[Predictive factors for skeletal-related events in lung cancer]. / Facteurs prédictifs de survenue d'évènements osseux dans le cancer bronchique.

INTRODUCTION: Skeletal-related events (SRE) are common in patients with bone metastatic lung cancer and have a negative impact on quality of life and survival. The objective of this study is to identify predictive factors for SRE occurrence among this population. METHODS: We conducted a 3-year retrospective study including 100 lung cancer patients with bone metastasis. RESULTS: Eighty-two patients presented at least one SRE (69.5% at baseline). The median occurrence for SRE was 4.5 months and severe bone pain was the most common SRE (56%). The alkaline phosphatase serum level>120IU/L (hazard ratio [sHR]=2.8; 95% confidence interval (CI) [1.5-5.4]; P=0.002) and calcemia>2.6mmol/L ([sHR]=9.7; 95% CI [5.1-18.4]; P<0.001) were identified as risk factors for SRE occurrence while the presence of an initial SRE was associated with a decrease of this risk ([sHR]=0.2; 95% CI [0.1-0.4]; P<0.001). CONCLUSION: The elevated alkaline phosphatase serum level and hypercalcemia are risk factors for SRE occurrence in bone metastatic lung cancer patients and should be used as biomarkers to adapt current medical practice for these patients.

[Bronchial carcinoma and tobacco: An update]. / Cancer bronchique et tabac : mise à jour.

Lung cancer remains the most lethal cancer. The most common cause is smoking, which is also preventable, unlike the causes of other types of cancer. A genetic characteristic has emerged over several years, which explains particular profiles of smokers, or highly dependent smokers. The emergence of new therapies for the treatment of lung cancer, and the impact of tobacco on reducing the effectiveness of these therapies must challenge practitioners to obtain a complete cessation of smoking regardless of the stage of the disease.

Lung Cancer App (LuCApp) study protocol: a randomised controlled trial to evaluate a mobile supportive care app for patients with metastatic lung cancer.

INTRODUCTION: Mobile health technologies may enhance patient empowerment and data integration along the whole care continuum. However, these interventions pose relatively new regulatory, organisational and technological challenges that limit appropriate evaluation. Lung Cancer App (LuCApp) is a mobile application developed by researchers and clinicians to promote real-time monitoring and management of patients' symptoms. This protocol illustrates a clinical trial designed to evaluate the usability, effectiveness and cost-effectiveness of LuCApp versus standard of care. METHODS AND ANALYSIS: This is a 24-week two-arm non-blinded multicentre parallel randomised controlled trial. A total of 120 adult patients diagnosed with small or non-small cell lung cancer and eligible for pharmaceutical treatments will be allocated 1:1 to receiving either standard care or LuCApp in addition to standard care at three oncology sites in Northern Italy. During the treatment period, LuCApp allows daily monitoring and grading of a list of symptoms, which trigger alerts to the physicians in case predefined severity thresholds are met. Patients will complete a baseline assessment and a set of valid and reliable patient-reported outcome measures every 3±1 weeks, and up to 24 weeks. The primary outcome is the change in the score of the Trial Outcome Index in the Functional Assessment of Cancer Therapy (Lung) questionnaire from baseline to 12 weeks. Secondary outcomes are the Lung Cancer Subscale, the EuroQoL 5D-5L questionnaire, the Hospital Anxiety and Depression Scale, the Supportive Care Needs Survey Short Form, the app usability questionnaire and the Zarit Burden Interview for the main caregiver. ETHICS AND DISSEMINATION: The trial received ethical approval from the three clinical sites. Trial results will be disseminated through peer-reviewed publications and conference presentations. CONCLUSIONS: This trial makes a timely contribution to test a mobile application designed to improve the quality of life and delivery of care for patients with lung cancer. TRIAL REGISTRATION NUMBER: NCT03512015; Pre-results.

Recommendations for the Diagnosis and Management of Asbestos-Related Pleural and Pulmonary Disease. / Recomendaciones sobre el diagnóstico y manejo de la enfermedad pleural y pulmonar por asbesto.

Asbestos is the term used for a set of mineral silicates that tend to break up into fibers. Its use has been associated with numerous diseases affecting the lung and pleura in particular, all of which are characterized by their long period of latency. Asbestos, moreover, has been recognized by the WHO as a Group IA carcinogen since 1987 and its use was banned in Spain in 2002. The publication in 2013 of the 3rd edition of the specific asbestos health monitoring protocol, together with the development of new diagnostic techniques, prompted the SEPAR EROM group to sponsor publication of guidelines, which review the clinical, radiological and functional aspects of the different asbestos-related diseases. Recommendations have also been made for the diagnosis and follow-up of exposed patients. These recommendations were drawn up in accordance with the GRADE classification system.

Palliative use of noninvasive ventilation: navigating murky waters.

BACKGROUND: The use of noninvasive positive pressure ventilation (NPPV) as a palliative treatment for respiratory failure and dyspnea has become increasingly common. NPPV has a well-established, evidence-based role in the management of respiratory failure due to acute exacerbations of congestive heart failure and chronic obstructive pulmonary disease, both for patients with and without restrictions on endotracheal intubation. There are emerging uses of NPPV in patients clearly nearing the end-of-life, but the evidence to support these applications is limited. Alongside these emerging applications of NPPV are new ethical dilemmas that should be considered in medical decision-making regarding these therapies. DISCUSSION: Herein, we describe the use of NPPV in four patients with advanced disease and preexisting treatment-limiting directives. We discuss some of the ethical dilemmas and unintended consequences that may accompany the use of NPPV in such circumstances, and we review the benefits and burdens of palliative NPPV. CONCLUSION: Finally, we conclude with a summary of principles that can be used as a guide to decision making regarding palliative NPPV.

[Pulmonary rehabilitation and non-invasive ventilation before lung surgery in very high-risk patients]. / Réhabilitation et VNI avant exérèse pulmonaire chez les patients à haut risque opératoire.

INTRODUCTION: The benefits of a rehabilitation program before surgical lung cancer resection remain to be defined. The purpose of this prospective observational study was to assess the effects of rehabilitation together with the use of noninvasive ventilation (NIV) in patients who were at a high operative risk. METHODS: Between January 2010 and June 2011, 20 consecutive patients (16 males, four females, mean age: 66 years [44-79]) with a clinical N0 non-small cell lung cancer were included. Eligibility criteria were predicted post-operative respiratory function (FEV1, VO2 max) below the guideline thresholds for eligibility for surgical resection and/or associated with severe co-morbidities. The protocol included a cardiorespiratory rehabilitation program and 3 hours of NIV each day. Functional tests were repeated after 3 weeks of therapy. RESULTS: Participants displayed a significant increase in their FEV1 and VO2 max, which allowed surgical resection to go ahead in all patients (lobectomy, n=15; pneumonectomy, n=3; bilobectomy, n=2). The morbidity rate was 20% (acute renal failure, n=2; pneumonia, n=1; haemothorax, n=1). The mortality rate was 5% (myocardial infarction, n=1). Further postoperative rehabilitation allowed a return at home in 19 patients after a mean hospital stay of 11 days. CONCLUSION: Pulmonary rehabilitation associated with a period of preoperative NIV allows surgery to be performed in patients who are not initially eligible for resection. An evaluation of long-term outcomes survival in comparison to non-surgical therapies is necessary.

Malignant tumors could be misinterpreted as temporomandibular joint disorders.

OBJECTIVES: This article stresses the importance of exclusion of malignant tumors as a cause of temporomandibular joint disorder, which is usually caused by intra-articular or musculoligamental dysfunction without considering malignant tumors as a cause of such complaints. METHOD AND RESULTS: Three patients were referred to us because of persistent and recurrent temporomandibular joint dysfunction. All patients were treated more than once through their general practitioner, ear nose and throat physician, or dental physician without significant improvement. After adequate clinical and radiological examination, malignant tumors were discovered as a cause of such complaints. CONCLUSIONS: Patients with primary or secondary tumors could present with symptoms simulating temporomandibular joint disorder and will therefore be treated similarly. In such condition, missing that rare cause will consequently lead to unnecessary delayed diagnosis and may cost the patients their lives.

[Comparative analysis of clinical features of lung cancer in west China hospital in 2000 and 2010].

BACKGROUND AND OBJECTIVE: Primary lung cancer is one of the most common malignant tumors. The aim of the current study is to retrospectively analyze the clinical features variation of patients with primary bronchogenic carcinoma in West China Hospital Sichuan University to provide information for early detection and treatment of lung cancer. METHODS: We collected data of patients of permanent population in Sichuan province who diagnosed primary bronchogenic carcinoma in 2000 and 2010 in West China Hospital Sichuan University respectively for comparative analysis of reasons to visit the doctor, duration from symptom onset to visit the doctor, combined diseases, incidences of bi-primary carcinoma, family history of malignant tumor, sites of tumors, grade of differentiation, tumor staging and initial treatment modalities. RESULTS: A total of 2,167 cases (616 cases in 2000 and 1,551 cases in 2010) met inclusion criteria were retrieved for analysis. In 2010, compared with data of 2000, the rate of patients who visit the doctors because abnormalities were detected by health examination elevated remarkably (5.2% vs 16.7%, P<0.001), the duration from symptom onset to visit the doctor abridged significantly (P<0.001), patients with family history of malignant tumor increased significantly (3.9% vs 13.7%, P<0.001), the constituent ratio of poorly differentiated adenocarcinoma decreased (72.3% vs 51.8%, P=0.002) accompanied with low differentiated squamous cell carcinoma increased (59.4% vs 76.7%, P=0.002). For NSCLC staging, there is a notably increase of rate of stage Ia (1.0% vs 4.5%, P< 0.001) and stage IV (30.4% vs 37.8%, P<0.001) while decrease of stage IIIa (26.6% vs 14.8%, P=0.002). For initial treatment modalities, there is markedly increased chemotherapy rate of non-small cell lung cancer (NSCLC) patients (41.8% vs 63.4%, P=0.002) while remarkably increased surgery rate of stage IIIa patients (41.8% vs 63.4%, P=0.002) and decreased surgery rate of stage IV patients (9.4% vs 3.1%, P=0.001). The surgery rate of small cell lung cancer (SCLC) patients decrease sharply (30.4% vs 4.3%, P<0.001). CONCLUSIONS: There clinical features of lung cancer patients were significantly changed in the past ten years, new prevention, diagnosis and treatment strategies are needed to accommodate the variation.

Bronchial carcinoma after lung transplantation: a single-center experience.

BACKGROUND: Lung transplantation (LTx) remains the best option for selected patients with end-stage lung disease. Long-term survival is hampered by the development of chronic allograft dysfunction, which is the main reason for mortality at 3 to 5 years after LTx. Prevalence of and mortality due to solid-organ tumors also increases and we specifically investigated the development of primary bronchial carcinoma (BC) and its outcome after LTx. METHODS: From January 2000 until June 2011, 494 lung and heart-lung transplantations were performed. Among this population, 13 patients developed bronchial carcinoma at 41 ± 27 (mean ± SD) months after LTx. Of these 13 patients, there were 9 men and 4 women. They were transplanted at a mean age of 59 ± 2.8 years; 8 patients were transplanted for emphysema and 5 for pulmonary fibrosis. RESULTS: Nine of 92 single LTx patients (transplanted for emphysema or lung fibrosis) developed a bronchial carcinoma in their native lung, whereas only 4 of 224 bilateral LTx patients (also for emphysema or fibrosis) developed a bronchial carcinoma (p = 0.0026). At diagnosis, 4 patients had local disease (cT1N0M0 and cT2N0M0), whereas all others had locoregionally advanced or metastatic disease. Five patients were surgically treated; however, 1 had unforeseen N2 disease with additional pleural metastasis at surgery. All other patients (except 2 who died very soon after diagnosis) were treated with chemotherapy with or without radiotherapy. The median survival after diagnosis was only 10 ± 7 months, with a significant survival difference between patients with limited and extensive disease (p = 0.037). The latter had a median survival of only 6 months compared with 21 months for patients with limited stages of bronchial carcinoma. CONCLUSIONS: Bronchial carcinoma, especially of the native lung after single LTx, is a significant problem and the survival after diagnosis is very poor, although patients with limited (operable) disease tend to have better results.

[Subcutaneous mass as initial manifestation of an osteolytic metastasis]. / Subkutane Weichteilschwellung als Erstmanifestation einer osteolytischen Knochenmetastase.

HISTORY AND CLINICAL FINDINGS: A 69-year-old woman was admitted for evaluation of a left occipital subcutaneous tumour which had grown during the preceding eight weeks from 2 × 2 cm to 4 × 4 cm. INVESTIGATIONS: Sonography revealed a pressure-sensitive subcutaneous mass with osteolytic destruction in the occipital bone. Cranial magnetic resonance imaging confirmed the osteolytic lesion. Thoracic computed tomography showed a lesion in the upper left lobe of the lung with metastases in the hilar lymph nodes. DIAGNOSIS, TREATMENT AND COURSE: Transbronchial biopsy revealed a bronchial carcinoma. After resection of the osteolytic lesion its histology was confirmed to be an osseous metastasis of the carcinoma. Palliative chemotherapy and cranial irradiation were initiated. CONCLUSION: Solitary osteolytic lesions of the skull occur in the context of osseous metastases. Other possible causes include solitary plasmocytoma and eosinophilic granuloma.

Malignancies following lung transplantation.

Malignancy is an important complication of thoracic organ transplantation and is associated with significant morbidity and mortality. Lung transplant recipients are at greater risk for cancer than immunocompetent persons, with cancer-specific incidence rates up to 60-fold higher than the general population. The increased risk for cancer is attributed to neoplastic properties of immunosuppressive medications, oncogenic viruses, and cancer-specific risk factors. This article addresses the epidemiology, presentation, and treatment of the most common malignancies after lung transplantation, including skin cancer, posttransplant lymphoproliferative disorder, and bronchogenic carcinoma.

[Recent results of research on cancer of the colon, gastric cancer, sarcoma and bronchial carcinoma]. / Neue Forschungsergebnisse zum Kolonkarzinom, Magenkarzinom, Sarkomen und Bronchialkarzinom.

In patients up to 70 years of age with colon carcinoma stage III adjuvant chemotherapy with infusions of fluorouracil (5-FU) or oral capecitabine combined with oxaliplatin should be the standard method. A new standard for the palliative treatment of Her2/newly positive advanced gastric cancer and cancer at the gastro-esophageal junction is the administration of trastuzumab combined with chemotherapy. Patients with high-risk soft tissue sarcoma can be helped, in addition to surgical resection and subsequent radiotherapy, by neoadjuvant chemotherapy combined with regional deep hyperthermia. For patients with lung cancer additional individualized treatment is about to become routine. In addition to the EGFR mutation status, all non-smokers should in future be tested for aberration in the anaplastic lymphoma kinase (ALK) gene.

[Delay in the diagnosis of primary bronchial cancer. Study carried out in the pneumology unit of Ibn Sina university hospital, Rabat (Morocco)]. / Retard diagnostique du cancer bronchique primitif. Étude réalisée dans le service de pneumologie du CHU Ibn Sina de Rabat (Maroc).

INTRODUCTION: Primary bronchial cancer (PBC) is a major public health problem. The diagnosis is often late resulting in a poor prognosis. PURPOSE: To determine the factors leading to a late diagnosis. PATIENTS AND METHODS: All PBCs diagnosed between 01 January and 31 December were included. The factors studied were: "age, sex, smoking, place of residence, socioeconomic level, clinical signs, diagnostic means, histological types, the stages and date of treatment". The date of the first symptom (D1s), the date of care (Dpch), the date of the diagnosis (Ddg) and the date of the beginning of treatment (Dttt) were used to determine the delay before care. RESULTS: One hundred and three cases of PBC were included. The medium delay before hospitalisation (D1s to Dpch) was 76 days, the delay before the diagnosis (Dpch to Ddg) was 25 days, the time before treatment (Ddg to Dttt) was 27 days, the time between hospitalisation and treatment (Dpch to Dttt) was 69 days, the overall delay (D1s to Dttt) was 160 days. The time before the diagnosis was longer in cases with a low socioeconomic level (30 days vs. 21 days, p: 0.06). The time before treatment was shorter for small cell carcinomas (SCC) (23 days vs. 31 days: p: 0.06). The time between hospitalisation and treatment was shorter for stages IIIB and IV of NSCBC (60 days vs. 67 days, p: 0.03). The overall delay was shorter for SCC (152 days vs. 168 days, p: 0.001). CONCLUSION: The study confirms the problem of a delay in diagnosis. The effect of these delays on the prognosis has not been demonstrated and requires further study.

The molecular and cellular biology of lung cancer: identifying novel therapeutic strategies.

INTRODUCTION: Lung cancer is the commonest fatal malignancy in the developed world. Survival rates for lung cancer have not changed significantly over the past 30 years. Sources of data This report is a systematic review of the literature on our current understanding of lung cancer biology. Searches were carried out using PUBMED. 1990-2010. AREAS OF AGREEMENT: A concerted effort to reduce cigarette smoking and nicotine addiction is required. A better understanding of the biology of lung cancer will lead to the identification of earlier diagnostic markers and improved therapy. AREAS OF CONTROVERSY: How chronic inflammatory disorders such as COPD and lung fibrosis contribute to lung cancer development is incompletely understood. GROWING POINTS: Developing novel biological agents to target lung cancer. New microarray-based technologies provide new methods for predicting prognosis and response to treatment. AREAS TIMELY FOR DEVELOPING RESEARCH: Developing strategies to target lung cancer stem cells may provide a novel approach for treating drug resistant disease.

[PET/CT for diagnostics and therapy stratification of lung cancer]. / Einsatz der PET/CT zur Diagnostik und Therapiestratifizierung des Bronchialkarzinoms.

With the introduction of positron emission tomography (PET) and more recently the hybrid systems PET/CT, the management of cancer patients in the treatment strategy has changed tremendously. The combination of PET with multidetector CT scanning enables the integration of metabolic and high resolution morphological image information. PET/CT is nowadays an established modality for tumor detection, characterization, staging and response monitoring. The increased installation of PET/CT systems worldwide and also the increased scientific publications underline the importance of this imaging modality. PET/CT is particular the imaging modality of choice in lung cancer staging and re-staging (T, N and M staging). The possible increased success of surgery in lung cancer patients and also the expected reduction in additional invasive diagnostics lead to benefits for both the individual patient and the healthcare system. In this review article PET and PET/CT is presented for diagnostic and therapeutic stratification in lung cancer. The fundamentals of glucose metabolism, staging, tumor recurrence and therapeutic monitoring are presented.