Diagnosis and management of patients with stage III non­small cell lung cancer: A joint statement by the Lebanese Society of Medical Oncology and the Lebanese Pulmonary Society (Review).

Proper management of stage III non-small cell lung cancer (NSCLC) might result in a cure or patient long-term survival. Management should therefore be preceded by adequate and accurate diagnosis and staging, which will inform therapeutic decisions. A panel of oncologists, surgeons and pulmonologists in Lebanon convened to establish a set of recommendations to guide and unify clinical practice, in alignment with international standards of care. Whilst chest computerized tomography (CT) scanning remains a cornerstone in the discovery of a lung lesion, a positron-emission tomography (PET)/CT scan and a tumor biopsy allows for staging of the cancer and defining the resectability of the tumor(s). A multidisciplinary discussion meeting is currently widely advised for evaluating patients on a case-by-case basis, and should include at least the treating oncologist, a thoracic surgeon, a radiation oncologist and a pulmonologist, in addition to physicians from other specialties as needed. The standard of care for unresectable stage III NSCLC is concurrent chemotherapy and radiation therapy, followed by consolidation therapy with durvalumab, which should be initiated within 42 days of the last radiation dose; for resectable tumors, neoadjuvant therapy followed by surgical resection is recommended. This joint statement is based on the expertise of the physician panel, available literature and evidence governing the treatment, management and follow-up of patients with stage III NSCLC.

PRevalence of the Eosinophilic Phenotype Among SeveRE asthma patients in Lebanon: results of the PREPARE study.

BACKGROUND: The prevalence of eosinophilic asthma in Lebanon, one of the most severe phenotypes among severe asthma, is not known. This study aimed at determining the prevalence of the eosinophilic phenotype defined as an eosinophil count ≥ 300 cells/mm3 among severe asthma patients in Lebanon. METHODS: The Lebanese Chapter of the PREPARE study was a national, multicenter, cross-sectional observational study. Patients aged ≥ 12 years with severe asthma were identified and prospectively enrolled during clinic visits and completed the Global Initiative for Asthma (GINA) assessment of asthma control questionnaire. Patients' health characteristics were collected from medical records and blood samples were obtained for measurement of serum IgE levels and blood eosinophils count. RESULTS: Overall, 101 patients (with mean age of 46.3 ± 17.0 years and 73.27% females) with severe asthma were included and, among them, 37% had eosinophilic phenotype, 67.3% had atopic phenotype with IgE > 100 IU/mL and 25.7% patients had overlapping atopic and eosinophilic phenotypes. Close to 80% had late-onset asthma, beyond 12 years of age, and around 85% had at least one severe exacerbation in the 12 months prior to study enrolment. The majority of participants [64.4%] had uncontrolled asthma, 24.7% had partially controlled symptoms and 10.9% had controlled symptoms. 19.8% of participants were on chronic oral corticosteroids, 78.2% had short course treatment of corticosteroids and all were prescribed a combination of inhaled corticosteroids and long-acting beta-agonist. CONCLUSIONS: The majority of patients with severe asthma were uncontrolled of which 37% present with an eosinophilic phenotype, which should be taken into consideration for better management of these patients in view of the novel phenotype-specific therapeutic options.

Large thymolipoma causing primarily respiratory distress.

Thymolipoma, is an anterior mediastinal tumor that is benign in origin. It is often asymptomatic, but can enlarge significantly prior to diagnosis. It consists of thymic and fatty tissue and is surrounded by a capsule. Less than a hundred cases have been reported worldwide. Although rare, it should be considered in the differential diagnosis of mediastinal tumors. In this paper, we report the case of a 44-year-old woman presenting with a giant thymolipoma causing symptoms of severe respiratory distress. The patient underwent surgical resection, which is the main treatment, and remains free of disease.

[Asthma control in Lebanon the asthma insights and reality in Lebanon].

INTRODUCTION: Current practice guidelines provide recommendations for the optimal management and control of asthma. However, the implementation of the recommendations in specific areas needs to be adapted to local conditions. No data on the burden of asthma and on the quality of asthma treatment and control are currently available in Lebanon. This study was therefore conducted to determine how closely asthma management guidelines are being followed in Lebanon. METHODS: The Asthma Insights and Reality in Lebanon (AIREL) survey is based on information from 200 adults and children with asthma in 2007-2008. Participants were interviewed on symptoms and severity, health care utilization, activity limitations and medication use. RESULTS: Daytime asthma symptoms were reported by 80% of respondents and 72% reported being awakened by their asthma in the preceding 4 weeks. Use of health services in the last 12 months due to asthma was high with 22% been hospitalized and 21% attended a hospital emergency department. Absence from school and work in the past year were reported by 69% of children and 31% of adults, respectively. Use of peak expiratory flow was only 14%, and 50% of participants had never undergone a lung function test. CONCLUSIONS: Current levels of asthma control in Lebanon fall far short of goals specified in international guidelines for asthma management.In many aspects, asthma care and control in Lebanon is at least as poor as in other areas of the world.

Methacholine challenge test: correlation with symptoms and atopy.

Methacholine challenge test (MCT) is a diagnostic test to assess airway hyperresponsiveness, one feature of asthma. Our study presents the results of MCT, done in our pulmonary function laboratory, correlated with patients' symptoms and allergic status. This is a cross-sectional study, where 134 patients were included : 60 patients had a PC-20 < or = 32 mg/ml (MCT+ group), while 74 had a PC-20 > 32 mg/ml (MCT- group). Dyspnea and wheezing were correlated to positive methacholine reactivity while cough was inversely correlated to it. In the 66 patients presenting isolated cough, 21 were MCT+ (32%). Methacholine reactivity was correlated to positive prick test, particularly for dust mite allergy (p = 0.006). There was a positive trend towards a higher incidence of dyspnea and wheezing with lower methacholine concentrations (p < 0.01), and lower incidence of cough with lower methacholine concentrations (p = 0.004). MCT was valuable in excluding the diagnosis of asthma in more than 50% of the cases and when positive, a good tool in guiding therapeutic choices. It showed a high correlation with the atopic status of the patient. It has definitely its place in diagnostic approach of respiratory symptoms.

Metastatic prostate adenocarcinoma presenting with pulmonary symptoms: a case report and review of the literature.

INTRODUCTION: Prostate cancer has a high tendency to spread to bone. Pulmonary metastasis and generalized lymphadenopathy commonly develop after pelvic and bone involvement have already occurred. Few patients with prostate cancer present initially with symptomatic metastatic lung lesions and lymphadenopathy without any other concomitant distant dissemination. CASE PRESENTATION: We report a case of a 73-year-old white male who sought medical help for symptoms of cough, hemoptysis, and dyspnea. A chest X-ray was done revealing multiple "cannon ball" infiltrates involving all segments of the lung parenchyma. Fine-needle aspiration cytology under computed tomography guidance of a subpleural lesion revealed adenocarcinomatous cells. Despite the absence of any detectable osseous lesions and with the presence of multiple hilar, mediastinal, para-aortic, and pelvic lymphadenopathy, the patient had a complete work-up in search for the primary adenocarcinoma. His prostate specific antigen was 146 ng/ml and a prostatic biopsy done, revealing an acinar prostatic adenocarcinoma. A tru-cut biopsy of a lung lesion under computed tomography guidance showed a metastatic prostatic adenocarcinoma positive for prostate specific antigen stain. CONCLUSION: This case sheds light on an unusual metastatic pattern of prostatic adenocarcinoma. It also emphasizes the importance of including prostate cancer in the differential diagnosis of men with adenocarcinoma of unknown origin.