Metastatic NSCLC: Clinical, molecular, and therapeutic factors associated with long-term survival.

BACKGROUND: Patients with metastatic non-small-cell lung cancer (NSCLC) who survive more than 2 years are considered long-term survivors (LTSs). The present study examined factors associated with long-term survival and collected information for future comparison. METHODS: Clinical, molecular, and therapeutic data were collected from patients followed for primary stage IV (7th TNM classification) NSCLC within 2 years from diagnosis in the respiratory medicine departments of 53 French non-teaching hospitals. LTS and non-LTS records were compared. Factors associated with long-term survival were examined by univariate and multivariate analyses using logistic regression models. RESULTS: Vital status at least 2 years after diagnosis was known for 1977 stage IV NSCLC patients; 220 (11.1%) were LTSs. On multivariate analysis, independent positive factors comprised: TTF-1(+) immunochemistry, EGFR-mutation, surgery, rescue radiotherapy, and targeted therapy. Independent negative factors comprised: prediagnosis weight loss>5kg, ECOG performance status>1, and primary radiotherapy. CONCLUSIONS: Molecular biology and targeted therapy were decisive for long-term survival. With their development and their widespread implementation in clinical practice, the percentage of LTSs is expected to grow. Factors determining long-term survival found in this study should be taken into account when considering treatment options for patients with stage IV NSCLC.

Classic biphasic pulmonary blastoma: A case report and review of the literature.

Pulmonary blastomas represent about 0.5% of primary pulmonary malignancies. The prognosis is poor. Standard treatment consists of surgical excision. There are no published series on which to judge the efficacy of chemotherapy or radiation therapy. We describe an unusual case of classic biphasic pulmonary blastoma (CBPC), with long-term survival despite numerous and varied cancer-related events and review the literature. Our 71-year-old Caucasian woman presented with history of blood in sputum in 2009. Right lower lobectomy yielded a diagnosis of sarcomatoid carcinoma (pneumoblastoma). Unusually, our patient is still alive 7 years after initial surgery, despite metastatic first relapse after 2 years. Metastatic progression was confirmed histologically on three separate occasions during the disease course. The patient received a combination of cisplatin (or carboplatin) and etoposide on three separate occasions. Molecular biology studies of CBPC are needed to identify effective treatments, and a patient registry should be created.

Carboplatin as radiosensitizer in non-small cell lung cancer after cisplatin containing chemotherapy. A phase I study of a groupe francais de pneumo-cancerologie (G.F.P.C.).

A Phase I trial of carboplatin therapy was performed on patients with locally advanced non-small cell lung cancer who had been previously treated with cisplatin, mitomycin and a vinca aklaloïd. This was administered as a daily bolus infusion or as a continuous infusion for 6 weeks with concurrent daily thoracic radiation. All patients had to be objective responders or to show no change after chemotherapy. The carboplatin was started at 10 mg/m2 per day, and increased to 15 mg/m2 per day and 20 mg/m2 per day, if treatment was feasible in successive cohorts of at least six patients. The radiation therapy consisted of 62-66 Gray on the tumor and the ipsilateral mediastinal nodes, 50 Gray on the mediastinum and 40-45 Gray on the supraclavicular lymph nodes. Twenty-nine patients took part in this study. Thrombocytopenia was the principal dose-limiting toxicity, with 15 mg/m2 per day of bolus or continuous infusion. Other toxicities included a fall in haemoglobin level, a fall in white-blood cell count, nausea and vomiting. The median survival time was 12 months, but the response rate cannot be determined among patients selected on the basis of response to chemotherapy. The recommended Phase II dose for patients previously treated with cisplatin containing chemotherapy, is 10 mg/m2 per day of either a bolus or continuous infusion.

[Bronchial cancer with normal thoracic image discovered by endoscopy. Apropos of 11 cases]. / Cancer bronchique à image thoracique normale de découverte endoscopique. A propos de onze observations.

The authors report about eleven cases, distributed over four years, of bronchial cancers with a normal thoracic image that were discovered on bronchial endoscopy. In this context, they sum up the limitations of medical imaging, the undisputed merits of bronchial endoscopy, and the major epidemiological and therapeutic features of this clinical form of bronchial cancer.

[Giant cell tumors of the ribs. Apropos of a case]. / Tumerurs à cellules géantes des côtes. A propos d'une observation.

The authors report a case of grade I-II giant-cell tumour of the ribs extending to the thorax and the vertebral column. The tumour was treated by surgical resection followed by vertebral curettage in two stages and adjuvant regional radiotherapy. Giant-cell tumours of the ribs are exceptional and rarely found in the literature. They raise a therapeutic problem (surgery is essential, but radiotherapy is controverted), and a prognostic problem (there is always a potential risk of recurrent malignancy).

Experience of multidisciplinary assessment of elderly patients with cancer in a French general hospital during 1 year: a new model care study.

OBJECTIVES: Our main aim was to describe and explore a multidisciplinary approach to the management of elderly patients with cancer, who constitute a heterogeneous population. MATERIALS AND METHODS: This descriptive study was performed between October 2009 and September 2010. Patients with cancer ≥ 70 years of age were included. Some underwent a simplified multidimensional geriatric assessment with a Charlson score administered by an oncologist, and the evaluation was submitted to a geriatrician who decided whether or not a complete a comprehensive geriatric assessment (CGA) (n=54) should be done. Another group of patients directly underwent a CGA (n=49), and a few patients included in a specific trial underwent a geriatric assessment (n=8). Each patient was classified as fit, vulnerable, or frail by a multidisciplinary team. RESULTS: 111 patients were included (median age: 81 years [range: 65-96]; 60 males). The most frequent types of cancer were lung (n=29), gastrointestinal (n=20) and head and neck (n=14). Median Charlson score was 2.1 [range: 0-9]. Standard therapy was given to 37/41 (90%) fit, 19/41 (42%) vulnerable, and 6/29 (21%) frail patients. Thirteen frail patients received best supportive care. A social worker was mobilized for 2/41 (5%) fit, 14/41 (34%) vulnerable, and 11/29 (38%) frail patients. CONCLUSIONS: Our study outlines the possibilities of cooperation between geriatricians and oncologists in a general hospital. This collaboration could modify therapeutic schedules especially in frail and vulnerable patients.

[Prospective evaluation of antibiotic combinations in a general hospital]. / Evaluation prospective des associations antibiotiques d'un centre hospitalier général.

INTRODUCTION: We previously reported a 30% rate of inadequate antibiotic therapy in a general hospital with optimal organization. This data led to implement a systematic weekly infectious diseases consultation. We report an evaluation of antibiotic combinations. PATIENTS AND METHODS: The infectious diseases consultation was scheduled half-a-day per week. Antibiotic combinations were collected by the pharmacist via computerized prescriptions. Discussion with the managing physician was systematic in order to evaluate the adequacy of the treatment both in terms of diagnosis and therapy. RESULTS: For 9 months, 381 patients were prescribed 486 antibiotic combinations, among which 116 were evaluated. The infectious diseases specialist suggested a similar diagnosis in 71 antibiotic treatments (61%), the diagnosis appeared doubtful in 36 cases (31%), and a true diagnostic discordance was noted in nine cases. The discussion between specialist and managing physician suggested that the antibiotic combination was justified in 35%, of limited usefulness in 22%, and inadequate in 43% of the cases. There was a significant correlation between the result of the discussion and the accuracy of the antibiotic combination (p<0.001). Respiratory infections were the main reason for inadequate or limited usefulness of antibiotic combinations (30/49, 61%). CONCLUSION: Computerized prescriptions allow the evaluation of antibiotic therapy even when the infectious diseases specialist intervention is short. The discussion with the managing physician on diagnosis and treatment appears to play a central role for a better use of antibiotherapy.

Comparisons among external resistive loading, drug-induced bronchospasm, and dense gas breathing in cats: roles of vagal and spinal afferents.

In anesthetized cats, breathing spontaneously, increase in lung resistance (RL) was induced by either external resistive loads (ERL) or internal loading produced by dense gas breathing (sulfur hexafluoride, SF6) or serotonin (5-HT)-induced bronchoconstriction. The 3 test agents were used in each animal. Arterial blood gases were maintained in the normal range. Ventilatory and cardiovascular responses were studied in 3 groups of animals: intact, vagotomized, or spinalized at C8 level, a condition that preserved diaphragmatic afferents. In intact or spinal animals, ERL as well as SF6 inhalation lengthened the inspiratory and/or the expiratory periods, whereas 5-HT injections elicited rapid shallow breathing. The changes in ventilatory timing with either type of load were not observed in vagotomized cats. In all animals, ERL breathing or 5-HT injections increased the moving-time average of diaphragmatic EMG measured at constant time (Edi 0.1 and 0.5 secs), but this was not observed during SF6 inhalation, a condition in which the magnitude of RL increase was less than in the 2 other situations. The changes in systemic arterial blood pressure and/or cardiac frequency were mostly associated with 5 HT-induced bronchoconstriction. They persisted in spinalized cats, but were not observed or reversed in vagotomized ones. These observations demonstrate that vagal afferents play a major role in the changes in ventilatory timing and cardiovascular function in response to both external or internal moderate resistive loading. The existence of Edi changes in the 3 groups of cats suggests also that diaphragmatic afferents, preserved in both situations, are involved in this response.

Color density spectral array for quick evaluation of sleep during nasal continuous positive airway pressure.

EEG color density spectral array enables quick evaluation of sleep. The aim of the study was to evaluate if an easily calculated sleep score based on this method could be used to assess the improvement of sleep after nasal continuous positive airway pressure (CPAP) in patients with sleep apnea syndrome (SAS). Eight hours of sleep are displayed on a single sheet along with EEG amplitude, 2 EEG channel spectra (FFT), electromyogram envelope and electro-oculogram. The x-axis corresponds to time, the y-axis to EEG frequency (range 0-16 Hz), and the color to the frequency power. This system allows the detection of sleep spindles, REM sleep and deep sleep (stages 3 and 4) as well as the evaluation of the sleep cyclic organization and its fragmentation by apnea. Based on these findings a sleep score is calculated. Eight young normal subjects were successively recorded as well as 15 SAS patients and with and without nasal CPAP. During the 1st night, the sleep score was lower in SAS patients than in normal subjects. With CPAP the apnea number decreased and the sleep score returned to normal in all patients except 1. A positive correlation was found between sleep score and duration of stage 2, stage 3 or REM sleep. A negative correlation was found between sleep score and the apnea index. This sleep score enables a quick and reliable evaluation of sleep in patients with SAS before and during nasal CPAP.

Fibrinolytic and inflammatory processes in pleural effusions.

This study was designed to evaluate major fibrinolytic parameters in relation to parameters of inflammation associated with different kinds of pleural effusion. Sixty patients with pleural effusion were studied. The underlying aetiology was empyema in 10 cases, tuberculosis in 9, cancer in 31, cardiac failure in 7, and undetermined in 3. Plasminogen, plasminogen activator inhibitor 1 (PAI-1) and 2 (PAI-2), tissue type plasminogen activator (t-PA), urokinase (u-PA) and D-dimers (D-D) were quantified in plasma samples and pleural effusion specimens. These data were then correlated with inflammatory or infectious parameters, i.e. fibrinogen, von Willebrand factor (vWF), erythrocyte sedimentation rate (ESR), protein concentration, and white blood cell count. D-D levels were higher in pleural fluid than in plasma. D-D levels were not correlated with either plasminogen activator or plasminogen activator inhibitor levels, suggesting the presence of other fibrinolytic pathways. PAI levels (PAI activity, PAI-1 antigenicity, PAI-2 antigenicity) and vWF levels were significantly higher in patients with tuberculosis and empyema than in patients with cancer or cardiac failure. Regression analysis between inflammatory and fibrinolytic parameters showed that pleural PAI levels were significantly correlated with pleural neutrophil count, vWF levels, and plasma fibrinogen levels. D-D levels were correlated with blood ESR. No significant difference in pleural t-PA, u-PA and D-D levels was observed between aetiologies. The highest pleural t-PA and u-PA values were noted in patients with cancer, especially lymphoma. Plasma t-PA levels were higher inpatients with pleural effusion secondary to congestive heart failure, but this difference did not reach statistical significance.(ABSTRACT TRUNCATED AT 250 WORDS)