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Collaud S, Stork T, Kaman H, Bauer S, Pöttgen C, Schildhaus HU, Schmack B, Aigner C. Giant middle mediastinal lesions: when tumor size correlates with mesenchymal origin-a retrospective single-center analysis. Mediastinum 2023; 7:24. [PMID: 37701639 PMCID: PMC10493615 DOI: 10.21037/med-22-49] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 08/02/2023] [Indexed: 09/14/2023]
Abstract
Background The International Thymic Malignancy Interest Group (ITMIG) proposed an internationally accepted division of the mediastinum into three compartments based on computed tomography (CT): anterior (prevascular), middle (visceral) and posterior (paravertebral) compartment. There is no generally accepted definition for the term "giant" when applied to middle mediastinal lesions. We defined the term "giant" and described our surgical experience in treating patients with giant lesions of the middle mediastinum. Methods CT imaging of patients operated in our center from January 2016 to August 2021 for mediastinal lesions was reviewed. Lesions were categorized to one of the ITMIG-defined compartments. Lesion size at diagnosis was measured at its largest diameter on axial CT imaging. Giant middle mediastinal lesions were defined as lesions having a size ≥90th percentile of our middle mediastinal lesion cohort. Patients with giant middle mediastinal lesions were further analyzed. Results Thirty-six patients (23%) had lesions located in the middle mediastinal compartment. Most common diagnoses were mediastinal cysts (n=10, 28%), metastatic lesions (n=6, 17%), lymphomas (n=5, 14%), and sarcomas (n=3, 8%). Ninetieth percentile lesion size was 73 mm. As per definition, four patients had giant middle mediastinal lesions. All these four lesions were of mesenchymal origin including oesophageal leiomyoma, synovial sarcoma, leiomyosarcoma and undifferentiated round cell sarcoma. Resection was performed through posterolateral thoracotomy or sternotomy, with or without cardiopulmonary bypass. Conclusions The term "giant" could be defined as a mass larger or equal to 73 mm. This definition selected specifically lesions with mesenchymal origin and may therefore guide diagnostic algorithm and patient management.
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Affiliation(s)
- Stéphane Collaud
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
- Lung Clinic, Department of Thoracic Surgery, Hospital Cologne-Merheim, University Witten Herdecke, Cologne, Germany
| | - Theresa Stork
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
- Lung Clinic, Department of Thoracic Surgery, Hospital Cologne-Merheim, University Witten Herdecke, Cologne, Germany
| | - Hafsa Kaman
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
- Lung Clinic, Department of Thoracic Surgery, Hospital Cologne-Merheim, University Witten Herdecke, Cologne, Germany
| | - Sebastian Bauer
- Department of Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christoph Pöttgen
- Department of Radiation Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Hans-Ulrich Schildhaus
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Bastian Schmack
- Department of Cardiac Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
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Kersting J, Ranft A, Bhadri V, Brichard B, Collaud S, Cyprová S, Eich H, Ek T, Gelderblom H, Hardes J, Haveman L, Hartmann W, Hauser P, Heesen P, Jürgens H, Kanerva J, Kühne T, Raciborska A, Rascon J, Rechl V, Streitbürger A, Timmermann B, Uhlenbruch Y, Dirksen U. Effect of Radiotherapy Dose on Outcome in Nonmetastatic Ewing Sarcoma. Adv Radiat Oncol 2023; 8:101269. [PMID: 37334316 PMCID: PMC10276219 DOI: 10.1016/j.adro.2023.101269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 04/12/2023] [Indexed: 06/20/2023] Open
Abstract
Purpose Radiation therapy (RT) is an integral part of Ewing sarcoma (EwS) therapy. The Ewing 2008 protocol recommended RT doses ranging from 45 to 54 Gy. However, some patients received other doses of RT. We analyzed the effect of different RT doses on event-free survival (EFS) and overall survival (OS) in patients with EwS. Methods and Materials The Ewing 2008 database included 528 RT-admitted patients with nonmetastatic EwS. Recommended multimodal therapy consisted of multiagent chemotherapy and local treatment consisting of surgery (S&RT group) and/or RT (RT group). EFS and OS were analyzed with uni- and multivariable Cox regression models including known prognostic factors such as age, sex, tumor volume, surgical margins, and histologic response. Results S&RT was performed in 332 patients (62.9%), and 145 patients (27.5%) received definitive RT. Standard dose ≤ 53 Gy (d1) was admitted in 57.8%, high dose of 54 to 58 Gy (d2) in 35.5%, and very high dose ≥ 59 Gy (d3) in 6.6% of patients. In the RT group, RT dose was d1 in 11.7%, d2 in 44.1%, and d3 in 44.1% of patients. Three-year EFS in the S&RT group was 76.6% for d1, 73.7% for d2, and 68.2% for d3 (P = .42) and in the RT group 52.9%, 62.5%, and 70.3% (P = .63), respectively. Multivariable Cox regression revealed age ≥ 15 years (hazard ratio [HR], 2.68; 95% confidence interval [CI], 1.63-4.38) and nonradical margins (HR, 1.76; 95% CI, 1.05-2.93) for the S&RT group (sex, P = .96; histologic response, P = .07; tumor volume, P = .50; dose, P = .10) and large tumor volume (HR, 2.20; 95% CI, 1.21-4.0) for the RT group as independent factors (dose, P = .15; age, P = .08; sex, P = .40). Conclusions In the combined local therapy modality group, treatment with higher RT dose had an effect on EFS, whereas higher dose of radiation when treated with definitive RT was associated with an increased OS. Indications for selection biases for dosage were found. Upcoming trials will assess the value of different RT doses in a randomized manner to control for potential selection bias.
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Affiliation(s)
- Josephine Kersting
- Pediatrics III, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium, Partnersite Essen, Essen, Germany
| | - Andreas Ranft
- Pediatrics III, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium, Partnersite Essen, Essen, Germany
| | - Vivek Bhadri
- Chris O´ Brien Lifehouse, Camperdown, Australia Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Bénédicte Brichard
- Cliniques Universitaires Saint Luc, Department of Pediatric Haematology and Oncology, Université Catholique de Louvain, Brussels, Belgium
| | - Stéphane Collaud
- Department of Thoracic Surgery, Lung Clinic, Cologne-Merheim City Hospital, University of Witten Herdecke, Cologne, Germany
| | - Sona Cyprová
- Charles University, Motol Children´s Hospital, Prague, Czech Republic
| | - Hans Eich
- Radiotherapy and Radiooncology, University Hospital Muenster, West German Cancer Center Network, Muenster, Germany
| | - Torben Ek
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jendrik Hardes
- German Cancer Consortium, Partnersite Essen, Essen, Germany
- Clinic of Orthopedics, University Hospital Essen, West German Cancer Centre, Essen, Germany
| | - Lianne Haveman
- Department of Solid Tumors, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Wolfgang Hartmann
- Gerhard Domagk Institute for Pathology, University Hospital Muenster, West German Cancer Center Network, Muenster, Germany
| | - Peter Hauser
- Second Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Philip Heesen
- Pediatrics III, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Heribert Jürgens
- Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, West German Cancer Center Network, Münster, Germany
| | - Jukka Kanerva
- HUS Helsinki University Hospital, New Children´s Hospital, Div. Hematology and Stem Cell Transplantation, Helsinki, Finland
| | - Thomas Kühne
- Department of Oncology/Haematology, University Children´s Hospital Basel, Basel, Switzerland
| | - Anna Raciborska
- Department of Oncology and Surgical Oncology for Children and Youth, Mother and Child Institute, Warsaw, Poland
| | - Jelena Rascon
- Center for Pediatric Oncology and Hematology, Vilnius University Hospital Santaros Klinikos, Vilnius University, Vilnius, Lithuania
| | - Victor Rechl
- Pediatrics III, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Arne Streitbürger
- German Cancer Consortium, Partnersite Essen, Essen, Germany
- Clinic of Orthopedics, University Hospital Essen, West German Cancer Centre, Essen, Germany
| | - Beate Timmermann
- German Cancer Consortium, Partnersite Essen, Essen, Germany
- Clinic for Particle Therapy, West German Proton Beam Centre, University Hospital Essen, West German Cancer Centre, German Cancer Research Centre (DKTK), Essen, Germany
| | | | - Uta Dirksen
- Pediatrics III, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium, Partnersite Essen, Essen, Germany
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Collaud S, Aigner C. A case report of a giant middle mediastinal leiomyosarcoma. Mediastinum 2022; 6:38. [PMID: 36582976 PMCID: PMC9792857 DOI: 10.21037/med-21-44] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/18/2022] [Indexed: 01/01/2023]
Abstract
Primary mediastinal leiomyosarcomas are extremely rare soft tissue tumors, accounting for less than 15% of all primary mediastinal sarcomas. Middle mediastinal tumors are very rare, with a prevalence of 0.1% in healthy individuals. Usually, mediastinal leiomyosarcoma originates and involves mediastinal structures such as oesophagus, heart or great vessels. Here we report the rare case of a giant middle mediastinal leiomyosarcoma without involvement of any surrounding structures in a 70 years old female. Main related symptoms were cough and increasing dyspnea. Imaging work-up showed an 11-cm giant middle mediastinal tumor located in the subcarinal space and compressing the oesophagus. Cytopathologic examination of endobronchial ultrasound-guided transbronchial needle aspiration diagnosed leiomyosarcoma. The tumor was completely removed through a right posterolateral thoracotomy in the fifth intercostal space. None of the surrounding structures were involved by the tumor intraoperatively. The patient underwent adjuvant chemoradiation as advised by the sarcoma tumor board (5 cycles of dacarbazine and doxorubicin followed by 60 Gy). At last follow-up, no evidence of recurrence was seen on imaging ten months after surgery. This rare case confirms that giant middle mediastinal leiomyosarcoma may not involve surrounding mediastinal structure and that resection can be completely and safely done without the need for resection of neighboring structures. The relevant literature on the subject is reviewed here.
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Affiliation(s)
- Stéphane Collaud
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
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Stork T, Ranft A, Aigner C, Dirksen U, Collaud S. EP07.01-026 Primary Pulmonary Ewing'S Sarcoma: Post Hoc Analysis From Two International Multicenter Prospective Randomized Trials. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.558] [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: 10/14/2022]
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Stork T, Hegedüs B, Guder W, Hamacher R, Hardes J, Kaths M, Plönes T, Pöttgen C, Schildhaus HU, Streitbürger A, Treckmann J, Bauer S, Aigner C, Collaud S. Prognostic Factors for Leiomyosarcoma with Isolated Metastases to the Lungs: Impact of Metastasectomy. Ann Surg Oncol 2022; 29:10.1245/s10434-022-11806-8. [PMID: 35552929 PMCID: PMC9174305 DOI: 10.1245/s10434-022-11806-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/06/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Leiomyosarcoma (LMS) most frequently metastasizes to the lung. Metastatic LMS is considered incurable. Selected patients may benefit from pulmonary metastasectomy (PM) within multimodal therapy. This study analyzed the prognostic relevance of clinicopathologic factors in these patients. METHODS Patients with metastatic LMS to the lung treated in our center from 2004 to 2020 were included in this single-center retrospective study. Overall survival (OS), progression-free survival (PFS), and prognostic factors were analyzed. RESULTS The study had 64 patients (33 males, 52%) with metastatic LMS to the lung. The 5-year OS was 55% after the diagnosis of pulmonary metastases. Age older than 60 years at the primary tumor diagnosis, primary tumor larger than 70 mm, and five or more lung metastases were associated with poorer OS. Of the 64 patients, 44 underwent PM. The postoperative mortality rate was 0%. The patients selected for PM were younger and had smaller primary tumors, fewer metastases, and metastases that more often were metachronous. Metastasis grade (G1 vs. G2/3) and size (20-mm cutoff) were significant prognostic factors for OS (p = 0.05) and PFS (p = 0.028) after PM, respectively. The 44 patients who underwent PM had a survival benefit compared with the patients who were selected but did not undergo PM (n = 6) and the patients who were not selected for PM (n = 14). Three patients (7%) were alive and free of disease at the last follow-up visit respectively 5.5, 9, and 12 years after PM. CONCLUSIONS For patients with leiomyosarcoma, PM is safe. Despite aggressive multimodal treatment, most patients will experience recurrence and eventually die of their disease. However, a small subgroup of patients could potentially be cured after PM.
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Affiliation(s)
- Theresa Stork
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Center Essen, Germany
| | - Balazs Hegedüs
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Center Essen, Germany
| | - Wiebke Guder
- German Cancer Consortium (DKTK), Center Essen, Germany
- Department of Tumor Orthopedics and Sarcoma Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Rainer Hamacher
- German Cancer Consortium (DKTK), Center Essen, Germany
- Department of Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jendrik Hardes
- German Cancer Consortium (DKTK), Center Essen, Germany
- Department of Tumor Orthopedics and Sarcoma Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Moritz Kaths
- German Cancer Consortium (DKTK), Center Essen, Germany
- Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Till Plönes
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Center Essen, Germany
| | - Christoph Pöttgen
- German Cancer Consortium (DKTK), Center Essen, Germany
- Department of Radiation Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Hans-Ulrich Schildhaus
- German Cancer Consortium (DKTK), Center Essen, Germany
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Arne Streitbürger
- German Cancer Consortium (DKTK), Center Essen, Germany
- Department of Tumor Orthopedics and Sarcoma Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Juergen Treckmann
- German Cancer Consortium (DKTK), Center Essen, Germany
- Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Sebastian Bauer
- German Cancer Consortium (DKTK), Center Essen, Germany
- Department of Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany.
- German Cancer Consortium (DKTK), Center Essen, Germany.
| | - Stéphane Collaud
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Center Essen, Germany
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Schaarschmidt BM, Slama A, Collaud S, Okumus Ö, Steinberg H, Bauer S, Schildhaus HU, Theysohn J, Aigner C. Reversible occlusion of the pulmonary vasculature by transarterial embolisation with degradable starch microspheres: preclinical assessment in a human isolated lung perfusion model. Eur Radiol Exp 2022; 6:6. [PMID: 35118584 PMCID: PMC8814074 DOI: 10.1186/s41747-021-00255-9] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 11/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transpulmonary embolisation (TPE) using degradable starch microspheres (DSM) is a potential approach to treat pulmonary metastases. However, there is a paucity of detailed information on perfusion dynamics. The aim of this study was to establish a human ex vivo isolated lung perfusion (ILP) model to observe and evaluate the effects of DSM-TPE in a near-physiologic setting. METHODS ILP was carried out on six surgically resected lung lobes. At baseline, computed tomography (CT), including CT perfusion imaging (CTPI), and histopathological sampling were performed (t30). DSM-TPE was initiated and increased stepwise (t45, t60, t75, and t90) to be followed by CT imaging, histopathological sampling, and pulmonary arterial pressure (PAP). After the last assessment (t90), alpha-amylase was injected into the pulmonary artery to allow for DSM hydrolysation and two additional assessments (t105; t120). Histopathological specimens were evaluated using a semiquantitative ordinal score. CTPI was used for time to peak (TTP) analysis. RESULTS After DSM administration, PAP and TTP increased significantly: PAP slope 95% confidence interval (CI) 0.104-0.483, p = 0.004; TTP t30 versus t45, p = 0.046. After the addition of alpha-amylase, functional parameters reverted to values comparable to baseline. In histopathological samples, embolisation grades increased significantly until t90 (slope 95% CI 0.027-0.066, p < 0.001) and decreased after addition of alpha-amylase (slope 95% CI -0.060-0.012, p = 0.165), CONCLUSIONS: The ILP model demonstrated successfully both the physiologic effect of DSM-TPE on human lungs and its reversibility with alpha-amylase. Thus, it can be used as a near-physiologic preclinical tool to simulate and assess later clinical approaches.
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Affiliation(s)
- Benedikt M Schaarschmidt
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany.
| | - Alexis Slama
- Department of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen-Ruhrlandklinik, Essen, Germany
| | - Stéphane Collaud
- Department of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen-Ruhrlandklinik, Essen, Germany
| | - Özlem Okumus
- Department of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen-Ruhrlandklinik, Essen, Germany
| | - Hannah Steinberg
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Sebastian Bauer
- Sarcoma Center, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Hans-Ulrich Schildhaus
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Center Essen, Essen, Germany
| | - Jens Theysohn
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen-Ruhrlandklinik, Essen, Germany
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Clermidy H, Maury JM, Collaud S, Drevet G, Ginoux M, Chalabreysse L, Mornex F, Girard N, Tronc F. Lymph Node Dissection in Thymoma: Is it worth it? Lung Cancer 2021; 157:156-162. [PMID: 34053783 DOI: 10.1016/j.lungcan.2021.05.022] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/12/2021] [Accepted: 05/18/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Lymph node dissection (LND) and nodal metastases in thymomas remain controversial and understudied. The aim of our study was to evaluate the incidence of nodal metastasis and the short term outcomes of systematic LND in thymomas. MATERIAL AND METHODS From December 2017 to September 2020, we performed 54 LND conducted according to the International Thymic Malignancy Interest Group (ITMIG) lymph node map. This group was compared to a historical control group of 55 patients who underwent surgery in our center from January 2015 to November 2017. RESULTS LND was performed in 72 % and in 5 % of the cases in the study cohort group and historical control group, respectively. The number of lymph nodes retrieved was significantly higher in the study cohort group (3.89 per patient vs. 1.62, p = 0.0021). In the whole population studied, nodal metastases were found in 3 patients (2.8 % of all patients) with 5.6 % in the cohort study group vs. 0 % in the control group (p = 0.12). Patients with nodal metastasis had larger tumors (> 7 cm), and a higher histology grade (B2 and B3). There was a trend towards higher risk of laryngeal nerve palsy in the cohort study group (9.3 % vs. 1.8 %, p = 0.11). CONCLUSION Systematic LND increases the number of lymph node harvested and detects more lymph node metastases, which remains infrequent in thymomas. The impact of LND and the true prognostic significance of lymph node metastases remains controversial. Given the potential complications, LND or sampling should not be perfomed in small, encapsulated and low grade thymomas.
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Affiliation(s)
- Hugo Clermidy
- Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jean-Michel Maury
- Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France; National Expert Center for Thymic Malignancies, Réseau Tumeurs THYMiques et Cancer (RYTHMIC), Lyon, France; IVPC, UMR 754, INRA, Univ Lyon1, Claude Bernard Lyon 1 University, EPHE, Lyon, France.
| | - Stéphane Collaud
- Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France; Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Gabrielle Drevet
- Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - Marylise Ginoux
- Department of Respiratory Medicine, National Expert Centre for Thymic Malignancies, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France; National Expert Center for Thymic Malignancies, Réseau Tumeurs THYMiques et Cancer (RYTHMIC), Lyon, France
| | - Lara Chalabreysse
- Department of Pathology, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France; National Expert Center for Thymic Malignancies, Réseau Tumeurs THYMiques et Cancer (RYTHMIC), Lyon, France
| | - Françoise Mornex
- Department of Cancerology and Radiotherapy, Lyon Sud Hospital, Hospices Civils de Lyon, Lyon, France
| | - Nicolas Girard
- Institute Curie, Institut du Thorax Curie Montsouris, Paris, France; National Expert Center for Thymic Malignancies, Réseau Tumeurs THYMiques et Cancer (RYTHMIC), Lyon, France
| | - François Tronc
- Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France; National Expert Center for Thymic Malignancies, Réseau Tumeurs THYMiques et Cancer (RYTHMIC), Lyon, France
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8
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Zöllner SK, Amatruda JF, Bauer S, Collaud S, de Álava E, DuBois SG, Hardes J, Hartmann W, Kovar H, Metzler M, Shulman DS, Streitbürger A, Timmermann B, Toretsky JA, Uhlenbruch Y, Vieth V, Grünewald TGP, Dirksen U. Ewing Sarcoma-Diagnosis, Treatment, Clinical Challenges and Future Perspectives. J Clin Med 2021; 10:1685. [PMID: 33919988 PMCID: PMC8071040 DOI: 10.3390/jcm10081685] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 02/08/2023] Open
Abstract
Ewing sarcoma, a highly aggressive bone and soft-tissue cancer, is considered a prime example of the paradigms of a translocation-positive sarcoma: a genetically rather simple disease with a specific and neomorphic-potential therapeutic target, whose oncogenic role was irrefutably defined decades ago. This is a disease that by definition has micrometastatic disease at diagnosis and a dismal prognosis for patients with macrometastatic or recurrent disease. International collaborations have defined the current standard of care in prospective studies, delivering multiple cycles of systemic therapy combined with local treatment; both are associated with significant morbidity that may result in strong psychological and physical burden for survivors. Nevertheless, the combination of non-directed chemotherapeutics and ever-evolving local modalities nowadays achieve a realistic chance of cure for the majority of patients with Ewing sarcoma. In this review, we focus on the current standard of diagnosis and treatment while attempting to answer some of the most pressing questions in clinical practice. In addition, this review provides scientific answers to clinical phenomena and occasionally defines the resulting translational studies needed to overcome the hurdle of treatment-associated morbidities and, most importantly, non-survival.
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Affiliation(s)
- Stefan K. Zöllner
- Pediatrics III, University Hospital Essen, 45147 Essen, Germany;
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany; (S.B.); (S.C.); (J.H.); (A.S.); (B.T.)
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
| | - James F. Amatruda
- Cancer and Blood Disease Institute, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA;
| | - Sebastian Bauer
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany; (S.B.); (S.C.); (J.H.); (A.S.); (B.T.)
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Department of Medical Oncology, Sarcoma Center, University Hospital Essen, 45147 Essen, Germany
| | - Stéphane Collaud
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany; (S.B.); (S.C.); (J.H.); (A.S.); (B.T.)
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Department of Thoracic Surgery, Ruhrlandklinik, University of Essen-Duisburg, 45239 Essen, Germany
| | - Enrique de Álava
- Institute of Biomedicine of Sevilla (IbiS), Virgen del Rocio University Hospital, CSIC, University of Sevilla, CIBERONC, 41013 Seville, Spain;
- Department of Normal and Pathological Cytology and Histology, School of Medicine, University of Seville, 41009 Seville, Spain
| | - Steven G. DuBois
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA 02215, USA; (S.G.D.); (D.S.S.)
| | - Jendrik Hardes
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany; (S.B.); (S.C.); (J.H.); (A.S.); (B.T.)
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Department of Musculoskeletal Oncology, Sarcoma Center, 45147 Essen, Germany
| | - Wolfgang Hartmann
- Division of Translational Pathology, Gerhard-Domagk Institute of Pathology, University Hospital Münster, 48149 Münster, Germany;
- West German Cancer Center (WTZ), Network Partner Site, University Hospital Münster, 48149 Münster, Germany
| | - Heinrich Kovar
- St. Anna Children’s Cancer Research Institute and Medical University Vienna, 1090 Vienna, Austria;
| | - Markus Metzler
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, 91054 Erlangen, Germany;
| | - David S. Shulman
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA 02215, USA; (S.G.D.); (D.S.S.)
| | - Arne Streitbürger
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany; (S.B.); (S.C.); (J.H.); (A.S.); (B.T.)
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Department of Musculoskeletal Oncology, Sarcoma Center, 45147 Essen, Germany
| | - Beate Timmermann
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany; (S.B.); (S.C.); (J.H.); (A.S.); (B.T.)
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre, 45147 Essen, Germany
| | - Jeffrey A. Toretsky
- Departments of Oncology and Pediatrics, Georgetown University, Washington, DC 20057, USA;
| | - Yasmin Uhlenbruch
- St. Josefs Hospital Bochum, University Hospital, 44791 Bochum, Germany;
| | - Volker Vieth
- Department of Radiology, Klinikum Ibbenbüren, 49477 Ibbenbühren, Germany;
| | - Thomas G. P. Grünewald
- Division of Translational Pediatric Sarcoma Research, Hopp-Children’s Cancer Center Heidelberg (KiTZ), 69120 Heidelberg, Germany;
- Division of Translational Pediatric Sarcoma Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Institute of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), Core Center, 69120 Heidelberg, Germany
| | - Uta Dirksen
- Pediatrics III, University Hospital Essen, 45147 Essen, Germany;
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany; (S.B.); (S.C.); (J.H.); (A.S.); (B.T.)
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
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9
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Stork T, Boemans R, Hardes J, Streitbürger A, Dirksen U, Pöttgen C, Schildhaus HU, Bauer S, Collaud S, Aigner C. Number of metastases and their response to chemotherapy impact survival of patients with isolated lung metastases from bone-derived sarcoma. BMC Cancer 2021; 21:375. [PMID: 33827467 PMCID: PMC8028220 DOI: 10.1186/s12885-021-08073-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/28/2020] [Accepted: 03/18/2021] [Indexed: 11/18/2022] Open
Abstract
Background Pulmonary metastasectomy (PM) is an established treatment for selected patients with metastatic sarcomas. The aim of this study was to examine our institutional experience and evaluate factors predicting outcome. Methods We retrospectively reviewed all patients undergoing PM for bone sarcoma in our center from 2001 to 2019. Survival was calculated from the date of PM. Impact on survival of clinical parameters was assessed. Results Thirty-eight patients (27 males, 71%) were included. Histology was osteosarcoma (n = 20, 53%), Ewing sarcoma (n = 13, 34%) and chondrosarcoma (n = 5, 13%). Twelve patients (31.5%) had synchronous metastases, all received chemotherapy before PM. Median number of metastases was 3 (1 to 29). Twenty (53%) patients had mediastinal lymph node sampling. One patient had positive lymph nodes. Ninety-day mortality was 0%. Three and 5-year PFS were 24.5 and 21%, respectively. Three and 5-year OS were 64.5 and 38.5%, respectively. More than three metastases and progression under chemotherapy were significant independent predictors for OS. Conclusion PM is a safe procedure and encouraging long-term outcome can be achieved. Patients with progression of pulmonary metastases under chemotherapy as well as patients with more than three metastases had significantly worse OS.
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Affiliation(s)
- Theresa Stork
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Ruhrlandklinik, Tüschener Weg 40, 45239, Essen, Germany.,German Cancer Consortium (DKTK), Center Essen, Essen, Germany
| | - Rebecca Boemans
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Ruhrlandklinik, Tüschener Weg 40, 45239, Essen, Germany.,German Cancer Consortium (DKTK), Center Essen, Essen, Germany
| | - Jendrik Hardes
- German Cancer Consortium (DKTK), Center Essen, Essen, Germany.,Department of Pediatrics III, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Arne Streitbürger
- German Cancer Consortium (DKTK), Center Essen, Essen, Germany.,Department of Pediatrics III, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Uta Dirksen
- German Cancer Consortium (DKTK), Center Essen, Essen, Germany.,Department of Tumor Orthopedics and Sarcoma Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christoph Pöttgen
- German Cancer Consortium (DKTK), Center Essen, Essen, Germany.,Department of Radiation Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Hans-Ulrich Schildhaus
- German Cancer Consortium (DKTK), Center Essen, Essen, Germany.,Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sebastian Bauer
- German Cancer Consortium (DKTK), Center Essen, Essen, Germany.,Department of Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Stéphane Collaud
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Ruhrlandklinik, Tüschener Weg 40, 45239, Essen, Germany.,German Cancer Consortium (DKTK), Center Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Ruhrlandklinik, Tüschener Weg 40, 45239, Essen, Germany. .,German Cancer Consortium (DKTK), Center Essen, Essen, Germany.
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10
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Collaud S, Stork T, Dirksen U, Pöttgen C, Hegedüs B, Schildhaus HU, Bauer S, Aigner C. Surgical Treatment for Primary Chest Wall Sarcoma: A Single-Institution Study. J Surg Res 2020; 260:149-154. [PMID: 33340868 DOI: 10.1016/j.jss.2020.11.078] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 11/04/2020] [Accepted: 11/15/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Primary sarcomas of the chest wall are rare aggressive tumors. Surgery is part of the multimodal treatment. We describe our institutional patient cohort and evaluate prognostic factors. METHODS All patients who had curative intent surgery for primary chest wall sarcoma from 2004 to 2019 were retrospectively reviewed. Impact on survival-calculated from the date of surgery until last follow-up- was assessed for the following variables: age, gender, type of resection, size, grading, stage, completeness of resection, and neoadjuvant and adjuvant therapy. RESULTS Twenty-three patients (15 males, 65%) with a median age of 54 y (4 to 82) were included. Most common histology was chondrosarcoma (n = 5, 22%). Seven patients (30%) received neoadjuvant and 13 patients (57%) received adjuvant treatment. R0 resection was achieved in 83%. Extended chest wall resection was performed in 14 patients (61%), including lung (n = 13, 57%), diaphragm (n = 2, 9%) and pericardium (n = 1, 4%). Morbidity and 90-day mortality were 23% and 0%, respectively. Three- and 5-year overall survival was 53% and 35%, respectively. R0 resection was predictor of overall survival (P = 0.029). Tumor grade and extended resections were predictors for recurrence (P = 0.034 and P = 0.018, respectively). CONCLUSIONS Surgical resection of primary chest wall sarcoma is a safe procedure even when extended resection is required.
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Affiliation(s)
- Stéphane Collaud
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Center Essen, Essen, Germany
| | - Theresa Stork
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Center Essen, Essen, Germany
| | - Uta Dirksen
- Department of Pediatrics III, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Center Essen, Essen, Germany
| | - Christoph Pöttgen
- Department of Radiation Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Center Essen, Essen, Germany
| | - Balazs Hegedüs
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Hans-Ulrich Schildhaus
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Center Essen, Essen, Germany
| | - Sebastian Bauer
- Department of Oncology, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Center Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Center Essen, Essen, Germany.
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11
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Collaud S, Stork T, Schildhaus HU, Pöttgen C, Plönes T, Valdivia D, Zaatar M, Dirksen U, Bauer S, Aigner C. Multimodality treatment including surgery for primary pulmonary sarcoma: Size does matter. J Surg Oncol 2020; 122:506-514. [PMID: 32410271 DOI: 10.1002/jso.25979] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 01/11/2020] [Accepted: 04/27/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES Primary pulmonary sarcoma (PPS) accounts for less than 1.1% of all pulmonary tumors. Few outcome data are reported. We evaluated outcome and prognostic factors in our series. METHODS We retrospectively reviewed all patients who underwent resection for PPS in our center from 2002 to 2018. Survival was calculated from the date of surgery until last follow-up. Impact on survival of gender, type of lung resection, completeness of resection, grade, size, and TNM staging for lung cancer and soft tissue sarcoma (STS) was assessed. RESULTS Thirteen patients were included. Eight (61.5%) patients received neoadjuvant treatment. Median tumor size at diagnosis was 11.5 cm (1-30 cm). Type of lung resection was wedge (n = 2, 15%), lobectomy (n = 4, 31%), intrapericardial (n = 3, 23%), and extrapleural pneumonectomies (n = 4, 31%). In-hospital mortality was 8%. Overall 5-year survival was 60%. Median disease-free survival was 17 months. Tumor size was a predictor for survival (P = .02) and recurrence (P = .05). Gender (P = .04) and type of lung resection (P = .04) were predictors of survival. T stage for STS of trunk and extremity, and TNM stage for lung cancer were predictors for recurrence (P = .03 and P = .04, respectively). CONCLUSION Surgical resection within a multimodality therapy concept in highly selected patients can offer good long-term outcome.
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Affiliation(s)
- Stéphane Collaud
- Department of Thoracic Surgery, University of Duisburg-Essen, Ruhrlandklinik, Essen, Germany.,German Cancer Consortium (DKTK), Center Essen, Germany
| | - Theresa Stork
- Department of Thoracic Surgery, University of Duisburg-Essen, Ruhrlandklinik, Essen, Germany.,German Cancer Consortium (DKTK), Center Essen, Germany
| | - Hans-Ulrich Schildhaus
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Center Essen, Germany
| | - Christoph Pöttgen
- Department of Radiation Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Center Essen, Germany
| | - Till Plönes
- Department of Thoracic Surgery, University of Duisburg-Essen, Ruhrlandklinik, Essen, Germany.,German Cancer Consortium (DKTK), Center Essen, Germany
| | - Daniel Valdivia
- Department of Thoracic Surgery, University of Duisburg-Essen, Ruhrlandklinik, Essen, Germany.,German Cancer Consortium (DKTK), Center Essen, Germany
| | - Mohamed Zaatar
- Department of Thoracic Surgery, University of Duisburg-Essen, Ruhrlandklinik, Essen, Germany.,German Cancer Consortium (DKTK), Center Essen, Germany
| | - Uta Dirksen
- Department of Pediatrics III, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Center Essen, Germany
| | - Sebastian Bauer
- Department of Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Center Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, University of Duisburg-Essen, Ruhrlandklinik, Essen, Germany.,German Cancer Consortium (DKTK), Center Essen, Germany
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12
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Zaatar M, Stork T, Valdivia D, Mardanzai K, Stefani D, Collaud S, Poellen P, Hegedus B, Ploenes T, Aigner C. Minimal-invasive approach reduces cardiopulmonary complications in elderly after lung cancer surgery. J Thorac Dis 2020; 12:2372-2379. [PMID: 32642142 PMCID: PMC7330380 DOI: 10.21037/jtd.2020.03.73] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background The number of elderly patients undergoing lung resection for lung cancer is continuously increasing. This study investigates the risk factors for postoperative complications in elderly lung cancer patients and the role of surgical approach in early postoperative outcome. Methods We reviewed all consecutive patients who underwent anatomical resection for early stage T1/2 lung cancer in a curative intent between January 2016 and November 2018 at our institution. Clinical data, postoperative complications, hospital stay and 30- and 90-day mortality were prospectively collected. Results A total of 505 (278 male) patients were included. One hundred ninety patients (38%) were ≥70 years of age. Forty-eight percent (n=241) had thoracotomy, 52% (n=264) were operated with video-assisted or robot-assisted thoracoscopy. Major cardiopulmonary complications were observed in 4.2% (n=21) patients. There was no significant difference in major cardiopulmonary complication rate following minimally invasive surgery between patients above or below 70 years of age (4.3% vs. 2.5%, P=0.47). In contrast, major cardiopulmonary complication rate was significantly higher in elderly thoracotomy patients than in patients below 70 years of age (9.9% vs. 2.6%, P=0.035). Elderly patients operated minimally invasive had a significantly shorter hospital stay compared to open approach (8.1 vs. 11.9 days, P<0.0001). Thirty- and 90-day mortality was comparable with 1.4% and 1.5%, respectively. Conclusions Pulmonary resection for lung cancer in elderly patients is safe and can be performed with a low morbidity and mortality. However, our results indicate that minimal invasive surgery leads to reduced postoperative complications especially in elderly and should be the preferred approach.
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Affiliation(s)
- Mohamed Zaatar
- Department of Thoracic Surgery, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Theresa Stork
- Department of Thoracic Surgery, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Daniel Valdivia
- Department of Thoracic Surgery, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Khaled Mardanzai
- Department of Thoracic Surgery, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Dirk Stefani
- Department of Thoracic Surgery, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Stéphane Collaud
- Department of Thoracic Surgery, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Pauline Poellen
- Department of Thoracic Surgery, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Balazs Hegedus
- Department of Thoracic Surgery, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Till Ploenes
- Department of Thoracic Surgery, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, Ruhrlandklinik, University Medicine Essen, Essen, Germany
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13
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Affiliation(s)
- Stéphane Collaud
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Theresa Stork
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Daniel Valdivia
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Keita Tokuishi
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
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14
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Drevet G, Collaud S, Tronc F, Girard N, Maury JM. Optimal management of thymic malignancies: current perspectives. Cancer Manag Res 2019; 11:6803-6814. [PMID: 31413632 PMCID: PMC6660626 DOI: 10.2147/cmar.s171683] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 04/20/2019] [Accepted: 06/28/2019] [Indexed: 12/19/2022] Open
Abstract
Thymic epithelial tumors (TETs) belong to orphan oncology. The incidence of TETs is about 1.3–3.2 cases per million worldwide. Following pathology, evolution and prognosis are variable. The World Health Organization classification distinguishes thymomas and thymic carcinomas. TETs are composed of thymic epithelial tumoral cells and normal lymphocytes. The mean age at diagnosis is 50–60 years-old. There are no identified risk factors. TETs are frequently associated with paraneoplastic syndromes as myasthenia gravis. The complete R0 surgical resection is the most significant prognosis factor on survival. In 2010, the French National Institute of Cancer labeled the RYTHMIC network as a specific tumor board including thoracic surgeons, oncologist, and radiation therapist to define standard of care for the management of TETs. The aim of the review was to update knowledge to optimize the standard of care.
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Affiliation(s)
- Gabrielle Drevet
- Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - Stéphane Collaud
- Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - François Tronc
- Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - Nicolas Girard
- Institute Curie, Institut du Thorax Curie Montsouris, 75248, Paris Cedex 05, France.,National Expert Center for Thymic Malignancies, Réseau Tumeurs THYMiques et Cancer (RYTHMIC), Lyon, France
| | - Jean-Michel Maury
- Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France.,National Expert Center for Thymic Malignancies, Réseau Tumeurs THYMiques et Cancer (RYTHMIC), Lyon, France.,IVPC UMR754 INRA, Univ Lyon, Université Claude Bernard Lyon 1, EPHE, Lyon, France
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15
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Maury JM, Drevet G, Collaud S, Grima R, Pavlakovic I, Rosamel P, Chalabreysse L, Girard N, Tronc F. Cytoreductive Pleurectomy and Intrathoracic Chemohyperthermia for Pleural Relapse of Thymomas. Ann Thorac Surg 2018; 107:e157-e160. [PMID: 30253161 DOI: 10.1016/j.athoracsur.2018.07.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/16/2018] [Accepted: 07/17/2018] [Indexed: 11/19/2022]
Abstract
Several surgical procedures, from debulking to extrapleural pneumonectomy, may be applied for stage IVa Masaoka thymomas, but their efficiency is still controversial. Case studies have favored R0 resection as the cornerstone of multimodal therapy for locoregional metastatic extension. This report describes a standardized procedure combining a cytoreductive surgical procedure and intrathoracic chemohyperthermia on a 46-year-old patient presenting with B2 thymoma and synchronous unilateral pleural metastasis.
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Affiliation(s)
- Jean-Michel Maury
- Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, Louis Pradel Hospital, Lyon, France; National Expert Center for Thymic Malignancies (RYTHMIC), Lyon, France; Viral Infection and Comparative Pathology (IVPC), UMR 754, Claude Bernard Lyon 1 University, Lyon, France.
| | - Gabrielle Drevet
- Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, Louis Pradel Hospital, Lyon, France
| | - Stéphane Collaud
- Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, Louis Pradel Hospital, Lyon, France
| | - Renaud Grima
- Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, Louis Pradel Hospital, Lyon, France
| | - Isabelle Pavlakovic
- Department of Anesthesiology and Critical Care, Louis Pradel Hospital, Lyon, France
| | - Pascal Rosamel
- Department of Anesthesiology and Critical Care, Louis Pradel Hospital, Lyon, France
| | | | - Nicolas Girard
- National Expert Center for Thymic Malignancies (RYTHMIC), Lyon, France; Viral Infection and Comparative Pathology (IVPC), UMR 754, Claude Bernard Lyon 1 University, Lyon, France; Department of Medical Oncology, Curie-Montsouris Thoracic Institute, Curie Institute, Paris, France; Department of Medical Oncology, Institut Curie, Paris, France
| | - François Tronc
- Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, Louis Pradel Hospital, Lyon, France
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16
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Collaud S, Provost B, Besse B, Fabre D, Le Chevalier T, Mercier O, Mussot S, Fadel E. Should surgery be part of the multimodality treatment for stage IIIB non-small cell lung cancer? J Surg Oncol 2018; 117:1570-1574. [DOI: 10.1002/jso.25042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 02/14/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Stéphane Collaud
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation; Marie Lannelongue Hospital; Paris Sud University; Le Plessis Robinson France
| | - Bastien Provost
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation; Marie Lannelongue Hospital; Paris Sud University; Le Plessis Robinson France
| | - Benjamin Besse
- Department of Medical Oncology; Gustave Roussy; Villejuif France
| | - Dominique Fabre
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation; Marie Lannelongue Hospital; Paris Sud University; Le Plessis Robinson France
| | - Thierry Le Chevalier
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation; Marie Lannelongue Hospital; Paris Sud University; Le Plessis Robinson France
- Department of Medical Oncology; Gustave Roussy; Villejuif France
| | - Olaf Mercier
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation; Marie Lannelongue Hospital; Paris Sud University; Le Plessis Robinson France
| | - Sacha Mussot
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation; Marie Lannelongue Hospital; Paris Sud University; Le Plessis Robinson France
| | - Elie Fadel
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation; Marie Lannelongue Hospital; Paris Sud University; Le Plessis Robinson France
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17
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Gebitekin C, Toker A, Weder W, Melek H, Özkan B, Opitz I, Cetinkaya G, Collaud S, Bayram A. P3.16-046 Pneumonectomy After Induction/Neoadjuvant Treatment for NSCLC: Morbidity, Mortality and Long-Term Survival. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1853] [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: 10/18/2022]
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18
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Tzafos S, Collaud S, Wilhelm M, Wieser S, Weder W, Inci I. Lung Volume Reduction Surgery on Extracorporeal Life Support. Ann Thorac Surg 2017; 103:e115-e117. [DOI: 10.1016/j.athoracsur.2016.07.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 06/09/2016] [Accepted: 07/25/2016] [Indexed: 11/28/2022]
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19
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Collaud S, Brenot P, Mercier O, Fadel E. Rescue balloon pulmonary angioplasty for early failure of pulmonary endarterectomy: The earlier the better? Int J Cardiol 2016; 222:39-40. [DOI: 10.1016/j.ijcard.2016.07.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 07/04/2016] [Indexed: 01/23/2023]
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Machuca TN, Mercier O, Collaud S, Tikkanen J, Krueger T, Yeung JC, Chen M, Azad S, Singer L, Yasufuku K, de Perrot M, Pierre A, Waddell TK, Keshavjee S, Cypel M. Lung transplantation with donation after circulatory determination of death donors and the impact of ex vivo lung perfusion. Am J Transplant 2015; 15:993-1002. [PMID: 25772069 DOI: 10.1111/ajt.13124] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [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: 08/05/2014] [Revised: 10/28/2014] [Accepted: 10/29/2014] [Indexed: 01/25/2023]
Abstract
The growing demand for suitable lungs for transplantation drives the quest for alternative strategies to expand the donor pool. The aim of this study is to evaluate the outcomes of lung transplantation (LTx) with donation after circulatory determination of death (DCDD) and the impact of selective ex vivo lung perfusion (EVLP). From 2007 to 2013, 673 LTx were performed, with 62 (9.2%) of them using DCDDs (seven bridged cases). Cases bridged with mechanical ventilation/extracorporeal life support were excluded. From 55 DCDDs, 28 (51%) underwent EVLP. Outcomes for LTx using DCDDs and donation after neurological determination of death (DNDD) donors were similar, with 1 and 5-year survivals of 85% and 54% versus 86% and 62%, respectively (p = 0.43). Although comparison of survival curves between DCDD + EVLP versus DCDD-no EVLP showed no significant difference, DCDD + EVLP cases presented shorter hospital stay (median 18 vs. 23 days, p = 0.047) and a trend toward shorter length of mechanical ventilation (2 vs. 3 days, p = 0.059). DCDDs represent a valuable source of lungs for transplantation, providing similar results to DNDDs. EVLP seems an important technique in the armamentarium to safely increase lung utilization from DCDDs; however, further studies are necessary to better define the role of EVLP in this context.
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Affiliation(s)
- T N Machuca
- Toronto Lung Transplant Program, University Health Network, University of Toronto, Toronto, ON, Canada
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21
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Collaud S, Tischler V, Atanassoff A, Wiedl T, Komminoth P, Oehlschlegel C, Weder W, Soltermann A. Lung neuroendocrine tumors: correlation of ubiquitinylation and sumoylation with nucleo-cytosolic partitioning of PTEN. BMC Cancer 2015; 15:74. [PMID: 25884169 PMCID: PMC4350902 DOI: 10.1186/s12885-015-1084-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 02/12/2015] [Indexed: 11/24/2022] Open
Abstract
Background The tumor suppressor phosphatase and tensin homolog (PTEN) is a pleiotropic enzyme, inhibiting phosphatidyl-inositol-3 kinase (PI3K) signaling in the cytosol and stabilizing the genome in the nucleus. Nucleo-cytosolic partitioning is dependent on the post-translational modifications ubiquitinylation and sumoylation. This cellular compartmentalization of PTEN was investigated in lung neuroendocrine tumors (lung NET). Methods Tumor tissues from 192 lung NET patients (surgical specimens = 183, autopsies = 9) were investigated on tissue microarrays. PTEN was H-scored by two investigators in nucleus and cytosol using the monoclonal antibody 6H2.1. Results were correlated with immunoreactivity for USP7 (herpes virus-associated ubiquitin-specific protease 7) and SUMO2/3 (small ubiquitin-related modifier protein 2/3) as well as PTEN and p53 FISH gene status. Clinico-pathologic data including overall survival, proliferation rate and diagnostic markers (synaptophysin, chromogranin A, Mib-1, TTF-1) were recorded. Results The multicentre cohort included 58 typical carcinoids (TC), 42 atypical carcinoids (AC), 32 large cell neuroendocrine carcinomas (LCNEC) and 60 small cell lung carcinomas (SCLC). Carcinoids were smaller in size and had higher synaptophysin and chromogranin A, but lower TTF-1 expressions. Patients with carcinoids were predominantly female and 10 years younger than patients with LCNEC/SCLC. In comparison to the carcinoids, LCNEC/SCLC tumors presented a stronger loss of nuclear and cytosolic PTEN associated with a loss of PTEN and p53. Concomitantly, a loss of nuclear USP7 but increase of nuclear and cytosolic SUMO2/3 was found. Loss of nuclear and cytosolic PTEN, loss of nuclear USP7 and increase of cytosolic SUMO2/3 thus correlated with poor survival. Among carcinoids, loss of cytosolic PTEN was predominantly found in TTF1-negative larger tumors of male patients. Among SCLC, loss of both cytosolic and nuclear PTEN but not proliferation rate or tumor size delineated a subgroup with poorer survival (all p-values <0.05). Conclusions Cellular ubiquitinylation and sumoylation likely influence the functional PTEN loss in high grade lung NET. Both nuclear and cytosolic PTEN immunoreactivity should be considered for correlation with clinico-pathologic parameters.
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Affiliation(s)
- Stéphane Collaud
- Division of Thoracic Surgery, University Hospital, Zurich, Switzerland.
| | - Verena Tischler
- Institute of Surgical Pathology, University Hospital Zurich, Schmelzbergstrasse 12, CH-8091, Zurich, Switzerland.
| | - Andrej Atanassoff
- Institute of Surgical Pathology, University Hospital Zurich, Schmelzbergstrasse 12, CH-8091, Zurich, Switzerland.
| | - Thomas Wiedl
- Division of Thoracic Surgery, University Hospital, Zurich, Switzerland.
| | - Paul Komminoth
- Institute of Pathology, Triemli Hospital, Zurich, Switzerland.
| | | | - Walter Weder
- Division of Thoracic Surgery, University Hospital, Zurich, Switzerland.
| | - Alex Soltermann
- Institute of Surgical Pathology, University Hospital Zurich, Schmelzbergstrasse 12, CH-8091, Zurich, Switzerland.
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Collaud S, Machuca T, Mercier O, Waddell TK, Yasufuku K, Pierre AF, Darling GE, Cypel M, Rampersaud YR, Lewis SJ, Shepherd FA, Leighl NB, Cho JBC, Bezjak A, Keshavjee S, de Perrot M. Long-term outcome after resection of non-small cell lung cancer invading the thoracic inlet. Ann Thorac Surg 2014; 98:962-7. [PMID: 25069687 DOI: 10.1016/j.athoracsur.2014.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 04/23/2014] [Accepted: 05/05/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The aim of this study was to update our previous experience and describe long-term results after resection of non-small-cell lung cancer (NSCLC) invading the thoracic inlet. METHODS Patients from a single center undergoing resection of NSCLC invading the thoracic inlet were reviewed with data retrieved retrospectively from their charts. RESULTS Sixty-five consecutive patients with a median age of 61 (32-76) years underwent resection of NSCLC invading the thoracic inlet from 1991 to 2011. Tumor location was divided into 5 anatomic zones from anterior to posterior. Fifty-two (80%) patients had induction therapy, mostly with 2 cycles of cisplatin-etoposide and 45 Gy of concurrent irradiation. All patients underwent at least first rib resection. Lobectomy was performed in 60 patients (92%). Twenty-four patients (37%) had vertebral resection. Arterial resections were performed in 7 patients (11%). Postoperative morbidity and mortality were 46% and 6%, respectively. Pathologic response to induction was complete (pCR) (n = 19) or nearly complete (pNR) (n = 12) in 31 patients (48%). Adjuvant treatment was administered in 14 (25%) patients. After a median follow-up of 20 (0-193) months, 34 patients are alive without recurrence. The overall 5-year survival reached 69%. Univariate analysis identified site of tumor within the thoracic inlet (p = 0.050), response to induction (p = 0.004), and presence of adjuvant treatment (p = 0.028) as survival predictors. CONCLUSIONS Survival after resection of NSCLC invading the thoracic inlet in highly selected patients reached 69% at 5 years. Tumor location within the thoracic inlet, pathologic response to induction therapy, and adjuvant treatments were significant survival predictors.
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Affiliation(s)
- Stéphane Collaud
- Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Tiago Machuca
- Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Olaf Mercier
- Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Thomas K Waddell
- Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Andrew F Pierre
- Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Gail E Darling
- Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Marcelo Cypel
- Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Yoga R Rampersaud
- Division of Orthopedic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Stephen J Lewis
- Division of Orthopedic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Frances A Shepherd
- Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre and the University of Toronto, Toronto, Ontario, Canada
| | - Natasha B Leighl
- Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre and the University of Toronto, Toronto, Ontario, Canada
| | - John B C Cho
- Department of Radiation Oncology, University Health Network, Princess Margaret Cancer Centre and the University of Toronto, Toronto, Ontario, Canada
| | - Andrea Bezjak
- Department of Radiation Oncology, University Health Network, Princess Margaret Cancer Centre and the University of Toronto, Toronto, Ontario, Canada
| | - Shaf Keshavjee
- Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Marc de Perrot
- Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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Machuca T, Mercier O, Collaud S, Linacre V, Krueger T, Azad S, Singer L, Yasufuku K, de Perrot M, Pierre A, Waddell T, Keshavjee S, Cypel M. Outcomes of Lung Transplantation Using Donation after Cardiac Death Donors: Should We Use Ex Vivo Lung Perfusion? J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.721] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Collaud S, Bayerl C, Wille G, Zehnder A, Grieder F, Meili S, Decurtins M. Mucinous cystadenoma arising in a completely isolated infected ileal duplication cyst. S AFR J SURG 2012; 50:45-46. [PMID: 22622103] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Accepted: 02/25/2011] [Indexed: 06/01/2023]
Abstract
Gastrointestinal duplications are uncommon congenital lesions that can occur anywhere along the alimentary tract, and the symptoms of which generally develop during infancy or childhood. Completely isolated duplication cysts are an extremely rare variant of duplication, where no communication between the cyst and the adjacent bowel segment is present. We report the unique case of an adult who presented with right lower abdominal pain and systemic signs of inflammation caused by infection of a completely isolated ileal duplication cyst. Histological examination of the cyst additionally revealed a low-grade mucinous cystadenoma. We discuss the clinical presentations, diagnosis and treatment of this rare entity.
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Affiliation(s)
- Stéphane Collaud
- Department of Visceral Surgery, Kantonsspital Winterthur, Winterthur.
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25
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Collaud S, Cadosch D, Wille G, Gmür E, Grieder F, Decurtins M. Tailgut cyst. ANZ J Surg 2012; 81:653. [PMID: 22295414 DOI: 10.1111/j.1445-2197.2011.05770.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wiedl T, Collaud S, Hillinger S, Arni S, Burgess C, Kroll W, Schraml P, Soltermann A, Moch H, Weder W. KRAS mutation is associated with elevated myeloblastin activity in human lung adenocarcinoma. Cancer Genomics Proteomics 2012; 9:51-54. [PMID: 22210048] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Lung cancer is the leading cause of all cancer deaths worldwide with suboptimal prognosis and treatment options. Therefore this study aimed to identify molecular characteristics with a predictive clinical utility which at the same time might represent novel therapeutic targets for human lung adenocarcinoma. Within this study mutations of v-Ki-RAS2 Kirsten rat sarcoma viral oncogene homolog (KRAS), a gene frequently mutated in lung adenocarcinoma, and their association with enzymatic activities, as assessed by activity-based proteomics, of members of the serine hydrolase (SH) superfamily, a large class of enzymes that have previously been linked to cancer was investigated. The results revealed that the activity of myeloblastin was significantly altered in the lung adenocarcinoma biopsies harboring a KRAS gene mutation. In conclusion myeloblastin is a potential therapeutic target for human lung adenocarcinoma, indicating that the combination of activity-based proteomics with mutational analysis is a valid approach for the discovery of novel biomarkers.
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Affiliation(s)
- Thomas Wiedl
- Division of Thoracic Surgery, Institute of Surgical Pathology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland.
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Collaud S, Lardinois D, Tischler V, Steinert HC, Stahel R, Weder W. Significance of a new fluorodeoxyglucose-positive lesion on restaging positron emission tomography/computed tomography after induction therapy for non-small-cell lung cancer. Eur J Cardiothorac Surg 2011; 41:612-6. [PMID: 22219415 DOI: 10.1093/ejcts/ezr109] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Restaging of patients with locally advanced non-small-cell lung cancer (NSCLC) is of paramount importance, since only patients with down-staging after induction therapy will benefit from surgery. In this study, we assessed the aetiology of new (18)fluoro-2-deoxy-d-glucose (FDG)-positive focal abnormalities on restaging positron emission tomography/computed tomography (PET/CT) in patients with a good response after induction chemotherapy in the primary tumour and lymph nodes. METHODS Between 2004 and 2008, 31 patients with histological proven stage III NSCLC had a PET/CT prior and after induction chemotherapy. Their medical charts were retrospectively reviewed. RESULTS Restaging PET/CT revealed a new FDG-positive lesion in 6 of 31 (20%) patients. The initial clinical stage of the disease was IIIA N2 in four and IIIB T4 in two patients. The maximal standard uptake value in the primary tumour (P = 0.043) and in the initially involved mediastinal nodes (P = 0.068) decreased after induction treatment in all patients. The new PET/CT findings were located in an ipsilateral cervical lymph node in two patients, a contralateral mediastinal in one patient and an ipsilateral mammary internal lymph node in one patient. Two other patients had a lesion on the contralateral lung. Malignant lymph node infiltrations were excluded following fine-needle puncture, intraoperative biopsy or follow-up PET/CT. Contralateral pulmonary lesions were diagnosed as benign following mini thoracotomy and pulmonary wedge resection. CONCLUSIONS New solitary FDG-positive lesions on restaging PET/CT after induction chemotherapy for NSCLC are not rare in good responders to chemotherapy. In our experience, all these lesions were not associated with malignancy.
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Affiliation(s)
- Stéphane Collaud
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
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28
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Wiedl T, Arni S, Roschitzki B, Grossmann J, Collaud S, Soltermann A, Hillinger S, Aebersold R, Weder W. Activity-based proteomics: Identification of ABHD11 and ESD activities as potential biomarkers for human lung adenocarcinoma. J Proteomics 2011; 74:1884-94. [DOI: 10.1016/j.jprot.2011.04.030] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 04/14/2011] [Accepted: 04/29/2011] [Indexed: 12/25/2022]
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29
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Weder W, Collaud S, Eberhardt WEE, Hillinger S, Welter S, Stahel R, Stamatis G. Pneumonectomy is a valuable treatment option after neoadjuvant therapy for stage III non-small-cell lung cancer. J Thorac Cardiovasc Surg 2010; 139:1424-30. [PMID: 20416887 DOI: 10.1016/j.jtcvs.2010.02.039] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 01/27/2010] [Accepted: 02/20/2010] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The mortality of pneumonectomy after chemotherapy or chemoradiotherapy for locally advanced non-small-cell lung cancer is reported to be as high as 26%. We retrospectively reviewed the medical records of patients undergoing these procedures in 2 specialized thoracic centers to determine the outcome. METHODS Retrospective analyses were performed of all patients who underwent pneumonectomy after neoadjuvant chemotherapy or chemoradiotherapy for locally advanced non-small-cell lung cancer from 1998 to 2007. Presurgical treatment consisted of 3-4 platin-based doublets alone in 20% of patients or combined with radiotherapy (45Gy) to the tumor and mediastinum in 80% of patients. RESULTS Of 827 patients who underwent neoadjuvant therapy, 176 pneumonectomies were performed, including 138 (78%) extended resections. Post-induction pathologic stages were 0 in 36 patients (21%), I in 33 patients (19%), II in 38 patients (21%), III in 57 patients (32%), and IV in 12 patients (7%). Three patients died of pulmonary embolism, 2 patients of respiratory failure, and 1 patient of cardiac failure, resulting in a 90 postoperative day mortality rate of 3%; 23 major complications occurred in 22 patients (13%). For the overall population, 3-year survival was 43% and 5-year survival was 38%. CONCLUSION Pneumonectomy after neoadjuvant therapy for non-small-cell lung cancer can be performed with a perioperative mortality rate of 3%. Thus, the need of a pneumonectomy for complete resection alone should not be a reason to exclude patients from a potentially curative procedure if done in an experienced center. The 5-year survival of 38%, which can be achieved, justifies extended surgery within a multimodality concept for selected patients with locally advanced non-small-cell lung cancer.
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Affiliation(s)
- Walter Weder
- Division of Thoracic Surgery, University Hospital Zurich, CH-8091 Zurich, Switzerland.
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30
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Collaud S, Wiedl T, Cattaneo E, Soltermann A, Hillinger S, Weder W, Arni S. Laser-capture microdissection impairs activity-based protein profiles for serine hydrolase in human lung adenocarcinoma. J Biomol Tech 2010; 21:25-28. [PMID: 20357979 PMCID: PMC2841994] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Laser-capture microdissection (LCM) enables the selection of a specific and pure cell population from a heterogenous tissue such as tumors. Activity-based protein profiling/profile (ABPP) is a chemical technology using enzyme-specific active site-directed probes to read out the functional state of many enzymes directly in any proteome. The aim of this work was to assess the compatibility of LCM with downstream ABPP for serine hydrolase (SH) in human lung adenocarcinoma. Fresh frozen lung adenocarcinoma tissue was stained with hematoxylin, toluidine blue, or methyl green (MG). Proteome from stained tissue was labeled further with SH-directed probes, and ABPPs were determined on a one-dimensional gel-based approach. This allowed us to assess the impact of staining procedures on their ABPPs. The effect of the LCM process on ABPPs was assessed furthermore using MG-stained lung adenocarcinoma tissue. The staining procedures led to strong changes in ABPPs. However, MG staining seemed the most compatible with downstream ABPP. MG-stained, laser-captured, microdissected tissue showed additional change in profiles as a result of the denaturing property of extraction buffer but not to the microdissection process itself. LCM staining procedures but not microdissection per se interfered with downstream ABPP and led to a strong change in ABPPs of SHs in human lung adenocarcinoma.
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Affiliation(s)
- Stéphane Collaud
- Department of Thoracic Surgery, University Hospital Zurich, Switzerland.
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31
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Affiliation(s)
- Stéphane Collaud
- Division of Thoracic Surgery, Zurich University Hospital, Zurich, Switzerland.
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Collaud S, Bongiovanni M, Pache J, Fioretta G, Robert JH. Survival according to the site of bronchial microscopic residual disease after lung resection for non–small cell lung cancer. J Thorac Cardiovasc Surg 2009; 137:622-6. [DOI: 10.1016/j.jtcvs.2008.10.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2007] [Revised: 10/08/2008] [Accepted: 10/13/2008] [Indexed: 11/30/2022]
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Myers PO, Kritikos N, Bongiovanni M, Triponez F, Collaud S, Pache JC, Robert JH. Primary intrapulmonary thymoma: A systematic review. Eur J Surg Oncol 2007; 33:1137-41. [PMID: 17442530 DOI: 10.1016/j.ejso.2007.02.033] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2007] [Accepted: 02/27/2007] [Indexed: 11/23/2022] Open
Abstract
AIM This article reviews the literature on the clinical features, diagnosis and management of primary intrapulmonary thymoma. METHODS Medline, Embase and Cochrane Library searches were performed on all relevant Anglo-Saxon language articles. The search words included "primary pulmonary thymoma" and "intrapulmonary thymoma". Secondary references were obtained from key articles. Prognostic and treatment strategies were analyzed by the Kaplan-Meier method, comparisons between curves were made using log rank test. RESULTS The searches yielded 25 cases of primary intrapulmonary thymoma. Median follow-up was 9 months (1 day to 13 years). At follow-up, 14 patients were tumor free, one patient had a local recurrence 8 years after radiotherapy, one patient responded favorably to radiotherapy, six patients died and three patients were lost to follow-up. The presence of a paraneoplastic syndrome decreased survival (P=0.02), however, histological subgroup (P=0.216), clinical stage (P=0.63) and tumor size (P=0.288) did not affect survival. Survival in surgically managed patients was significantly better than in conservatively managed patients (P=0.039). Adjuvant radiotherapy did not provide any benefit (P=0.4). CONCLUSION Complete resection of primary intrapulmonary thymomas appears sufficient in non-malignant tumors. Because of the risk of late local recurrence, long-term regular clinical follow-up is warranted.
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Affiliation(s)
- P O Myers
- Department of Cardiovascular Surgery, University Hospitals of Geneva, 24, rue Micheli-du-Crest, 1211 Geneva 14, Switzerland.
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Collaud S, Warloe T, Jordan O, Gurny R, Lange N. Clinical evaluation of bioadhesive hydrogels for topical delivery of hexylaminolevulinate to Barrett's esophagus. J Control Release 2007; 123:203-10. [PMID: 17884228 DOI: 10.1016/j.jconrel.2007.08.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2007] [Revised: 07/26/2007] [Accepted: 08/13/2007] [Indexed: 11/28/2022]
Abstract
Fluorescence diagnosis following oral administration of 5-aminolevulinic acid (5-ALA) has shown to enable the sensitive visualization of intestinal metaplasia, dysplasia and early carcinoma in Barrett's esophagus. Once being established, this technique will be a potential alternative to today's standard diagnosis, i.e. four-quadrant random biopsies which are taken every 1-2 cm of the esophagus for histopathological analysis. In order to further improve this methodology, topical application of lipophilic 5-ALA esters to the esophagus could be advantageous in terms of fluorescence contrast and fluorescence intensity in the target tissue, adverse side effects, as well as application time. Therefore, the aim of this study was to develop a bioadhesive formulation loaded with hexylaminolevulinate (HAL) targeting the esophageal lining. In the present study, different mucoadhesive gels including poloxamer 407, cross-linked polyacrylic acid, hydroxypropylmethylcellulose, sodium carboxymethylcellulose and chitosan have been evaluated with respect to bioadhesion to the esophagus using an ex vivo rat model and a clinical study on healthy volunteers. In order to visualize the mucoadhesive properties of the formulations, a blue dye was incorporated as contrast agent. Chitosan has shown the best esophageal adhesion both in vitro and in vivo. Furthermore, using the in vitro release profiles from chitosan loaded with 40 mM of HAL, one can estimate that after a residence time of 10 min on the esophageal wall, the amount of HAL delivered to the epithelium will be sufficient to perform fluorescence diagnosis of Barrett's esophagus following swallowing of this formulation.
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Affiliation(s)
- S Collaud
- Department of Pharmaceutics and Biopharmaceutics, School of Pharmaceutical Sciences, University of Geneva, Quai Ernest-Ansermet 30, 1211 Geneva 4, Switzerland
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Gonzalez M, Collaud S, Gervaz P, Frossard JL, Morel P. [Surgical treatment of duodenal stenosis in Crohn's disease]. ACTA ACUST UNITED AC 2006; 131:636-8. [PMID: 16836971 DOI: 10.1016/j.anchir.2006.06.007] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2005] [Accepted: 06/09/2006] [Indexed: 11/24/2022]
Abstract
Crohn's disease may involve any part of the alimentary tract, including the stomach and duodenum. We report herein the case of a 22 year-old male in whom Crohn disease was diagnosed due to weight loss in relation with a stenosis of the first and second parts of the duodenum. A gastrojejunostomy was performed with a good subsequent result. The initial management of a Crohn's disease with involvement of the duodenum is medical. When there is an indication for surgery, a gastroenterostomy is preferred, albeit with a high incidence of outlet obstruction and marginal ulceration.
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Affiliation(s)
- M Gonzalez
- Service de Chirurgie Viscérale, Hôpital Universitaire de Genève, 24, rue Micheli-du-Crest, 1211 Genève, Suisse.
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Collaud S, Jichlinski P, Marti A, Aymon D, Gurny R, Lange N. An Open Pharmacokinetic Study of??Hexylaminolevulinate-Induced Photodiagnosis after Intravesical Administration. Drugs R D 2006; 7:173-86. [PMID: 16752943 DOI: 10.2165/00126839-200607030-00005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Hexylaminolevulinate-mediated photodiagnosis of superficial bladder cancer recently gained marketing authorisation in Europe and is therefore being used increasingly, especially to visualise flat tumours such as carcinoma in situ. Although no significant adverse effects related to the drug have been reported to date, precise information with respect to the safety of this procedure in clinical practice has not yet been published. In the present study, we investigated the possible systemic absorption of different hexylaminolevulinate concentrations and characterised the adverse effects after bladder instillation. METHODS Twelve patients with known bladder cancer received a 2-hour administration of 50 mL of phosphate-buffered saline containing 4 mmol/L, 8 mmol/L or 16 mmol/L of hexylaminolevulinate. Safety was primarily evaluated by monitoring adverse effects. Standard haematology and clinical biochemistry were assessed by the local hospital laboratory. Measurements of hexylaminolevulinate, 5-aminolevulinate and protoporphyrin IX in plasma and solution collected after instillation were performed, as were fluorescence measurements in the urothelium and the skin by using an optical fibre-based spectrofluorometer. RESULTS No hexylaminolevulinate was found in the plasma. Furthermore, 5-aminolevulinate and protoporphyrin IX showed no significant increases in plasma after intravesical instillation of hexylaminolevulinate 4 mmol/L, 8 mmol/L or 16 mmol/L for 2 hours. This implies a very low systemic absorption at the administered doses with a hexylaminolevulinate uptake from the bladder of about 5%. Neither skin sensitivity nor adverse reactions that could be attributed to the drug were reported. Renal and liver function were not affected by the hexylaminolevulinate doses used in this study. CONCLUSION We demonstrated for the first time that hexylaminolevulinate-mediated photodiagnosis is a safe procedure for a patient undergoing this examination, the drug being only minimally systemically absorbed after intravesical instillation. Therefore, no or only minimal adverse effects compared with those seen with conventional photosensitising agents can be expected.
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Affiliation(s)
- S Collaud
- Department of Pharmaceutics and Biopharmaceutics, School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
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