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OBJECTIVES: The diagnosis of interstitial lung disease is based on clinical and biological analysis associated with computed tomography (CT) pattern after discussion in multidisciplinary discussion. Lung transbronchial cryobiopsy has emerged with acceptable diagnostic reliability and low morbidity and mortality. The goal of our work is to describe our experience with lung cryobiopsy. METHODS: This is monocentric and retrospective analysis of prospectively collected data on epidemiological, clinical, biological, CT, respiratory and histological features of patients with lung transbronchial cryobiopsy between January 1st, 2017, and July 1st, 2020. RESULTS: Lung transbronchial cryobiopsy has been done for 23 patients with sex ratio M/F of 1.1, majority of smoker/former smoker. Thirty-nine percent of procedures were complicated by pneumothorax. On the haemorrhagic level, we reported 1 grade 2 bleeding (no serious bleeding). An histological diagnosis was obtained for 19 patients (82%). Only 4 patients needed to discuss surgical lung biopsy: 2 (8.6%) surgical lung biopsy, 1 refused surgical lung biopsy and 1 patient lost to follow-up. CONCLUSION: Our results suggest that transbronchial lung cryobiopsy may be considered the first diagnostic modality instead of surgical lung biopsy for interstitial lung disease in appropriate patients. Larger studies are, however, needed to confirm our observations.
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BACKGROUND: Results of previous studies demonstrated that high-intensity end-of-life (EOL) care improves neither cancer patients' survival nor quality of life. Our objective was to assess the incidence of and factors associated with aggressiveness of care during the last 30 days of life (DOL) of lung cancer (LC) patients and the impacts of aggressiveness of care in EOL-care costs. PATIENTS AND METHODS: Using French national hospital database, all patients with LC who died between January 1, 2010, and December 31, 2011, or between January 1, 2015, and January 31, 2016, were included. EOL-care aggressiveness was assessed using the following criteria: chemotherapy administered within the last 14 DOL; more than one hospitalization within the last 30 DOL; admission to the intensive care unit within the last 30 DOL; and palliative care initiated < 3 days before death. Expenditures were limited to direct costs, from a health care payer's perspective. RESULTS: Among 79,746 adult LC patients identified; 57% had at least one indicator of EOL-care aggressiveness (49% repeated hospitalizations, 12% intensive care unit admissions, 9% chemotherapy, 5% palliative care). It increased significantly between the 2 periods (56% vs. 58%, P < .001). Young age, male sex, shorter time since diagnosis, comorbidities, no malnutrition, type of care facility other than general hospital, social deprivation, and low-density population were independently associated with having one or more indicator of aggressive EOL care. The mean EOL cost was 8152 ± 5117 per patient, but the cost was significantly higher for patients with at least one EOL-care aggressiveness criterion (9480 vs. 6376, P < .001). CONCLUSION: In France, a majority of LC patients had at least one criterion of aggressive EOL care that had a major economic impact on the health care system.
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Custos de Cuidados de Saúde/estatística & dados numéricos , Neoplasias Pulmonares/terapia , Cuidados Paliativos/estatística & dados numéricos , Assistência Terminal/métodos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , França , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/economia , Unidades de Terapia Intensiva/estatística & dados numéricos , Neoplasias Pulmonares/economia , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/economia , Estudos Retrospectivos , Fatores Sexuais , Assistência Terminal/economia , Adulto JovemRESUMO
OBJECTIVES: The preOVNI study was a randomized, controlled, open-label study that investigated whether preoperative noninvasive ventilation (NIV) could reduce postoperative complications after lung cancer surgery. METHODS: Adult patients with planned lung cancer resection and with at least 1 cardiac or respiratory comorbidity were included and randomly assigned to preoperative NIV (at least 7 days and 4 h/day) or no NIV. The primary endpoint was the rate of postoperative protocol-defined complications. RESULTS: Three hundred patients were included. In the NIV group, the median NIV duration was 8 days. No difference of postoperative complication rates was evidenced: 42.6% in NIV group and 44.8% in no-NIV group (P = .75). The rate of pneumonia was greater in no-NIV group compared with the NIV group, but statistical significance was not achieved (28.0 vs 37.7%, respectively; P = .08). The type of surgery (open or minimally invasive) did not impact these results after multivariable analysis. CONCLUSIONS: No benefit was evidenced for preoperative NIV before lung cancer surgery. Further studies should determine the optimal perioperative management to decrease the rate of postoperative complications.
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Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Pulmão/cirurgia , Ventilação não Invasiva , Pneumonectomia , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios , Idoso , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/fisiopatologia , Feminino , Volume Expiratório Forçado , França , Humanos , Pulmão/patologia , Pulmão/fisiopatologia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Capacidade VitalRESUMO
OBJECTIVES: Despite recent advances in thoracic oncology, most patients with metastatic lung cancer die within months of diagnosis. Aggressiveness of their end-of-life (EOL) care has been the subject of numerous studies. This study was undertaken to evaluate the literature on aggressive inpatient EOL care for lung cancer and analyse the evolution of its aggressiveness over time. METHODS: A systematic international literature search restricted to English-language publications used terms associated with aggressiveness of care, EOL and their synonyms. Two independent researchers screened for eligibility and extracted all data and another a random 10% sample of the abstracts. Electronic Medline and Embase databases were searched (2000-20 September 2018). EOL-care aggressiveness was defined as follows: 1) chemotherapy administered during the last 14 days of life (DOL) or new chemotherapy regimen during the last 30 DOL; 2) >2 emergency department visits; 3) >1 hospitalisation during the last 30 DOL; 4) ICU admission during the last 30 DOL and 5) palliative care started <3 days before death. RESULTS: Among the 150 articles identified, 42 were retained for review: 1 clinical trial, 3 observational cohorts, 21 retrospective analyses and 17 administrative data-based studies. The percentage of patients subjected to aggressive therapy seems to have increased over time. Early management by palliative care teams seems to limit aggressive care. CONCLUSIONS: Our analysis indicated very frequent aggressive EOL care for patients with lung cancer, regardless of the definition used. The extent of that aggressiveness and its impact on healthcare costs warrant further studies.
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Neoplasias Pulmonares/terapia , Assistência Terminal , Humanos , Pacientes Internados , Cuidados PaliativosRESUMO
Anaplastic lymphoma kinase (ALK) rearrangement is reported in 3% to 8% of patients with lung adenocarcinoma and can be detected by fluorescent in situ hybridization (FISH) or indirectly by immunohistochemistry. In FISH assay, isolated 5' signal (loss of 3' signal) is usually considered negative. We report three young nonsmoking patients with stage IV lung adenocarcinoma. Strong ALK expression in tumor cells detected by immunohistochemistry was observed in all cases, but FISH revealed an isolated 5' signal pattern. Massive parallel "next-generation" sequencing was performed in two patients and confirmed ALK rearrangement. The three patients were treated and responded to crizotinib after 14, 10, and 31â¯months.
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Targeted therapies have markedly improved the management of patients with advanced non-small-cell lung cancer (NSCLC), but their efficacy in localized NSCLC is less well established. The aim of this review is to analyze trials of targeted therapies in localized NSCLC. In patients with wild-type EGFR, tyrosine kinase inhibitors have shown no efficacy in Phase III trials. Few data are available for EGFR-mutated localized NSCLC, as routine biological profiling is not recommended. Available studies are small, often retrospectives, and/or conducted in a single-center making it difficult to draw firm conclusions. Ongoing prospective Phase III trials are comparing adjuvant tyrosine kinase inhibitor administration versus adjuvant chemotherapy. By analogy with the indication of bevacizumab in advanced NSCLC, use of antiangiogenic agents in the perioperative setting is currently restricted to nonsquamous NSCLC. Several trials of adjuvant or neoadjuvant bevacizumab are planned or ongoing, but for the moment there is no evidence of efficacy. Data on perioperative use of biomarkers in early-stage NSCLC come mainly from small, retrospective, uncontrolled studies. Assessment of customized adjuvant or neoadjuvant therapy in localized NSCLC (with or without oncogenic driver mutations) is a major challenge.
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Aneurisma da Aorta Abdominal/diagnóstico por imagem , Dissecção Aórtica/diagnóstico por imagem , Meios de Contraste , Infarto do Baço/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Dissecção Aórtica/complicações , Aneurisma da Aorta Abdominal/complicações , Artéria Celíaca/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Artéria Esplênica/diagnóstico por imagem , Infarto do Baço/tratamento farmacológico , Infarto do Baço/etiologia , Trombose/diagnóstico por imagem , Resultado do TratamentoRESUMO
Chemotherapy in advanced non-small-cell lung cancer may be a controversy because it is only palliative and costly. Benefit of chemotherapy is nevertheless clear in survival and particularly life quality. Beside this technical criteria, two other factors have an impact on the therapeutic decision: symptom control and patient's personal expectations. The aim of the strategy is to determine an acceptable compromise in each situation.
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Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Qualidade de Vida , Carcinoma Pulmonar de Células não Pequenas/patologia , Humanos , Neoplasias Pulmonares/patologiaRESUMO
A 16-year-old boy was hospitalized for fever, chest pain, and cardiovascular collapse. Transthoracic echocardiography revealed a 30-mm circumferential echogenic "porridge-like" pericardial effusion with signs of cardiac tamponade. Tuberculosis (TB) was suspected because of its prevalence in Djibouti. Emergency pericardiocentesis was attempted, but only 10 ml of pericardial fluid was obtained. Subxiphoid pericardiotomy and drainage were then performed, and pericardial fibrinous pockets were surgically collapsed. Antituberculosis chemotherapy was given, and the pericardial effusion progressively disappeared without corticosteroids. The diagnosis of TB was subsequently confirmed by cultures of the pericardial fluid. A pericardial biopsy was normal. After 3 months of follow-up, there was no sign of constrictive pericarditis. Pericardiocentesis may fail in cases of advanced-stage fibrinous TB pericardial effusion. Thus, pericardiotomy with complete open draining is the only lifesaving procedure.
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Tamponamento Cardíaco/cirurgia , Drenagem , Derrame Pericárdico/cirurgia , Pericardiectomia , Pericardiocentese , Pericardite Tuberculosa/cirurgia , Adolescente , Antituberculosos/uso terapêutico , Tamponamento Cardíaco/diagnóstico por imagem , Tamponamento Cardíaco/etiologia , Djibuti , Humanos , Masculino , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/etiologia , Pericardite Tuberculosa/complicações , Pericardite Tuberculosa/diagnóstico por imagem , Resultado do Tratamento , UltrassonografiaRESUMO
INTRODUCTION: The value of a nonanthracyclin regimen in thymic carcinoma and malignant thymoma is not well defined. These regimens may be useful in some patients, particularly with cardiac diseases. The objective of this study is to evaluate the response rate, progression free survival, overall survival and toxicity of combined etoposide, ifosfamide, and cisplatin in patients with advanced thymoma and thymic carcinoma. METHODS: From October 1995 to April 2001, 18 patients with advanced thymoma or thymic carcinoma were entered on trial, and receive etoposide (100 mg/m(2) on days 1-3), ifosfamide (1500 mg/m(2) on days 1-3), s and cisplatin (30 mg/m(2) on days 1-3). Cycles were repeated every 3 weeks for a total of six cycles. RESULTS: Among 16 evaluable patients, there were no complete responses and four partial responses (complete and partial responses rate, 25%; confidence interval [CI] 95, 7-48%). The median follow-up was 32.6 months (range, <9-84 months), and the median overall survival has not yet been reached because more than 50% of patients are still alive. Based on Kaplan-Meier estimates, the 1-year and 2-year survival rates were 93.8 and 78.1%, respectively. The toxicity was predominantly myelosuppresion and alopecia. CONCLUSIONS: The combined etoposide, ifosfamide, and cisplatin regimen has moderate activity in patients with advanced thymic tumors. Our results confirm the Eastern Cooperative Oncology Group trial published in 2001. Response rates appear to be lower to many phase II trials, but survival seems similar.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Timoma/tratamento farmacológico , Neoplasias do Timo/tratamento farmacológico , Adulto , Idoso , Cisplatino/administração & dosagem , Cisplatino/efeitos adversos , Etoposídeo/administração & dosagem , Etoposídeo/efeitos adversos , Feminino , Humanos , Ifosfamida/administração & dosagem , Ifosfamida/efeitos adversos , Masculino , Pessoa de Meia-Idade , Timoma/mortalidade , Neoplasias do Timo/mortalidadeRESUMO
BACKGROUND: In spite of adhesion to recommended disinfection procedures, the transmission of infections by bronchoscopes is a permanent problem. OBJECTIVE: The new device may prevent nosocomial infections because it consists of two parts: a specific bronchoscope Vision Sciences BF100 and a single-use protective sheath for each procedure. The aim of this paper is to report our practice and the difficulties encountered when using this system. METHODS: We report our experience from 1997 to 2002 after 328 elective and emergency endoscopic procedures with the BF100 device. In a retrospective study, we describe the population and the incidents during procedure. We discuss the impact of the use of BF100 on the cost of bronchoscopies. RESULTS: The major constraint is the care required in assembling the optical device and disposable sheath. The intrinsic qualities of the optics are confirmed; any sample may be taken although image quality and suction capacity are inferior to videoscopes. Maneuverability is inferior to videoscopes, but improves with a short experience. In addition, this device is expensive. CONCLUSIONS: The technical performances of the BF100 device are inferior to those of videoscopes but the concept of sterile single-use sheaths is able to prevent the nosocomial infections related to bronchoscopes. Because of the cost, examination with the BF100 should be reserved to patients with proved or suspected infection (multiresistant bacteria, tuberculosis, hepatitis C and B virus, HIV, prions) and immunosuppression (hematologic diseases).