and alanine aminotransferase were also observed in the dapagliflozin-treated group as compared with the placebo group (all P < 0.05). There was no significant difference in adipokines including adiponectin, leptin, and tumor necrosis factor-α changes between the dapagliflozin-treated group and the placebo group (all P = nonsignificant).

CONCLUSION

Dapagliflozin treatment for 12 weeks is associated with improvement in hepatic fat content, a decrease in visceral fat and bodyweight, enhanced glycemic control, and improved liver biochemistry among T2DM patients with NAFLD.

Effect of Insurance Type on Stage at Presentation, Surgical Approach, Tumor Recurrence and Cancer-Specific Survival in Resectable Non-Small Lung Cancer Patients

Purpose

The aim of this study was to identify the association between Thailand’s insurance types and stage at presentation, surgical approach, tumor recurrence and cancer-specific survival in resectable non-small cell lung cancer (NSCLC) patients in northern Thailand.

Patients and Methods

Medical records of patients with NSCLC who underwent pulmonary resection at Chiang Mai University Hospital from January 2007 through December 2015 were retrospectively reviewed. Patients were divided into two groups: patients with the Universal Coverage Scheme (UCS) or Social Security Scheme (SSS) and patients with the Civil Servant Medical Benefit Scheme (CSMBS) or private insurance (PI). Patient characteristics were assessed. The primary outcome was cancer-specific survival while the secondary outcome was tumor recurrence. Cox’s regression and matching propensity score analysis was used to analyze data.

Results

This study included 583 patients: 344 with UCS or SSS and 239 with CSMBS or PI. Patients with UCS or SSS were more likely to be active smokers, have a lower percent predicted FEV1, present with higher-stage tumors and worse differentiated tumors, present with tumor necrosis, and undergo an open surgical approach than those with CSMBS or PI. At multivariable analysis of all patients cohort, there were no significant differences in terms of early stage at presentation (adjusted odds ratio (OR_adj) = 0.94, 95% confidence interval (CI) = 0.65–1.37), undergoing lobectomy (OR_adj = 0.59, 95% CI = 0.24–1.46), and recurrent-free survival (adjusted hazard ratio (HR_adj) =1.20, 95% CI = 0.88–1.65) between groups (UCS/SSS versus CSMBS/PI). However, patients with UCS or SSS had shorter cancer-specific survival (HR_adj = 1.61, 95% CI = 1.22–2.15). The results from the propensity score matched patient cohort were not different from those analyses on the full patient cohort.

Conclusion

Thai insurance types have an effect on cancer-specific survival. The Thai government should recognize the importance of these differences, and further multi-center studies with a larger sample size are warranted to confirm this result.

THU0368 RAPID SKIN THICKNESS PROGRESSION RATE IS ASSOCIATED WITH HIGH INCIDENCE RATE OF CARDIOPULMONARY INVOLVEMENT AND MORTALITY IN PATIENTS WITH EARLY DIFFUSE CUTANEOUS SYSTEMIC SCLEROSIS (DCSSC)

Background:

There has been no prior inception cohort study regarding the incidence rate of cardiopulmonary involvement in patients with early dcSSc comparing among different groups of skin thickness progression rate.

Objectives:

The aims of this study were to compare differences in early dcSSc patients, which were classified into 3 subgroups; (a) rapid skin progression [RPsp], (b) intermediate skin progression [IMsp], and (c) slow skin progression [SLsp]; regarding: (1) clinical characteristics,(2) incidence rate of left ventricular ejection fraction (LVEF) < 50 %, interstitial lung disease (ILD),and pulmonary hypertension (PH). In addition, to compare mortality rate between skin improved and non-improved skin group.

Methods:

We used an inception cohort of early dcSSc patients seen at the Rheumatology clinic, Maharaj Nakorn Chiang Mai Hospital, between January 2010 and December 2017. All patients were assessed for demographic data, clinical manifestations, modified Rodnan Skin Score (mRSS) and underwent echocardiography, and HRCT at the study entry and then annually.

Results:

One hundred and two dcSSc patients (55 females and 89 anti-Scl 70 antibody positivity) with a mean±SD age of 53.2 ± 8.8 years and mean disease duration of 11.2 ± 8.7 months were enrolled, during a mean observation period of 54.0 ± 24.0 months. Mean±SD of baseline mRSS was 21.9 ± 9.1. Patients were classified into 3 groups: (a) 41 (40.2 %) patients with RPsp; (b) 37 (36.3 %) IMsp and; (c) 24 (23.5 %) SLsp. At enrollment, the RPsp group had significantly differences in clinical manifestations compared to IMSp and SLsp group as the followings: mean disease duration (5.4 ± 2.3 vs. 11.5 ± 6.1 and 20.7 ± 10.3 months, p < 0.001), anti-Scl 70 antibody- positive (95.1 % vs. 75.7 % and 91.7 %, p= 0.035), mRSS (26.4 ± 7.9 vs. 22.1 ± 8.4 and 13.8 ± 6.5, p < 0.001), dry mouth (48.8 % vs. 37.8 % and 8.3 %, p= 0.005), LVEF < 50 % (26.8 % vs. 21.6 % and 0, p= 0.010), pericardial effusion (0 vs. 10.8 % and 0, p= 0.018), arrhythmia (7.3 % vs. 29.7 % and 8.3 %, p= 0.018), muscle weakness (26.8 % vs. 27.0 % and 0, p= 0.009), creatine kinase ≥ 500 U/L (34.1 % vs. 18.9 % and 4.2 %, p= 0.016, and NT-proBNP (935.7 ± 2300.3 vs. 746.4 ± 1385.2 and 164.0 ± 225.3 ng/L, p= 0.001). During the observation period, the RPsp group had a significantly higher incidence rate of LVEF < 50 % compared with the SLsp group (6.06 vs. 0 per 100 person-years, incidence rate ratio= 21.27, p= 0.001). The RPsp group had a significantly higher incidence of ILD compared with the SLsp group (69.69 vs. 34.66 per 100 person-years, incidence rate ratio= 2.01, p= 0.012). Skin non-improved group had higher mortality rate compared with the skin improved group (28.6 % vs. 5.9 %, p= 0.004).

Conclusion:

Our study cohort found that early dcSSc patients with rapid skin progression had higher incidence rate of LVEF < 50 % and ILD compared to those with slow skin progression. In addition, skin non-improved patients had significantly higher mortality rates than those with skin improved.

Disclosure of Interests:

None declared

Rapid skin thickness progression rate is associated with high incidence rate of cardiopulmonary complications in patients with early diffuse cutaneous systemic sclerosis: inception cohort study

OBJECTIVES

We aimed to investigate patients with early diffuse cutaneous systemic sclerosis (dcSSc) with regard to: 1. the association between skin thickness progression rate (STPR) at baseline visit and incidence rate of cardiopulmonary complications; 2. comparison of the mortality rate between patients with skin improvers and those with skin non-improvers.

METHODS

An inception cohort of early dcSSc patients seen at the Rheumatology Clinic, Maharaj Nakorn Chiang Mai Hospital, Thailand, was selected. All patients were assessed for clinical manifestations, and modified Rodnan skin score (mRSS) and underwent echocardiography, and HRCT at study entry and then annually.

RESULTS

One hundred and four dcSSc patients (57 of whom were females and 91 anti-topoisomerase I-positive) with a mean disease duration of 11.1±8.6 months were enrolled. Forty-two patients had rapid STPR [RPsp], 38 intermediate STPR [IMsp] and 24 slow STPR [SLsp]. At enrolment, the RPsp group had a significantly shorter disease duration, more prevalent anti-topoisomerase-I-positive, higher mRSS, more prevalent creatine kinase≥500 IU/L and higher NT-proBNP levels compared to the IMSp and SLsp groups. During a mean observation period of 4.5±2.0 years, the RPsp group had a significantly higher incidence rate of LVEF< 50% (6.06 vs. 0 per 100 person- years, p=<0.01) and interstitial lung disease (ILD) (69.69 vs. 34.66 per 100 person-years, p=0.012) than the SLsp group. Skin non-improvers had a signif- icantly higher mortality rate than skin improvers (28.6% vs. 5.8 %, p= 0.004).

CONCLUSIONS

In this early dcSSc study cohort it was found that skin change determined by STPR at the baseline visit was a useful surrogate marker for cardiac and ILD complications. It was also found that skin improvers assessed 1-year later were a useful surrogate marker of mortality.

Conventional versus hypofractionated postmastectomy radiotherapy: a report on long-term outcomes and late toxicity

Objective

We evaluated the long-term outcomes and late toxicity of conventional fractionated (CF) and hypofractionated (HF) postmastectomy radiotherapy (PMRT) in terms of locoregional recurrence-free survival (LRRFS), disease-free survival (DFS), overall survival (OS), and late toxicity.

Methods

A cohort of 1640 of breast cancer patients receiving PMRT between January 2004 and December 2014 were enrolled. Nine hundred eighty patients were treated with HF-PMRT: 2.65 Gy/fraction to a total of 42.4–53 Gy and 660 patients were treated with CF-PMRT: 2 Gy/fraction to a total of 50–60 Gy.

Results

The median follow-up time was 71.8 months (range 41.5–115.9 months). No significant difference was found in the rates of 5-year LRRFS, DFS, and OS of HF-PMRT vs CF-PMRT; 96% vs. 94% (p = 0.373), 70% vs. 72% (p = 0.849), and 73% vs. 74% (p = 0.463), respectively. We identified a cohort of 937 eligible breast cancer patients who could receive late toxicities assessment. With a median follow-up time of this patient cohort of 106.3 months (range 76–134 months), there was a significant higher incidence of grade 2 or more late skin (4% vs 1%) and subcutaneous (7% vs 2%) toxicity in patients treated with HF-PMRT vs CF-PMRT. Patients who received additional radiation boost were significantly higher in the HF-PMRT group. Grade 2 or more late RTOG/EORTC lung toxicity was significant lesser in HF-PMRT vs CF-PMRT (9% vs 16%). Grade 1 brachial plexopathy was also significant lesser in HF-PMRT vs CF-PMRT (2% vs 8%). Heart toxicity and lymphedema were similar in both groups.

Conclusions

HF-PMRT is feasible to deliver with comparable long-term efficacy to CF-PMRT. HF-PMRT had higher grade 2 or more skin and subcutaneous toxicity but less lung and brachial plexus toxicity.

Clinical Manifestation and Incidence of Cardiopulmonary Complications in Early Systemic Sclerosis Patients with Different Antibody Profiles

Background

There has been no prior inception cohort study comparing clinical manifestations and incidence rate (IR) of cardiopulmonary involvement among early systemic sclerosis (SSc) patients by difference in autoantibody profiles. We compared the differences in the clinical presentation at study entry and cumulative organ complications at last visit, as well as the IR of cardiopulmonary complications between anti-topoisomerase I antibody-positive SSc patients (pATA), ATA-negative (nATA), and the positive anti-centromere antibody patients (pACA).

Methods

An inception cohort of early diagnosis SSc patients (disease duration ≤ 3 years) seen at the Rheumatology Clinic, Maharaj Nakorn Chiang Mai Hospital, between January 2010 and June 2016, was studied. SSc patients who had follow-up duration as less than 1 year and those diagnosed with an overlap syndrome were excluded. All participants underwent electrocardiography (ECG), echocardiography, and high-resolution computed tomography (HRCT) at the study entry and then annually.

Results

A total of 114 patients (90 diffuse cutaneous SSc (dcSSc), 69 women) with mean (standard deviation, SD) disease duration of 11.7 (8.8) months at cohort entry and an observational period of 3.8 (1.6) years, were recruited. There were 89 patients (78.1%) with pATA, 18 (15.8%) with nATA, and 7 (6.1%) with pACA. At enrollment, both pATA and nATA groups had a higher prevalence of dcSSc subtype, and interstitial lung disease (ILD) when compared with the pACA group. At the last visit, the pATA group had a higher cumulative prevalence of digital ulcers, joint contracture and tendon friction rub than the other groups. Both the pATA and nATA groups had a significantly higher IR of ILD compared to the pACA group (54.9 and 57.8 vs. 6.3 per 100 person-years). During the study period, no suspected myositis, systolic pulmonary artery pressure (sPAP) ≥ 50 mm Hg or cardiac complications was observed in the pACA group.

Conclusions

In our study cohort, the majority of which were dcSSc subtype with pATA, it was found that the presence of SSc-specific autoantibodies was associated with a distinctive clinical presentation and cumulative internal organ involvement, even in the early phase of the disease. Cardiopulmonary complications were rarely seen in the pACA group; whereas ILD complications were very common in both the pATA and nATA groups. A further study into the association of autoantibodies in nATA patients with ILD complications is needed.

Outcomes of pulmonary resection in non-small cell lung cancer patients older than 70 years old

BACKGROUND

An appropriate treatment of older lung cancer patients has become an important issue. The aim of this study is to evaluate the short and long-term surgical outcomes in lung cancer patients using 70 years as a cut-point, and to identify prognostic factors of cancer-specific mortality in patients older than 70 years.

METHODS

Medical records of non-small cell lung cancer (NSCLC) patients who underwent pulmonary resection at Chiang Mai University Hospital from January 2002 through December 2016 were retrospectively reviewed. Patients were divided into age less than 70 years (control group) and 70 years or more (study group). Primary outcomes were major post-operative complications and in-hospital death (POM); secondary outcome was long-term survival. Multivariable regression analysis was used.

RESULTS

This study included 583 patients, 167 for study group, and 416 for control group. There were no differences in POM, both at univariable and multivariable analyses, however, for long-term cancer-specific mortality, the study group was more likely to die (HR_adj = 1.40, 95%CI = 1.03-1.89). Adverse prognostic factors for long-term mortality in study group were having universal coverage scheme (HR_adj = 1.70, 95%CI = 1.03-2.79), the presence of intratumoral lymphatic invasion (HR_adj = 2.83, 95%CI = 1.28-6.29), perineural invasion (HR_adj = 2.80, 95%CI = 1.13-6.94), underwent lymph node sampling (HR_adj = 2.23, 95%CI = 1.16-4.30) and higher stage of disease (HR_adj = 2.02, 95%CI = 1.06-3.85 for stage III, HR_adj = 3.40, 95%CI = 1.29-8.94 for stage IV).

CONCLUSIONS

In-hospital mortality and composite post-operative complications are acceptable in pulmonary resection for NSCLC patients older than 70 years. However, these patients had shorter long-term survival, especially who have some adverse prognostic factors. Further studies with larger sample size are warranted.

Tuberculosis among Healthcare Workers at Chiang Mai University Hospital, Thailand: Clinical and Microbiological Characteristics and Treatment Outcomes

Tuberculosis (TB) among healthcare workers (HCWs) highly affects morbidity and TB transmission in hospitals. A retrospective cohort study of TB among HCWs (HCW-TB) was conducted using a registered database from 2003 to 2016 at Chiang Mai University Hospital to determine clinical and microbiological characteristics and treatment outcomes of HCW-TB. A total of 76 patients comprising 54 nurses (71.1%), 12 physicians (15.8%), and 10 paramedics (13.2%) were diagnosed with TB disease. The men to women ratio was 25:51, with a mean age of 37.0±11.6 years, a median work duration of 12.0 years (5-20) and a body mass index of 19.4±2.5 kg/m². Within the HCW-TB group, 28 (36.8%) worked in the Medical Department, 12 (15.8%) worked in the Outpatient Department/Emergency Room, and 9 (11.8%) worked in the Surgical Department. Pulmonary TB (PTB) was the most common manifestation of HCW-TB (92.1%). Sputum acid-fast stains were positive among 28 (40.0%) HCWs with PTB. Mycobacterium tuberculosis cultures were positive in 26 (34.2%) patients. Drug susceptibility testing showed sensitivity to all first-line drugs (75.0%), resistance to any one first-line drug (20.8%), and multidrug-resistant TB comprised 4.2%. The end-of-treatment success rate was 100%. Therefore, TB control guidelines should be strictly implemented to prevent TB transmission in healthcare settings.

Causes of death, survival and risk factors of mortality in Thai patients with early systemic sclerosis: inception cohort study

Inception cohort study regarding the causes of death and risk factors for mortality in patients with early systemic sclerosis (SSc), especially diffuse SSc (dcSSc) has not been well elucidated. Therefore, the aim of our study was to determine the causes of death, survival rates, and risk factors for mortality in Thai patients with early SSc of whom the majority belonged to the dcSSc subset. We used an inception cohort of early-SSc patients seen between January 2010 and August 2014. All patients were evaluated for clinical and laboratory data at the study entry and then every 6 months. A total of 115 patients (68 female, 91 dcSSc) were enrolled. The mean ± SD age at onset, duration of disease, and duration of follow-up were 52.5 ± 8.5 years, 12.3 ± 9.2 months, and 27.5 ± 16.4 months, respectively. During the follow-up, 11(9.6%) SSc patients died. The mortality rate was 4.17 per 100 person-years (95% CI 2.31, 7.53). The leading cause of SSc-related death was dilated cardiomyopathy (27.2%). Infection was the most common cause of non-SSc-related death (18.2%). Survival rates at 1, 2, 3, and 4 years after the study entry were 93, 91, 88, and 88%, respectively. In the multivariate Cox regression analysis, ESR ≥ 40 mm/h [HR 8.65 (95% CI 1.66,45.17)], hemoglobin < 10 mg/dL [HR 4.57 (95% CI 1.14,18.34)], and mRSS [HR 1.09 (95% CI 1.03,1.15)] were independent risk factors for mortality. Our data suggest that dilated cardiomyopathy was the most common SSc-related cause of death in Thai patients with early SSc, of whom majority was dcSSc subset. Elevated ESR, anemia, and increased mRSS predicted poor outcome.

Results of an Evidence-Based Care Bundle for Reducing Ventilator-Associated Pneumonia (VAP) in Neurosurgical Patients

BACKGROUND

Ventilator-associated pneumonia (VAP) is the most common intensive care unit-acquired infection, resulting in increased morbidity and mortality as well as increased hospital costs.

OBJECTIVE

To determine the VAP rate before and after using the care bundle.

MATERIAL AND METHOD

A pre- and intervention study was conducted in the Neurosurgical Critical Care Unit (NCCU) at a university hospital between April 2012 and February 2013. This was compared with the twelve-month period before intervention. The six-element VAP prevention bundle called Suandok Model was implemented. It included 30-degree head elevation, bedside hand hygiene, oral chlorhexidine mouth care, inflating of the cuff of the endotracheal tube maintaining 20 to 25 mmHg, checking residual gastric content before feeding, and implementing a weaning protocol.

RESULTS

The samples before and after interventions were 66 and 68 cases, respectively. There were no significant differences between sex, age, GCS, diagnosis, and operation. The incidence rates of VAP in the intervention period showed a significant decrease (p = 0.001, 39.55 per 1,000 ventilator days vs. 13.30 per 1,000 ventilator days).

CONCLUSION

The Suandok Model reduced VAP in NCCU patients.

Correlation of delta high-resolution computed tomography (HRCT) score with delta clinical variables in early systemic sclerosis (SSc) patients

BACKGROUND

The correlation of changes (delta: Δ) of high-resolution computed tomography (HRCT) score with the Δ of other clinical variables has not been well studied. The purpose of this study was to determine the correlation of Δ HRCT score with Δ percent predicted forced vital capacity (%pFVC), Δ modified Rodnan Skin Score (mRSS), Δ erythrocyte sedimentation rate (ESR), and Δ percent of oxygen saturation at room air (%SpO₂) in patients with early systemic sclerosis (SSc).

METHODS

We used an inception cohort of early-SSc patients seen at the Rheumatology Clinic, Chiang Mai University, Thailand, between January 2010 and June 2014. All patients underwent HRCT at study entry and every 12 months thereafter. Thirty-one SSc patients who underwent pulmonary function test (PFT) within 12 weeks of their corresponding HRCT at baseline and last visit were identified. The extent of ground glass (GG), lung fibrosis (Fib), bronchiectasis (B), and honeycombing (HC) was scored, and then aggregated to produce a total (t) HRCT score.

RESULTS

Mean ± SD age and disease duration from non-Raynaud's phenomenon (NRP) to undergo HRCT at baseline were 52.2±8.8 years and 11.7±7.1 months, respectively. Seventeen (54.8%) patients were female and 20 (64.5%) were classified as dcSSc. The mean ± SD interval between the two HRCT tests was 16.0±7.2 months. The Δ HRCT scores [total fibrosis scores (t-Fib), total bronchiectasis scores (t-B), and total HRCT score (t-HRCT) scores] and Δ mRSS, but not Δ %pFVC, showed significant change over the observation period. We found significant correlation of Δ total honeycombing scores (t-HC) with Δ ESR (r=-0.44, P<0.05), and Δ t-Fib with Δ %SpO₂ (r=-0.38, P<0.05). However, no significant correlation of any Δ HRCT scores with Δ %pFVC and Δ mRSS were observed.

CONCLUSIONS

In this study, the changes in the HRCT scores were greater than %pFVC; this, along with their correlations with the changes in ESR and %SpO₂, suggest that HRCT scores are a useful and sensitive method for monitoring disease progression in early SSc-related ILD (SSc-ILD).

Learning styles and academic achievement among undergraduate medical students in Thailand

PURPOSE

This study aimed to explore the associations between learning styles and high academic achievement and to ascertain whether the factors associated with high academic achievement differed between preclinical and clinical students.

METHODS

A survey was conducted among undergraduate medical students in Chiang Mai University, Thailand. The Index of Learning Styles questionnaire was used to assess each student's learning style across four domains. High academic achievement was defined as a grade point average of at least 3.0.

RESULTS

Of the 1,248 eligible medical students, 1,014 (81.3%) participated. Learning styles differed between the preclinical and clinical students in the active/reflective domain. A sequential learning style was associated with high academic achievement in both preclinical and clinical students. A reflective learning style was only associated with high academic achievement among preclinical students.

CONCLUSION

The association between learning styles and academic achievement may have differed between preclinical and clinical students due to different learning content and teaching methods. Students should be encouraged to be flexible in their own learning styles in order to engage successfully with various and changing teaching methods across the curriculum. Instructors should be also encouraged to provide a variety of teaching materials and resources to suit different learning styles.

Retrospective study of ALK rearrangement and clinicopathological implications in completely resected non- small cell lung cancer patients in Northern Thailand: role of screening with D5F3 antibodies

BACKGROUND

Anaplastic lymphoma kinase (ALK) gene rearrangement in non-small cell lung cancer (NSCLC) has been intensively studied. The gold standard for ALK detection is FISH, but this is not routinely conducted in clinical practice, so that the IHC method has a role. The aim of this study was to identify the incidence of ALK rearrangement and risk or prognostic factors for ALK positivity using both of IHC and FISH methods.

MATERIALS AND METHODS

From January 2008 to December 2012, 267 completely resected NSCLC patients in Chiang Mai University Hospital were enrolled in this study. Clinical and pathological variables and outcomes of treatment were retrospectively reviewed. IHC and FISH were used to evaluate ALK rearrangement. Sensitivity and specificity of IHC were analyzed. Multivariable analysis was used to identify clinico-pathological correlations with positive results of IHC and clinical outcomes.

RESULTS

Twenty-two (8.2%) of 267 specimens were IHC-positive for ALK with intense cytoplasmic staining, whereas only 10 (3.8%) were FISH-positive. Sensitivity, specificity and the positive likelihood ratio with IHC were 80.0%, 94.9%, and 15.8 respectively. Age less than 55 years (RR 4.4, 95%CI 1.78-10.73, p value=0.001) and presence of visceral pleural invasion (VPI) (RR 2.9, 95%CI 1.21-6.78, p value =0.017) were identified as risk factors for ALK rearrangement with FISH. There were no statistically significant differences in other clinical and pathological variables. ALK rearrangement was not a prognostic factor for tumor recurrence or overall survival.

CONCLUSIONS

The incidences of ALK positivity in completely resected NSCLCs in northern Thailand were 8.2% by IHC and 3.8% by FISH. IHC with mouse monoclonal, Ventana D5F3 antibody can be used as a screening tool before FISH method because of high specificity and high positive likelihood ratio. Age less than 55 years and VPI are risk factors for ALK positivity.

The relevance of high-resolution computed tomographic findings and pulmonary arterial hypertension in systemic sclerosis-associated interstitial lung disease

OBJECTIVE

To compare the high-resolution computed tomographic (HRCT) findings between systemic sclerosis-associated interstitial lung disease (SSc-ILD) with and without pulmonary arterial hypertension (PAH), as well as to correlate the calculated HRCT scores and the estimated systolic pulmonary artery pressure (sPAP).

MATERIAL AND METHOD

The medical records of all SSc-ILD patients who presented at the Rheumatology Clinic, Chiang Mai University Hospital were retrospectively reviewed Patients with the availability of echocardiography performed within six months of the corresponding HRCT were included The extent of ground glass, lung fibrosis, and honeycombing were scored The maximum diameter of the main pulmonary artery (MPAD) and ascending aortic diameter (AD) were measured The PAH was defined by sPAP >45 mmHg.

RESULTS

Fifty patients with SSc-ILD diagnosed with HRCT were included Echocardiography identified 19 (38.0%) patients with PAH. The SSc-ILD with PAH had significantly higher mean (SD) lung fibrosis (9.9 [3.6] vs. 7.8 [3.5], p = 0.03), and CT-total scores (20.5 [6.9] vs. 14.9 [6.2], p<0. 01) than those without PAH. In the total group, the CT-total score correlated positively with sPAP (r = 0.384, p<0.01). No significant correlation of MPAD or MPAD/AD with sPAP was found.

CONCLUSION

SSc-ILD with PAH had more severe lung fibrosis than those without PAH The calculated total HRCT score may be useful to identify PAH in SSc-ILD.

Nodal involvement pattern in resectable lung cancer according to tumor location

The aim in this study was to define the pattern of lymph node metastasis according to the primary tumor location. In this retrospective cohort study, each of the operable patients diagnosed with lung cancer was grouped by tumor mass location. The International Association for the Study of Lung Cancer nodal chart with stations and zones, established in 2009, was used to define lymph node levels. From 2006 to 2010, 197 patients underwent a lobectomy with systematic nodal resection for primary lung cancer at Chiang Mai University Hospital. There were 123 male and 74 female patients, with ages ranging from 16– 85 years old and an average age of 61.31. Analyses of tumor location, histology type, and nodal metastasis were performed. The locations were the right upper lobe in 63 patients (31.98%), the right middle lobe in 18 patients (9.14%), the right lower lobe in 30 patients (15.23%), the left upper lobe in 55 patients (27.92%), the left lower lobe in 16 patients (8.12%), and mixed lobes (more than one lobe) in 15 patients (7.61%). The mean tumor size was 4.45 cm in diameter (range 1.2–16.5 cm). Adenocarcinoma was the most common histological type, which occurred in 132 cases (67.01%), followed by squamous cell carcinoma in 41 cases (20.81%), bronchiolo alveolar cell carcinoma in nine cases (4.57%), and large cell carcinoma in seven cases (3.55%). Eighteen cases (9.6%) had skip metastasis (mediastinal lymph node metastasis without hilar node metastasis). Adenocarcinoma and intratumoral lymphatic invasion were the predictors of mediastinal lymph node metastases. There were statistically significant differences between a tumor in the right upper lobe and the right lower lobe. However, there were no statistically significant differences between tumors in the other lobes. In conclusion, tumor location is not a precise predictor of the pattern of nodal metastasis. Systematic lymph node dissection is the only way to accurately determine lymph node status. Further studies are required for evaluation and conclusions.

A retrospective study comparing hypofractionated radiotherapy and conventional radiotherapy in postmastectomy breast cancer

BACKGROUND

The conventional radiotherapy (CRT) in postmastectomy breast cancer is 1.8-2.0 Gy daily for 25 fractions, while hypofractionated radiotherapy (HFRT) delivered dose in fewer fractions with larger radiation intensity. The present study compares the efficacy of HFRT and CRT.

MATERIAL AND METHOD

From 2004 to 2006, 215 patients were retrospectively reviewed. Sixty seven patients received CRT and 148 patients received HFRT (2.65 Gy in 16-18 fractions). Five-year locoregional control (LRC), disease free survival (DFS), overall survival (OS) and toxicities were analyzed.

RESULTS

Median follow-up was 39 months. Five-year LRC was 86.6% in CRT and 85.8% in HFRT (p = 0.852). Five-year DFS was 62.7% and 69.6% (p = 0.136) in CRTand HFRT respectively. Patients who received HFRT had significant increase in 5-year OS (62.7% and 73.0% (p = 0.048). No difference of toxicities including changes in chest wall appearance, skin fibrosis, brachial plexopathy, arm edema, pulmonary fibrosis, rib fractures and cardiovascular events was found between two groups.

CONCLUSION

HFRT is as effective as CRT in postmastectomy breast cancer.

Hydronephrosis after radical hysterectomy: a prospective study

One part of the operative procedure of radical hysterectomy (RH) is the dissection of the ureter from its overlying tissue and this may result in injury to the ureteric adventitia. This might induce ureteric obstruction and consequently produce hydronephrosis. The objective of this prospective study was to evaluate the incidence of hydronephrosis after RH in patients with early stage cervical cancer. From July 2006 through March 2007, 77 patients with IA2-IIA cervical cancer who planned to undergo radical hysterectomy and pelvic lymphadenectomy (RHPL) received urinary tract ultrasonography 5 times (one day before surgery and 7 days, 6 weeks, 3 months and 6 months after the operation) from one radiologist. Patients who had hydronephrosis before surgery, suffered intraoperative ureteric injury, or were lost follow-up at 7 days after surgery were excluded from the study. Urinary tract ultrasonography was performed on 77, 55, 52 and 52 patients at each visit. Right hydronephrosis was detected in 16, 7, 5 and 3 patients, and left hydronephrosis in 16, 11, 3 and 1 , at 7 days, 6 weeks, 3 months and 6 months, respectively, after the operation. Hydronephrosis persisted in 8 patients (15%) after 3 months. Two of these had undergone exploratory laparotomy for lysis of ureteral adhesions. One patient who developed hydronephrosis had local recurrence and received further treatment with concurrent chemoradiation therapy. In conclusion, the incidence of persistent hydronephrosis over 3 months after RHPL was 15%, even without intra-operative ureteric injury. However, only a few cases required surgical intervention.

Normal thoracic aortic diameter in Thai people by multidetector computed tomography

OBJECTIVE

To determine the normal size of the thoracic aorta among Thai people.

MATERIAL AND METHOD

The aortic diameter of 73 Thai males and 56 Thai females, in four age groups, were measured from thoracic Multidetector Computed Tomography (MDCT) images. Aortic size were analyzed and correlated by age, sex, and vertebral body.

RESULTS

All showed normal aortic configuration, i.e. smooth tapering from aortic root to ascending and descending aorta. Mean aortic diameters were 3.12 cm at proximal ascending aorta, 2.95 cm at distal ascending aorta, 2.59 cm at mid arch, 2.33 cm at proximal descending aorta, 2.14 cm at distal descending aorta, and 2.03 cm at diaphragm. Males' aorta were larger than females, and all levels of the aorta were significantly enlarged with increasing age. Tapering of the vessel ratio of the ascending aorta/distal aorta at diaphragm was 1.5 without statistical significance. There was a weak correlation between aortic size and vertebral body at all levels. Comparing the size of the aorta to that of the vertebrae, the aorta was larger at the ascending part, equal at the mid arch and smaller at the descending part.

CONCLUSION

Among the Northern Thai people, the average size of the aorta was determined at each level. It was found that aortic size is significantly dependent on age, sex, and vertebral body width.

Spectrum of imaging findings in melioidosis

This pictorial review aims to highlight the clinical and imaging features of melioidosis in various organ systems. The patients were from two centres: one in Thailand and one in Singapore. The annual average incidence of melioidosis is estimated to be 4.4 in 100 000 in north-eastern Thailand and 1.7 in 100 000 in Singapore. Melioidosis affects many different organs and produces a spectrum of imaging features. The lung is the most frequently involved organ and, on radiographs and computed tomography, melioidosis may manifest as acute pulmonary consolidation, multiple nodules and abscesses. The finding of multiple small discrete abscesses in both the liver and the spleen is highly suggestive of visceral melioidosis and is best diagnosed on ultrasonography and computed tomography. Bone and soft tissue musculoskeletal involvement is usually part of disseminated melioidosis, with changes being seen on radiographs and MRI. Although imaging findings of melioidosis are not specific, this infection requires a high index of clinical suspicion, particularly in patients with pre-disposing comorbidities, such as diabetes mellitus, chronic renal failure, alcoholism or malignancy, those who are immunosuppressed as the result of either diseases or drug treatment, and those living in or with a history of travel to endemic areas.

Unexpected pulmonary involvement in extrapulmonary tuberculosis patients

BACKGROUND

This study aimed to assess the utility of sputum examinations and chest radiographs (CXRs) in patients with extrapulmonary tuberculosis (XPTB) to detect pulmonary involvement of tuberculosis (TB).

METHODS

We studied 72 XPTB patients who were managed through the TB Program, King County, WA, from January 2003 through November 2004.

RESULTS

The two most common sites of XPTB were the lymph nodes (36 [50%]) and pleura (12 [17%]). Thirty-five of 72 XPTB patients (49%) had abnormal CXR findings. Sputum was not obtained from 15 patients despite sputum induction. Of the 57 patients from whom sputum was collected, 30 (53%) had abnormal CXR findings, 5 (9%) had sputum smears that were positive for acid-fast bacilli, and 12 (21%) had sputum cultures that were positive for Mycobacterium tuberculosis. Weight loss was significantly associated with positive sputum culture findings in a multivariate analysis (odds ratio, 4.3; 95% confidence interval, 1.01 to 18.72; p = 0.049). There was no significant difference in the occurrence of positive sputum culture results between patients with abnormal CXR findings and those with normal CXR findings (7 of 30 patients [23%] vs 5 of 27 patients [19%], respectively; p = 0.656). Of 24 HIV-negative XPTB patients with normal CXR findings, 2 patients (8%) had positive sputum culture findings.

CONCLUSIONS

CXR results did not reliably differentiate XPTB patients with and without positive sputum culture findings. Some XPTB patients had positive sputum culture results despite normal CXR findings and negative HIV status. Weight loss in XPTB patients was associated with positive sputum culture results. Sputum examinations in XPTB patients, regardless of the CXR results, may identify potentially infectious cases of TB.

Phase II study of cisplatin combined to irinotecan administered alternatingly with docetaxel in advanced non-small cell lung cancer

OBJECTIVE

To assess the activity and toxicity of cisplatin and irinotecan alternating with docetaxel in patients with advanced non-small cell lung cancer (NSCLC).

MATERIAL AND METHOD

Eligibility included chemo-naïve stage IIIB with malignant effusion and stage IV NSCLC patients with measurable disease and a good performance status. Twenty-four patients were enrolled into the present study. There were 19 males and 5 females with a median age of 58.5 years and the median performance status was 1. Ninety-six percent had stage IV disease. These patients received cisplatin at 80 mg/ m2 and irinotecan at 200 mg/m2 on day 1, followed by docetaxel at 75 mg/m2 on day 22, in 6-week cycle for a maximum of 3 cycles.

RESULTS

Eight out of twenty-two evaluable patients obtained a partial response (36%). The median time to tumor progression was 6 months. The median survival time and 1-year survival rate were 10.4 months and 45% respectively. The most frequent severe toxicities were neutropenia, anemia, and diarrhea. Febrile neutropenia occurred in four patients (16%), and was the cause of treatment-related deaths in two (8%). Other nonhematologic toxicities were mild including nausea, vomiting, and skin rash.

CONCLUSION

Alternating cisplatin and irinotecan with docetaxel, as used in the present study was feasible and demonstrated encouraging efficacy in patients with non-small cell lung cancer However, this approach appears to be more toxic, especially in myelosuppression, than in previous reports of the sequential use of the similar agents.

Nonvascular Mediastinal Trauma

This article discusses the radiologic and clinical features of nonvascular mediastinal trauma, and focuses on the tracheobronchial tree, the esophagus, and the thoracic duct. Blunt chest and penetrating trauma account for most of the causes of such nonvascular injuries, but iatrogenic and inhalation injuries are other well-known causes. The injury distribution and clinical manifestations are different for each structure. In our combined experience at a level 1 trauma center, the overall prevalence of injury in each organ is low compared with vascular injuries. As such, and given the frequent nonspecific nature of clinical signs and symptoms of nonvascular mediastinal injuries, the diagnosis often is delayed and results in poor treatment outcome.

Clinics in diagnostic imaging (86). Ruptured bronchogenic cyst

An eight-year-old boy presented with a sudden onset of chest pain. He had been diagnosed to have a left spontaneous pneumothorax. Chest radiographs and computed tomography of the chest showed a thin-walled cyst in the left lower lobe. Thoracotomy and a segmentectomy of the apical segment of the lower lobe was performed, confirming the diagnosis of a ruptured bronchogenic cyst. Imaging findings of various pulmonary cystic lesions in children are discussed.

Paclitaxel and carboplatin plus megestrol acetate in the treatment of advanced non-small cell lung cancer

The present study evaluated the efficacy and toxicity of paclitaxel and carboplatin with megestrol acetate for patients with stage IIIb and IV non-small cell lung cancer (NSCLC). Forty patients with no prior chemotherapy and Karnofsky performance status of > or = 60 were enrolled in the study. There were 18 males and 22 females with a median age of 57.5 years, and the median performance status was 70 per cent. Eleven cases were stage IIIb and 29 cases were stage IV. Twenty-five cases were adenoCA, 12 were squamous cell, 2 were large cell and one was undifferentiated NSCLC. These patients received paclitaxel 135 mg/m2 by intravenous infusion over 24 hours before carboplatin was given at AUC=6 by 2 hours infusion. Megestrol acetate 160 mg/day was given to all patients from day 2 to 14. This treatment produced partial remission in 12 of 39 evaluable patients (30.76%). Toxicity caused mild nausea, vomiting, myalgia, neuropathy, 20.95 per cent grade 3 neutropenia and 4.15 per cent grade 4 neutropenia. Grade 3 thrombocytopenia was 5.4 per cent, without grade 4. There were no statistically significant changes in weight, serum albumin, and quality of life throughout the cycle 1-6.

CONCLUSION

The addition of megestrol acetate to chemotherapy benefitted these patients by minimizing constitute symptoms throughout the treatment period especially in the quality of life, weight loss and stabilized serum albumin.