Image Findings of Rare Case of Peritoneal Carcinomatosis from Non Small Cell Lung Cancer and Response to Erlotinib in F-18 FDG Positron Emission Tomography/Computed Tomography

Therapeutic Strategies and Oncological Outcome of Peritoneal Metastases from Lung Cancer: A Systematic Review and Pooled Analysis

The peritoneum is an unusual site of metastases from lung cancer, and optimal management at the moment remains unclear and mostly based on palliative strategies. Therefore, the aim of the study was to investigate demographic characteristics, management and overall survival of patients with peritoneal metastases from lung cancer (PCLC). A PRISMA-compliant systematic review and pooled analysis was performed searching all English studies published until December 2022. PROSPERO, CRD42022349362. Inclusion criteria were original articles including patients with peritoneal carcinomatosis from lung cancer, specifying at least one outcome of interest. Exclusion criteria were being unable to retrieve patient data from articles, and the same patient series included in different studies. Among 1746 studies imported for screening, twenty-one were included (2783 patients). Mean overall survival was between 0.5 and 5 months after peritoneal carcinomatosis diagnosis and 9 and 21 months from lung cancer diagnosis. In total, 27% of patients underwent first-line or palliative chemotherapy and 7% of them surgery. Management differs significantly among published studies. The literature on PCLC is scarce. Its incidence is low but appears to be substantially rising and is likely to be an underestimation. Prognosis is very poor and therapeutic strategies have been limited and used in a minority of patients. Subcategories of PCLC patients may have an improved prognosis and may benefit from an aggressive oncological approach, including cytoreductive surgery. Further investigation would be needed in this regard.

Application of radiography of computed tomography in non-small cell lung cancer using prognosis model

Objective

Studying the diagnostic value of CT imaging in non-small cell lung cancer (NSCLC), and establishing a prognosis model combined with clinical characteristics is the objective, so as to provide a reference for the survival prediction of NSCLC patients.

Method

CT scan data of NSCLC 200 patients were taken as the research object. Through image segmentation, the radiology features of CT images were extracted. The reliability and performance of the prognosis model based on the optimal feature number of specific algorithm and the prognosis model based on the global optimal feature number were compared.

Results

30-RELF-NB (30 optimal features, RELF feature selection algorithm and NB classifier) has the highest accuracy and AUC (area under the subject characteristic curve) in the prognosis model based on the optimal features of specific algorithm. Among the prognosis models based on global optimal features, 25-NB (25 global optimal features, naive Bayes classification algorithm classifier) has the highest accuracy and AUC. Compared with the prediction model based on feature training of specific feature selection algorithm, the overall performance and stability of the prediction model based on global optimal feature are higher.

Conclusion

The prognosis model based on the global optimal feature established in this paper has good reliability and performance, and can be applied to the CT radiology of NSCLC.

Clinical efficacy of concurrent bevacizumab for malignant ascites in nonsquamous cell carcinoma of the lung

PURPOSE

Lung cancer with malignant peritoneal carcinomatosis and malignant ascites is rare, often indicates the terminal stage, and is refractory to treatment. The median survival time of lung cancer patients with malignant ascites has been reported to be as short as 15 days to 2 months in retrospective studies.

METHODS

We reviewed all lung cancer patients who had cytologically or pathologically proven malignant ascites and received aggressive therapy including chemotherapy, anti-angiogenesis agents and target therapy at a Taiwan hospital from January 2015 to December 2017. In addition, we searched PubMed using the terms "lung cancer," "peritoneal carcinomatosis" and "malignant ascites" to find other studies reporting experience of such treatment.

RESULTS

Three consecutive lung cancer patients with malignant ascites (3/265, 1.13%) were included in this case series study, all of whom received bevacizumab with three other drugs (erlotinib, afatinib and gemcitabine). All of the patients showed a good response to treatment with a marked decrease in ascites. Two of the patients had a long progression-free survival time of more than 5 months. In the literature review, several cases reports and case series documented the treatment efficacy, however no prospective or retrospective studies reported treatment strategies.

CONCLUSIONS

Aggressive treatment for lung cancer with malignant ascites is encouraged when possible. Bevacizumab-based treatment may serve as one effective treatment strategy for non-squamous cell lung carcinoma with malignant ascites. Further prospective trials are urgently needed.