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BACKGROUND/AIM: Brain metastases (BMs) are common in patients with non-small cell lung cancer (NSCLC). Whole-brain radiotherapy (WBRT) with or without corticosteroid use has historically been the first choice for most patients with BMs despite its negative impact on cognition and quality of life. However, stereotactic radiosurgery (SRS) has emerged as a safe and effective treatment and has been established for patients with limited, inoperable BMs. SRS and WBRT are either used separately or together, in an attempt to achieve the best possible local and distal control rates and even improve overall survival. A number of phase III trials have focused on answering the question which modality - SRS, WBRT or both - can achieve the best possible results. In this review, we present the existing data regarding the use of SRS compared with WBRT and their combination for NSCLC patients with limited, non-operable BMs. MATERIALS AND METHODS: A literature review was performed in PubMed, Medline, and the Cochrane Library databases from 1995 up to 2021. Principles outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement were followed. RESULTS: We identified seven randomised control trials (RCTs) that compared WBRT with WBRT plus SRS boost and four RCTs that compared SRS alone with SRS plus WBRT. CONCLUSION: Overall, addition of WBRT to SRS did not improve survival but had a positive effect on locoregional control.
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BACKGROUND/AIM: Prophylactic cranial irradiation (PCI) is a well-established treatment of small cell lung cancer (SCLC) patients following response to initial chemoradiotherapy. The benefit of PCI does, however, come at the cost of cognitive decline. This has been attributed to radiation-induced toxicity at the hippocampus, a crucial anatomic area for cognition. Modern radiotherapy techniques allow dose reduction at the hippocampal region. In this review, the safety profile, effect on cognition, and changes on brain imaging modalities of hippocampal avoidance-PCI (HA-PCI) will be presented, aiming to identify a potential clinical rationale for SCLC patients. MATERIALS AND METHODS: A systematic review of the literature was performed in Pubmed, Cochrane library databases and ClinicalTrials.gov with no past date limitations until 07/01/2022. Principles as outlined in the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement were followed. RESULTS: Eight studies published from 2015 to 2021 were included. CONCLUSION: HA-PCI is safe, yet its effect on neurocognition and imaging remains unclear, as studies have shown contradictory results.
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INTRODUCTION: This study's principal objective was to evaluate the critical role of the application of immunocytochemistry to a novel panel of diagnostic markers for the accurate detection of the source of malignancies in pleural effusions of lung adenocarcinoma. MATERIALS AND METHODS: In 40 effusion smears from lung adenocarcinoma, the expression of the E-cadherin, a-catenin, Thyroid Transcription Factor (TTF-1), Epidermal Growth Factor Receptor (EGFR), p53, caspase 9 and 3, Bax and Bcl-2 was examined by immunocytochemistry. RESULTS: All cases showed positive immunoreactivity of tumour cells to caspase 3 (42,5%), caspase 9 (40%), Bcl-2 (30%), Bax (40%), p53 (55%), E-cadherin (82,5%), a-catenin (80%), TTF-1 (87,5%) and EGFR (62,5%). The Pearson's x2 analysis demonstrated a highly significant correlation to each of the other marker when analysed separately. Caspase 3 expression was correlated significantly with caspase 9 (p<0.0001), Bax (p=0.002), Bcl-2(p=0.014) and p53 (p=0.011). Caspase 9 was correlated with Bax (p=0.005) and p53 (p=0.047), p53 correlated with E-cadherin (p=0.011), a-catenin(p=0.011), EGFR (p<0.0001) and Bax (p=0.032). Correlation was also observed between Bcl-2 and Bax expression (p<0.0001), E-cadherin and a-catenin expression (p<0.0001) and a-catenin and TTF-1 expression (p=0.002). CONCLUSIONS: The use of a panel of biomarkers can be of great value in determining effusion immunoprofile in patients with lung adenocarcinoma for clinical application.