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Hireche K, Canaud L, Peyron PA, Sakhri L, Serres I, Kamel S, Lounes Y, Gandet T, Alric P. Ex Vivo Comparison of the Elastic Properties of Vascular Substitutes Used for Pulmonary Artery Replacement. J Surg Res 2024; 295:222-230. [PMID: 38039727 DOI: 10.1016/j.jss.2023.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 10/17/2023] [Accepted: 10/30/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION Study aims were to evaluate the elastic properties of vascular substitutes frequently used for pulmonary artery (PA) replacement, and then to compare their compliance and stiffness indexes to those of human PA. METHODS A bench-test pulsatile flow experiment was developed to perfuse human cadaveric vascular substitutes (PA, thoracic aorta, human pericardial conduit), bovine pericardial conduit, and prosthetic vascular substitutes (polytetrafluorethylene and Dacron grafts) at a flow and low pulsed pressure mimicking pulmonary circulation. Intraluminal pressure was measured. An ultrasound system with an echo-tracking function was used to monitor vessel wall movements. The diameter, compliance, and stiffness index were calculated for each vascular substitute and compared to the human PA at mean pressures ranging from 10 to 50 mmHg. RESULTS The compliance of the PA and the thoracic aorta were similar at mean physiological pressures of 10 mmHg and 20 mmHg. The PA was significantly less compliant than the aorta at mean pressures above 30 mmHg (P = 0.017). However, there was no difference in stiffness index between the two substitutes over the entire pressure range. Compared to the PA, human pericardial conduit was less compliant at 10 mmHg (P = 0.033) and stiffer at 10 mmHg (P = 0.00038) and 20 mmHg (P = 0.026). Bovine pericardial conduit and synthetic prostheses were significantly less compliant and stiffer than the PA for mean pressures of 10, 20, and 30 mmHg. There were no differences at 40 and 50 mmHg. CONCLUSIONS Allogenic arterial grafts appear to be the most suitable vascular substitutes in terms of compliance and stiffness for PA replacement.
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Affiliation(s)
- Kheira Hireche
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France; PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France.
| | - Ludovic Canaud
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France; PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Pierre Antoine Peyron
- Department of Forensic Medicine, Lapeyronie University Hospital, Montpellier, France
| | - Linda Sakhri
- Groupe Hospitalier Mutualiste de grenoble, Daniel Hollard Cancer Institute, Grenoble, France
| | - Isabelle Serres
- Department of Anatomical Pathology, Gui De Chauliac Hospital, Montpellier, France
| | - Sanaa Kamel
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France
| | - Youcef Lounes
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France; PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Thomas Gandet
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France
| | - Pierre Alric
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France; PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
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Catho H, Guigard S, Toffart AC, Frey G, Chollier T, Brichon PY, Roux JF, Sakhri L, Bertrand D, Aguirre C, Gorain S, Wuyam B, Arbib F, Borel JC. What are the barriers to the completion of a home-based rehabilitation programme for patients awaiting surgery for lung cancer: a prospective observational study. BMJ Open 2021; 11:e041907. [PMID: 33568371 PMCID: PMC7878140 DOI: 10.1136/bmjopen-2020-041907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Home-based rehabilitation programmes (H-RPs) could facilitate the implementation of pulmonary rehabilitation prior to resection for non-small cell lung cancer (NSCLC), but their feasibility has not been evaluated. The aim of this study was to identify determinants of non-completion of an H-RP and the factors associated with medical events occurring 30 days after hospital discharge. DESIGN A prospective observational study. INTERVENTION All patients with confirmed or suspected NSCLC were enrolled in a four-component H-RP prior to surgery: (i) smoking cessation, (ii) nutritional support, (iii) physiotherapy (at least one session/week) and (iv) home cycle-ergometry (at least three times/week). OUTCOMES The H-RP was defined as 'completed' if the four components were performed before surgery. RESULTS Out of 50 patients included, 42 underwent surgery (80% men; median age: 69 (IQR 25%-75%; 60-74) years; 64% Chronic Obstructive Pulmonary Disease (COPD); 29% type 2 diabetes). Twenty patients (48%) completed 100% of the programme. The median (IQR) duration of the H-RP was 32 (19; 46) days. Multivariate analysis showed polypharmacy (n=24) OR=12.2 (95% CI 2.0 to 74.2), living alone (n=8) (single vs couple) OR=21.5 (95% CI 1.4 to >100) and a long delay before starting the H-RP (n=18) OR=6.24 (95% CI 1.1 to 36.6) were independently associated with a risk of non-completion. In univariate analyses, factors associated with medical events at 30 days were H-RP non-completion, diabetes, polypharmacy, social precariousness and female sex. CONCLUSION Facing multiple comorbidities, living alone and a long delay before starting the rehabilitation increase the risk of not completing preoperative H-RP. TRIAL REGISTRATION NUMBER NCT03530059.
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Affiliation(s)
- Heloise Catho
- Department of Pneumology, University Hospital of Grenoble, Grenoble, France
| | - Sebastien Guigard
- Department of Thoracic surgery, Clinique Belledonne, Grenoble, France
| | - Anne-Claire Toffart
- Department of Pneumo-oncology, University Hospital of Grenoble, Grenoble, France
| | - Gil Frey
- Department of Thoracic surgery, University Hospital of Grenoble, Grenoble, France
| | - Thibaut Chollier
- Department of Thoracic surgery, University Hospital of Grenoble, Grenoble, France
| | - Pierre-Yves Brichon
- Department of Thoracic surgery, University Hospital of Grenoble, Grenoble, France
| | | | - Linda Sakhri
- Department of Oncology, Institut Daniel Hollard, groupe hospitalier mutualiste, Grenoble, France
| | | | | | - Sandy Gorain
- Research and Development, Agir à Dom, Association, Meylan, France
| | - Bernard Wuyam
- Clinical Research, HP2, INSERM U1042, Université Grenoble Alpes, Grenoble, France
- Sleep Laboratory and Exercise Physiology, Thorax and Vessels Division, Grenoble Alps University Hospital, Grenoble, France
| | - François Arbib
- Department of Pneumology, University Hospital of Grenoble, Grenoble, France
| | - Jean Christian Borel
- Research and Development, Agir à Dom, Association, Meylan, France
- Clinical Research, HP2, INSERM U1042, Université Grenoble Alpes, Grenoble, France
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Sakhri L, Bertocchi M. [Bronchial carcinoma and tobacco: An update]. Rev Mal Respir 2019; 36:1129-1138. [PMID: 31767264 DOI: 10.1016/j.rmr.2018.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 06/18/2018] [Indexed: 11/29/2022]
Abstract
Lung cancer remains the most lethal cancer. The most common cause is smoking, which is also preventable, unlike the causes of other types of cancer. A genetic characteristic has emerged over several years, which explains particular profiles of smokers, or highly dependent smokers. The emergence of new therapies for the treatment of lung cancer, and the impact of tobacco on reducing the effectiveness of these therapies must challenge practitioners to obtain a complete cessation of smoking regardless of the stage of the disease.
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Affiliation(s)
- L Sakhri
- Institut de cancérologie Daniel-Hollard, groupe hospitalier mutualiste de Grenoble, 8, rue Docteur-Calmette, 38028 Grenoble cedex 1, France.
| | - M Bertocchi
- Service de pneumologie, centre hospitalier Annecy Genevois, 1, avenue de l'Hôpital, 74374 Pringy, France
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Denis N, Timsit JF, Giaj Levra M, Sakhri L, Duruisseaux M, Schwebel C, Merle P, Pinsolle J, Ferrer L, Moro-Sibilot D, Toffart AC. Impact of systematic advanced care planning in lung cancer patients: A prospective study. Respir Med Res 2019; 77:11-17. [PMID: 31927479 DOI: 10.1016/j.resmer.2019.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/24/2019] [Accepted: 09/29/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND End-of-life (EOL) communication is crucial, particularly for cancer patients. While advanced care planning is still uncommon, we sought to investigate its impact on care intensity in case of organ failure in lung cancer patients. METHODS We prospectively included consecutive lung cancer patients hospitalised at the Grenoble University Hospital, France, between January 1, 2014 and March 31, 2016. Patients could be admitted several times and benefited from advanced care planning based on three care intensities: intensive care, maximal medical care, and exclusive palliative care. Patients' wishes were addressed. RESULTS Data of 739 hospitalisations concerning 482 patients were studied. During the three first admissions, 173 (25%) patients developed organ failure, with intensive care proposed to 56 (32%), maximal medical care to 104 (60%), and exclusive palliative care to 13 (8%). Median time to organ failure was 9 days [IQR 25%-75%: 3-13]. All patients benefited from care intensity that was either equal to or lower than the care proposed. Specific wishes were recorded for 158 (91%) patients, with a discussion about EOL conditions held in 116 (73%). CONCLUSIONS In case of organ failure, advanced care planning helps provide reasonable care intensity. The role of the patient's wishes as to the proposed care must be further investigated. CLINICAL TRIAL REGISTRATION The study was registered at www.ClinicalTrials.gov with the identifier NCT02852629.
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Affiliation(s)
- N Denis
- Department of pneumology, CHU Grenoble Alpes, 38000 Grenoble, France
| | - J-F Timsit
- Department of medical and infectious resuscitation, hôpital Bichat Claude Bernard, 75018 Paris, France
| | - M Giaj Levra
- Department of pneumology, CHU Grenoble Alpes, 38000 Grenoble, France
| | - L Sakhri
- Department of oncology, Institut Daniel Hollard, groupe hospitalier mutualiste, 38000 Grenoble, France
| | - M Duruisseaux
- Department of pneumology, hôpital Louis Pradel, Institut de Cancérologie des Hospices Civils de Lyon, 69500 Bron, France
| | - C Schwebel
- Pôle urgences médecine aiguë, department of intensive care and resuscitation, centre hospitalier universitaire Grenoble Alpes, 38000 Grenoble, France; Laboratoires des pharmaceutiques biocliniques U 1039, université Grenoble Alpes, 38700 La Tronche, France
| | - P Merle
- UMR Inserm 1240, department of pneumology, CHU G Montpied, 63000 Clermont-Ferrand, France
| | - J Pinsolle
- Department of pneumology, CHU Grenoble Alpes, 38000 Grenoble, France
| | - L Ferrer
- Department of pneumology, CHU Grenoble Alpes, 38000 Grenoble, France
| | - D Moro-Sibilot
- Department of pneumology, CHU Grenoble Alpes, 38000 Grenoble, France; Inserm U 1209/CNRS UMR 5309, Centre de Recherche UGA, Institut pour l'Avancée des Biosciences, 38700 La Tronche, France
| | - A-C Toffart
- Department of pneumology, CHU Grenoble Alpes, 38000 Grenoble, France; Inserm U 1209/CNRS UMR 5309, Centre de Recherche UGA, Institut pour l'Avancée des Biosciences, 38700 La Tronche, France.
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Toffart A, Denis N, Giaj Levra M, Sakhri L, Duruisseaux M, Pinsolle J, Ferrer L, Moro-Sibilot D, Timsit J. MA14.02 Use and Impact of A Systematic Advanced Care Planning in Hospitalized Lung Cancer Patients: A Prospective Study. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.431] [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: 11/28/2022]
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Albin N, Mc Leer A, Sakhri L. [Precision medicine: A major step forward in specific situations, a myth in refractory cancers?]. Bull Cancer 2018; 105:375-396. [PMID: 29501208 DOI: 10.1016/j.bulcan.2018.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 11/22/2017] [Accepted: 01/06/2018] [Indexed: 01/09/2023]
Abstract
In recent years, high-throughput sequencing techniques have been developed for cancerology and many clinical trials are currently structured around biomarkers that can guide specific treatment choices. This approach is characteristic of precision medicine, which is actually a concept initiated several decades ago with, for example, retinoic acid in promyelocytic leukemia. This paper will review the different types of molecular alterations and « -omics » biological analyses, bioinformatics tools, coupled drug/biomarkers already validated, the ethical issues of whole genomic sequencing of an individual as part of an inclusion in a clinical trial and finally the first results of precision medicine trials. The AcSé crizotinib program, supported by the Inca (french Cancer National Institute), is emblematic of a success of this personalized medicine illustrated by 4 points: the discovery of a cohort of patients with lung cancer with a ROS1 rearrangement characteristic of a sensitivity to crizotinib, a rapid availability of this innovation through the implementation of a temporary recommendation for use (ANSM), the obtention of a conditional marketing authorization by the pharmaceutical industry and finally, financial assumption of responsibility by French social security (HAS), despite preliminary and non-comparative data. In the case of cancers refractory to standard chemotherapy, and regarding our system of access to drugs illustrated by the PROFILER clinical trial, this approach allows the access to a therapeutic drug targeting specific biomarkers only in 7% of patients included. This does not bode well for efficient treatment and even less for survival. Allowing patients to be included in trials that identify molecular targets by molecular screening, and not being able to propose the drug of interest is a traumatic event for those patients who live in the hope of an immediate future. In refractory disease we must rethink precision medicine in a more humanistic vision for our patients and not only in a dimension of medico-industrial promotion. The implementation of a new multi-drug/multi-molecular target program could address this issue.
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Affiliation(s)
- Nicolas Albin
- Groupe hospitalier mutualiste de Grenoble, institut de cancérologie Daniel-Hollard, 8, rue Docteur-Calmette, 38028 Grenoble cedex 1, France.
| | - Anne Mc Leer
- Université Grenoble-Alpes, CHU de Grenoble, département d'anatomie et de cytologie pathologiques, unité fonctionnelle de pathologie moléculaire, pôle biologie, 38043 Grenoble cedex 9, France
| | - Linda Sakhri
- Groupe hospitalier mutualiste de Grenoble, institut de cancérologie Daniel-Hollard, 8, rue Docteur-Calmette, 38028 Grenoble cedex 1, France
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Sakhri L, Pinsolle J, Moro-Sibilot D, Pluchart H. Unusually prolonged pemetrexed cytotoxicity in a patient with a lung adenocarcinoma: a case report. J Med Case Rep 2017; 11:262. [PMID: 28915906 PMCID: PMC5603063 DOI: 10.1186/s13256-017-1436-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 08/27/2017] [Indexed: 01/05/2023] Open
Abstract
Background We describe a case of pemetrexed toxicities related to reabsorption by an ileal neobladder, which caused prolonged hematotoxicity and nephrotoxicity. Case presentation A 59-year-old white man was diagnosed with metastatic wild-type adenocarcinoma of the upper lobe of his right lung. After a first cycle of cisplatin and pemetrexed, he had unusually prolonged aplasia and acute kidney injury. The prolonged aplasia was caused by pemetrexed reabsorption by the ileal mucosa of the neobladder as pemetrexed was eliminated renally in an active form and is partly lipophilic. Conclusions Pemetrexed may be reabsorbed by the ileal mucosa of the neobladder because of its hydrophobic structure and renal excretion in its active form. Acute urinary retention may maintain this phenomenon. Published data excluded a potential role for cisplatin in this toxicity; furthermore, we could not assess pemetrexed concentrations in the blood or urine as these assay techniques are not validated. Thus, care is needed when giving chemotherapy to patients with a neobladder.
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Affiliation(s)
- Linda Sakhri
- Institut de Cancérologie Daniel Hollard, Groupe Hospitalier Mutualiste, 124 rue d'Alembert, 38000, Grenoble, France.
| | - Julian Pinsolle
- UM Oncologie Thoracique, Clinique de pneumologie, Pôle Thorax et vaisseaux, Centre Hospitalier Universitaire Michallon, BP217, 38043, Grenoble cedex 9, France
| | - Denis Moro-Sibilot
- UM Oncologie Thoracique, Clinique de pneumologie, Pôle Thorax et vaisseaux, Centre Hospitalier Universitaire Michallon, BP217, 38043, Grenoble cedex 9, France
| | - Hélène Pluchart
- UM Pharmacie Clinique, Pôle Pharmacie, Centre Hospitalier Universitaire Michallon, BP217, 38043, Grenoble cedex 9, France
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Kastler A, Krainik A, Sakhri L, Mousseau M, Kastler B. Feasibility of Real-Time Intraprocedural Temperature Control during Bone Metastasis Thermal Microwave Ablation: A Bicentric Retrospective Study. J Vasc Interv Radiol 2017; 28:366-371. [DOI: 10.1016/j.jvir.2016.09.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 09/20/2016] [Accepted: 09/26/2016] [Indexed: 12/22/2022] Open
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Abstract
ecancer 7 312 (2013) The report in this article of the treatment the patient received is incorrect. Three of the authors (Jean Luc Michel, Clara Fernandez and Audrey Derouet) were unaware that their names had been added to the author list. The three remaining authors (Nidal Alsit, Linda Sakhri and Augustin Pirvu) were not involved with the treatment of the patient.
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Affiliation(s)
- Nidal Alsit
- Department of Thoracic, Vascular, and Cardiac Surgery, University Hospital Felix Guyon, Reunion, France
| | - Clara Fernandez
- Department of Pathological Anatomy, University Hospital Felix Guyon, Reunion, France
| | - Jean Luc Michel
- Department of Pediatrics Surgery, University Hospital Felix Guyon, Reunion, France
| | - Linda Sakhri
- Department of Onco-pneumology, University Hospital Grenoble, France
| | - Audrey Derouet
- Department of Pediatrics, University Hospital Felix Guyon, Reunion, France
| | - Augustin Pirvu
- Department of Thoracic, Vascular, and Endocrine Surgery, University Hospital Grenoble, France
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Sakhri L, Saint-Raymond C, Quetant S, Pison C, Lagrange E, Hamidfar Roy R, Janssens JP, Maindet-Dominici C, Garrouste-Orgeas M, Levy-Soussan M, Terzi N, Toffart AC. [Limitations of active therapeutic and palliative care in chronic respiratory disease]. Rev Mal Respir 2016; 34:102-120. [PMID: 27639947 DOI: 10.1016/j.rmr.2016.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 06/29/2016] [Indexed: 11/16/2022]
Abstract
The issue of intensive and palliative care in patients with chronic disease frequently arises. This review aims to describe the prognostic factors of chronic respiratory diseases in stable and in acute situations in order to improve the management of these complex situations. The various laws on patients' rights provide a legal framework and define the concept of unreasonable obstinacy. For patients with chronic obstructive pulmonary disease, the most robust decision factors are good knowledge of the respiratory disease, the comorbidities, the history of previous exacerbations and patient preferences. In the case of idiopathic pulmonary fibrosis, it is necessary to know if there is a prospect of transplantation and to assess the reversibility of the respiratory distress. In the case of amyotrophic lateral sclerosis, treatment decisions depend on the presence of advance directives about the use of intubation and tracheostomy. For lung cancer patients, general condition, cancer history and the tumor treatment plan are important factors. A multidisciplinary discussion that takes into account the patient's medical history, wishes and the current state of knowledge permits the taking of a coherent decision.
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Affiliation(s)
- L Sakhri
- Institut de cancérologie Daniel-Hollard, groupe hospitalier Mutualiste, 38000 Grenoble, France
| | - C Saint-Raymond
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble, 38000 Grenoble, France
| | - S Quetant
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble, 38000 Grenoble, France
| | - C Pison
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble, 38000 Grenoble, France; Laboratoire de bioénergétique fondamentale et appliquée, Inserm 1055, 38400 Saint-Martin-d'Hères, France; Université Grenoble Alpes, 38400 Saint-Martin-d'Hères, France
| | - E Lagrange
- Pôle psychiatrie, neurologie et rééducation neurologique, clinique de neurologie, CHU de Grenoble, 38000 Grenoble, France
| | - R Hamidfar Roy
- Pôle urgences médecine aiguë, clinique de réanimation médicale, CHU de Grenoble, 38000 Grenoble, France
| | - J-P Janssens
- Service de pneumologie, hôpital Cantonal universitaire, Genève, Suisse
| | - C Maindet-Dominici
- Pôle anesthésie réanimation, centre de la douleur, CHU de Grenoble, 38000 Grenoble, France
| | - M Garrouste-Orgeas
- Service de médecine intensive et de réanimation, groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - M Levy-Soussan
- Unité mobile d'accompagnement et de soins palliatifs, hôpital universitaire Pitié-Salpêtrière, 75006 Paris, France
| | - N Terzi
- Université Grenoble Alpes, 38400 Saint-Martin-d'Hères, France; Pôle psychiatrie, neurologie et rééducation neurologique, clinique de neurologie, CHU de Grenoble, 38000 Grenoble, France; Inserm U1042, université Grenoble Alpes, HP2, CHU de Grenoble, 38000 Grenoble, France
| | - A-C Toffart
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble, 38000 Grenoble, France; Université Grenoble Alpes, 38400 Saint-Martin-d'Hères, France; Institut pour l'avancée des biosciences, centre de recherche UGA, Inserm U 1209, CNRS UMR 5309, 38000 Grenoble, France.
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Ferretti GR, Reymond E, Delouche A, Sakhri L, Jankowski A, Moro-Sibilot D, Lantuejoul S, Toffart AC. Personalized chemotherapy of lung cancer: What the radiologist should know. Diagn Interv Imaging 2016; 97:287-96. [PMID: 26857787 DOI: 10.1016/j.diii.2015.11.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 11/05/2015] [Accepted: 11/05/2015] [Indexed: 11/24/2022]
Abstract
Lung cancer is the leading cause of deaths due to cancer in France. More than half of lung cancers are discovered at an advanced-stage. New anticancer treatment strategies (i.e., the so-called personalized or targeted therapy) have recently been introduced and validated for non-small-cell lung cancer (NSCLC), in addition to or in association with standard chemotherapy. Personalized therapy includes tyrosine kinase inhibitors (TKIs), antiangiogenic treatments and immunotherapy. Because these treatments may be responsible for atypical thoracic adverse effects and responses as compared to standard chemotherapy, RECIST 1.1 criteria may be inadequate to evaluate the responses to these agents. The goal of this article was to review personalized treatment strategies for NSCLC, to consider the therapy-specific responses and thoracic complications induced by these new therapeutic agents and finally to discuss future directions for the personalized assessment of tumor response.
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Affiliation(s)
- G R Ferretti
- Clinique universitaire de radiologie et imagerie médicale, CHU A.-Michallon, BP 217, 38043 Grenoble cedex 9, France; Inserm U 823, institut A.-Bonniot, 38000 Grenoble, France; Université Grenoble-Alpes, 38000 Grenoble, France.
| | - E Reymond
- Clinique universitaire de radiologie et imagerie médicale, CHU A.-Michallon, BP 217, 38043 Grenoble cedex 9, France; Inserm U 823, institut A.-Bonniot, 38000 Grenoble, France; Université Grenoble-Alpes, 38000 Grenoble, France
| | - A Delouche
- Clinique universitaire de radiologie et imagerie médicale, CHU A.-Michallon, BP 217, 38043 Grenoble cedex 9, France
| | - L Sakhri
- Clinique universitaire de pneumologie, pôle d'oncologie, CHU A.-Michallon, 38043 Grenoble, France
| | - A Jankowski
- Clinique universitaire de radiologie et imagerie médicale, CHU A.-Michallon, BP 217, 38043 Grenoble cedex 9, France
| | - D Moro-Sibilot
- Inserm U 823, institut A.-Bonniot, 38000 Grenoble, France; Université Grenoble-Alpes, 38000 Grenoble, France; Clinique universitaire de pneumologie, pôle d'oncologie, CHU A.-Michallon, 38043 Grenoble, France
| | - S Lantuejoul
- Inserm U 823, institut A.-Bonniot, 38000 Grenoble, France; Université Grenoble-Alpes, 38000 Grenoble, France; Département d'anatomo-cytologie pathologie, CHU A.-Michallon, 38043 Grenoble, France
| | - A C Toffart
- Inserm U 823, institut A.-Bonniot, 38000 Grenoble, France; Université Grenoble-Alpes, 38000 Grenoble, France; Clinique universitaire de pneumologie, pôle d'oncologie, CHU A.-Michallon, 38043 Grenoble, France
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Collart C, Maignan M, Sakhri L, Paquier C, Moro-Sibilot D, Carpentier F, Toffart A. Caractéristiques et orientation des patients atteints d’un cancer bronchique avec défaillance d’organe admis aux urgences du CHU de Grenoble. Rev Mal Respir 2016. [DOI: 10.1016/j.rmr.2015.10.675] [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: 10/22/2022]
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Toffart AC, Duruisseaux M, Sakhri L, Giaj Levra M, Moro-Sibilot D, Timsit JF. Indications de réanimation en oncologie thoracique. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/s1877-1203(16)30039-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Toffart A, Perrin M, Giaj Levra M, Sakhri L, Brichon P, Villa J, Hoffmann D, Guillem P, Moro-Sibilot D, Duruisseaux M. 3015 Chemotherapy and complete surgical resection are prognostic factors of survival in stage IV NSCLC with synchronous isolated metastasis. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31659-8] [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: 10/22/2022]
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15
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Toffart AC, Duruisseaux M, Nagy-Mignotte H, Sakhri L, Brichon PY, Villa J, Hoffman D, Guillem P, Timsit JF, Moro-Sibilot D. Cancers bronchiques oligométastatiques : une survie proche des maladies localement avancées. Rev Mal Respir 2015. [DOI: 10.1016/j.rmr.2014.10.064] [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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16
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Toffart AC, Sakhri L, Girard N, Couraud S, Merle P, Fournel P, Perol M, Souquet PJ, Timsit JF, Moro-Sibilot D. Évaluation d’une fiche d’aide à la décision en cas d’aggravation d’un patient cancéreux. Rev Mal Respir 2015; 32:66-72. [DOI: 10.1016/j.rmr.2014.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 12/28/2013] [Indexed: 11/25/2022]
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17
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Toffart AC, Pizarro CA, Schwebel C, Sakhri L, Minet C, Duruisseaux M, Azoulay E, Moro-Sibilot D, Timsit JF. Selection criteria for intensive care unit referral of lung cancer patients: a pilot study. Eur Respir J 2014; 45:491-500. [DOI: 10.1183/09031936.00118114] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The decision-making process for the intensity of care delivered to patients with lung cancer and organ failure is poorly understood, and does not always involve intensivists. Our objective was to describe the potential suitability for intensive care unit (ICU) referral of lung cancer in-patients with organ failures.We prospectively included consecutive lung cancer patients with failure of at least one organ admitted to the teaching hospital in Grenoble, France, between December 2010 and October 2012.Of 140 patients, 121 (86%) were evaluated by an oncologist and 49 (35%) were referred for ICU admission, with subsequent admission for 36 (73%) out of those 49. Factors independently associated with ICU referral were performance status ⩽2 (OR 10.07, 95% CI 3.85–26.32), nonprogressive malignancy (OR 7.00, 95% CI 2.24–21.80), and no explicit refusal of ICU admission by the patient and/or family (OR 7.95, 95% CI 2.39–26.37). Factors independently associated with ICU admission were the initial ward being other than the lung cancer unit (OR 6.02, 95% CI 1.11–32.80) and an available medical ICU bed (OR 8.19, 95% CI 1.48–45.35).Only one-third of lung cancer patients with organ failures were referred for ICU admission. The decision not to consider ICU admission was often taken by a non-intensivist, with advice from an oncologist rather than an intensivist.
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Sakhri L, Meynet E, Ferrer L, Pirvu A, Ferretti G, Moro-Sibilot D. Atypical response to erlotinib in a patient with metastatic lung adenocarcinoma: a case report. J Med Case Rep 2014; 8:335. [PMID: 25301323 PMCID: PMC4202250 DOI: 10.1186/1752-1947-8-335] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 08/08/2014] [Indexed: 11/29/2022] Open
Abstract
Introduction Tyrosine kinase inhibitors are widely prescribed in thoracic oncology and have excellent responses as a first-line treatment for locally advanced or metastatic lung cancer with epidermal growth factor receptor mutations. The side effects of tyrosine kinase inhibitors are mostly gastrointestinal and dermatological, and are usually resolved after symptomatic treatment. However, new complications have now arisen due to increased use of these drugs. Here we report a side effect of erlotinib that has not been described previously: that is, metastatic lung tumor nodules were transformed into cysts, which ruptured the pleura and were responsible for bilateral life-threatening pneumothorax. Case presentation We report the case of a 35-year-old Caucasian woman with metastatic adenocarcinoma and a deletion in epidermal growth factor receptor exon 19 (del E746-A750). She was treated with erlotinib for metastatic lung adenocarcinoma. Treatment with erlotinib resulted in the replacement of pulmonary tumor nodules with air-containing cysts. These cysts ruptured in the pleura causing a life-threatening bilateral pneumothorax. To the best of our knowledge, this tumor–cystic response after erlotinib therapy has not been previously described. Conclusions Tyrosine kinase inhibitors are widely prescribed in thoracic oncology, and managing toxicities must be optimal in order to improve adherence. Transformation of pulmonary nodules into cysts must be known and clinicians should be aware of this potential complication, which can lead to life-threatening pneumothorax.
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Affiliation(s)
- Linda Sakhri
- Pôle thorax et vaisseaux, Unité d'oncologie thoracique, CHU Grenoble, BP217, 38043 Grenoble cedex 9, France.
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Toffart AC, Sakhri L, Duruisseaux M, Shestaeva O, Giroud M, Mercier-Cubizolles V, Courby S, Schwebel C, Carlin N, Grünwald D, Moro-Sibilot D, Mousseau M, Laval G. Pathologie avancée et défaillances d’organes : outil d’aide à la décision. Médecine Palliative : Soins de Support - Accompagnement - Éthique 2014. [DOI: 10.1016/j.medpal.2013.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Toffart A, Lugosi M, Sakhri L, Duruisseaux M, Vesin A, Schwebel C, Moro-Sibilot D, Timsit J. Cancer bronchique et défaillance d’organe : déterminants de la prise en charge. Rev Mal Respir 2014. [DOI: 10.1016/j.rmr.2013.10.071] [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: 10/25/2022]
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Mescam-Mancini L, Lantuéjoul S, Moro-Sibilot D, Rouquette I, Souquet PJ, Audigier-Valette C, Sabourin JC, Decroisette C, Sakhri L, Brambilla E, McLeer-Florin A. On the relevance of a testing algorithm for the detection of ROS1-rearranged lung adenocarcinomas. Lung Cancer 2013; 83:168-73. [PMID: 24380695 DOI: 10.1016/j.lungcan.2013.11.019] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 11/19/2013] [Accepted: 11/24/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVES ROS1 proto-oncogene translocations define a new molecular subgroup in non-small cell lung cancers (NSCLC) and are associated with a response to the MET/ALK inhibitor, crizotinib. These rearrangements are described in 0.9-1.7% NSCLC, in wild-type EGFR, KRAS and ALK ("triple negative") lung adenocarcinomas. Rapid and efficient identification of these alterations is thus becoming increasingly important. MATERIALS AND METHODS In this study, 121 triple negative lung adenocarcinomas were screened by both IHC with the ROS1 D4D6 antibody, and FISH using two commercially available ROS1 break-apart probes. To address a possible cross-reactivity of the ROS1 antibody with other protein kinase receptors, we screened 80 additional cases with known EGFR, KRAS, PI3KCA, BRAF, HER2 mutations or ALK-rearrangement. RESULTS We diagnosed 9 ROS1-rearranged adenocarcinomas, with both a positive FISH result (51-87% rearranged nuclei) and a positive IHC staining (2+/3+ cytoplasmic staining). Only one of the ROS1-positive FISH cases was characterized by a classical split pattern, the others showed a variant pattern, most commonly involving a loss of the 5' telomeric probe. Considering a positivity threshold of 2+ stained cells, the sensitivity of the ROS1 D4D6 antibody compared to FISH was 100% and the specificity 96.9%, as two HER2-mutated tumors were positive with D4D6 antibody, without any translocation in FISH. All the ROS1-positive cases were at an advanced stage, arising in never or light smokers. They were mainly solid cribriform and acinar adenocarcinomas, with signet ring cells noted in 5 cases, and calcifications in 3 cases. One positive case was an invasive mucinous carcinoma. CONCLUSION Our results show that a screening algorithm based on an IHC detection of ROS1 fusion proteins, confirmed if positive or doubtful by a ROS1 break-apart FISH assay, is pertinent in advanced "triple negative" lung adenocarcinomas, since the prevalence of ROS1-positive cases in this selected population reaches 7.4% in our series.
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Affiliation(s)
- Lénaïg Mescam-Mancini
- Département d'Anatomie et Cytologie Pathologiques, Pôle de Biologie et Pathologie, CHU Grenoble, France; Plateforme de Génétique Moléculaire des Tumeurs, Pôle de Biologie et Pathologie, CHU Grenoble, France
| | - Sylvie Lantuéjoul
- Département d'Anatomie et Cytologie Pathologiques, Pôle de Biologie et Pathologie, CHU Grenoble, France; Plateforme de Génétique Moléculaire des Tumeurs, Pôle de Biologie et Pathologie, CHU Grenoble, France; INSERM U 823-Institut A Bonniot-Université J Fourier, Grenoble, France
| | - Denis Moro-Sibilot
- Pôle de médecine aigue communautaire, Unité d'oncologie thoracique, CHU Grenoble, France; INSERM U 823-Institut A Bonniot-Université J Fourier, Grenoble, France
| | | | | | | | | | - Chantal Decroisette
- Service de Pneumologie, Centre Hospitalier de la Région d'Annecy, Annecy, France
| | - Linda Sakhri
- Pôle de médecine aigue communautaire, Unité d'oncologie thoracique, CHU Grenoble, France
| | - Elisabeth Brambilla
- Département d'Anatomie et Cytologie Pathologiques, Pôle de Biologie et Pathologie, CHU Grenoble, France; INSERM U 823-Institut A Bonniot-Université J Fourier, Grenoble, France
| | - Anne McLeer-Florin
- Département d'Anatomie et Cytologie Pathologiques, Pôle de Biologie et Pathologie, CHU Grenoble, France; Plateforme de Génétique Moléculaire des Tumeurs, Pôle de Biologie et Pathologie, CHU Grenoble, France; INSERM U 823-Institut A Bonniot-Université J Fourier, Grenoble, France.
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Sakhri L, Mennecier B, Quoix A. [Hemolytic anemia under erlotinib treatment]. Rev Pneumol Clin 2013; 69:345-350. [PMID: 24183296 DOI: 10.1016/j.pneumo.2013.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Revised: 06/08/2013] [Accepted: 06/15/2013] [Indexed: 06/02/2023]
Abstract
Erlotinib is a tyrosine kinase inhibitor widely prescribed of which the most common sides effects are grade I or II rash and diarrhea. We report two cases of hemolytic anemia (HA) induced by erlotinib. Our two patients were treated with erlotinib after a prior line of systemic platinum-doublet therapy for metastatic non-small cell lung cancer. Both patients presented, shortly after starting treatment with erlotinib, an HA which was fatal for one of them. To our knowledge, this major side effect of erlotinib has not been reported in the literature. We will try through this article to make a literature review of the most important side effects of erlotinib and we will also focus on the HA induced by other molecules used in oncology.
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Affiliation(s)
- L Sakhri
- Service de pneumologie, pôle de cancérologie, médecine aiguë et communautaire, CHU Michallon, boulevard de la Chantourne, BP 217, 38043 Grenoble cedex 9, France.
| | - B Mennecier
- Service de pneumologie, nouvel hôpital civil, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
| | - A Quoix
- Service de pneumologie, nouvel hôpital civil, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
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Abstract
We report a case of primary extraosseous Ewing sarcoma (EES) of the lung in a four-year-old child. In the literature, there are only a few case reports of EES located in the thorax.
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Affiliation(s)
- Nidal Alsit
- Department of Thoracic, Vascular, and Cardiac Surgery, University Hospital Felix Guyon, Reunion, France
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Toffart AC, Sakhri L, Moro-Sibilot D. [Crizotinib: a targeted therapy in advanced ALK-positive non-small cell lung cancer]. Rev Pneumol Clin 2013; 69:111-116. [PMID: 23561899 DOI: 10.1016/j.pneumo.2012.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 11/20/2012] [Accepted: 11/22/2012] [Indexed: 06/02/2023]
Abstract
Crizotinib is a small orally-administered ALK inhibitor for patients with non-small cell lung cancer with EML4-ALK rearrangement (echinoderm microtubule-associated protein-like 4 and anaplastic lymphoma kinase). This fusion gene is detected with a break apart fluorescence in situ hybridization (FISH) assay. Phase I to III trials have shown an interesting disease control rate and acceptable tolerability. Crizotinib is available in France under temporary use authorization. New potentially effective therapeutics in ALK-positive NSCLC are being developed.
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Affiliation(s)
- A-C Toffart
- UM Oncologie Thoracique, pôle Cancérologie Médecine Aiguë et Communautaire, Centre Hospitalier Universitaire A.-Michallon, BP 217, 38043 Grenoble cedex 9, France.
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Toffart AC, Sakhri L, Potton L, Minet C, Guillem P, Schwebel C, Moro-Sibilot D, Timsit JF. Admission en réanimation pour les cancers du poumon: quels patients pour quels bénéfices ? ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s13546-012-0632-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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26
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Nagy-Mignotte H, Guillem P, Vignoud L, Coudurier M, Vesin A, Bonneterre V, Toffart AC, Sakhri L, Brambilla C, Brambilla E, Timsit JF, Moro-Sibilot D. Outcomes in recurrent small-cell lung cancer after one to four chemotherapy lines: A retrospective study of 300 patients. Lung Cancer 2012; 78:112-20. [DOI: 10.1016/j.lungcan.2012.06.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 05/31/2012] [Accepted: 06/09/2012] [Indexed: 12/23/2022]
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Sakhri L, Mennecier B, Jacqmin D, Di Marco A, Schumacher C, Chenard MP, Bergmann E, Quoix E. [Atypical metastatic site of lung adenocarcinoma]. Rev Pneumol Clin 2011; 67:375-379. [PMID: 22137284 DOI: 10.1016/j.pneumo.2011.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 01/24/2011] [Accepted: 01/29/2011] [Indexed: 05/31/2023]
Abstract
The case concerns a 40 years old smoker male, treated for an adenocarcinoma of the left upper lobe, metastatic in muscle extended to the right femur cortex. The patient had first a surgical excision of the mass of the thigh, an intramedullary femoral nailing, and six courses of chemotherapy (cisplatin-vinorelbine) with concurrent thoracic radiotherapy. This treatment led to disease stability. One year later, hematuria revealed a bladder tumor. Cystoscopy with biopsy concluded to an adenocarcinoma pulmonary origin. The PET-scanner showed an uptake of the bladder mass, a hypermetabolic right adrenal gland and subcutaneous left shoulder nodule. The patient had a partial cystectomy associated with enterocystoplasty and left ureteral reimplantation, plus excision of the subcutaneous nodule located in the left shoulder and a right adrenalectomy during the same time. All of the sites were metastasis from adenocarcinoma of pulmonary origin. A salvage chemotherapy was initiated. In the vast majority of cases, bladder metastasis as primary bladder tumours is revealed by hematuria, cystitis or sometimes vague pelvic pain. Our case is a very unusual bladder metastatic site from lung cancer. We will discuss the different procedures and the therapeutic strategies on the basis of the published data.
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Affiliation(s)
- L Sakhri
- Service de pneumologie, nouvel hôpital Civil, Strasbourg, France
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Sakhri L, Jeung MY, Forher C, Pauli G, Quoix E, Mennecier B. [Disseminated intravascular coagulation syndrome and thromboembolic complications of non-small-cell lung cancer. A case report]. Rev Pneumol Clin 2007; 63:48-54. [PMID: 17457285 DOI: 10.1016/s0761-8417(07)90090-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Hemostatic disorders can be found in approximately 90% of cancer patients, but clinical expression in only 15%. Hemorrhagic complications are more frequent in acute leukaemia; solid tumors are often associated with deep venous thromboses (DVP). Disseminated intravascular coagulation syndrome (DICS) can be latent or acute, and has various clinical presentations, occurring in the course of many serious conditions including cancer. Patients have higher morbidity and mortality. Irrespective of the etiology, DICS can be revealed by a wide variety of clinical manifestations, from mild biological hemostasis disorders, to intravascular or extravascular microthromboses or lethal hemorrhagic events. We report the case of a 45-year-old female with non-small-cell lung cancer with metastases at diagnosis. The patient developed and finally died of numberous thromboembolic events subsequent to DICS. This case illustrates some rather rare complications of DICS and offers the opportunity to discuss the main therapeutic goal in this situation, i.e. to modulate the disproportionate production of thrombin, inducing thromboses and/or hemorrhages by consumption of the cellular and plasmatic coagulation factors. This means a symptomatic and mostly etiologic treatment, especially chemotherapy which can in itself provoke thromboembolic events.
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Affiliation(s)
- L Sakhri
- Département de Pneumologie, Hôpital Lyautey, 1, rue des Canonniers, 67100 Strasbourg
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Barnig C, Mennecier B, Bambara M, Sakhri L, Andres E, Pauli G, Quoix E. Thrombophilie, Alimta® et mutation hétérozygote C677T MTHFR. Rev Mal Respir 2006. [DOI: 10.1016/s0761-8425(06)72127-1] [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: 11/29/2022]
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