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Pulmonary AND Bronchogenic carcinoma [keywords]
- Surgical pathology of lung cancer. [Journal Article]
- Semin Respir Crit Care Med 2013 Dec; 34(6):770-86.
The diagnosis, treatment, and management of lung tumors represent a complex set of decision algorithms and require the cooperation and interaction of a team of experts and support systems. The surgical pathologist, an early, important member of the diagnostic team, uses clinical and radiological evidence to differentiate benign from malignant tumors and renders a unique diagnosis that provides both prognostic and treatment information. Using routine histopathologic criteria, histochemical and immunohistochemical stains, and molecular and genetic testing, surgical pathologists and cytopathologists may distinguish between small cell and other bronchogenic carcinomas, separate adenocarcinomas from squamous cell carcinomas, differentiate between pleural carcinomas and diffuse malignant mesotheliomas, and discriminate among the varieties of neuroendocrine carcinomas. Among adenocarcinomas, the pathological examination stratifies those tumors with absent or minimal central invasive cores that have an excellent prognosis from the more common adenocarcinomas with larger invasive components. These distinctions are necessary based on differences in tumor biology, response to therapy, and prognosis for these different histological types. Histopathologic analysis should attempt to provide a precise diagnosis and limit the usage of the term non-small cell carcinoma. The team approach also enables the optimal use of tumor tissue for diagnostic purposes as well as molecular genetic testing and the discovery of targetable sites for therapeutic management. Though low-stage tumors tend to be initially treated with surgical resection, more advanced stages will be approached with limited tissue acquisition, necessitating a strategy for best practices of scarce tissue resources. The awareness of diagnostic modalities and tissue handling by all members of the team ensures the best patient-centered care.
- Importance of systemic mediastinal lymphadenectomy in exact staging of bronchogenic carcinoma. [Journal Article]
- Bratisl Lek Listy 2013; 114(10):569-72.
Constituent part of radical lung resection for lung cancer is a dissection of mediastinal lymph nodes. Lymphadenectomy is a standard procedure in an assessment of clinical stage of the disease. The aim of the study was to map metastasizing of bronchogenic non-small cell lung carcinoma into homolateral mediastinal lymph nodes and to assess the importance of mediastinal lymphadenectomy for exact staging and survival.
Methods:Study of 31patients with lung resection and systematic mediastinal lymphadenectomy operated from August 2004 to January 2007, with pre-operative stage Ia to IIb (TNM classification) - according to CT without mediastinal lymph nodes invasion and with positive histological finding after systematic mediastinal lymphadenectomy.
Results:Tumors in right upper lobe metastasized in 45.5 % into group 1 nodes (stages N1-N4) and group 3 nodes (stages N7) and in 9 % into group 4 nodes (stages N8-N9). Tumors of the right middle lobe metastasized in 100 % into group 3 nodes (stage N7).Tumors of the right lower lobe metastasized in 87.5 % into group 3 nodes (N7) and in 12.5 % into group 4 nodes (stages N8-N9). Tumors of the left upper lobe metastasized in 9.0 % in group 1 nodes (stages N1-N4), in 82 % into group 2 nodes (stages N5-N6) and in 9.0 % were found skip metastases into group 4 nodes (stages N8-N9). Tumors of the left lower lobe metastasized in 26.7 % in group 4 nodes, 46.6 % into group 3 nodes, in 20,0 % into group 2 nodes and in 6,7 % into group 1 nodes.
Conclusion:Systematic mediastinal lymphadenectomy is crucial for determining the stage of the disease according to the TNM classification. Systematic lymphadenectomy is essential for the diagnosis of stage IIIa disease and setting of additional therapy that prolongs survival (Ref. 17). Keywords: systematic lymphadenectomy, bronchogenic carcinoma, additional therapy, lung cancer.
- Retrospective cohort study of bronchial doses and radiation-induced atelectasis after stereotactic body radiation therapy of lung tumors located close to the bronchial tree. [Journal Article, Research Support, Non-U.S. Gov't]
- Int J Radiat Oncol Biol Phys 2013 Nov 1; 87(3):590-5.
To evaluate the dose-response relationship between radiation-induced atelectasis after stereotactic body radiation therapy (SBRT) and bronchial dose.Seventy-four patients treated with SBRT for tumors close to main, lobar, or segmental bronchi were selected. The association between incidence of atelectasis and bronchial dose parameters (maximum point-dose and minimum dose to the high-dose bronchial volume [ranging from 0.1 cm(3) up to 2.0 cm(3)]) was statistically evaluated with survival analysis models.Prescribed doses varied between 4 and 20 Gy per fraction in 2-5 fractions. Eighteen patients (24.3%) developed atelectasis considered to be radiation-induced. Statistical analysis showed a significant correlation between the incidence of radiation-induced atelectasis and minimum dose to the high-dose bronchial volumes, of which 0.1 cm(3) (D(0.1cm3)) was used for further analysis. The median value of D(0.1cm3) (α/β = 3 Gy) was EQD(2,LQ) = 147 Gy3 (range, 20-293 Gy3). For patients who developed atelectasis the median value was EQD(2,LQ) = 210 Gy3, and for patients who did not develop atelectasis, EQD(2,LQ) = 105 Gy3. Median time from treatment to development of atelectasis was 8.0 months (range, 1.1-30.1 months).In this retrospective study a significant dose-response relationship between the incidence of atelectasis and the dose to the high-dose volume of the bronchi is shown.
- Effects of respiratory motion on passively scattered proton therapy versus intensity modulated photon therapy for stage III lung cancer: are proton plans more sensitive to breathing motion? [Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural]
- Int J Radiat Oncol Biol Phys 2013 Nov 1; 87(3):576-82.
To quantify and compare the effects of respiratory motion on paired passively scattered proton therapy (PSPT) and intensity modulated photon therapy (IMRT) plans; and to establish the relationship between the magnitude of tumor motion and the respiratory-induced dose difference for both modalities.In a randomized clinical trial comparing PSPT and IMRT, radiation therapy plans have been designed according to common planning protocols. Four-dimensional (4D) dose was computed for PSPT and IMRT plans for a patient cohort with respiratory motion ranging from 3 to 17 mm. Image registration and dose accumulation were performed using grayscale-based deformable image registration algorithms. The dose-volume histogram (DVH) differences (4D-3D [3D = 3-dimensional]) were compared for PSPT and IMRT. Changes in 4D-3D dose were correlated to the magnitude of tumor respiratory motion.The average 4D-3D dose to 95% of the internal target volume was close to zero, with 19 of 20 patients within 1% of prescribed dose for both modalities. The mean 4D-3D between the 2 modalities was not statistically significant (P<.05) for all dose-volume histogram indices (mean ± SD) except the lung V5 (PSPT: +1.1% ± 0.9%; IMRT: +0.4% ± 1.2%) and maximum cord dose (PSPT: +1.5 ± 2.9 Gy; IMRT: 0.0 ± 0.2 Gy). Changes in 4D-3D dose were correlated to tumor motion for only 2 indices: dose to 95% planning target volume, and heterogeneity index.With our current margin formalisms, target coverage was maintained in the presence of respiratory motion up to 17 mm for both PSPT and IMRT. Only 2 of 11 4D-3D indices (lung V5 and spinal cord maximum) were statistically distinguishable between PSPT and IMRT, contrary to the notion that proton therapy will be more susceptible to respiratory motion. Because of the lack of strong correlations with 4D-3D dose differences in PSPT and IMRT, the extent of tumor motion was not an adequate predictor of potential dosimetric error caused by breathing motion.
- Relationship between programmed death-ligand 1 and clinicopathological characteristics in non-small cell lung cancer patients. [Journal Article]
- Chin Med Sci J 2013 Sep; 28(3):147-51.
To evaluate the correlation between programmed death-ligand 1 (PD-L1) expression in primary lung cancer cells, tumor associated macrophages (TAM) and patients' clinicopathological characteristics.From 2008 to 2010, 208 non-small cell lung cancer patients who underwent surgery or CT-guided biopsy were recruited from Huadong Hospital, Fudan University. Immunohistochemistry staining was performed to evaluate the PD-L1 expression in both primary lung cancer cells and CD68 positive TAM. The relationship between PD-L1 expression and the clinical pathology was evaluated using χ(2) test. Spearman's rank correlations were used to determine the correlation between PD-L1 expression in tumor cells and macrophages.Positive PD-L1 expression in primary cancer cells was found in 136 (65.3%) patients, which were negatively correlated with lymph node metastasis (P=0.009) and smoking history (P=0.036). Besides, TAM with PD-L1 expression (found in 116 patients) was positively associated with smoking history (P=0.034), well-differentiation (P=0.029) and negative lymph node metastasis (P=0.0096). A correlation between PD-L1 expression in primary tumor cells and non-small cell lung cancer associated macrophages was found (r=0.228, P=0.021).PD-L1, secreted from TAM, might induce cancer cells apoptosis, and decrease lymph node metastasis.
- Low-dose CT angiography: which contrast medium? Reply. [Comment, Letter]
- AJR Am J Roentgenol 2013 Oct; 201(4):W661.
- Low-dose CT angiography: which contrast medium? [Comment, Letter]
- AJR Am J Roentgenol 2013 Oct; 201(4):W660.
- Exophthalmos as a first manifestation of the systemic spread of small cell lung cancer. [Case Reports, Journal Article]
- Klin Oczna 2013; 115(2):135-40.
Small cell lung cancer is characterized by rapid growth and early metastases. The most frequent locations of the secondary lesions include adrenal glands, brain, liver, and skeleton. On initial diagnosis, up to 70% of patients with small cell lung cancer have metastases. Metastases to the eye or orbit developed approximately 0.7-12% of patients with lung cancer. Clinical signs and symptoms of orbital metastases may include exophthalmos, diplopia, pain, limited ocular motility, blurred vision, swollen eyelid, conjunctival hyperemia and edema, increased ocular pressure and papilledema. Here, we report a rare case of exophthalmos as the first manifestation of a metastatic tumor of orbit due to small cell lung cancer.
- [Alterations in tears aqueous layer during cytostatics treatment]. [Comparative Study, English Abstract, Journal Article]
- Klin Oczna 2013; 115(2):115-20.
The aim of the study was to evaluate tears secretion, pH and lysozyme activity in tears aqueous layer during chemotherapy in lung, breast and bowel cancer.36 patients were enrolled to the study. Depending on the type of cancer and type of chemotherapy patients were divided into three groups. Group I (12 patients) diagnosed with non-small-cell lung cancer treated with PE schema (cisplatin, etoposide), Group II (12 patients) with breast cancer treated with FAC schema (fluorouracil, doxorubicin, cyclophosphamide), Group III (12 patients) with bowel cancer treated with FU/LV schema (fluorouracil, leucovorin). In all the patients: Schirmer's I test, pH measurements and lysozyme test were performed. Patients were examined before chemotherapy, after 2nd, 4th, 6th cycle.In group I and II lowering of tears secretion (p < 0.001) was revealed. In group III there was higher tears secretion (p < 0.001). PH was lowered after 2nd chemotherapy course in group I and II. In further treatment pH value were in the same lower level as after the second course. In group III there was higher pH--more alkaline (p < 0.001) after 2nd cycle of treatment and it was on the same level to the end of the examination process. Lowering of lysozyme activity in the tears film in all groups (p < 0.001) was established. The higher alterations of the lysozyme activity were observed in group treated with FAC schema.Cytostatic treatment has major influence on tears aqueous layer causing alterations of tears secretions. PH alterations depending on type of chemotherapy was observed. Lowering of lysozyme activity in tears was observed. All the deteriorations aggravate with duration of chemotherapy. Alterations of tears film parameters during chemotherapy may influence upon eye surface homeostasis and infectious complication. tears aqueous layer, Schirmer's test, lysozyme activity, tears pH.
- [Imaging diagnosis. Q & A: A raised lesion at the entry to the right lobar bronchus]. [Case Reports, Journal Article]
- Kyobu Geka 2013 Jan; 66(1):68-71.