RESUMO
OBJECTIVE: To construct a new pulmonary nodule diagnostic model with high diagnostic efficiency, non-invasive and simple to measure. METHODS: This study included 424 patients with radioactive pulmonary nodules who underwent preoperative 7-autoantibody (7-AAB) panel testing, CT-based AI diagnosis, and pathological diagnosis by surgical resection. The patients were randomly divided into a training set (n = 212) and a validation set (n = 212). The nomogram was developed through forward stepwise logistic regression based on the predictive factors identified by univariate and multivariate analyses in the training set and was verified internally in the verification set. RESULTS: A diagnostic nomogram was constructed based on the statistically significant variables of age as well as CT-based AI diagnostic, 7-AAB panel, and CEA test results. In the validation set, the sensitivity, specificity, positive predictive value, and AUC were 82.29%, 90.48%, 97.24%, and 0.899 (95%[CI], 0.851-0.936), respectively. The nomogram showed significantly higher sensitivity than the 7-AAB panel test result (82.29% vs. 35.88%, p < 0.001) and CEA (82.29% vs. 18.82%, p < 0.001); it also had a significantly higher specificity than AI diagnosis (90.48% vs. 69.04%, p = 0.022). For lesions with a diameter of ≤ 2 cm, the specificity of the Nomogram was higher than that of the AI diagnostic system (90.00% vs. 67.50%, p = 0.022). CONCLUSIONS: Based on the combination of a 7-AAB panel, an AI diagnostic system, and other clinical features, our Nomogram demonstrated good diagnostic performance in distinguishing lung nodules, especially those with ≤ 2 cm diameters. KEY POINTS: ⢠A novel diagnostic model of lung nodules was constructed by combining high-specific tumor markers with a high-sensitivity artificial intelligence diagnostic system. ⢠The diagnostic model has good diagnostic performance in distinguishing malignant and benign pulmonary nodules, especially for nodules smaller than 2 cm. ⢠The diagnostic model can assist the clinical decision-making of pulmonary nodules, with the advantages of high diagnostic efficiency, noninvasive, and simple measurement.
Assuntos
Neoplasias Pulmonares , Nódulos Pulmonares Múltiplos , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Inteligência Artificial , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/cirurgia , Autoanticorpos , Tomografia Computadorizada por Raios X/métodos , Estudos RetrospectivosRESUMO
The role of two- or three-field nodal dissection in the surgical treatment of esophageal and gastroesophageal junction cancer in the minimally invasive era is still controversial. This review aims to clarify the extension of nodal dissection in esophageal and gastroesophageal junctional cancer. A basic evidence-based analysis was designed, and seven research questions were formulated and answered with a narrative review. Reports with little or no data, single cases, small series and review articles were not included. Three-field lymph node dissection improves staging accuracy, enhances locoregional disease control and might improve survival in the group of patients with cervical and upper mediastinal metastatic lymph nodal involvement from middle and proximal-third esophageal cancer.
Assuntos
Neoplasias Esofágicas , Neoplasias Gástricas , Humanos , Esofagectomia , Excisão de Linfonodo , Neoplasias Esofágicas/patologia , Linfonodos/cirurgia , Linfonodos/patologia , Junção Esofagogástrica/cirurgia , Junção Esofagogástrica/patologia , Neoplasias Gástricas/cirurgia , Neoplasias Gástricas/patologia , Estadiamento de NeoplasiasRESUMO
The topic of pulmonary metastases has long been of high interest and ongoing controversy. There is a group of patients with pulmonary metastases who may benefit from curative resection. It remains unclear which among them will benefit from surgery in terms of survival. This work updates a previously proposed classification system for pulmonary metastases, similar in its essence to the tumor, nodes, metastasis (TNM) classification used for primary tumors and named pmTNM classification, where 'pm' stands for 'pulmonary metastasis'. The objective is to allow future studies to explore predictive and survival prognostic factors for pulmonary metastases and separate patients who will benefit from lung metastasectomy from those who will not. The secondary aim is to provide a classification system that will allow physicians, oncologists and surgeons to speak the same language in comparing their data and assessing the results of treatment of lung metastases.
Assuntos
Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/secundário , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/cirurgia , Metastasectomia , Estadiamento de NeoplasiasRESUMO
The value of pulmonary metastasis (PM) resection in the context of controlled primary tumor sites was shown to improve survival of patients if complete resection could be achieved. The surgeon's approach can be modulated by various parameters pertaining to safety margins including local growth properties, size, spread and location of PMs. Lymph node dissection and assessment is recommended although its impact on survival remains unclear. Thoracoscopic surgery combined to thin slice chest CT scans has shown results comparable to thoracotomy in patients with few PMs. The management of PMs should therefore be discussed on an individual, interdisciplinary basis to offer the best possible oncological and surgical results as well as to maximize long term patient survival rates.
Assuntos
Neoplasias Colorretais/terapia , Neoplasias Pulmonares/terapia , Pneumonectomia/métodos , Cirurgia Torácica Vídeoassistida/métodos , Biomarcadores Tumorais/análise , Quimioterapia Adjuvante , Tomada de Decisão Clínica , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/patologia , Intervalo Livre de Doença , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pulmão/cirurgia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/secundário , Excisão de Linfonodo , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática/diagnóstico , Metástase Linfática/patologia , Margens de Excisão , Seleção de Pacientes , Prognóstico , Tomografia Computadorizada por Raios XRESUMO
Cancer is a leading cause of death worldwide. Literature reports depression and anxiety are the most common psychiatric symptoms in cancer patients. Notably, lung cancer is associated with major depressive disorder in 5-13% of cases. The present article aims to give an overview regarding the impact of mood disorders on the outcomes of patients affected by lung cancer. Our review showed that pharmacological treatment and psychotherapy can be useful to improve the quality of life of patients with lung cancer. Moreover, the treatment of depression and anxiety can be associated with a reduced mortality. In conclusion, it is important to consider psychiatric care as important as other adjuvant oncologic therapies in patients with cancer.
Assuntos
Ansiedade/terapia , Depressão/terapia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias/terapia , Ansiedade/epidemiologia , Ansiedade/etiologia , Ansiedade/psicologia , Citalopram/uso terapêutico , Terapia Cognitivo-Comportamental/métodos , Terapia Combinada/métodos , Depressão/epidemiologia , Depressão/etiologia , Depressão/psicologia , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/psicologia , Equipe de Assistência ao Paciente , Pneumonectomia/psicologia , Pneumonectomia/reabilitação , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/psicologia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Sertralina/uso terapêutico , Tentativa de Suicídio/prevenção & controle , Tentativa de Suicídio/psicologia , Taxa de Sobrevida , Resultado do TratamentoRESUMO
Aim: The aim of this study is to assess the efficacy of external laryngeal medialization acquired through a Gore-Tex implant in a 45 patients affected by unilateral vocal fold paralysis in abduction after pneumonectomy. Method: The cohort of patients was made up of 30 male (73.1%) and 11 female patients (26.9%) with an average age of 66.7 years in a range between 46 and 78 years. Results: The results were analyzed with the objective and subjective analysis of voicing and swallowing. In 95.2% of cases, voice and swallow improvement with statistically significant evidences. Conclusion: We can conclude that Gore-Tex implantation is a simple, reproducible and minimally invasive procedure for management of selected cases of vocal fold unilateral paralysis in the abductory position.
Assuntos
Laringoplastia/instrumentação , Neoplasias Pulmonares/cirurgia , Pneumonectomia/efeitos adversos , Politetrafluoretileno , Complicações Pós-Operatórias/cirurgia , Traumatismos do Nervo Laríngeo Recorrente/cirurgia , Paralisia das Pregas Vocais/cirurgia , Idoso , Deglutição/fisiologia , Feminino , Humanos , Laringoplastia/métodos , Laringoscopia , Laringe/diagnóstico por imagem , Laringe/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Traumatismos do Nervo Laríngeo Recorrente/diagnóstico , Traumatismos do Nervo Laríngeo Recorrente/etiologia , Traumatismos do Nervo Laríngeo Recorrente/fisiopatologia , Reprodutibilidade dos Testes , Fala/fisiologia , Resultado do Tratamento , Paralisia das Pregas Vocais/diagnóstico , Paralisia das Pregas Vocais/etiologia , Paralisia das Pregas Vocais/fisiopatologiaRESUMO
Aim: Adenoid cystic carcinoma is a rare tumor of head and neck region and its development in the thoracic region is even less frequent. This implies the absence of guidelines for therapeutic management and a consequent case-by-case approach. The role of radiotherapy is not yet clearly defined, but intensity-modulated radiotherapy allows for improved organ-at-risk sparing. Materials & methods: We have collected the cases of four patients treated at our institutions by the means of intensity-modulated radiotherapy, after endoscopic resection. Results & conclusion: Patients treated achieved long-term disease control of about 5 years, with a minimal acute toxicity. Longer follow-up is needed to drain conclusion on the impact of this treatment on overall survival.
Assuntos
Broncoscopia/métodos , Carcinoma Adenoide Cístico/terapia , Implantação de Prótese/métodos , Radioterapia de Intensidade Modulada/métodos , Neoplasias da Traqueia/terapia , Idoso , Biópsia , Broncoscopia/efeitos adversos , Carcinoma Adenoide Cístico/diagnóstico , Carcinoma Adenoide Cístico/patologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Implantação de Prótese/efeitos adversos , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador , Radioterapia Adjuvante/métodos , Radioterapia de Intensidade Modulada/efeitos adversos , Fatores de Tempo , Traqueia/diagnóstico por imagem , Traqueia/patologia , Traqueia/cirurgia , Neoplasias da Traqueia/diagnóstico , Neoplasias da Traqueia/patologia , Resultado do TratamentoRESUMO
An increased standardized incidence and mortality rate were reported due to malignant mesothelioma (MM) in Biancavilla. Environmental investigations showed the presence of an asbestiform fiber: fluoro-edenite (FE). MM develops with a latency of 20-60 years from exposure and specific and sensitive biomarkers are urgently needed. For this purpose, we evaluated Fibulin-3 (Fb-3) immunoexpression in human cases of MM related to FE exposure and its prognostic role. Immunohistochemical analysis of Fb-3 was carried out in eight MM patients resident in Biancavilla and the analysis showed evidence of environmental exposure to FE fibers. Six MM cases (3 epithelioid and 3 biphasic) showed a high immunoexpression of Fb-3 in neoplastic cells with nuclear and cytoplasmic localization. One epithelioid and one biphasic subtype did not show Fb-3 immunostaining. The results demonstrate the implication of Fb-3 in MM due to FE exposure and may possibly suggest its potential role as a diagnostic and prognostic marker.
Assuntos
Amiantos Anfibólicos/toxicidade , Exposição Ambiental/efeitos adversos , Proteínas da Matriz Extracelular/metabolismo , Neoplasias Pulmonares/patologia , Mesotelioma/patologia , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/metabolismo , Biópsia , Feminino , Seguimentos , Humanos , Incidência , Pulmão/patologia , Neoplasias Pulmonares/induzido quimicamente , Neoplasias Pulmonares/epidemiologia , Masculino , Mesotelioma/induzido quimicamente , Mesotelioma/epidemiologia , Mesotelioma Maligno , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Sicília/epidemiologiaRESUMO
This report highlights the results of the Italian video-assisted thoracoscopic surgery (VATS) Group, launched in mid 2013, which now has a website and an established database with over 4000 VATS lobectomy cases recruited from 67 thoracic surgery units across Italy. The year 2016 has been crucial for the following steps: inclusion of a dedicated biostatistician and a 'Survey Analysis & Data Quality Check'; the First Consensus Meeting with statements consequently adopted as Recommendations for the Italian Thoracic Surgery Society and published in a peer-reviewed journal; two papers published under the logo Italian VATS Group and seven abstracts accepted at annual international meetings (European Society of Thoracic Surgeons, European Association of Cardio-Thoracic Surgeons, European Lung Cancer Conference and European Respiratory Society); the institution of a Master Course on VATS lobectomy; the partnership with AME Publishing Company.
Assuntos
Neoplasias Pulmonares/cirurgia , Sistemas On-Line/estatística & dados numéricos , Pneumonectomia/normas , Sistema de Registros/estatística & dados numéricos , Cirurgia Torácica Vídeoassistida/normas , Conferências de Consenso como Assunto , Bases de Dados como Assunto , Humanos , Itália/epidemiologia , Pulmão/patologia , Pulmão/cirurgia , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/patologia , Pneumonectomia/efeitos adversos , Pneumonectomia/economia , Pneumonectomia/métodos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/economia , Cirurgia Torácica Vídeoassistida/métodos , Resultado do TratamentoRESUMO
AIM: The multimodal approach to malignant pleural mesothelioma is gradually becoming the standard of care for this disease in patients with good performance status. Materials & methods: We report our experience concerning eight cases treated with the use of static step-and-shoot intensity-modulated radiotherapy to the whole pleural cavity, in patients already undergoing surgical and/or antiblastic therapy. Results & conclusion: Results at a median follow-up of 16 months showed a median survival from the initial treatment of 29 months, with lung toxicity of grade II reported only in two patients.
Assuntos
Neoplasias Pulmonares/terapia , Mesotelioma/terapia , Neoplasias Pleurais/terapia , Lesões por Radiação/epidemiologia , Radioterapia de Intensidade Modulada/efeitos adversos , Idoso , Antineoplásicos/uso terapêutico , Terapia Combinada/métodos , Feminino , Seguimentos , Humanos , Itália , Pulmão/patologia , Pulmão/efeitos da radiação , Pulmão/cirurgia , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Mesotelioma/mortalidade , Mesotelioma/patologia , Mesotelioma Maligno , Pessoa de Meia-Idade , Pleura/patologia , Pleura/cirurgia , Neoplasias Pleurais/mortalidade , Neoplasias Pleurais/patologia , Pneumonectomia/métodos , Lesões por Radiação/etiologia , Resultado do TratamentoRESUMO
An environmental contamination due to an asbestiform mineral fiber, fluoro-edenite (FE), caused a significantly increased mortality rate for malignant mesothelioma in Biancavilla, Italy. Exposure to fluoro-edenite has been associated with inflammatory processes as an early response to inhaled fibers. The aim was to explore prevalence of anti-nuclear autoantibodies (ANA) in a group of construction workers residing and working in the contaminated area. Prevalences for samples positive to ANA were 60% (n = 9) and 13% (n = 2), for exposed and nonexposed, respectively (p-value <0.05), the odds ratio was 9.75 (95% CI: 1.59-59.69). The significance of elevated ANAs in subjects exposed to fibers is unknown; additional studies may provide a better opportunity to establish a correlation between autoimmunity and environmental exposure.
Assuntos
Anticorpos Antinucleares/sangue , Amiantos Anfibólicos/toxicidade , Neoplasias Pulmonares/imunologia , Mesotelioma/imunologia , Exposição Ocupacional/efeitos adversos , Adulto , Anticorpos Antinucleares/imunologia , Humanos , Pulmão/patologia , Neoplasias Pulmonares/sangue , Neoplasias Pulmonares/induzido quimicamente , Neoplasias Pulmonares/mortalidade , Masculino , Mesotelioma/sangue , Mesotelioma/induzido quimicamente , Mesotelioma/mortalidade , Mesotelioma Maligno , Pessoa de Meia-Idade , Sicília/epidemiologia , Taxa de SobrevidaRESUMO
We describe our experience, gained over the past 3 years, in the treatment of gastroesophageal junction adenocarcinoma, whose incidence has been increasing in recent years. In our series, we present the results to a follow-up of about 2 years for a total of 18 patients, treated with a particularly intensive combination treatment. It consists of neoadjuvant induction chemotherapy with the protocol docetaxel-cisplatin-5-fluorouracil for four cycles, before a concomitant chemoradiotherapy treatment. During combined phase, patients received an intensity-modulated radiotherapy and a weekly cisplatin. We will present the data to a long follow-up time and we will discuss the literature, the integration with thoracoabdominal surgery and other specific issues of this pathology.
Assuntos
Adenocarcinoma/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Esofágicas/terapia , Junção Esofagogástrica/patologia , Radioterapia de Intensidade Modulada/métodos , Neoplasias Gástricas/terapia , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Idoso , Idoso de 80 Anos ou mais , Quimiorradioterapia/métodos , Intervalo Livre de Doença , Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/patologia , Junção Esofagogástrica/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/efeitos adversos , Terapia Neoadjuvante/métodos , Estadiamento de Neoplasias , Doses de Radiação , Radioterapia de Intensidade Modulada/efeitos adversos , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/patologia , Taxoides/uso terapêutico , Tomografia Computadorizada por Raios XRESUMO
As part of the third Mediterranean Symposium in Thoracic Surgical Oncology, we introduce the Italian VATS Group ( http://vatsgroup.org/sito/index.php ). This national collaborative initiative was established in 2013 and started to recruit patients in January 2014; as of July 2016, 3680 patients have been enrolled in the database. Three different video-assisted thoracic surgery approaches have been predominantly used by Italian thoracic surgery centers, 71% of them preferentially adopting a multi-portal approach, with a 20% recorded morbidity. The majority of the cases were stage I adenocarcinomas of the lung. Conversion to open surgery occurred in 9% of the cases. The study suggests video-assisted thoracic surgery lobectomy as a 'gold standard' for the surgical treatment of early-stage lung cancer in Italy.
Assuntos
Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Cirurgia Torácica Vídeoassistida/métodos , Humanos , Itália , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/mortalidade , Mortalidade , Estadiamento de Neoplasias , Resultado do TratamentoRESUMO
Unilateral single left pulmonary vein is a congenital anomaly of the pulmonary venous system. Surgical treatment is not commonly required for this anatomical variant except in rare circumstances. No previous cases of lung cancer involving the intrapericardial portion of a single left pulmonary vein have been published in the peer-reviewed literature. We describe the case of a 69-year-old man with lung cancer invading single left pulmonary vein, which required intrapericardial pneumonectomy and partial resection of the left atrium.
Assuntos
Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Veias Pulmonares/patologia , Idoso , Biópsia , Terapia Combinada , Humanos , Imageamento Tridimensional/métodos , Neoplasias Pulmonares/tratamento farmacológico , Masculino , Invasividade Neoplásica , Tomografia Computadorizada Espiral/métodos , Resultado do TratamentoRESUMO
Since 1998, we started a clinical program for awake video-assisted thoracic surgery in our unit using four-step local anesthesia and sedation. Throughout the years, we experienced several difficult cases, three of them had complications postpneumonectomy. The aim of this paper is to report these three cases.
Assuntos
Anestesia/métodos , Neoplasias Pulmonares/cirurgia , Pneumonectomia/efeitos adversos , Pneumonectomia/métodos , Complicações Pós-Operatórias/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Empiema/diagnóstico , Empiema/etiologia , Empiema/cirurgia , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/mortalidade , Masculino , Pneumotórax/diagnóstico , Pneumotórax/etiologia , Pneumotórax/cirurgia , Complicações Pós-Operatórias/diagnóstico , Radiografia Torácica , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Several studies have demonstrated that for complex surgical procedures, surgeons who treat more patients have better outcomes than their lower-volume counterparts. The aim of this paper is to review the experience with video-assisted thoracic surgery (VATS) lobectomies in our small thoracic unit (group A), to understand whether our short-term results were different to the outcomes obtained by the same surgeon previously working in a high-volume unit (group B). 37 patients underwent VATS lobectomy. Hospital stay was on average 4.5 days (group A) versus 4.1 days (group B). Operative time and the number of 'frozen sections' were higher in group A. Hospital mortality was 0. VATS lobectomies are a safe approach in a low-volume unit formed by a single surgeon with a previous high-volume experience.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Diagnóstico por Imagem , Feminino , Humanos , Tempo de Internação , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Duração da Cirurgia , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias , Cirurgia Torácica Vídeoassistida/efeitos adversos , Resultado do TratamentoRESUMO
Fluoro-edenite (FE) is a natural mineral asbestos-like fibrous species first isolated in Biancavilla, Sicily. In order to clarify potential involvement of IL-18 in the pathogenesis of FE-induced chest abnormalities, we analyzed IL-18 serum levels in FE-exposed workers (FEEW) and correlated them with pleural and parenchymal abnormalities. A total of 21 FEEWs, residing in Biancavilla for >30 years, with a working seniority of 17 ± 6.1 years were examined. High-resolution computed tomography scans revealed low grade of fibrosis in 8 (38%) FEEWs, and pleural plaques (PPs) in 13 (62%) FEEWs. The mean IL-18 level was 203.13 ± 90.43 pg/ml. Pearson correlation showed a significant association (p < 0.0001) between IL-18 and PPs and parenchymal abnormality scores. Data suggest a potential role of IL-18 in the pathogenesis of these diseases.
Assuntos
Amiantos Anfibólicos/efeitos adversos , Interleucina-18/sangue , Doenças Pulmonares Intersticiais/sangue , Doenças Pulmonares Intersticiais/etiologia , Exposição Ocupacional/efeitos adversos , Doenças Pleurais/sangue , Doenças Pleurais/etiologia , Adulto , Feminino , Humanos , Doenças Pulmonares Intersticiais/diagnóstico , Doenças Pulmonares Intersticiais/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças Pleurais/diagnóstico , Doenças Pleurais/epidemiologia , Testes de Função Respiratória , Fatores de Risco , Tomografia Computadorizada EspiralRESUMO
The use of novel radiotherapy techniques is widely increasing, allowing clinicians to treat diseases that were previously difficult to treat with radiation therapy. Malignant pleural mesothelioma is a clear example of this clinical challenge. We describe our first experience with intensity-modulated radiotherapy technique which was used to treat a 73-year-old patient with multiple relapsing malignant pleural mesothelioma. Intensity-modulated radiation therapy has allowed to respect the QUANTEC (quantitative analyses of normal tissue effects in the clinic) dose constraints, patient has experienced a 14 months progression-free time, without relevant subacute or late lung toxicity.