RESUMO
BACKGROUND: Malignant pleural mesothelioma (MPM) is a rare disease with poor prognosis in spite of significant improvement in survival, due to new chemotherapy regimens. We describe here patients' profiles and management in daily practice in France. METHODS: Observational retrospective study. Data were collected from medical files. All patients with histologically proven MPM diagnosed from January 2005 to December 2008 were included in the participating sites. RESULTS: Four hundred and six patients were included in 37 sites: mean age 68.9 ± 9.8 years, male predominance (sex ratio 3.27), latency of the disease 45.7 years, epithelioïd type 83 %. Diagnosis was made using thoracoscopy in 80.8 % of patients. Radical surgery was performed in 6.2 % of cases. Chemotherapy was administered to 74.6 % of patients. First line regimens consisted mainly of platinum + pemetrexed (91 %) or pemetrexed alone (7 %). Objective response rate was 17.2 % and another 41.6 % of patients experienced disease stabilization. Half of these patients underwent second line chemotherapy (platinium + pemetrexed 31.6 %, pemetrexed alone 24.6 %), resulting in a 6 % response rate. Third-line chemotherapy (56 patients) yielded disease control in 5.4 % of cases. CONCLUSIONS: The management of MPM in France is usually in accordance with guidelines. Response rates are somewhat lower than those described in clinical trials.
Assuntos
Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/terapia , Mesotelioma/diagnóstico , Mesotelioma/terapia , Neoplasias Pleurais/diagnóstico , Neoplasias Pleurais/terapia , Idoso , Gerenciamento Clínico , Feminino , França/epidemiologia , Humanos , Neoplasias Pulmonares/epidemiologia , Masculino , Mesotelioma/epidemiologia , Mesotelioma Maligno , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Neoplasias Pleurais/epidemiologia , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND: Lung cancer in women is on the rise, with a higher proportion occurring in lifelong never-smokers. Lung cancer in never-smokers (LCINS) exhibits a high frequency of driver oncogene alterations. In this study, we aimed to investigate whether exposure to reproductive factors in women with LCINS may modulate the molecular pattern. METHODS: All newly diagnosed LCINSs were included in a prospective, observational study (IFCT-1002 BioCAST). Each patient responded to a questionnaire including reproductive factors. Biomarker test results were also collected. RESULTS: Two hundred and sixty women were included in this analysis, and 166 alterations were characterized. EGFR mutation frequency proved greater among patients with late menarche (74% in age>14 vs. 40% and 41% for 12-14 and ≤12 years, respectively; P=0.020) and tended to decrease with increasingly late age at menopause. In multivariate analysis, EGFR mutation frequency increased by 23% per increment of 1 year of age at menarche (P=0.048), and by 9% for each year at age at first birth (P=0.035). ALK alteration frequency was greater in women with high parity (50% in≥5 vs. 12% and 7% for 1-4 and nulliparity, respectively; P=0.021). CONCLUSION: In a cohort of women LCINSs, female hormonal factors appear to impact molecular pattern.
Assuntos
Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/genética , História Reprodutiva , Idoso , Idoso de 80 Anos ou mais , Quinase do Linfoma Anaplásico/genética , Estudos de Coortes , Análise Mutacional de DNA , Receptores ErbB/genética , Feminino , França/epidemiologia , Frequência do Gene , Humanos , Neoplasias Pulmonares/complicações , Pessoa de Meia-Idade , Oncogenes/genética , Proteínas Proto-Oncogênicas p21(ras)/genética , Fatores de Risco , Fumantes/estatística & dados numéricosRESUMO
INTRODUCTION: Osteochondroplastic tracheobronchopathy (OCTB) is a rare disorder of unknown cause that affects the tracheobronchial tree. It is characterized by multiple cartilaginous formations or bone nodules projecting into the tracheal or proximal bronchial lumen. It is usually asymptomatic because of the slow progression of the nodules. However, chronic cough, recurrent hemoptysis or recurrent respiratory infections have been reported. OBSERVATIONS: We describe the cases of three patients with symptomatic OCTB: two men and one woman consulting for bronchial infections or pneumonia with sputum difficulties (2 cases) or simply for chronic cough (1 case). In all three cases, the diagnosis was suspected because of irregularities of the tracheal or bronchial wall with calcification seen on imaging and confirmed at bronchoscopy with biopsy specimens. No specific therapy was initiated in these patients except for the treatment of associated complications or comorbidities. CONCLUSION: OCTB is a benign pathology which can lead to bronchial symptoms ranging from mild cough to severe airway obstruction due to tracheobronchial stenosis. A key to diagnosis, limiting non-essential examinations and biopsies, is to consider OCTB based on CT scan or bronchoscopy based on irregularities of the tracheal or bronchial wall with calcification.
Assuntos
Broncopatias/diagnóstico , Osteocondrodisplasias/diagnóstico , Doenças da Traqueia/diagnóstico , Idoso , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/patologia , Broncopatias/patologia , Broncoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteocondrodisplasias/patologia , Doenças da Traqueia/patologiaRESUMO
OBJECTIVE: To determine the incidence, clinical characteristics, microbiological features and outcome of Mycobacterium xenopi infections in patients attending a university hospital. METHODS: We reviewed the files of HIV-seronegative patients meeting ATS criteria for M. xenopi pulmonary infection between 1993 and 2004. RESULTS: Ten patients were studied (7 men, 60+/-27 years). All but one had underlying chronic health disorders (chronic lung disease, cancer, alcoholism, systemic steroid therapy). The clinical and radiological findings were those associated with tuberculosis. Acid-fast bacilli were detected by direct examination in 9 cases, and antituberculous treatment prescribed in 8 patients. Specific treatment was started an average of 60+/-25 days after sampling, and generally combined a fluoroquinolone, clarithromycin and rifampicin, with or without ethambutol, for a mean of 11.4 months (1-37 months). Five patients had surgical excision (diagnostic in 1 case). Four patients died of their underlying disease. Two patients recovered with antibiotics alone and three with antibiotics and surgery. One patient was lost to follow-up after five months. CONCLUSION: Pulmonary infection by M. xenopi is rare in HIV-seronegative patients. The prognosis depends mainly on the patient's underlying health status. Surgery is an important component of treatment.
Assuntos
Infecções por Mycobacterium não Tuberculosas/diagnóstico , Mycobacterium xenopi/isolamento & purificação , Tuberculose Pulmonar/microbiologia , Adulto , Idoso , Antituberculosos/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/terapia , Estudos Retrospectivos , Tuberculose Pulmonar/terapiaRESUMO
BACKGROUND: The aim of ESCAP-2011-CPHG, promoted by the French College of General Hospital Respiratory Physicians, was to describe therapeutic strategies in lung cancer in the first 2 years after diagnosis, in a real-life setting. This article focuses on patients undergoing surgical management of a non-small cell lung cancer (NSCLC). METHODS: A prospective multicentre study was conducted in 53 French general hospitals. For each patient with lung cancer diagnosed in 2010, a standardised form was completed following each change in treatment strategy up to 2 years after diagnosis. RESULTS: Overall, 3418 of the 3943 included patients had NSCLC. 741 patients (21.7%) underwent curative surgery (stage 0-II, IIIA, IIIB, and IV: 65%, 27%, 3% and 5%, respectively). The therapeutic strategy changed less often in surgical than non-surgical patients and average follow-up time was longer: 23.3 months (SD: 9.3) versus 10.4 months (SD: 9.5) for non-surgical patients. Among patients with a surgical first strategy (92.6% of surgical patients as a whole), 56.9% did not receive any other treatment, 34.7% received chemotherapy, 5.9% radio-chemotherapy, 2.6% radiotherapy. At the end of follow-up, 55.8% were still alive without any other strategy, 13.1% had died, and 31.1% had received at least one more strategy. Among patients with a surgical second strategy, 63% had received chemotherapy alone during the first strategy. CONCLUSIONS: ESCAP -2011- CPHG assessed everyday professional practice in the surgical management of NSCLC in general hospitals. It pointed out the discrepancies between current guidelines and the therapeutic strategies applied in real life conditions.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Carcinoma Pulmonar de Células não Pequenas/terapia , Neoplasias Pulmonares/cirurgia , Neoplasias Pulmonares/terapia , Padrões de Prática Médica , Pneumologia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/epidemiologia , Estudos de Coortes , Feminino , Seguimentos , França/epidemiologia , Hospitais Gerais/organização & administração , Hospitais Gerais/estatística & dados numéricos , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/epidemiologia , Masculino , Pessoa de Meia-Idade , Pneumonectomia/métodos , Pneumonectomia/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Pneumologia/organização & administração , Sociedades Médicas/organização & administração , Sociedades Médicas/normas , Recursos HumanosRESUMO
COPD is a slowly progressive chronic respiratory disease causing an irreversible decrease in air flow. The main cause is smoking, which provokes inflammatory phenomena in the respiratory tract. COPD is a serious public health issue, causing high morbidity, mortality and disability. Related comorbidities are linked to ageing, common risk factors and genetic predispositions. A combination of comorbidities increases healthcare costs. For instance, patients with more than two comorbidities represent a quarter of all COPD sufferers but account for half the related health costs. Our review describes different comorbidities and their impact on the COPD prognosis. The comorbidities include: cardiovascular diseases, osteoporosis, denutrition, obesity, ageing, anemia, sleeping disorders, diabetes, metabolic syndrome, anxiety-depression and lung cancer. The prognosis worsens with one or more comorbidities. Clinicians are faced with the challenge of finding practical and appropriate ways of treating these comorbidities, and there is increasing interest in developing a global, multidisciplinary approach to management. Managing this chronic disease should be based on a holistic, patient-centred approach and smoking cessation remains the key factor in the care of COPD patients.