Allergic bronchopulmonary aspergillosis in a lung transplant recipient treated with mepolizumab.

Allergic bronchopulmonary aspergillosis (ABPA) is a complex hypersensitivity reaction to Aspergillus spp. ABPA diagnosis may be challenging due to its non-specific presentation. Standard ABPA treatment consists of systemic corticosteroids and antifungal agents. Mepolizumab, a monoclonal antibody against interleukin-5 seems to be a promising treatment for ABPA. Data about ABPA following lung transplantation (LuTx) are scarce. LuTx recipients are at higher risk for adverse effects of ABPA treatment compared to the general population. Here we present a case of a LuTx recipient who was successfully treated with mepolizumab for ABPA following LuTx. Prolonged administration of high dose prednisone was thus avoided. To our knowledge, this is the first case describing mepolizumab administration following LuTx. Mepolizumab seems particularly attractive as a corticosteroid-sparing agent or as an alternative option to antifungal treatments, because of its excellent safety profile and low risk of drug interactions.

Associations of Depressive and Anxiety Disorders with Pulmonary Disorders in the Community: The PneumoLaus and PsyCoLaus Studies.

INTRODUCTION: Mental health disorders figure among the many comorbidities of obstructive respiratory diseases. The multisystemic characteristics of chronic respiratory disease and its impact on quality of life could affect depressive and/or anxiety disorders. We aimed to evaluate the association of spirometric indices, ventilatory disorders, and self-reported respiratory diseases with psychiatric disorders considering potential confounders. METHODS: We analysed data from CoLaus|PsyCoLaus, a Swiss population-based cohort study, consisting of 2'774 participants (56% women; mean age: 62.3 (standard deviation = ±9.9) years) who performed spirometry and completed semi-structured psychiatric interviews. We defined ventilatory disorders using GLI-2012 references. Major depressive episode (MDE) and anxiety disorders were defined using the DSM-IV (Diagnostic and Statistical Manual). RESULTS: 630 subjects (22.7%) presented a recent MDE. Reversible obstructive ventilatory disorders were associated with recent MDE (OR = 1.94, 95% confidence interval (95% CI) 1.10-3.43) and recent anxiety disorders (2.21 [1.16-4.22]) only in unadjusted model. Self-reported chronic obstructive pulmonary (COPD) and asthma were associated with MDE with ORs of 2.49 (95% CI, 1.19-5.27) and 1.56 (95% CI, 1.04-2.35) after adjustment, respectively. Possible restrictive ventilatory impairment was positively associated with recent anxiety disorders (OR = 2.46, 1.10-5.51). Z-scores of FEV1, FVC, and maximal mid-expiratory flow were not associated with psychiatric disorders. There was no association between ventilatory disorders and MDE in adjusted models. CONCLUSIONS: In this cross-sectional population-based study, the association between respiratory disorders and depressive disorders was observed for self-reported COPD and asthma, but not with objective diagnoses based on spirometry. Lung volumes are not associated with psychiatric disorders. Further prospective studies will be necessary to understand the significance of the association.

Outcomes of SARS-CoV-2 infection among lung transplant recipients: A single center retrospective study.

BACKGROUND: Lung transplant recipients (LTRs) are at increased risk for coronavirus disease 2019 (COVID-19)-associated complications. METHODS: We aimed to describe the outcomes of polymerase chain reaction-documented severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in LTRs followed at our institution from March 2020 to July 2022. The primary outcome investigated was hospitalization or death from COVID-19-related symptoms within 28 days from diagnosis. RESULTS: Overall, 60 cases were included, of which 18 (30%) reached the primary outcome. Only one patient (2%) died. Anti-spike monoclonal antibodies (mAbs) were administered as early treatment in 36 patients (casirivimab/imdevimab = 2, sotrovimab = 31, and tixagevimab/cilgavimab = 3). Multivariate analysis revealed that age >60 years (p = .003; odds ratio [OR] 9.41; confidence interval [CI] 2.52-41.05) was associated with a higher risk for the primary outcome, while administration of mAbs as early treatment (p = .030; OR 0.23; CI 0.06-0.87) was associated with a lower risk. No effect of vaccination and SARS-CoV-2 variant was observed. Forced expiratory volume in 1 s and forced vital capacity values did not decrease among 37 patients who had spirometry performed 1 month after COVID-19. CONCLUSIONS: We observed a relatively low morbidity and mortality of COVID-19 in LTR. mAb administration was associated with a better outcome.

Impact of COVID-19 on long-term lung function in lung transplant recipients: A single-center retrospective cohort study.

Available data are limited concerning long-term lung function (LF) evolution after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in lung transplant (LT) recipients. The aim of this study is to determine the effect of first SARS-CoV-2 infection on long-term LF in LT recipients. We analyzed spirometry results of LT recipients followed at our institution (March 2020 to July 2022) at 3, 6, and 12 months after first SARS-CoV-2 infection. Overall, 42 LT patients of our cohort (70%) with COVID-19 were included for long-term LF analysis. Forced expiratory volume in 1 s (FEV1 ) declined significantly at 3 months (-4.5%, -97 mL, 95% CI [-163; -31], p < .01), but not at 6 and 12 months (-3.9%, -65 mL, 95% CI [-168; +39], p = .21). Results were quite similar for the forced vital capacity. Spirometry values declined significantly at 3 months after COVID-19 in LT recipients, presented a mixed decline at 6 months, and no significant decline at 12 months.

[Radiation-induced pneumonitis : pathophysiology, risk factors and work-up in 2022]. / Pneumopathies radiques - Pathophysiologie, classification, facteurs de risque et prise en charge en 2022.

Despite technical improvements concerning lung irradiation modalities, radiation-induced pneumonitis remains a usual complication, notably in the field of lung cancer treatment. This complication may remain asymptomatic but can also lead to respiratory distress. Thus, a low degree of suspicion and a comprehensive work-up is mandatory to evaluate the indication for specific treatment. In this article, we discuss the hypothesized pathophysiologic pathways, risk factors, clinical/radiological presentation and management.

Malgré les améliorations des techniques d'irradiation à l'étage thoracique, la pneumopathie radique (PpR) reste une complication fréquente, en particulier dans le cadre du traitement du cancer pulmonaire. Cette complication, qu'elle soit précoce ou tardive, peut demeurer silencieuse ou causer une détresse respiratoire potentiellement fatale. C'est pourquoi un faible degré de suspicion est nécessaire, de manière à débuter précocement un bilan d'investigation et décider de l'indication à un traitement spécifique. Dans cet article, nous discutons des hypothèses pathophysiologiques qui sous-tendent la PpR, des facteurs de risque de survenue, de la présentation clinique et radiologique, ainsi que de sa prise en charge.

[When to consider lung transplantation?] / Quand penser à la transplantation pulmonaire ?

Pulmonary transplantation remains the ultimate therapeutic option for selected patients with an advanced pulmonary disease and terminal respiratory insufficiency when all other therapeutic options have been exhausted. The optimal time-frame to proceed to a first discussion and evaluation about lung transplantation may be difficult to determine. This article describes the pathway of a patient towards lung transplantation and summarizes the criteria, which may help to timely identify eligibility for this therapeutic modality. We will focus mainly on the 2021 update of the International Society for Heart and Lung Transplantation (ISHLT) recommendations for the selection of lung transplant candidates.

La transplantation pulmonaire reste l'ultime option thérapeutique pour des patients sélectionnés présentant une maladie pulmonaire avancée au stade d'insuffisance respiratoire terminale, une fois les autres traitements reconnus épuisés. Le moment idéal pour une première discussion et l'évaluation d'une transplantation pulmonaire peut être difficile à identifier. Cet article décrit le parcours d'un patient vers la transplantation pulmonaire et résume les différents facteurs qui permettent d'identifier son éligibilité pour ce traitement. Nous nous focalisons notamment sur les recommandations pour la sélection des receveurs de transplantation pulmonaire mises à jour en 2021 par l'International Society for Heart and Lung Transplantation (ISHLT).

Endobronchial coil spring fiducial markers for CyberKnife® stereotactic body radiation therapy.

BACKGROUND AND OBJECTIVE: SBRT is an alternative treatment for early-stage inoperable lung cancer. Metallic FM allow to increase tumour tracking precision by CyberKnife®. Currently used techniques for FM placement have many limitations; transthoracic insertion has a high risk for pneumothorax, endovascular insertion requires expertise and dedicated angiography infrastructure and endobronchial linear-gold FM dislocate frequently. This is the first study to assess the safety and efficacy of cs-FM endobronchial insertion under fluoroscopy with or without R-EBUS assessment. METHODS: We retrospectively evaluated all consecutive patients undergoing endobronchial cs-FM placement for at least one PPL <25 mm between 10.2015 and 12.2019. TBB of the PPL were performed in case of a typical R-EBUS signal. PPL tracking accuracy by CyberKnife, complications, cs-FM migration rate and procedure duration were analysed. RESULTS: A total of 52 patients were treated during 55 procedures and 207 cs-FM were placed in 70 PPL. Tracking was successful for 65 of 70 (93%) PPL. R-EBUS was performed for 33 (47%) PPL and TBB for 9 (13%) PPL. Bronchospasm occurred once and any other complications were observed. Migration of cs-FM occurred in 16 of 207 (8%) cs-FM. Migration was more frequent when the target was in a previously irradiated area (P = 0.022). The median bronchoscopy duration was 31.5 min (n = 48 procedures). CONCLUSION: Bronchoscopic cs-FM placement is a rapid and safe procedure. It is associated with a low migration rate and allows precise SBRT delivery. Previous irradiation of the PPL was associated with a higher migration rate.

[Clinical approach to enlarged mediastinal and hilar lymph nodes other than the oncological causes]. / Adénomégalies médiastinohilaires - Approche clinique chez l'adulte immunocompétent hors contexte oncologique.

Widespread use of CT-scans leads to increased discovery of mediastinal and hilar lymph node enlargement, a frequent motive for consulting a pulmonologist. The persistence or progression of such lymphadenopathies outside of an oncological context is most often associated with an infectious process or inflammatory disorders. The history will also point to possible occupational or environmental exposure. The radiological characteristics specific to lymphadenopathies and any associated parenchymal lung damage will most often orient the diagnosis. Endobronchial ultrasound-guided techniques allow targeted and real-time sampling of the mediastinum and hilar lymph nodes, representing the first-line investigation before more invasive surgical procedures.

La découverte d'adénomégalies médiastinohilaires (AMH) est un motif fréquent de consultation en pneumologie. Utilisés à grande échelle, les CT-scans thoraciques en sont les principaux révélateurs. La persistance ou la progression d'AMH en dehors d'un contexte oncologique est le plus souvent d'origine infectieuse ou associée à un processus inflammatoire. L'anamnèse nous orientera vers une possible exposition à des facteurs environnementaux y compris en milieu professionnel. La plupart du temps, les caractéristiques radiologiques propres aux AMH ainsi qu'une éventuelle atteinte parenchymateuse pulmonaire associée pourront orienter le diagnostic. L'échoendoscopie bronchique permettant un échantillonnage ganglionnaire médiastinohilaire ciblé est l'examen de première intention avant des abords diagnostiques plus invasifs.

[Lung cancer screening in Switzerland†: Who†? How†? When†?] / Dépistage du cancer pulmonaire en Suisse†: Qui†? Comment†? Quand†?

Professional societies encourage the establishment of coordinated national screening programs for lung cancer by «â€…low-dose ¼ chest CT scans. The interdisciplinary Swiss Lung Cancer Screening Implementation Group (CH-LSIG) is exploring the feasibility of such a project. However, several questions still remain unanswered, namely the -financing of such a program, the ideal «â€…number-needed to screen ¼, the definition and follow-up of «â€…positive cases ¼, as well as the role of smoking cessation measures. The key points to discuss in the future with patients requesting screening are based on the «â€…shared -decision-making ¼ approach. Pilot projects guided by the CH-LSIG could help to identify the optimal strategy for establishing a national screening program based on the best available scientific evidence.

Les sociétés savantes encouragent le développement de programmes nationaux de dépistage du cancer pulmonaire par CT-scan thoracique low-dose. En Suisse, le groupe de travail ­interdisciplinaire Swiss Lung Cancer Screening Implementation Group (CH-LSIG) s'emploie à la mise en œuvre d'un tel projet. Néanmoins, de nombreuses questions demeurent encore ouvertes, portant sur le financement d'un tel programme, le Number ­Needed to Screen idéal, la définition des «â€…cas positifs ¼ et l'intégration optimale des mesures de sevrage tabagique. Le concept de décision médicale partagée servira de modèle pour répondre aux futurs patients demandeurs d'un examen de dépistage. Des projets pilotes guidés par le CH-LSIG pourraient permettre d'identifier la stratégie la plus performante afin d'implémenter un programme fondé sur les preuves.

[Lung cancer screening: what can we tell our patients while we await a screening program†?] / Dépistage du cancer du poumon†: que dire à nos patient·e·s en attendant un programme organisé†?

The NLST study in the United States showed, in 2011, that low-dose lung CT scans can reduce lung cancer mortality but was limited in its routine recommendation by 96% of false positive screening results. The European NELSON trial, published in 2020, confirmed a 24% decrease in lung cancer mortality and, by using lung nodule volume and volume doubling time, decreased false positive results to 56% of positive tests. The implementation of screening programs is now expected in Europe, including Switzerland. In anticipation, we have developed a decision aid to present patients with the benefits (decreased lung cancer mortality), risks (false positives and indeterminate results), and uncertainties (incidental findings) of lung cancer screening.

L'étude clinique américaine National Lung Screening Trial a démontré en 2011 que le dépistage du cancer du poumon par CT-scan thoracique à faible dose (low-dose) pouvait en diminuer la mortalité, mais était limité dans son applicabilité par une proportion rédhibitoire de 96 % de faux positifs. L'étude clinique européenne Nederlands-Leuven Screening Onderzoek, publiée en 2020, confirme une diminution de la mortalité du cancer du poumon de 24 % et, en se basant sur le temps de doublement du volume des nodules pulmonaires, a pu réduire la prévalence de faux positifs à 56 %. Des programmes de dépistage se préparent dans plusieurs pays européens, y compris la Suisse. Dans ce contexte, nous avons développé une aide à la décision qui reprend les bénéfices (diminution de la mortalité), les risques (faux positifs et résultats indéterminés) et incertitudes (découvertes fortuites) du dépistage du cancer du poumon.

[Computer instruments for the management of isolated pulmonary nodule. Detectability and prediction of malignancy]. / Outils informatiques pour la prise en charge du nodule pulmonaire isolé - Détectabilité et prédiction de malignité.

Lung cancer remains the most common cause of cancer deaths in the world, but its mortality can be significantly reduced by diagnosis and early detection. Computerized resources were developed to assist radiologists in their management of the large volume of thoracic images to be analyzed. Their objective is the detection of pulmonary nodules with high sensitivity and a low rate of false-positives and the ability to differentiate benign and malignant nodules. The volume of a pulmonary nodule and its volume doubling time are essential to nodule management. Computer aided detection or diagnosis (CAD) software are not currently used in clinically settings on a routine basis . Significant advances are expected due to the implementation of the artificial intelligence systems who will probably be integrated into the multidisciplinary management of any pulmonary nodule.

Le cancer du poumon reste la principale cause de décès par cancer dans le monde. Sa mortalité peut être significativement réduite par un diagnostic et un dépistage précoce. Des outils informatiques ont été développés afin d'aider les radiologues à gérer la quantité d'images thoraciques à analyser. Ils ont pour objectif la détection des nodules pulmonaires avec une haute sensibilité et un taux faible de faux positifs, mais aussi la différenciation des nodules bénins et malins. Le volume d'un nodule pulmonaire et le temps de doublement déterminent la suite de la prise en charge de ce nodule. Ces deux paramètres sont inclus dans la plupart des recommandations actuelles. Les logiciels de détection assistés par ordinateur (CAD) ne sont pas utilisés en routine clinique actuellement. Des avancées dans ce domaine sont attendues en utilisant l'intelligence artificielle, notamment dans le cadre de la prise de décision multidisciplinaire.

Radial Ultrasound-Assisted Transbronchial Biopsy: A New Diagnostic Approach for Non-Resolving Pulmonary Infiltrates in Neutropenic Hemato-Oncological Patients.

The role of radial-endobronchial ultrasound (R-EBUS) assisted transbronchial biopsy (TBB) for the diagnosis of peripheral pulmonary lesions is well established. However, no study has addressed its safety and value in hemato-oncological patients presenting with non-resolving infiltrates during persistent febrile neutropenia. To assess safety and feasibility of R-EBUS assisted TBB in severe thrombocytopenic and neutropenic patients. Over a period of 18 months, eight patients were assessed with R-EBUS assisted TBB after adequate platelet transfusion. This technique allowed precise localisation and sampling of the pulmonary lesions in seven of eight patients. In the seven patients, R-EBUS assisted TBB enabled treatment optimization. Invasive fungal infection was diagnosed in four patients, idiopathic acute fibrinous and organising pneumonia in three patients, and a granulomatous inflammation of undetermined origin in one patient. Importantly, no complications, such as bleeding, were observed. R-EBUS assisted TBB is a promising and safe procedure for the evaluation of nonresolving pulmonary infiltrates in febrile neutropenic hemato-oncological patients.

Prevalence of small airway dysfunction in the Swiss PneumoLaus Cohort.

Background: Recent evidence identified exposure to particulate matter of size ≤2.5 µm (PM2.5) as a risk factor for high prevalence of small airway dysfunction (SAD). We assessed the prevalence of SAD in a European region with low air pollution levels. Methods: SAD was defined as a maximum mid-expiratory flow (MMEF) <65% of predicted value (PV) or MMEF 65 years only. In an area where ambient PM2.5 concentration was <15 µg·m-3 during the observation period (2010 and 2020), ≥72% of participants with SAD were ever-smokers. Conclusions: The observed low prevalence of SAD of 5.0-12.7% depending on criteria employed may be related to lower PM2.5 exposure. Smoking was the main factor associated with SAD in an area with low PM2.5 exposure. Employing a MMEF threshold <65% PV carries a risk of SAD overdiagnosis in elderly individuals.

Atypical imaging patterns during lung invasive mould diseases: lessons for clinicians.

Imaging of pulmonary invasive mould diseases (IMDs), which represents a cornerstone in their work-up, is mainly based on computed tomography (CT). The purpose of this review is to discuss their CT features, mainly those related to aspergillosis and mucormycosis. We will especially focus on atypical radiological presentations that are increasingly observed among non-neutropenic emerging populations of patients at risk, such as those receiving novel anticancer therapies or those in the intensive care unit. We will also discuss the interest of other available imaging techniques, mainly positron emission tomography/CT, that may play a role in the diagnosis as well as evaluation of disease extent and follow-up. We will show that any new airway-centred abnormality or caveated lesion should evoke IMDs in mildly immunocompromised hosts. Limitations in their recognition may be due to potential underlying abnormalities that increase the complexity of interpretation of lung imaging, as well as the non-specificity of imaging features. In this way, the differentials of all morphological/metabolic aspects must be kept in mind for the optimal management of patients, as well as the benefit of evaluation of the vascular status.

Salvage LATTICE radiotherapy for a growing tumour despite conventional radio chemotherapy treatment of lung cancer.

A 40-year-old patient with cT4cN1M0 squamous cell lung cancer of the upper right lobe received preoperative induction chemotherapy. Systemic induction treatment failed to reverse tumour growth with the addition of conventional radiotherapy (RT). A salvage lattice RT boost of 12 Gy was administered immediately to increase the dose to the tumour. Conventional RT was resumed at the planned dose of 60 Gy. The tumour shrank rapidly, and the patient was surged. The postoperative pathology remained ypT0ypN0 status.

Antibody Response After the Third SARS-CoV-2 Vaccine in Solid Organ Transplant Recipients and People Living With HIV (COVERALL-2).

Background: After basic immunization with 2 mRNA SARS-CoV-2 vaccine doses, only a small proportion of patients who are severely immunocompromised generate a sufficient antibody response. Hence, we assessed the additional benefit of a third SARS-CoV-2 vaccine in patients with different levels of immunosuppression. Methods: In this observational extension of the COVERALL trial (Corona Vaccine Trial Platform), we recruited patients from the Swiss HIV Cohort Study and the Swiss Transplant Cohort Study (ie, lung and kidney transplant recipients). We collected blood samples before and 8 weeks after the third SARS-CoV-2 vaccination with either mRNA-1273 (Moderna) or BNT162b2 (Pfizer-BioNTech). The primary outcome was the proportion of participants showing an antibody response (Elecsys Anti-SARS-CoV-2 S test; threshold ≥100 U/mL) 8 weeks after the third SARS-CoV-2 vaccination. We also compared the proportion of patients who reached the primary outcome from basic immunization (the first and second vaccines) to the third vaccination. Results: Nearly all participants (97.2% [95% CI, 95.9%-98.6%], 564/580) had an antibody response. This response was comparable between mRNA-1273 (96.1% [95% CI, 93.7%-98.6%], 245/255) and BNT162b2 (98.2% [95% CI, 96.7%-99.6%], 319/325). Stratification by cohort showed that 99.8% (502/503) of people living with HIV and 80.5% (62/77) of recipients of solid organ transplants achieved the primary endpoint. The proportion of patients with an antibody response in solid organ transplant recipients improved from the second vaccination (22.7%, 15/66) to the third (80.5%, 62/77). Conclusions: People living with HIV had a high antibody response. The third vaccine increased the proportion of solid organ transplant recipients with an antibody response. Clinical Trials Registration. NCT04805125 (ClinicalTrials.gov).

Fiducial markers for stereotactic lung radiation therapy: review of the transthoracic, endovascular and endobronchial approaches.

Stereotactic body radiation therapy is an alternative to surgery for early-stage, inoperable peripheral non-small cell lung cancer. As opposed to linear accelerator (linac)-based (e.g. gating) and free-breathing techniques, CyberKnife® with Synchrony® technology allows accurate radiation delivery by means of a real-time respiratory motion tracking system using, in most cases, metal fiducial markers (FMs) placed in the vicinity of the target. The aims of this review are as follows. First, to describe the safety and efficacy of the transthoracic, endovascular and endobronchial FM insertion techniques for peripheral pulmonary lesions (PPLs). Second, to analyse performance in terms of the migration and tracking rates of different FM types. Recent developments in FM tracking for central lesions will also be reviewed. In conclusion, for PPLs, the endobronchial approach provides a low rate of pneumothorax, offers the possibility of concurrent diagnostic sampling for both the PPL and the lymph nodes, and, finally, reduces the intervention time compared to other techniques. In this context, coil-tailed and coil-spring FMs have shown the lowest migration rate with a consequently high tracking rate.

Comparison Between Magnetic Resonance Imaging and Computed Tomography in the Detection and Volumetric Assessment of Lung Nodules: A Prospective Study.

Rationale and Objectives: Computed tomography (CT) lung nodule assessment is routinely performed and appears very promising for lung cancer screening. However, the radiation exposure through time remains a concern. With the overall goal of an optimal management of indeterminate lung nodules, the objective of this prospective study was therefore to evaluate the potential of optimized ultra-short echo time (UTE) MRI for lung nodule detection and volumetric assessment. Materials and Methods: Eight (54.9 ± 13.2 years) patients with at least 1 non-calcified nodule ≥4 mm were included. UTE under high-frequency non-invasive ventilation (UTE-HF-NIV) and in free-breathing at tidal volume (UTE-FB) were investigated along with volumetric interpolated breath-hold examination at full inspiration (VIBE-BH). Three experienced readers assessed the detection rate of nodules ≥4 mm and ≥6 mm, and reported their location, 2D-measurements and solid/subsolid nature. Volumes were measured by two experienced readers. Subsequently, two readers assessed the detection and volume measurements of lung nodules ≥4mm in gold-standard CT images with soft and lung kernel reconstructions. Volumetry was performed with lesion management software (Carestream, Rochester, New York, USA). Results: UTE-HF-NIV provided the highest detection rate for nodules ≥4 mm (n = 66) and ≥6 mm (n = 32) (35 and 50%, respectively). No dependencies were found between nodule detection and their location in the lung with UTE-HF-NIV (p > 0.4), such a dependency was observed for two readers with VIBE-BH (p = 0.002 and 0.03). Dependencies between the nodule's detection and their size were noticed among readers and techniques (p < 0.02). When comparing nodule volume measurements, an excellent concordance was observed between CT and UTE-HF-NIV, with an overestimation of 13.2% by UTE-HF-NIV, <25%-threshold used for nodule's growth, conversely to VIBE-BH that overestimated the nodule volume by 28.8%. Conclusion: UTE-HF-NIV is not ready to replace low-dose CT for lung nodule detection, but could be used for follow-up studies, alternating with CT, based on its volumetric accuracy.

Stereotactic lung reirradiation for local relapse: A case series.

INTRODUCTION: Local recurrence after lung SBRT for early stage NSCLC is rare but its treatment remains a challenge due to limited surgical options. We report a case series of 5 patients treated by stereotactic lung salvage reirradiation for local relapse after a previous lung SBRT. MATERIAL AND METHODS: Included patients presented an isolated primary lung relapse within at least the 50% isodose of the previous SBRT treatment. Typical reirradiation schedule was 60 Gy in 8 fractions at isodose 80% and was delivered by Cyberknife® using Synchrony® fiducial tracking system. Dose summations were performed to evaluate the safety of the reirradiation. RESULTS: We identified 5 patients presenting peripheral lesions. All reirradiated lesions were locally controlled after a median follow-up of 11.1 months (6,7-12,2), while PFS at 6 months was 60% (n = 3). We did not notice any Grade 3 or more acute or late adverse event. CONCLUSION: We observed encouraging short-term outcome of lung SBRT reirradiation in patients presenting isolated local relapse of an early-stage NSCLC. Further studies are necessary to confirm the safety and efficiency of this salvage treatment approach.

High prevalence of peribronchial focal lesions of airway invasive aspergillosis in hematological cancer patients with prolonged neutropenia.

OBJECTIVE: The aim of this study is to characterize chest CT findings of neutropenic patients with proven/probable invasive pulmonary aspergillosis (IPA). METHODS: Hematological cancer patients admitted to our institution (2007-2017) were retrospectively enrolled if the diagnostic criteria of proven/probable IPA during the neutropenia were met (EORTC/MSG). Galactomannan (GM) was routinely measured in serum and chest CT-scan was routinely performed in case of recurrent/persistent fever. Bronchoscopy was performed in case of chest CT-scan abnormalities. Chest CT-scan and GM dosage were analyzed at the time of IPA suspicion. Chest lesions were classified using a clinical report form by two expert radiologists. RESULTS: 35 patients were identified. Peribronchial focal lesions were observed in 29 IPA (82.9%) by the first radiologist and in 31 (88.5%) by the second (k = 0.768). 12 weeks mortality was 20%. CONCLUSION: Peribronchial focal lesions are a common finding in early-IPA whatever the GM value during neutropenia and our findings reinforce the efficiency of a preemptive approach. ADVANCES IN KNOWLEDGE;: Peribronchial focal lesions, which are classically described in airway invasive aspergillosis, are a common finding in early-IPA in hematological cancer patients with prolonged neutropenia regardless of the GM value, and such peribronchial lesions should reinforce the possibility of IPA.