Radiotherapy in the management of synchronous metastatic lung cancer.

Metastatic lung cancer classically portends a poor prognosis. The management of metastatic lung cancer has dramatically changed with the emergence of immune checkpoint inhibitors, targeted therapy and due to a better understanding of the oligometastatic process. In metastatic lung cancers, radiation therapy which was only used with palliative intent for decades, represents today a promising way to treat primary and oligometastatic sites with a curative intent. Herein we present through a literature review the role of radiotherapy in the management of synchronous metastatic lung cancers.

The contribution of heart disease to pregnancy-related mortality according to the pregnancy mortality surveillance system.

OBJECTIVE: The objective of this study was to demonstrate the increasing importance of heart disease as a cause of pregnancy-related mortality in Hawaii and the rest of the United States. STUDY DESIGN: Hawaii's Department of Public Health identified all pregnancy-associated death certificates from 1991 to 2007. Hospital records and autopsy reports were reviewed to determine whether deaths were pregnancy-related. RESULT: From 1991 to 2007, Hawaii registered 156 deaths occurring within 1 year of pregnancy, which represented 4.2% of the total number of women who died in the same 17 to 46 years age group and 9.0% of the total number of women who died in the same 17 to 34 years age group. The pregnancy-related mortality ratio was 22.4 and the pregnancy-associated mortality ratio was 50. The leading cause of pregnancy-associated mortality was heart disease (20.5%) followed by cancer (18.6%) and suicide/homicide (12.2%). Pregnancy-related deaths (n=70) were attributed to heart disease (45.7%) followed by sepsis (14.2%) and hemorrhage (12.9%). The new Hawaii death certificate beginning in 2006 increased the detection of both pregnancy-related and -associated deaths. CONCLUSION: Heart disease is the most common cause of pregnancy-related mortality in Hawaii, and with improved ascertainment, may be determined to be the most common cause of pregnancy-related mortality in the rest of the United States.