The Role of a Vibration Response Imaging Device in the Selection of Patients for Lung Resection Surgery.

BACKGROUND: Simpler and radiation free alternatives have been researched to estimate postoperative lung functions. Objective of the study is to investigate the reliability of predicted postoperative (ppo) forced expiratory volume in 1 second (FEV1) and carbon monoxide diffusion capacity (DLCO) calculated by vibration response imaging (VRI) to guide the selection of patients for lung resection surgery in comparison with quantitative perfusion scintigraphy (Q scan). METHODS: 35 candidates for lung resection were enrolled in the study for preoperative and postoperative evaluation of FEV1 and DLCO. RESULTS: Totally 25 patients had preoperative tests. VRI measurements showed strong correlation with Q scan measurements of predicted postoperative (ppo) FEV1% (r= .87, p<.001), ppo FEV1(L) (r=.90, p<.001) and ppo DLCO% (r=.90, p<.001). There was a correlation between ppo FEV1 (% and L) calculated by Q scan and postoperative actual FEV1 (% and L) (r=.47, p<.05; r=.73, p<.001). There was no difference between VRI measurements of ppo FEV1(% and L) and postoperative actual FEV1 values. There was a correlation between ppo FEV1 (% and L) calculated by VRI and postoperative actual FEV1(% and L) (r= .52, p<.05; r= .79, p<.001). The mean differences between ppo and postoperative actual FEV1 values was 49ml for VRI versus 230ml for Q scan. Both VRI and Q scan ppo DLCO% did not show agreement with postoperative actual DLCO%. CONCLUSIONS: VRI, which is a non-invasive, radiation free and simple test, may be valuable in the preoperative evaluation of lung resection surgery. It may be a good alternative to Q scan.

Vibration-response imaging versus quantitative perfusion scintigraphy in the selection of patients for lung-resection surgery.

BACKGROUND: In patients being considered for lung-resection surgery, quantitative perfusion scintigraphy is used to predict postoperative lung function and guide the determination of lung-resection candidacy. Vibration-response imaging has been proposed as a noninvasive, radiation-free, and simpler method to predict postoperative lung function. We compared vibration-response imaging to quantitative perfusion scintigraphy for predicting postoperative FEV(1) and diffusing capacity of the lung for carbon monoxide (D(LCO)). METHODS: We enrolled 35 candidates for lung resection. Twenty-five patients had preoperative FEV(1) and D(LCO) MEASUREMENTS: RESULTS: The vibration-response-imaging measurements showed strong correlation with the quantitative-perfusion-scintigraphy measurements of predicted postoperative FEV(1)% (r = 0.87, P < .001), predicted postoperative FEV(1) (r = 0.90, P < .001), and predicted postoperative D(LCO)% (r = 0.90, P < .001). There was a correlation between predicted postoperative FEV(1) (% and L) measured via quantitative perfusion scintigraphy and the actual postoperative FEV(1) (% and L) (r = 0.47, P = .048, r = 0.73, P < .001). There was no difference between the vibration-response-imaging measurements and the actual postoperative measurements of predicted postoperative FEV(1) (% and L). There was a correlation between predicted postoperative FEV(1) (% and L) measured via vibration-response imaging and actual postoperative FEV(1) (% and L) (r = 0.52, P = .044, r = 0.79, P < .001). The mean differences between the predicted and actual postoperative FEV(1) values were 49 mL with vibration-response imaging, versus 230 mL with quantitative perfusion scintigraphy. Neither the vibration-response imaging nor the quantitative perfusion scintigraphy predicted postoperative D(LCO)% values agreed with the actual postoperative D(LCO)% values. CONCLUSIONS: Vibration-response imaging may be a good alternative to quantitative perfusion scintigraphy in evaluating lung-resection candidacy.

Reirradiation for locally recurrent nasopharyngeal carcinoma: treatment results and prognostic factors.

PURPOSE: To analyze the results and evaluate the prognostic factors in the retreatment of locally recurrent nasopharyngeal carcinoma. METHODS AND MATERIALS: Forty-one patients with locally recurrent nasopharyngeal carcinoma, who were reirradiated between 1979 and 2000, were retrospectively analyzed. There were 32 men and 9 women with median age of 46 years. Histologically, 9 tumors (22%) were World Health Organization (WHO) I, 17 (41.5%) WHO II, and 15 (36.5%) WHO III. According to the 1998 TNM staging system of the American Joint Committee on Cancer, the recurrent disease was Stage I in 5 (12.2%), Stage II in 11 (26.8%), Stage III in 6 (14.6%), and Stage IV in 19 (46.4%) patients. Treatment was delivered with 4-6 MV X-rays or Co-60 gamma rays. The median reirradiation dose was 50 Gy. Treatment was delivered at 1.8-2 Gy/fraction daily, 5 days a week. Chemotherapy was used in 41.5% of the patients. RESULTS: Median follow-up was 23 months (range, 3-143 months). The 2-year and 5-year local progression-free and overall survival rates were 39%, 23%, 48%, and 28%, respectively. On univariate analysis, age (p = 0.04), total reirradiation dose (p = 0.0008) were significant prognostic factors for local progression-free rate. For overall survival age, total reirradiation dose, stage, T stage were significant. On multivariate analysis only total dose (p = 0.005) remained significant for local progression-free rate and total reirradiation dose (p = 0.02), interval to recurrence (p = 0.03), stage (p = 0.018) were significant for overall survival. CONCLUSIONS: Early diagnosis of local recurrence and high-dose reirradiation (60 Gy) are crucial for improving the local control and survival.