Lung cancer in never-smokers - what are the differences?

INTRODUCTION: Characteristics of never-smokers with lung cancer are still not fully clarified. The aim of this study was to compare never-smokers and ever-smokers with non-small cell lung cancer (NSCLC) regarding patient and tumor characteristics. METHODS: All consecutive newly NSCLC patients with known smoking status diagnosed between 2011 and 2015 were included in this retrospective cohort study. Clinical, histological, and molecular characteristics were compared between ever-smokers and never-smokers. RESULTS: Of the 558 included patients, 125 (22.4%) were never-smokers. These patients were more likely to be female (74% vs. 7%, p < .001), older (67 vs. 66 years-old, p = .019), and have adenocarcinoma (93% vs. 65%, p < .001). Never-smokers took longer to seek medical care after the symptoms onset (3 vs. 2 months, p < .001), regardless of the symptoms, histological type, or gender (OR: 1.2 [1.4-2.0]). The metastatic pattern was different in never-smokers: pleural metastases were more frequent (OR: 2.1 [1.1-4.0]), regardless of the histological type and gender. Never-smokers had a higher prevalence of ALK translocations (26% vs. 4%, p < .001) and EGFR mutations (36% vs. 8%, p < .001). The type of EGFR mutation was also significantly different between groups. CONCLUSIONS: Never-smokers with NSCLC present distinct demographic and clinical characteristics. The characteristics of tumor also differ between never-smokers and ever-smokers, which may suggest different carcinogenic pathways.

Oxidative stability and sensory evaluation of microencapsulated flaxseed oil.

Cold pressed flaxseed oil was microencapsulated by spray drying using an emulsion containing modified starch. The fatty acid composition, moisture, water activity, wettability, water holding capacity, water solubility, crystallinity, and particle size distribution of the microcapsules were determined. The stability of the microcapsules and the crude oil were assessed. An acceptance test was used for the sensory evaluation of a powdered supplement containing the microcapsules. The fatty acid composition was not significantly affected by the microencapsulation. The moisture, water activity, wettability, water solubility and crystallinity were appropriate for dry powders. The microcapsules had no cracks and showed better oxidative stability compared with the crude oil. Storage under vacuum prevented oxidation of the microcapsules. In sensory evaluation, all quality scores of the supplement containing microcapsules were mid-range or higher. The microencapsulation improved the oxidative stability of the oil and this procedure was satisfactorily applied in powdered food.

Phytophotodermatitis Due to Fig Tree Sap Activated by Ultraviolet Light: A Case Report.

Phytophotodermatitis is a dermatological reaction caused by exposure to certain plants, which becomes activated upon subsequent exposure to sunlight. This can frequently result in a rash. Typically, supportive treatment is recommended. In this report, we describe the case of phytophotodermatitis in a 57-year-old man who experienced a painful rash with streaked lesions following the pruning of a fig tree during the summer. The patient, with no significant medical history, presented to the emergency department in July with a painful, streaked rash on both forearms. The lesions appeared overnight, predominantly on areas of skin exposed while sleeping. The patient denied contact with potential irritants and had not engaged in recent travel or altered his usual habits. Laboratory tests, including complete blood count and markers of inflammation, showed no abnormalities. A thorough patient history revealed recent fig tree pruning, a task usually undertaken in winter. The diagnosis of phytophotodermatitis was made based on the characteristic skin lesions and the patient's history of exposure to fig tree sap. Treatment with antihistamines led to improvement in symptoms, and the patient was discharged with a week-long course of antihistamines and advice to avoid sunlight and contact with fig trees. This case underscores the importance of a detailed medical history, especially in the context of dermatological lesions, to accurately diagnose and treat conditions like phytophotodermatitis.

Characteristics and patient-reported outcomes of long-term lung cancer survivors.

Background: Due to advances in screening and treatment of lung cancer, there has been increased interest in long-term lung cancer survivors (LTLCS). The aim of this study was to evaluate the prevalence of LTLCS, their characteristics and patient-reported outcomes (PROs) of LTLCS. Methods: Cross-sectional study that included patients diagnosed with primary lung cancer between Jan 2012 and Dec 2016 whose overall survival (OS) was greater than 5 years. A self-administered questionnaire was applied, including European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30), Patient Health Questionnaire-4 (PHQ-4) and two open questions regarding quality of life (QoL) and suggestions for improvements. Factors potentially related to QoL were analysed. Results: Of 767 lung cancer patients, 158 (20.6%) were LTLCS and LTLCS' proportion increased yearly. Most patients were male (70.9%) with median age of 65 [interquartile range (IQR), 56-71] years. Fifty-seven percent had adenocarcinoma, 66.2% were diagnosed at early stages but 8.9% were at stage IV. During follow-up, 77.1% quitted smoking, 31.8% had disease progression/relapse and 15.2% developed other tumours. Of all living LTLCS, 100 (85%) patients answered the PROs questionnaire. The median Global Health score was 66.67 (IQR, 50-83), social functioning had the best score and emotional functioning the worst. Pain and fatigue were the symptoms with the worst impact on QoL. PHQ-4 identified mental distress in 36% and patients with a lower QoL were more likely to present anxiety (35.3% vs. 9.4%, P=0.007) or depression (27.9% vs. 3%, P=0.006). In the open questions, patients reported pain (17%), lack of familiar/financial support (16%), dyspnoea (14%), depression (8%), concern for the future (8%) and limitations performing daily activities (8%) as the aspects with most impact in QoL. The most suggested measures were improvement of care provided by health institutions (25%) and better social support (16%). Conclusions: Prevalence of LTLCS is increasing and survivors may experience a high prevalence of anxiety and depression as well as a high disease burden affecting QoL. Therefore, it's important to provide multidisciplinary continuous patient-centred care and a careful follow-up for all lung cancer patients, including LTLCS.

Tracheostomy care for adults and the elderly in the home environment: a scoping review.

OBJECTIVE: To map out scientific knowledge regarding tracheostomy care for adults and the elderly carried out by individuals, famies or caregivers in home environments. METHOD: Scoping review, conducted in February 2023, according to the methodology of the Joanna Briggs Institute. The guiding question was: what and how should adult/elderly tracheostomy care be carried out by the individual/family/caregiver in the home environment? Studies published in Portuguese, English and Spanish were considered. The databases consulted were: Lilacs; Medline, via PubMed; Cinahl; Cochrane Library; PEDro; Embase; Scopus and Web of Science. RESULTS: 2158 articles were identified, of which 81 were read in full and 14 included in the review. The main types of care identified included psychobiological needs: airway suction, changing the tracheostomy attachment, cleaning the endocannula and sanitizing the peristomal skin. As for psychosocial needs, incentives for communication and autonomy were identified. There were no recommendations for care related to psychospiritual needs. CONCLUSION: The findings prioritize biological care, few studies have detailed how to carry out such care at home.

Epidemiological and molecular evidence of intrafamilial transmission through sexual and vertical routes in Bahia, the state with the highest prevalence of HTLV-1 in Brazil.

INTRODUCTION: Familial clustering of HTLV-1 and related diseases has been reported in Brazil. However, intrafamilial transmission of HTLV-1 based on molecular analysis has been studied only in a few communities of Japanese immigrants and African-Brazilians. OBJECTIVE: To investigate the familial clustering of HTLV-1 infection and to determine the likely routes of transmission through epidemiological and genetic analyzes. METHODS: Medical records of 1,759 HTLV-1+ patients from de the Center for HTLV in Salvador, Brazil, were evaluated to identify first-degree relatives previously tested for HTLV-1. Familial clustering was assumed if more than one member of the same family was HTLV-1+. LTR regions of HTLV-1 sequences were analyzed for the presence of intrafamilial polymorphisms. Family pedigrees were constructed and analyzed to infer the likely transmission routes of HTLV-1. RESULTS: In 154 patients at least one other family member had tested positive for HTLV-1 (a total of 182 first-degree relatives). Of the 91 couples (182 individuals), 51.6% were breastfed, and 67.4% reported never using a condom. Of the 42 mother-child pairs, 23.8% had a child aged 13 years or younger; all mothers reported breastfeeding their babies. Pedigrees of families with 4 or more members suggests that vertical transmission is a likely mode of transmission in three families. Three families may have had both vertical and sexual transmission routes for HTLV-1. The genetic signatures of the LTR region of 8 families revealed 3 families with evidence of vertical transmission, another 3 families (spouses) with sexual transmission, and one family with both transmission routes. HTLV-1 sequences belonged to Cosmopolitan subtype HTLV-1a Transcontinental subgroup A. CONCLUSION: Sexual and vertical transmission routes contribute to the intrafamilial spread of HTLV-1 in the state of Bahia.

Portuguese Consensus Recommendations for Next-Generation Sequencing of Lung Cancer, Rare Tumors, and Cancers of Unknown Primary Origin in Clinical Practice.

Next-generation sequencing (NGS) has been implemented in clinical oncology for diagnosis, prognosis, and therapeutic guidance. Among the various NGS applications in molecular oncology, we focused on the following topics: laboratory standards for targeted gene panels (somatic mutations) and therapeutic guidance based on NGS of lung cancer and rare cancers, namely sarcomas and cancers of unknown primary. Multiple quality control checkpoints should be addressed in the pre-analytical phase for good quality and interpretation of the NGS results. It includes tumor size and cellularity, tissue processing and decalcification, tumor fraction, tumor viability, fixatives, and staining. Communication between clinicians and laboratory support is also essential. In lung cancer, all patients with non-squamous non-small cell lung cancer should be tested with a NGS panel, and it should include not only genes with approved targeted therapies (ALK, BRAF, EGFR, MET, NTRK, RET, and ROS1) but also genes with potentially actionable genomic alterations (HER2 and KRAS). Since there is a lack of extensive knowledge regarding the use of NGS in rare tumors performing comprehensive genomic profiling, NGS panels to better manage the disease are recommended. Moreover, other patients with other incurable solid tumors may benefit from being included in biomarker-driven clinical trials. Multidisciplinary tumor boards with the participation of experts with the ability to integrate genomic profiling data are essential to tailor the best strategy for each patient. Considering that there are no national guidelines, this article aims to guide laboratory and clinical practice for the use of NGS in the context of lung cancer, rare tumors, and cancer of unknown primary in Portugal.

Na área da oncologia clínica, a sequenciação de nova geração (NGS) foi implementada com o objetivo de contribuir para o diagnóstico, prognóstico e orientação terapêutica. A utilização de NGS em oncologia molecular é vasta, focalizando-se estas recomendações nas: normas laboratoriais para painéis genéticos direcionados (mutações somáticas) e na orientação terapêutica baseada em NGS de cancro do pulmão e cancros raros, nomeadamente sarcomas e cancros de origem desconhecida. Para que sejam obtidos resultados de NGS com a qualidade que permita a sua correta interpretação, devem ser abordados múltiplos controlos de qualidade na fase pré-analítica que disponibilizem informação sobre o tamanho e celularidade do tumor, processamento e descalcificação de tecidos, fração tumoral, viabilidade do tumor, fixadores e coloração utilizados. A comunicação entre os diferentes intervenientes no processo, em particular entre os clínicos e o laboratório também contribui, de forma inequívoca, para a interpretação dos resultados de NGS. Todos os doentes com cancro do pulmão de não pequenas células não escamoso devem ser testados com um painel de NGS, que deve incluir não só genes com terapias dirigidas aprovadas (ALK, BRAF, EGFR, MET, NTRK, RET e ROS1), mas também genes com alterações genómicas identificadas como potenciais alvos terapêuticos (HER2 e KRAS). Dada a escassez de evidência científica sobre a utilização de NGS em tumores raros, recomenda-se a realização de painéis genómicos abrangentes que poderão contribuir para uma melhor gestão da doença. Adicionalmente, outros doentes, com outros tumores sólidos incuráveis, podem beneficiar da inclusão em ensaios clínicos orientados por biomarcadores. A realização de reuniões multidisciplinares com a participação de diferentes especialistas capazes de integrar dados dos perfis genómicos são fundamentais para a escolha da melhor estratégia para cada doente. Considerando que não existem recomendações nacionais, este artigo visa orientar a prática laboratorial e clínica para a utilização de NGS em tumores do pulmão, raros e cancros de origem primária desconhecida em Portugal.

Integrative and Multidisciplinary Care for People Living With Human T-Cell Lymphotropic Virus in Bahia, Brazil: 20 Years of Experience.

Brazil is home to the highest absolute number of human T-cell lymphotropic virus type-1 (HTLV-1)-infected individuals worldwide; the city of Salvador, Bahia, has the highest prevalence of HTLV-1 infection in Brazil. Due to the complex nature of several diseases associated with this retrovirus, a multidisciplinary health care approach is necessary to care for people living with HTLV-1. The Bahia School of Medicine and Public Health's Integrative Multidisciplinary HTLV Center (CHTLV) has been providing support to people living with HTLV and their families since 2002, striving to ensure physical and mental well-being by addressing biopsychosocial aspects, providing clinical care and follow-up, including to pregnant/postpartum women, as well as comprehensive laboratory diagnostics, psychological therapy, and counseling to family members. To date, CHTLV has served a total of 2,169 HTLV-infected patients. The average patient age is 49.8 (SD 15.9) years, 70.3% are female, most are considered low-income and have low levels of education. The majority (98.9%) are HTLV-1 cases, and approximately 10% have been diagnosed with tropical spastic paraparesis/HTLV-1-associated myelopathy (TSP/HAM), while 2.2% have infective dermatitis and 1.1% have adult T-cell lymphoma. In all, 178 pregnant/postpartum women [mean age: 32.7 (±6.5) years] have received care at CHTLV. Regarding vertical transmission, 53% of breastfed infants screened for HTLV tested positive in their second year of life, nearly 18 times the rate found in non-breastfed infants. This article documents 20 years of experience in implementing an integrative and multidisciplinary care center for people living with HTLV in Bahia, Brazil. Still, significant challenges remain regarding infection control, and HTLV-infected individuals continue to struggle with the obtainment of equitable and efficient healthcare.

Detection of early seeding of Richter transformation in chronic lymphocytic leukemia.

Richter transformation (RT) is a paradigmatic evolution of chronic lymphocytic leukemia (CLL) into a very aggressive large B cell lymphoma conferring a dismal prognosis. The mechanisms driving RT remain largely unknown. We characterized the whole genome, epigenome and transcriptome, combined with single-cell DNA/RNA-sequencing analyses and functional experiments, of 19 cases of CLL developing RT. Studying 54 longitudinal samples covering up to 19 years of disease course, we uncovered minute subclones carrying genomic, immunogenetic and transcriptomic features of RT cells already at CLL diagnosis, which were dormant for up to 19 years before transformation. We also identified new driver alterations, discovered a new mutational signature (SBS-RT), recognized an oxidative phosphorylation (OXPHOS)high-B cell receptor (BCR)low-signaling transcriptional axis in RT and showed that OXPHOS inhibition reduces the proliferation of RT cells. These findings demonstrate the early seeding of subclones driving advanced stages of cancer evolution and uncover potential therapeutic targets for RT.

Peripheral blood eosinophilia may be a prognostic biomarker in non-small cell lung cancer patients treated with immunotherapy.

BACKGROUND: Eosinophils have been traditionally associated with the initiation and propagation of inflammatory responses, particularly in allergic diseases and helminth infections. More recently, an association between eosinophils and cancer has been the focus of several studies, but controversial results have emerged. This study aims to evaluate the prognostic role of peripheral blood eosinophilia in non-small cell lung cancer (NSCLC) patients receiving immunotherapy (IO). We also evaluated the impact of peripheral eosinophilia on the occurrence of immune-related adverse effects (irAEs). METHODS: Advanced NSCLC patients under IO were included in a retrospective single-center study. Peripheral blood eosinophilia was defined by a count greater than 500/µL. Patients were analyzed for eosinophil counts, overall survival (OS), progression-free survival (PFS), overall response rate (ORR) and disease control rate (DCR). RESULTS: A total of 121 NSCLC patients receiving IO were included. Thirty-three (27.3%) patients presented peripheral blood eosinophilia during treatment. Patients with peripheral eosinophilia presented more frequently non-progression as best overall response to IO (83.3% vs. 58.1%, P=0.014), higher median OS (26.6 vs. 9.5 months, P=0.022) and higher median PFS (13.8 vs. 4.6 months, P=0.013). IrAEs were more common in patients with peripheral eosinophilia (66.7% vs. 36.4%, P=0.003). CONCLUSIONS: This study suggests that peripheral blood eosinophilia may predict better outcomes in NSCLC patients receiving IO, despite being associated with an increased risk of irAEs. According to our findings eosinophils may be involved in immune response against tumor. Routine eosinophils count assessment may be an additional prognostic tool in NSCLC patients receiving IO.

Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia: A Clinical Case.

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare pulmonary condition characterized by diffuse proliferation of neuroendocrine cells in the epithelium of the bronchial wall. DIPNECH may be easily missed in daily clinical practice and diagnosis is often delayed, which may impair prognosis since this condition is considered a pre-invasive lesion for lung carcinoid tumours. We report a clinical case of DIPNECH in order to discuss the diagnostic and therapeutic approach for this entity, the management of which is not yet well established in the literature. LEARNING POINTS: DIPNECH is a poorly understood lung condition characterized histologically by diffuse proliferation of pulmonary neuroendocrine cells in the bronchial wall, clinically by obstructive respiratory symptoms and radiologically by small airway disease features and pulmonary nodules.DIPNECH is considered to be a preneoplastic lesion within the spectrum of pulmonary neuroendocrine tumours.Treatment is usually guided by the symptoms and prognosis is highly variable.

Pan-cancer analysis of whole genomes identifies driver rearrangements promoted by LINE-1 retrotransposition.

About half of all cancers have somatic integrations of retrotransposons. Here, to characterize their role in oncogenesis, we analyzed the patterns and mechanisms of somatic retrotransposition in 2,954 cancer genomes from 38 histological cancer subtypes within the framework of the Pan-Cancer Analysis of Whole Genomes (PCAWG) project. We identified 19,166 somatically acquired retrotransposition events, which affected 35% of samples and spanned a range of event types. Long interspersed nuclear element (LINE-1; L1 hereafter) insertions emerged as the first most frequent type of somatic structural variation in esophageal adenocarcinoma, and the second most frequent in head-and-neck and colorectal cancers. Aberrant L1 integrations can delete megabase-scale regions of a chromosome, which sometimes leads to the removal of tumor-suppressor genes, and can induce complex translocations and large-scale duplications. Somatic retrotranspositions can also initiate breakage-fusion-bridge cycles, leading to high-level amplification of oncogenes. These observations illuminate a relevant role of L1 retrotransposition in remodeling the cancer genome, with potential implications for the development of human tumors.

Description and management of cutaneous side effects during erlotinib and cetuximab treatment in lung and colorectal cancer patients: a prospective and descriptive study of 19 patients.

Erlotinib and cetuximab are human epidermal growth factor receptor inhibitors (EGFRI) that are approved in monotherapy for the treatment of patients with locally advanced or metastatic non-small cell lung cancer after failure of at least one prior chemotherapy regimen. Papulopustular eruptions are the most frequent adverse effect, their occurrence being associated with increased survival in some studies. We describe 19 patients who presented with a rash located mainly to the face and trunk, without presence of comedones, shortly after initiation of EGFRI therapy. We present our algorithm to manage these patients and their respective responses. We also report other therapeutic options and cutaneous alterations that may be seen.

Nivolumab-induced hypothyroidism followed by isolated ACTH deficiency.

Cancer immunotherapy has been used in several malignancies with clinical benefit. Despite the clinical success, immune-related adverse events are frequent and endocrinopathies can be particularly severe. We report a 55-year-old male patient with stage IV pulmonary carcinoma treated with nivolumab who presented with thyroid dysfunction after the sixth administration of the drug. One year after thyroid dysfunction, the patient complained of severe fatigue, asthenia and weight loss. Laboratory testing showed low morning cortisol with undetected adrenocorticotropic hormone; other pituitary hormones were normal and MRI showed homogeneous enhancement of the pituitary gland and no space-occupying lesions. The diagnosis of nivolumab-induced hypophysitis was made and replacement treatment with hydrocortisone was started with clinical improvement. This case demonstrates that patients under immunotherapy are at risk for a large spectrum of endocrine dysfunctions that may worsen their prognosis. Close monitoring of these patients is warranted.

Pulmonary cement embolism following balloon kyphoplasty: The impact of a procedural complication in a new era for lung cancer management.

Pulmonary cement embolism (PCE) is a recognized complication of balloon kyphoplasty, a vertebral augmentation technique that stabilizes vertebral compression fractures, alleviating associated pain. Balloon kyphoplasty is particularly relevant when patients with advanced stages of cancer present with longer survival times, and therefore benefit from such augmentation techniques to improve pain and prevent additional complications. The embolization of cement to pulmonary vasculature may be unnoticed given the frequent absence of symptoms and routine imaging tests following the procedure. The present study reports the case of a 58-year-old female with stage IV lung cancer with a painful compression L3 fracture who underwent balloon kyphoplasty with no initially reported complications. The patient maintained the usual respiratory symptoms; therefore, the diagnosis was only made in a routine CT scan 3 months after the surgery. A literature review of PCE is performed, integrating the current evidence regarding diagnosis, therapeutics, prognosis and prevention. Certain poorly clarified aspects are identified as potential investigation starting points.

Tracheostomy care for adults and the elderly in the home environment: a scoping review / Cuidados de traqueostomía para adultos y ancianos en el entorno domiciliario: una revisión de alcance / Cuidados com traqueostomia em adultos e idosos no ambiente domiciliar: revisão de escopo

ABSTRACT Objective: To map out scientific knowledge regarding tracheostomy care for adults and the elderly carried out by individuals, famies or caregivers in home environments. Method: Scoping review, conducted in February 2023, according to the methodology of the Joanna Briggs Institute. The guiding question was: what and how should adult/elderly tracheostomy care be carried out by the individual/family/caregiver in the home environment? Studies published in Portuguese, English and Spanish were considered. The databases consulted were: Lilacs; Medline, via PubMed; Cinahl; Cochrane Library; PEDro; Embase; Scopus and Web of Science. Results: 2158 articles were identified, of which 81 were read in full and 14 included in the review. The main types of care identified included psychobiological needs: airway suction, changing the tracheostomy attachment, cleaning the endocannula and sanitizing the peristomal skin. As for psychosocial needs, incentives for communication and autonomy were identified. There were no recommendations for care related to psychospiritual needs. Conclusion: The findings prioritize biological care, few studies have detailed how to carry out such care at home.

RESUMEN Objetivo: Mapear el conocimiento científico sobre cuidados de traqueostomía para adultos y ancianos realizados por individuos, familias o cuidadores en el entorno domiciliario. Método: Revisión exploratoria, realizada en febrero de 2023, según la metodología del Instituto Joanna Briggs. La pregunta-guía fue: ¿qué y cómo debe ser realizado el cuidado de la traqueostomía del adulto/anciano por el individuo/familia/cuidador en el ambiente domiciliario? Se consideraron estudios publicados en portugués, inglés y español. Las bases de datos consultadas fueron: Lilacs; Medline, vía PubMed; Cinahl; Cochrane Library; PEDro; Embase; Scopus y Web of Science. Resultados: Se identificaron 2158 artículos, de los cuales 81 fueron leídos en su totalidad y 14 incluidos en la revisión. Los principales tipos de cuidados identificados incluyeron necesidades psicobiológicas: succión de la vía aérea, cambio del accesorio de traqueostomía, limpieza de la endocánula e higienización de la piel periestomal. En cuanto a las necesidades psicosociales, se identificaron incentivos para la comunicación y la autonomía. No hubo recomendaciones para los cuidados relacionados con las necesidades psicoespirituales. Conclusión: Los hallazgos priorizan los cuidados biológicos y pocos estudios han detallado cómo llevar a cabo dichos cuidados en el domicilio.

RESUMO Objetivo: Mapear o conhecimento científico sobre cuidados com a traqueostomia de adultos e idosos realizados pelo indivíduo, família ou cuidador no ambiente domiciliar. Método: Revisão de Escopo, conduzida em fevereiro de 2023, segundo a metodologia do Joanna Briggs Institute. A questão norteadora foi: quais e como devem ser realizados os cuidados com a traqueostomia de adultos/idosos conduzidos pelo indivíduo/família/cuidador no ambiente domiciliar? Foram considerados estudos publicados em português, inglês e espanhol. As bases de dados consultadas foram: Lilacs; Medline, via PubMed; Cinahl; Cochrane Library; PEDro; Embase; Scopus e Web of Science. Resultados: Foram identificados 2158 artigos, dos quais 81 foram lidos na íntegra e 14 incluídos na revisão. Os principais cuidados identificados contemplavam necessidades psicobiológicas: aspiração de vias aéreas, troca de fixação da traqueostomia, limpeza da endocânula e higienização da pele periestomal. Quanto às necessidades psicossociais foram identificados: incentivos à comunicação e à autonomia. Não houve recomendações de cuidados relativos às necessidades psicoespirituais. Conclusão: Os achados priorizam cuidados biológicos e poucos estudos apresentaram o detalhamento sobre como realizar tais cuidados no domicílio.

Treatment of advanced non small cell lung cancer with erlotinib. Two clinical cases. / Erlotinib no tratamento do carcinoma pulmonar de não pequenas células, doença avançada. A propósito de dois casos clínicos.

Early studies with tirosine kinase inhibitors (TKI), namely Erlotinib and Gefitinib, in patients with non small cell lung cancer (NSCLC), showed that although most patients did not respond radiologically, a small percentage of those patients (about 10%) had an excellent response to treatment, with radiological regression and clinical response duration. Four patient populations are known as having better response to TKI as opposed to other patients: adenocarcinoma patients, non-smokers, women and asians. Nevertheless, a good general status remains a predictive factor for treatment response. The discovery of the EGFR mutation in NSCLC patients' tumors and its association with clinical response to Erlotinib and Gefitinib, confirmed by a considerable number of retrospective and prospective studies, showed that response rates are between 75-80% in patients carrying this mutation. Although several mutations have been identified, the two commonest (approximately 90%) are located in exons 19 and 21. The authors present two patients studied and treated at the Pulmonology Department's Lung Oncology Unit of CHVNGaia, where Erlotinib was used as 3(rd) line treatment: in one patient, which was part of the population with good response to TKI, a classic exon 19 was identified, and was treated with Erlotinib for twenty months with clinical stability; the other patient did not belong to the above mentioned population and an Exon 20 mutation was identified (a mutation not yet described in literature, being not clear its association with response to treatment with TKI) - treatment was stopped after 7.4months due to disease progression. Rev Port Pneumol 2008; XIV (Supl 3): S43-S51.

Subcutaneous metastasis of a pulmonary carcinoid tumor: A case report.

RATIONALE: Carcinoid tumors are derived from neuroendocrine cells and are most frequently found in the gastrointestinal tract and bronchopulmonary system. They are generally characterized by an indolent clinical course but may in some instances spread to regional lymph nodes or to distant sites. Subcutaneous metastases of carcinoid tumors are extremely rare; there are only few cases reported in the literature and the site of the primary tumor was mainly the gastrointestinal tract. Also, the diagnosis of this type of lesions many years after the surgical resection of the pulmonary carcinoid (PC) could be a challenge for clinicians. PATIENT CONCERNS: A nonsmoker woman diagnosed with a atypical carcinoid stage IA2 maintained follow-up at our institution. Seven years later she incidentally detected a subcutaneous nodular lesion in the lumbar region. DIAGNOSES: A positron emission tomography-computed tomography (PET/CT) was performed and showed pathological uptake of the refered lesion. An excisional biopsy was performed and with the support of immunohistochemistry the diagnosis of a subcutaneous metastasis from a pulmonary atypical carcinoid was made. INTERVENTIONS: The patient initiated chemotherapy with carboplatin plus etoposide and complied 4 cycles of treatment. OUTCOMES: She maintained tight follow-up at our center and for 12 months there were no signs of relapse. LESSONS: This extremely rare case highlights the difficulties in the differential diagnosis and the importance of diagnostic tests as PET/CT and immunohistochemistry in the establishment of a diagnosis. Physicians should be aware of signs of skin metastasis from lung malignancies even if the prognosis is good or many years have passed since the surgical resection.