Case Report: Neoadjuvant and Adjuvant Crizotinib Targeted Therapy in Stage IIIA-N2 ALK-Positive Non-Small-Cell Lung Cancer.

The treatment of anaplastic lymphoma kinase (ALK)-positive locally advanced non-small-cell lung cancer (NSCLC) is challenging because there is no randomized controlled trial has been reported. The value of neoadjuvant and adjuvant targeted therapy remains unclear. Herein, we show that systemic treatment with ALK inhibitor crizotinib before surgery can provide the potential to cure the initially inoperable tumor. A 27-year-old man was diagnosed with a stage IIIAcT3N2M0 (7thUICC/AJCC) upper left lung adenocarcinoma harboring EML4-ALK fusion gene. Clinically, the patient had a large primary lesion adjacent to the pericardium and regional lymph node metastasis at the ipsilateral mediastinum. Poor tumor response was observed after 3 cycles of chemotherapy (gemcitabine plus cisplatin), and upon multidisciplinary discussion, the patient was started with 250 mg crizotinib twice daily. Successive clinical examinations showed a progressive reduction of the lesions. After 2 months of therapy, the patient was downstaged to cT2aN2M0, then video-assisted thoracic surgery was performed and the final histopathological stage was ypT2aN2M0. The treatment with crizotinib (250 mg, qd) was continued more than 30 months post surgery and stopped until intracranial oligometastasis. The patient's overall survival (OS) time is 68 months at last follow-up. This case presented here supports the use of neoadjuvant and adjuvant treatment with ALK inhibitors in ALK positive locally advanced NSCLC.

Right lung upper lobe carcinoma radical excision plus superior vena cava angioplasty.

An elderly male patient was found to be with "nodule in upper lobe of right lung" during his health examination, although without any symptom. Chest CT at admission showed that the nodules were close to the superior vena cava, and CT reconstruction displayed an adipose space between the nodules and the superior vena cava. However, bronchoscopy showed negative results. Pre-operative exploration showed that the right upper lung nodules were tightly attached to the surface of superior vena cava and could not be effectively divided; an invasion could not be ruled out. The surgery was performed in a distal-proximal manner. The pulmonary fissure, bronchi, and arteries were divided firstly, followed by veins and the surrounding tissues of the lung. After the surrounding spaces of the tumor were sufficiently disassociated, superior vena cava angioplasty was performed using a stapler. The surgery was performed completely under thoracoscopy, during which the surgical incision was not enlarged. The main operation port was about 4 cm in diameter. Two axillary operation ports (about 1.2 and 0.6 cm in diameter, respectively) were also used. All the surgical equipment were used smoothly, and thus the surgery was completed with lowest invasion.

[Value of endobronchial ultrasound-transbronchial needle aspiration biopsy for diagnosis of PET-CT positive mediastinal lymph nodes].

OBJECTIVE: To evaluate the clinical value of endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) biopsy for diagnosis of PET-CT positive mediastinal lymph nodes. METHODS: One hundred and twenty-six patients with lung cancer undergoing both PET-CT scanning and EBUS-TBNA biopsy in the First Affiliated Hospital of Guanzhou Medical College from July 2008 to August 2010 were included in this study. There were 89 male and 37 female patients with a mean age of 56.3 years (range 34 to 81 years). (18)FDG-PET was considered positive in mediastinal nodes if the PET-CT reported hypermetabolic activity consistent with malignant disease (standardized uptake value > 2.5). All of the patients were clinically followed up. RESULTS: Among the 126 patients, 185 stations of lymph nodes were punctured. The mean diameter of the nodes was 13.6 mm and the range was 6 - 23 mm. There were no procedural complications. The diagnostic accuracy, sensitivity, and specificity of EBUS-TBNA were 95.7%, 95.7%, and 100%, respectively. CONCLUSIONS: EBUS-TBNA is a minimally invasive, highly effective and accurate, practical and safe procedure for diagnosis of PET-CT positive mediastinal lymph nodes.

Three-dimensional image fusion across PET+MRI modalities based on the approach of characteristic coregistration.

BACKGROUND AND AIMS: Because there is no complete three-dimensional (3D) hybrid detector integrated PET+MRI internationally, this study aims to investigate a registration approach for a two-dimensional (2D) hybrid based on characteristic localization to achieve a 3D fusion from the images of PET and MRI as a whole. METHODS: A cubic-oriented scheme of "9-point and 3-plane" for a coregistration design was verified to be geometrically practical. Through 3D reconstruction and virtual dissection, human internal feature points were sorted to combine with preselected external feature points for matching process. By following the procedure of feature extraction and image mapping, the processes of "picking points to form planes" and "picking planes for segmentation" were executed. Eventually, the image fusion was implemented at the real-time workstation Mimics based on auto-fuse techniques called "information exchange" and "signal overlay". RESULTS: A complementary 3D image across PET+MRI modalities, which simultaneously present metabolic activities and anatomic structures, was created with a detectable rate of 56%. This is equivalent to the detectable rate of PET+CT or MRI+CT with no statistically significant difference, and it facilitates a 3D vision that is not yet functional for 2D hybrid imaging. CONCLUSIONS: This cross-modality fusion is doubtless an essential complement for the existing toolkit of a 2D hybrid device. Thus, it would potentially improve the efficiency of diagnosis and therapy for oncology.

[Acupuncture for chronic pelvic pain syndromes (CPPS) and its effect on cytokines in prostatic fluid].

OBJECTIVE: To explore the effect of acupuncture on chronic pelvic pain syndromes (CPPS), and its therapeutic mechanism. METHODS: Fourty-seven cases of CPPS were treated with electroacupuncture on Zhongji (CV 3), Guilai (ST 29), Yinlingquan (SP 9), Sanyinjiao (SP 6), Guanyuan (CV 4), Shuidao(ST 28), Xuehai (SP 10) and Taichong (LR 3) as main acupoints. Chronic Prostatitis Symptom Index (CPSI) was adopted to grade the severity of pain or discomforts. Additionally, the levels of Interleukin-8 (IL-8), Interleukin-10 (IL-10) and Tumor necrosis factor-alpha (TNF-alpha) in prostate fluid were detected and the correlation between those changes and pain score was analyzed. RESULTS: After treatment, pain or discomfort score in CPSI decreased remarkably as compared with that before treatment (P < 0.01). The levels of IL-8, IL-10 and TNF-alpha were lower than those before treatment (P < 0.01, P < 0.05). The positive correlation was obtained between IL-10 level and pain score (P < 0.05). The total effective rate was 89.4% (42/47). CONCLUSION: Acupuncture has significant efficacy on CPPS through reducing IL-10 level to ease pain, and reducing the levels of IL-8 and TNF-alpha to relieve inflammatory reaction.

[Single lung transplantation for emphysema: analysis of 6 cases].

OBJECTIVE: To review the experience with the management of single lung transplantation for emphysema. METHODS: Between January 2003 and August 2006, single lung transplantation was performed in 6 patients for emphysema with cold low potassium solution flushing. A triple-drug regimen was adopted using steroids, mycophenolate mofetil and tacrolimus as the maintenance immunosuppressants. Chest radiograph score, oxygenation index, and pulmonary arterial pressure of the patients in early after the transplantation were reviewed. RESULTS: All the 6 patients survived for over 30 days after the operation, and 4 of them remained alive with good quality-of-life. Four patients recovered from acute rejection successfully after methylprednisolone pulse therapy for 3 days. One patient underwent reoperation for hemorrhage in the thoracic cavity and finally recovered; spontaneous pneumothorax of the autologous lungs occurred in two patients, who underwent reoperation but finally died 74 days and 77 days after the transplantation, respectively. CONCLUSION: Single lung transplantation is effective for end-stage emphysema. Carefully selected recipients and comprehensive design of the surgical procedures are critical to successful lung transplantation.

[Injection of activated carbon nanoparticles for guiding lymphadenectomy during minimal invasive surgery in lung cancer].

OBJECTIVE: To evaluate the clinical value of activated carbon nanoparticles for guiding lymphadenectomy in lung cancer. METHODS: Fourty-two lung cancer patients were divided into two groups: the control group (22 cases) and experiment group (20 cases) who received activated carbon nanoparticles injection around the tumor either by endoscopic injection or intraoperative subserosal injection. The number of dissected lymph node, black-stained lymph node, positive lymph node and the side effect of the procedure were analyzed, respectively. RESULTS: No severe complication was observed in the experiment group. The operative time was not prolonged significantly in the experiment group either. However, the number of average lymph nodes dissected in the experiment group (25.5) was significantly more than that in the control group (14.6) (P <0.01). CONCLUSION: Local injection of activated carbon nanoparticles around the tumor during surgical exploration is effective, safe and easy to do for guiding lymphadenectomy in lung cancer patient.

[Bronchial sleeve resection and reconstruction of pulmonary artery by video-assisted thoracic small incision surgery for central lung cancer: a report of 139 cases].

OBJECTIVE: To evaluate the efficacy and practicability between bronchial sleeve resection or reconstruction of the pulmonary artery by video-assisted thoracic small incision and routine posterolateral incision for lung cancer. METHODS: The clinic data was analyzed retrospectively, including 139 cases in our hospital underwent sleeve lobectomy and bronchoplasty by video-assisted thoracic small incision surgery for lung cancer from January 1995 to July 2007 and 99 cases in the HUAXI Hospital of SICHUAN University underwent routine posterolateral incision from April 2000 to December 2005. All patients whose bronchus and/or pulmonary artery were involved underwent the operation and experienced the bronchial sleeve resection or reconstruction of the pulmonary artery. RESULTS: All patients were done operation successfully with no perioperative mortality and no occurrence of anastomosis stenosis as well as fistula. The median survival period of video-assisted thoracic small incision patients and the posterolateral incision patients were 63.17 months and 42.00 months, respectively (P > 0.05). There was no sign of reperfusion injury in the reconstruction of the pulmonary artery patients. The small incisions' length was from 8 to 13 cm and the mean length was 10 cm. The routine posterolateral incisions' mean length was 30 cm. Compared to the patients underwent the routine posterolateral incision, patients underwent the operation of video assisted thoracic small incision had less operation time, less chest tube time, less hospitalization time and less postoperative shoulder joint dysfunction. CONCLUSIONS: The bronchial sleeve resection and reconstruction of the pulmonary artery by video-assisted thoracic small incision surgery for lung cancer can finish the same work as the traditional thoracic lateral incision with less trauma and recovery time.

[The management of the contralateral lungs in four cases with single allograft lung transplantation].

OBJECTIVE: To report the management of the contralateral lungs in 4 cases with single allograft lung transplantation. METHODS: Four cases receiving lung transplantation were analyzed respectively. One presented with bilateral multiple lung cysts and three with chronic obstructive pulmonary disease (COPD) with bilateral bullae. In the case with bilateral multiple cysts, the contralateral lung remained untreated after operation. For the contralateral lungs in the three cases with COPD, one remained untreated, one received lung volume reduction surgery (LVRS) immediately after lung transplantation, and one received LVRS 47 days after lung transplantation. RESULTS: Three patients recovered after operation, and 2 of them survived more than 18 months. One patient with delayed contralateral LVRS died 74 days after lung transplantation. CONCLUSIONS: For advanced stage COPD with bilateral bullae, contralateral LVRS may be performed immediately after single lung transplantation. In patient with bilateral cysts only, the resection of the contralateral cysts may be avoided if there is no severe infection.