ABSTRACT
BACKGROUND: UK COVID-19 mortality rates are amongst the highest globally. Controversy exists on the vulnerability of thoracic cancer patients. We describe the characteristics and sequelae of patients with thoracic cancer treated at a UK cancer centre infected with COVID-19. METHODS: Patients undergoing care for thoracic cancer diagnosed with COVID-19 (RT-PCR/radiology/clinically) between March-June 2020 were included. Data were extracted from patient records. RESULTS: Thirty-two patients were included: 14 (43%) diagnosed by RT-PCR, 18 (57%) by radiology and/or convincing symptoms. 88% had advanced thoracic malignancies. Eleven of 14 (79%) patients diagnosed by RT-PCR and 12 of 18 (56%) patients diagnosed by radiology/clinically were hospitalised, of which four (29%) and 2 (11%) patients required high-dependency/intensive care respectively. Three (21%) patients diagnosed by RT-PCR and 2 (11%) patients diagnosed by radiology/clinically required non-invasive ventilation; none were intubated. Complications included pneumonia and sepsis (43% and 14% respectively in patients diagnosed by RT-PCR; 17% and 11% respectively in patients diagnosed by radiology/clinically). In patients receiving active cancer treatment, therapy was delayed/ceased in 10/12 (83%) and 7/11 (64%) patients diagnosed by RT-PCR and radiology/clinically respectively. Nine (28%) patients died; all were smokers. Median time from symptom onset to death was 7 days (range 3-37). CONCLUSIONS: The immediate morbidity from COVID-19 is high in thoracic cancer patients. Hospitalisation and treatment interruption rates were high. Improved risk-stratification models for UK cancer patients are urgently needed to guide safe cancer-care delivery without compromising efficacy.
Subject(s)
COVID-19/epidemiology , SARS-CoV-2/pathogenicity , Thoracic Neoplasms/epidemiology , Adult , COVID-19/complications , COVID-19/virology , Critical Care , Female , Hospitalization , Humans , Male , Middle Aged , Thoracic Neoplasms/complications , Thoracic Neoplasms/virology , United Kingdom/epidemiologyABSTRACT
To understand the real impact of COVID-19 on cancer patients, an entirely new data collection effort was initiated within the Thoracic Cancers International COVID-19 Collaboration (TERAVOLT). TERAVOLT reported high mortality related to COVID-19 infection in thoracic cancer patients and identified several negative prognostic factors. In this commentary, we discuss the importance and limits of patient registries to support decision-making in thoracic cancer during the SARS-CoV-2 pandemic.
Subject(s)
Betacoronavirus/isolation & purification , Clinical Decision-Making , Coronavirus Infections/complications , Global Burden of Disease/standards , Pneumonia, Viral/complications , Practice Guidelines as Topic/standards , Thoracic Neoplasms/therapy , COVID-19 , Coronavirus Infections/virology , Humans , International Cooperation , Pandemics , Pneumonia, Viral/virology , Registries , SARS-CoV-2 , Thoracic Neoplasms/epidemiology , Thoracic Neoplasms/virologyABSTRACT
To date, the impact, timeline and duration of COVID-19 pandemic remains unknown and more than ever it is necessary to provide safe pathways for cancer patients. Multiple triage systems for nonemergent surgical procedures have been published, but potentially curative cancer procedures are essential surgery rather than elective surgery. In the present and future scenario of our country, thoracic oncology teams may have the difficult decision of weighing the utility of surgical intervention against the risk for inadvertent COVID-19 exposure for patients and medical staff. In consequence, traditional pathways of surgical care must be adjusted to reduce the risk of infection and the use of resources. It is recommended that all thoracic cancer patients should be offered treatment according to the accepted standard of care until shortage of services require a progressive reduction in surgical cases. Here, we present a consensus of recommendations discussed by a multidisciplinary panel of experts on thoracic oncology and based on the best available evidence, and hope it will provide a modifiable framework of guidance for local strategy planners in thoracic cancer care services in Mexico. KEY POINTS: SIGNIFICANT FINDINGS OF THE STUDY: This article provides recommendations to guarantee the continuity of surgical care for thoracic oncology cases during COVID-19 pandemic, whilst maintaining the safety of patients and medical staff. WHAT THIS STUDY ADDS: This guideline is the result of an expert consensus on thoracic surgical oncology with recommendations adapted to medical, economic and social realities of Mexico.
Subject(s)
COVID-19/epidemiology , Lung Neoplasms/epidemiology , Pandemics , Thoracic Neoplasms/epidemiology , COVID-19/complications , COVID-19/virology , Guidelines as Topic , Humans , Lung Neoplasms/complications , Lung Neoplasms/surgery , Lung Neoplasms/virology , Medical Oncology/trends , Mexico/epidemiology , SARS-CoV-2/pathogenicity , Thoracic Neoplasms/complications , Thoracic Neoplasms/surgery , Thoracic Neoplasms/virology , TriageSubject(s)
Herpesviridae Infections/transmission , Immunosuppressive Agents/adverse effects , Lung Transplantation/adverse effects , Postoperative Complications/etiology , Sarcoma, Kaposi/etiology , Thoracic Neoplasms/etiology , Antibodies, Viral/blood , Drug Substitution , Erythema/etiology , Everolimus/therapeutic use , Herpesvirus 8, Human/immunology , Herpesvirus 8, Human/isolation & purification , Humans , Male , Middle Aged , Mycophenolic Acid/adverse effects , Mycophenolic Acid/therapeutic use , Postoperative Complications/diagnosis , Postoperative Complications/virology , Sarcoma, Kaposi/diagnosis , Sarcoma, Kaposi/virology , Tacrolimus/adverse effects , Tacrolimus/therapeutic use , Thoracic Neoplasms/diagnosis , Thoracic Neoplasms/virology , Tissue Donors , Viremia/diagnosis , Viremia/etiologyABSTRACT
A socially-housed New Zealand white rabbit presented with a large subcutaneous mass on the ventral thorax approximately 11 mo after the intrahepatic delivery of a suspension of VX2 carcinoma cells to induce hepatocellular carcinoma as part of a nanoparticle study. The mass and closely associated axillary lymph node were removed en bloc. Immunohistochemical staining identified the mass as an undifferentiated carcinoma. The rabbit demonstrated no appreciable pathology at the study end point at 16 mo after VX2 inoculation. An additional rabbit from the same VX2 injection cohort was found at necropsy to have an unanticipated intraabdominal mass, also identified as an undifferentiated carcinoma. This case report summarizes the molecular analysis of both tumors through a novel PCR assay, which identified the delayed and aberrant onset of VX2 carcinoma in an extended timeframe not previously reported.
Subject(s)
Abdominal Neoplasms/pathology , Carcinoma, Hepatocellular/pathology , Liver Neoplasms, Experimental/pathology , Thoracic Neoplasms/pathology , Abdominal Neoplasms/genetics , Abdominal Neoplasms/metabolism , Abdominal Neoplasms/virology , Animals , Biomarkers, Tumor/genetics , Biomarkers, Tumor/metabolism , Carcinoma, Hepatocellular/genetics , Carcinoma, Hepatocellular/metabolism , Carcinoma, Hepatocellular/virology , Cell Line, Tumor , Cottontail rabbit papillomavirus/pathogenicity , Immunohistochemistry , Liver Neoplasms, Experimental/genetics , Liver Neoplasms, Experimental/metabolism , Liver Neoplasms, Experimental/virology , Neoplasm Transplantation , Polymerase Chain Reaction , Rabbits , Thoracic Neoplasms/genetics , Thoracic Neoplasms/metabolism , Thoracic Neoplasms/virology , Time FactorsSubject(s)
Antirheumatic Agents/adverse effects , Epstein-Barr Virus Infections/etiology , Lymphoma, B-Cell/virology , Methotrexate/adverse effects , Mouth Neoplasms/virology , Thoracic Neoplasms/virology , Aged , Antirheumatic Agents/therapeutic use , Arthritis, Rheumatoid/drug therapy , Epstein-Barr Virus Infections/immunology , Female , Humans , Immune System/drug effects , Lymphoma, B-Cell/diagnosis , Methotrexate/therapeutic use , Mouth Neoplasms/diagnosis , Thoracic Neoplasms/diagnosis , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE: The objective of this article is to introduce the reader to the thoracic manifestations of neoplasms that are related to common oncogenic viruses in HIV-infected patients. We review the pathologic basis of the infections and illustrate the imaging features of their thoracic manifestations. CONCLUSION: The intrathoracic manifestations of oncogenic viral infection in AIDS patients are protean. Understanding their epidemiologic, pathologic, and imaging features is crucial to diagnosing and managing these often-treatable conditions.
Subject(s)
AIDS-Related Opportunistic Infections/diagnostic imaging , Oncogenic Viruses , Thoracic Neoplasms/diagnostic imaging , Tomography, X-Ray Computed/methods , Tumor Virus Infections/diagnostic imaging , AIDS-Related Opportunistic Infections/complications , AIDS-Related Opportunistic Infections/virology , Adult , Aged , Female , Humans , Male , Middle Aged , Practice Guidelines as Topic , Practice Patterns, Physicians' , Thoracic Neoplasms/etiology , Thoracic Neoplasms/virology , Tumor Virus Infections/complications , Tumor Virus Infections/virologyABSTRACT
To evaluate the etiology and differential features of intrathoracic lymphadenopathy (LAD) in HIV patients, chest computed tomography (CT) records from an 18-month period were reviewed to identify all HIV-positive patients with intrathoracic LAD (nodal size > or = 1 cm). Medical records were reviewed for the documentation of specific diseases causing LAD and the CD4 count at the time of imaging. Of 45 HIV-positive patients with LAD, 40 had specific diagnoses including 22 (55%) infections and 17 (43%) tumors; one patient had both (3%). Mycobacterial disease accounted for 78% of infections; five cases were secondary to bacterial pneumonia and sepsis. Of tumors, lymphoma (7 cases, 39%) was most common, followed by lung cancer, germ cell tumors, and Kaposi's sarcoma. Mean CD4 cell count in patients with tumors was much higher than in patients with infections (314 vs. 62, p < .01). Patients with tumors were somewhat more likely than patients with infections to demonstrate axillary adenopathy (29 vs. 5%, p = .068). Cavitary disease was only observed in patients with infections (27%, p < .03). CT and clinical findings may help direct the differential diagnosis of LAD in AIDS, and promote expedient definitive diagnosis and therapy.
Subject(s)
HIV Infections/complications , Infections/diagnostic imaging , Infections/virology , Lymphatic Diseases/diagnostic imaging , Lymphatic Diseases/virology , Thoracic Diseases/diagnostic imaging , Thoracic Diseases/virology , Thoracic Neoplasms/diagnostic imaging , Thoracic Neoplasms/virology , Adult , CD4 Lymphocyte Count , Diagnosis, Differential , Fatal Outcome , Female , HIV Infections/blood , HIV Infections/immunology , Humans , Infections/therapy , Lymphatic Diseases/therapy , Male , Middle Aged , Retrospective Studies , Thoracic Diseases/therapy , Thoracic Neoplasms/therapy , Tomography, X-Ray ComputedABSTRACT
Chronic tuberculous pyothrax and the development of non-Hodgkin's lymphoma (NHL) on the chest wall are believed to be closely related. We encountered three patients with NHL involving the chest wall in whom the tumor may have had a different origin Patient 1: A 65-year-old man with a history of pulmonary tuberculosis and right-sided pyothrax at the age of 28 years was found to have a tumor on the right sided of the chest wall, and NHL was diagnosed. Patient 2: A 65-year old woman with a history of right-sided tuberculous pyothrax at the age of 2 years had a left-sided chest-wall tumor, and NHL was diagnosed. Patient 3: A 78-year-old man with a history of tuberclous pleuritis on the left side at the age of 77 years was found to have a left-sided chest-wall tumor, and NHL was diagnosed. In patients 1 and 2, the Epstein-Barr virus was found in tissue specimens by in situ hybridization. These findings suggest that chronic tuberculous pyothrax and the development of NHL on the chest wall were not closely related in these patients, and that the Epstein-Barr virus may play an important role in the development of NHL on the chest wall after tuberculous pyothrax.