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Joosten PJ, Winkelman TA, Heineman DJ, Hashemi SM, Bahce I, Senan S, Paul MA, Hartemink KJ, Dahele M, Dickhoff C. Salvage Surgery for Patients With Local Recurrence or Persistent Disease After Treatment With Chemoradiotherapy for SCLC. JTO Clin Res Rep 2021; 2:100172. [PMID: 34590022 PMCID: PMC8474289 DOI: 10.1016/j.jtocrr.2021.100172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/28/2021] [Accepted: 04/01/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction The role of salvage surgery for patients with locoregional (LR) recurrence or persistent SCLC after radical chemoradiotherapy (CRT) for limited-stage disease is not well established. We evaluated our experience. Methods We conducted a retrospective study of consecutive patients who underwent salvage pulmonary resection for LR-recurrent or persistent SCLC between 2008 and 2020 at the Amsterdam University Medical Center. Results A total of 10 patients were identified. Median age at initial diagnosis of limited-stage SCLC was 58.5 years (48-71 y). All patients had radical-intent concurrent CRT. Of the 10 patients, 9 were diagnosed with LR-recurrent or persistent disease with a median of 18 months (3-78 y) after CRT. All patients underwent an anatomical radical resection and mediastinal lymph node dissection. No 90-day mortality was recorded. In addition, one patient developed a LR recurrence 7 months after resection. Distant progression was found in three patients at 6, 32, and 61 months after surgery, all of whom subsequently died of progressive SCLC. Median follow-up was 22.5 months (2-86 mos). Disease-free survival was 34 months; overall survival was not reached. Conclusions For highly selected patients with LR-recurrent or persistent SCLC after CRT, salvage surgery is feasible and can result in clinically meaningful survival. Such patients should be presented to the multidisciplinary tumor board.
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Affiliation(s)
- Pieter J.M. Joosten
- Department of Surgery, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
- Department of Surgery, Netherlands Cancer Institute—Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Toon A. Winkelman
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
| | - David J. Heineman
- Department of Surgery, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
| | - Sayed M.S. Hashemi
- Department of Pulmonary Medicine, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
| | - Idris Bahce
- Department of Pulmonary Medicine, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
| | - Marinus A. Paul
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
| | - Koen J. Hartemink
- Department of Surgery, Netherlands Cancer Institute—Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Max Dahele
- Department of Radiation Oncology, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
| | - Chris Dickhoff
- Department of Surgery, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, location VUmc Cancer Amsterdam, Amsterdam, The Netherlands
- Corresponding author. Address for correspondence: Chris Dickhoff, MD, PhD, Department Cardiothoracic Surgery, Amsterdam University Medical Center, location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, The Netherlands.
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Winkelman JA, van der Woude L, Heineman DJ, Bahce I, Damhuis RA, Mahtab EAF, Hartemink KJ, Senan S, Maat APWM, Braun J, Paul MA, Dahele M, Dickhoff C. A nationwide population-based cohort study of surgical care for patients with superior sulcus tumors: Results from the Dutch Lung Cancer Audit for Surgery (DLCA-S). Lung Cancer 2021; 161:42-48. [PMID: 34509720 DOI: 10.1016/j.lungcan.2021.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/19/2021] [Accepted: 08/29/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Data on national patterns of care for patients with superior sulcus tumors (SST) is currently lacking. We investigated the distribution of surgical care and outcome for patients with SST in the Netherlands. MATERIAL AND METHODS Data was retrieved from the Dutch Lung Cancer Audit for Surgery (DLCA-S) for all patients undergoing resection for clinical stage IIB-IV SST from 2012 to 2019. Because DLCA-S is not linked to survival data, survival for a separate cohort (2015-2017) was obtained from the Netherlands Cancer Registry (NCR). RESULTS In the study period, 181 patients had SST surgery, representing 1.03% (181/17488) of all lung cancer pulmonary resections. For 2015-2017, the SST resection rate was 14.4% (79/549), and patients with stage IIB/III SST treated with trimodality had a 3-year overall survival of 67.4%. 63.5% of patients were male, and median age was 60 years. Almost 3/4 of tumors were right sided. Surgery was performed in 20 hospitals, with average number of annual resections ranging from ≤ 1 (n = 17) to 9 (n = 1). 39.8% of resections were performed in 1 center and 63.5% in the 3 most active centers. 12.7% of resections were extended (e.g. vertebral resection). 85.1% of resections were complete (R0). Morbidity and 30-day mortality were 51.4% and 3.3% respectively. Despite treating patients with a higher ECOG performance score and more extended resections, the highest volume center had rates of morbidity/mortality, and length of hospital stay that were comparable to those of the medium volume (n = 2) and low-volume centers (n = 1). CONCLUSION In the Netherlands, surgery for SST accounts for about 1% of all lung cancer pulmonary resections, the number of SST resections/hospital/year varies widely, with most centers performing an average of ≤ 1/year. Morbidity and mortality are acceptable and survival compares favourably with the literature. Although further centralisation is possible, it is unknown whether this will improve outcomes.
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Affiliation(s)
- J A Winkelman
- Department of Cardiothoracic Surgery, the Netherlands.
| | - L van der Woude
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Postbus 9101, 6500 HB Nijmegen, the Netherlands; Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333 AA Leiden, the Netherlands
| | - D J Heineman
- Department of Cardiothoracic Surgery, the Netherlands; Surgery, the Netherlands
| | - I Bahce
- Pulmonary Diseases, Amsterdam University Medical Center, Location VUmc, Cancer Center Amsterdam, de Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - R A Damhuis
- Department of Research, Netherlands Comprehensive Cancer Organization, Godebaldkwartier 419, 3511DT Utrecht, the Netherlands
| | - E A F Mahtab
- Department of Cardiothoracic Surgery, Erasmus Medical Center Rotterdam, Postbus 2040, 3000 CA Rotterdam, the Netherlands
| | - K J Hartemink
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - S Senan
- Radiation Oncology, the Netherlands
| | - A P W M Maat
- Department of Cardiothoracic Surgery, Erasmus Medical Center Rotterdam, Postbus 2040, 3000 CA Rotterdam, the Netherlands
| | - J Braun
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Albinusdreef 2, Postbus 9600, 2300 RC Leiden, the Netherlands
| | - M A Paul
- Department of Cardiothoracic Surgery, the Netherlands
| | - M Dahele
- Radiation Oncology, the Netherlands
| | - C Dickhoff
- Department of Cardiothoracic Surgery, the Netherlands; Surgery, the Netherlands
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Welvaart WN, Becker A, Zandbergen HR, Paul MA. Platypnoea-orthodeoxia due to cardiac compression is best treated by plication of the paralysed diaphragm. Eur J Cardiothorac Surg 2020; 58:659-663. [PMID: 32285093 DOI: 10.1093/ejcts/ezaa112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 03/10/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Willem N Welvaart
- Department of Surgery, Meander Medical Center, Amersfoort, Netherlands.,Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Annemarie Becker
- Department of Pulmonology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Harmen R Zandbergen
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Marinus A Paul
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
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Lindqvist J, van den Berg M, van der Pijl R, Hooijman PE, Beishuizen A, Elshof J, de Waard M, Girbes A, Spoelstra-de Man A, Shi ZH, van den Brom C, Bogaards S, Shen S, Strom J, Granzier H, Kole J, Musters RJP, Paul MA, Heunks LMA, Ottenheijm CAC. Positive End-Expiratory Pressure Ventilation Induces Longitudinal Atrophy in Diaphragm Fibers. Am J Respir Crit Care Med 2018; 198:472-485. [PMID: 29578749 PMCID: PMC6118031 DOI: 10.1164/rccm.201709-1917oc] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 03/26/2018] [Indexed: 01/11/2023] Open
Abstract
RATIONALE Diaphragm weakness in critically ill patients prolongs ventilator dependency and duration of hospital stay and increases mortality and healthcare costs. The mechanisms underlying diaphragm weakness include cross-sectional fiber atrophy and contractile protein dysfunction, but whether additional mechanisms are at play is unknown. OBJECTIVES To test the hypothesis that mechanical ventilation with positive end-expiratory pressure (PEEP) induces longitudinal atrophy by displacing the diaphragm in the caudal direction and reducing the length of fibers. METHODS We studied structure and function of diaphragm fibers of mechanically ventilated critically ill patients and mechanically ventilated rats with normal and increased titin compliance. MEASUREMENTS AND MAIN RESULTS PEEP causes a caudal movement of the diaphragm, both in critically ill patients and in rats, and this caudal movement reduces fiber length. Diaphragm fibers of 18-hour mechanically ventilated rats (PEEP of 2.5 cm H2O) adapt to the reduced length by absorbing serially linked sarcomeres, the smallest contractile units in muscle (i.e., longitudinal atrophy). Increasing the compliance of titin molecules reduces longitudinal atrophy. CONCLUSIONS Mechanical ventilation with PEEP results in longitudinal atrophy of diaphragm fibers, a response that is modulated by the elasticity of the giant sarcomeric protein titin. We postulate that longitudinal atrophy, in concert with the aforementioned cross-sectional atrophy, hampers spontaneous breathing trials in critically ill patients: during these efforts, end-expiratory lung volume is reduced, and the shortened diaphragm fibers are stretched to excessive sarcomere lengths. At these lengths, muscle fibers generate less force, and diaphragm weakness ensues.
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Affiliation(s)
- Johan Lindqvist
- Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona
| | | | - Robbert van der Pijl
- Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona
- Department of Physiology
| | | | - Albertus Beishuizen
- Department of Intensive Care, Medisch Spectrum Twente, Enschede, the Netherlands; and
| | | | | | | | | | - Zhong-Hua Shi
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
| | | | | | - Shengyi Shen
- Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona
| | - Joshua Strom
- Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona
| | - Henk Granzier
- Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona
| | | | | | - Marinus A. Paul
- Department of Cardiothoracic Surgery, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | | | - Coen A. C. Ottenheijm
- Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona
- Department of Physiology
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Dickhoff C, Hashemi SMS, Symersky P, Paul MA, Dahele M. [Salvage surgery for locally recurrent lung cancer: options for patients who have been treated with high dose radiotherapy]. Ned Tijdschr Geneeskd 2018; 162:D2826. [PMID: 30040314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A combination of chemotherapy and high dose radiotherapy is the cornerstone of the treatment of locally-advanced non-small cell lung cancer (NSCLC). For selected patients with early stage NSCLC, stereotactic body radiation therapy (SBRT, also known as SABR, stereotactic ablative radiotherapy) is a good option. Unfortunately, metastases can occur in patients following these treatments. However, in some patients, the recurrence remains localized to the previous irradiated area, so-called local recurrence. For selected patients with such a recurrence, radical salvage surgery - a treatment modality with curative intent - is an option. In this article we describe two patients with local recurrence after high dose radiotherapy, who were subsequently treated operatively. We also discuss which subset of lung cancer patients should be selected for this type of surgery.
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Affiliation(s)
- Chris Dickhoff
- VU medisch centrum, afd. Cardiothoracale Chirurgie en Heelkunde, Amsterdam
- Contact: C. Dickhoff
| | | | - Petr Symersky
- VU medisch centrum, afd. Cardiothoracale Chirurgie, Amsterdam
| | - Marinus A Paul
- VU medisch centrum, afd. Cardiothoracale Chirurgie, Amsterdam
| | - Max Dahele
- VU medisch centrum, afd. Radiotherapie, Amsterdam
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6
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van den Berg M, Hooijman PE, Beishuizen A, de Waard MC, Paul MA, Hartemink KJ, van Hees HWH, Lawlor MW, Brocca L, Bottinelli R, Pellegrino MA, Stienen GJM, Heunks LMA, Wüst RCI, Ottenheijm CAC. Diaphragm Atrophy and Weakness in the Absence of Mitochondrial Dysfunction in the Critically Ill. Am J Respir Crit Care Med 2017; 196:1544-1558. [PMID: 28787181 DOI: 10.1164/rccm.201703-0501oc] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
RATIONALE The clinical significance of diaphragm weakness in critically ill patients is evident: it prolongs ventilator dependency and increases morbidity, duration of hospital stay, and health care costs. The mechanisms underlying diaphragm weakness are unknown, but might include mitochondrial dysfunction and oxidative stress. OBJECTIVES We hypothesized that weakness of diaphragm muscle fibers in critically ill patients is accompanied by impaired mitochondrial function and structure, and by increased markers of oxidative stress. METHODS To test these hypotheses, we studied contractile force, mitochondrial function, and mitochondrial structure in diaphragm muscle fibers. Fibers were isolated from diaphragm biopsies of 36 mechanically ventilated critically ill patients and compared with those isolated from biopsies of 27 patients with suspected early-stage lung malignancy (control subjects). MEASUREMENTS AND MAIN RESULTS Diaphragm muscle fibers from critically ill patients displayed significant atrophy and contractile weakness, but lacked impaired mitochondrial respiration and increased levels of oxidative stress markers. Mitochondrial energy status and morphology were not altered, despite a lower content of fusion proteins. CONCLUSIONS Critically ill patients have manifest diaphragm muscle fiber atrophy and weakness in the absence of mitochondrial dysfunction and oxidative stress. Thus, mitochondrial dysfunction and oxidative stress do not play a causative role in the development of atrophy and contractile weakness of the diaphragm in critically ill patients.
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Affiliation(s)
| | | | - Albertus Beishuizen
- 2 Department of Intensive Care, Medisch Spectrum Twente, Enschede, the Netherlands
| | | | - Marinus A Paul
- 4 Department of Cardiothoracic Surgery, Vrije Universiteit (VU) University Medical Center, Amsterdam, the Netherlands
| | - Koen J Hartemink
- 5 Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | | | - Michael W Lawlor
- 7 Division of Pediatric Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Roberto Bottinelli
- 8 Department of Molecular Medicine.,10 Interdepartmental Center for Biology and Sport Medicine, and.,9 Fondazione Salvatore Maugeri (IRCCS), Scientific Institute of Pavia, Pavia, Italy
| | - Maria A Pellegrino
- 8 Department of Molecular Medicine.,10 Interdepartmental Center for Biology and Sport Medicine, and.,11 Interuniversity Institute of Myology, University of Pavia, Pavia, Italy
| | - Ger J M Stienen
- 1 Department of Physiology, Amsterdam Cardiovascular Sciences.,12 Faculty of Science, Department of Physics and Astronomy, VU Amsterdam, Amsterdam, the Netherlands
| | | | - Rob C I Wüst
- 1 Department of Physiology, Amsterdam Cardiovascular Sciences.,13 Laboratory Genetic Metabolic Diseases, Academic Medical Center, Amsterdam, the Netherlands; and
| | - Coen A C Ottenheijm
- 1 Department of Physiology, Amsterdam Cardiovascular Sciences.,14 Department of Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona
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7
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Dickhoff C, Dahele M, Hashemi SM, Senan S, Smit EF, Hartemink KJ, Paul MA. Surgical Treatment of Complications After High-Dose Chemoradiotherapy for Lung Cancer. Ann Thorac Surg 2017; 104:436-442. [DOI: 10.1016/j.athoracsur.2017.02.055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 02/06/2017] [Accepted: 02/13/2017] [Indexed: 11/26/2022]
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Szulcek R, Happé CM, Rol N, Fontijn RD, Dickhoff C, Hartemink KJ, Grünberg K, Tu L, Timens W, Nossent GD, Paul MA, Leyen TA, Horrevoets AJ, de Man FS, Guignabert C, Yu PB, Vonk-Noordegraaf A, van Nieuw Amerongen GP, Bogaard HJ. Delayed Microvascular Shear Adaptation in Pulmonary Arterial Hypertension. Role of Platelet Endothelial Cell Adhesion Molecule-1 Cleavage. Am J Respir Crit Care Med 2017; 193:1410-20. [PMID: 26760925 DOI: 10.1164/rccm.201506-1231oc] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
RATIONALE Altered pulmonary hemodynamics and fluid flow-induced high shear stress (HSS) are characteristic hallmarks in the pathogenesis of pulmonary arterial hypertension (PAH). However, the contribution of HSS to cellular and vascular alterations in PAH is unclear. OBJECTIVES We hypothesize that failing shear adaptation is an essential part of the endothelial dysfunction in all forms of PAH and tested whether microvascular endothelial cells (MVECs) or pulmonary arterial endothelial cells (PAECs) from lungs of patients with PAH adapt to HSS and if the shear defect partakes in vascular remodeling in vivo. METHODS PAH MVEC (n = 7) and PAH PAEC (n = 3) morphology, function, protein, and gene expressions were compared with control MVEC (n = 8) under static culture conditions and after 24, 72, and 120 hours of HSS. MEASUREMENTS AND MAIN RESULTS PAH MVEC showed a significantly delayed morphological shear adaptation (P = 0.03) and evidence of cell injury at sites of nonuniform shear profiles that are critical loci for vascular remodeling in PAH. In clear contrast, PAEC isolated from the same PAH lungs showed no impairments. PAH MVEC gene expression and transcriptional shear activation were not altered but showed significant decreased protein levels (P = 0.02) and disturbed interendothelial localization of the shear sensor platelet endothelial cell adhesion molecule-1 (PECAM-1). The decreased PECAM-1 levels were caused by caspase-mediated cytoplasmic cleavage but not increased cell apoptosis. Caspase blockade stabilized PECAM-1 levels, restored endothelial shear responsiveness in vitro, and attenuated occlusive vascular remodeling in chronically hypoxic Sugen5416-treated rats modeling severe PAH. CONCLUSIONS Delayed shear adaptation, which promotes shear-induced endothelial injury, is a newly identified dysfunction specific to the microvascular endothelium in PAH. The shear response is normalized on stabilization of PECAM-1, which reverses intimal remodeling in vivo.
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Affiliation(s)
| | | | - Nina Rol
- 1 Department of Pulmonology.,2 Department of Physiology
| | | | | | | | - Katrien Grünberg
- 5 Department of Pathology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Ly Tu
- 6 INSERM UMR_S 999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France.,7 Université Paris-Sud, School of Médecine, Le Kremlin-Bicêtre, Paris, France
| | - Wim Timens
- 8 Department of Pathology and Medical Biology, and
| | - George D Nossent
- 9 Department of Pulmonology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; and
| | | | | | | | | | - Christophe Guignabert
- 6 INSERM UMR_S 999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France.,7 Université Paris-Sud, School of Médecine, Le Kremlin-Bicêtre, Paris, France
| | - Paul B Yu
- 10 Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Verstegen NE, Maat APWM, Lagerwaard FJ, Paul MA, Versteegh MI, Joosten JJ, Lastdrager W, Smit EF, Slotman BJ, Nuyttens JJME, Senan S. Salvage surgery for local failures after stereotactic ablative radiotherapy for early stage non-small cell lung cancer. Radiat Oncol 2016; 11:131. [PMID: 27716240 PMCID: PMC5048455 DOI: 10.1186/s13014-016-0706-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 09/20/2016] [Indexed: 12/17/2022] Open
Abstract
Introduction The literature on surgical salvage, i.e. lung resections in patients who develop a local recurrence following stereotactic ablative radiotherapy (SABR), is limited. We describe our experience with salvage surgery in nine patients who developed a local recurrence following SABR for early stage non-small cell lung cancer (NSCLC). Methods Patients who underwent surgical salvage for a local recurrence following SABR for NSCLC were identified from two Dutch institutional databases. Complications were scored using the Dindo-Clavien-classification. Results Nine patients who underwent surgery for a local recurrence were identified. Median time to local recurrence was 22 months. Recurrences were diagnosed with CT- and/or 18FDG-PET-imaging, with four patients also having a pre-surgical pathological diagnosis. Extensive adhesions were observed during two resections, requiring conversion from a thoracoscopic procedure to thoracotomy during one of these procedures. Three patients experienced complications post-surgery; grade 2 (N = 2) and grade 3a (N = 1), respectively. All resection specimens showed viable tumor cells. Median length of hospital stay was 8 days (range 5–15 days) and 30-day mortality was 0 %. Lymph node dissection revealed mediastinal metastases in 3 patients, all of whom received adjuvant therapy. Conclusions Our experience with nine surgical procedures for local recurrences post-SABR revealed two grade IIIa complications, and a 30-day mortality of 0 %, suggesting that salvage surgery can be safely performed after SABR.
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Affiliation(s)
- Naomi E Verstegen
- Department of Radiation Oncology, VU University Medical Center Amsterdam, De Boelelaan 1117, Postbox 7057, 1007 MB, Amsterdam, The Netherlands
| | - Alexander P W M Maat
- Department of Cardiothoracic Surgery, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Frank J Lagerwaard
- Department of Radiation Oncology, VU University Medical Center Amsterdam, De Boelelaan 1117, Postbox 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Marinus A Paul
- Department of Cardiothoracic Surgery, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Michel I Versteegh
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Joris J Joosten
- Department of Surgery, Westfriesgasthuis Hoorn, Hoorn, The Netherlands
| | - Willem Lastdrager
- Department of Surgery, Gelre Hospital Apeldoorn, Apeldoorn, The Netherlands
| | - Egbert F Smit
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ben J Slotman
- Department of Radiation Oncology, VU University Medical Center Amsterdam, De Boelelaan 1117, Postbox 7057, 1007 MB, Amsterdam, The Netherlands
| | - Joost J M E Nuyttens
- Department of Radiation Oncology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Suresh Senan
- Department of Radiation Oncology, VU University Medical Center Amsterdam, De Boelelaan 1117, Postbox 7057, 1007 MB, Amsterdam, The Netherlands
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Johannesma PC, van de Beek I, van der Wel JWT, Paul MA, Houweling AC, Jonker MA, van Waesberghe JHTM, Reinhard R, Starink TM, van Moorselaar RJA, Menko FH, Postmus PE. Risk of spontaneous pneumothorax due to air travel and diving in patients with Birt-Hogg-Dubé syndrome. Springerplus 2016; 5:1506. [PMID: 27652079 PMCID: PMC5014776 DOI: 10.1186/s40064-016-3009-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 08/05/2016] [Indexed: 01/10/2023]
Abstract
Background and objectives Birt–Hogg–Dubé syndrome is an autosomal dominant disorder characterized by skin fibrofolliculomas, lung cysts, spontaneous pneumothorax and renal cell cancer due to germline folliculin (FLCN) mutations (Menko et al. in Lancet Oncol 10(12):1199–1206, 2009). The aim of this study was to evaluate the incidence of spontaneous pneumothorax in patients with BHD during or shortly after air travel and diving. Methods A questionnaire was sent to a cohort of 190 BHD patients and the medical files of these patients were evaluated. The diagnosis of BHD was confirmed by FLCN mutations analysis in all patients. We assessed how many spontaneous pneumothoraces (SP) occurred within 1 month after air travel or diving. Results In total 158 (83.2 %) patients returned the completed questionnaire. A total of 145 patients had a history of air travel. Sixty-one of them had a history of SP (42.1 %), with a mean of 2.48 episodes (range 1–10). Twenty-four (35.8 %) patients had a history of pneumothorax on both sides. Thirteen patients developed SP < 1 month after air travel (9.0 %) and two patients developed a SP < 1 month after diving (3.7 %). We found in this population of BHD patients a pneumothorax risk of 0.63 % per flight and a risk of 0.33 % per episode of diving. Symptoms possible related to SP were perceived in 30 patients (20.7 %) after air travel, respectively in ten patients (18.5 %) after diving. Conclusion Based on the results presented in this retrospective study, exposure of BHD patients to considerable changes in atmospheric pressure associated with flying and diving may be related to an increased risk for developing a symptomatic pneumothorax. Symptoms reported during or shortly after flying and diving might be related to the early phase of pneumothorax. An individualized advice should be given, taking also into account patients’ preferences and needs.
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Affiliation(s)
- P C Johannesma
- Department of Pulmonary Diseases, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - I van de Beek
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands
| | - J W T van der Wel
- Department of Pulmonary Diseases, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - M A Paul
- Department of Thoracic Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - A C Houweling
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands
| | - M A Jonker
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | | | - R Reinhard
- Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Th M Starink
- Department of Dermatology, VU University Medical Center, Amsterdam, The Netherlands
| | | | - F H Menko
- Family Cancer Clinic, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - P E Postmus
- Clatterbridge Cancer Centre, Liverpool Heart and Chest Hospital, Liverpool, UK ; Department of Thoracic Oncology, University of Liverpool, Liverpool, UK
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Louie AV, van Werkhoven E, Chen H, Smit EF, Paul MA, Widder J, Groen HJ, van den Borne BE, De Jaeger K, Slotman BJ, Senan S. Patient reported outcomes following stereotactic ablative radiotherapy or surgery for stage IA non-small-cell lung cancer: Results from the ROSEL multicenter randomized trial. Radiother Oncol 2015; 117:44-8. [DOI: 10.1016/j.radonc.2015.08.011] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 08/11/2015] [Accepted: 08/11/2015] [Indexed: 12/31/2022]
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Hooijman PE, Beishuizen A, Witt CC, de Waard MC, Girbes ARJ, Spoelstra-de Man AME, Niessen HWM, Manders E, van Hees HWH, van den Brom CE, Silderhuis V, Lawlor MW, Labeit S, Stienen GJM, Hartemink KJ, Paul MA, Heunks LMA, Ottenheijm CAC. Diaphragm muscle fiber weakness and ubiquitin-proteasome activation in critically ill patients. Am J Respir Crit Care Med 2015; 191:1126-38. [PMID: 25760684 DOI: 10.1164/rccm.201412-2214oc] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
RATIONALE The clinical significance of diaphragm weakness in critically ill patients is evident: it prolongs ventilator dependency, and increases morbidity and duration of hospital stay. To date, the nature of diaphragm weakness and its underlying pathophysiologic mechanisms are poorly understood. OBJECTIVES We hypothesized that diaphragm muscle fibers of mechanically ventilated critically ill patients display atrophy and contractile weakness, and that the ubiquitin-proteasome pathway is activated in the diaphragm. METHODS We obtained diaphragm muscle biopsies from 22 critically ill patients who received mechanical ventilation before surgery and compared these with biopsies obtained from patients during thoracic surgery for resection of a suspected early lung malignancy (control subjects). In a proof-of-concept study in a muscle-specific ring finger protein-1 (MuRF-1) knockout mouse model, we evaluated the role of the ubiquitin-proteasome pathway in the development of contractile weakness during mechanical ventilation. MEASUREMENTS AND MAIN RESULTS Both slow- and fast-twitch diaphragm muscle fibers of critically ill patients had approximately 25% smaller cross-sectional area, and had contractile force reduced by half or more. Markers of the ubiquitin-proteasome pathway were significantly up-regulated in the diaphragm of critically ill patients. Finally, MuRF-1 knockout mice were protected against the development of diaphragm contractile weakness during mechanical ventilation. CONCLUSIONS These findings show that diaphragm muscle fibers of critically ill patients display atrophy and severe contractile weakness, and in the diaphragm of critically ill patients the ubiquitin-proteasome pathway is activated. This study provides rationale for the development of treatment strategies that target the contractility of diaphragm fibers to facilitate weaning.
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13
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Chang JY, Senan S, Paul MA, Mehran RJ, Louie AV, Balter P, Groen HJM, McRae SE, Widder J, Feng L, van den Borne BEEM, Munsell MF, Hurkmans C, Berry DA, van Werkhoven E, Kresl JJ, Dingemans AM, Dawood O, Haasbeek CJA, Carpenter LS, De Jaeger K, Komaki R, Slotman BJ, Smit EF, Roth JA. Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-cell lung cancer: a pooled analysis of two randomised trials. Lancet Oncol 2015; 16:630-7. [PMID: 25981812 PMCID: PMC4489408 DOI: 10.1016/s1470-2045(15)70168-3] [Citation(s) in RCA: 1008] [Impact Index Per Article: 112.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The standard of care for operable, stage I, non-small-cell lung cancer (NSCLC) is lobectomy with mediastinal lymph node dissection or sampling. Stereotactic ablative radiotherapy (SABR) for inoperable stage I NSCLC has shown promising results, but two independent, randomised, phase 3 trials of SABR in patients with operable stage I NSCLC (STARS and ROSEL) closed early due to slow accrual. We aimed to assess overall survival for SABR versus surgery by pooling data from these trials. METHODS Eligible patients in the STARS and ROSEL studies were those with clinical T1-2a (<4 cm), N0M0, operable NSCLC. Patients were randomly assigned in a 1:1 ratio to SABR or lobectomy with mediastinal lymph node dissection or sampling. We did a pooled analysis in the intention-to-treat population using overall survival as the primary endpoint. Both trials are registered with ClinicalTrials.gov (STARS: NCT00840749; ROSEL: NCT00687986). FINDINGS 58 patients were enrolled and randomly assigned (31 to SABR and 27 to surgery). Median follow-up was 40·2 months (IQR 23·0-47·3) for the SABR group and 35·4 months (18·9-40·7) for the surgery group. Six patients in the surgery group died compared with one patient in the SABR group. Estimated overall survival at 3 years was 95% (95% CI 85-100) in the SABR group compared with 79% (64-97) in the surgery group (hazard ratio [HR] 0·14 [95% CI 0·017-1·190], log-rank p=0·037). Recurrence-free survival at 3 years was 86% (95% CI 74-100) in the SABR group and 80% (65-97) in the surgery group (HR 0·69 [95% CI 0·21-2·29], log-rank p=0·54). In the surgery group, one patient had regional nodal recurrence and two had distant metastases; in the SABR group, one patient had local recurrence, four had regional nodal recurrence, and one had distant metastases. Three (10%) patients in the SABR group had grade 3 treatment-related adverse events (three [10%] chest wall pain, two [6%] dyspnoea or cough, and one [3%] fatigue and rib fracture). No patients given SABR had grade 4 events or treatment-related death. In the surgery group, one (4%) patient died of surgical complications and 12 (44%) patients had grade 3-4 treatment-related adverse events. Grade 3 events occurring in more than one patient in the surgery group were dyspnoea (four [15%] patients), chest pain (four [15%] patients), and lung infections (two [7%]). INTERPRETATION SABR could be an option for treating operable stage I NSCLC. Because of the small patient sample size and short follow-up, additional randomised studies comparing SABR with surgery in operable patients are warranted. FUNDING Accuray Inc, Netherlands Organisation for Health Research and Development, NCI Cancer Center Support, NCI Clinical and Translational Science Award.
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Affiliation(s)
- Joe Y Chang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Suresh Senan
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, Netherlands
| | - Marinus A Paul
- Department of Cardiothoracic Surgery, VU University Medical Center, Amsterdam, Netherlands
| | - Reza J Mehran
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alexander V Louie
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, Netherlands
| | - Peter Balter
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Harry J M Groen
- Department of Pulmonary Diseases, University of Groningen and University Medical Center Groningen, Groningen, Netherlands
| | - Stephen E McRae
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joachim Widder
- Department of Radiation Oncology, University of Groningen and University Medical Center Groningen, Groningen, Netherlands
| | - Lei Feng
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Mark F Munsell
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Coen Hurkmans
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, Netherlands
| | - Donald A Berry
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Erik van Werkhoven
- Department of Biometrics, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - John J Kresl
- Phoenix CyberKnife and Radiation Oncology Center, Phoenix, AZ, USA
| | - Anne-Marie Dingemans
- Department of Pulmonary Diseases, Maastricht University Medical Center, Netherlands
| | | | - Cornelis J A Haasbeek
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, Netherlands
| | - Larry S Carpenter
- Department of Radiation Oncology, CHI St Luke's Health, Houston, TX, USA
| | - Katrien De Jaeger
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, Netherlands
| | - Ritsuko Komaki
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ben J Slotman
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, Netherlands
| | - Egbert F Smit
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, Netherlands
| | - Jack A Roth
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Dickhoff C, Daniels JMA, van den Brink A, Paul MA, Verhagen AFTM. Does hyperbaric oxygen therapy prevent airway anastomosis from breakdown? Ann Thorac Surg 2015; 99:682-5. [PMID: 25639406 DOI: 10.1016/j.athoracsur.2014.03.055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 01/27/2014] [Accepted: 03/26/2014] [Indexed: 10/24/2022]
Abstract
Ischemia with subsequent necrosis of anastomoses, after central airway resection and reconstruction, remains a feared complication for thoracic surgeons and their patients. To date, there is no evidence to support the use of hyperbaric oxygen in the prevention of necrosis of airway reconstructions in humans. We present a patient who underwent central airway surgery with postoperative ischemia of an end-to-side anastomosis. Repeat visit to a hyperbaric oxygen chamber seemed to prevent the anastomosis from subsequent necrosis and dehiscence with complete healing as a result. In conclusion, hyperbaric oxygen treatment can be considered when ischemia or necrosis is observed in central airway anastomoses during postoperative bronchoscopic surveillance.
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Affiliation(s)
- Chris Dickhoff
- Department of Cardiothoracic Surgery, VU University Medical Centre, Amsterdam; Department of Surgery, VU University Medical Centre, Amsterdam.
| | | | - Ad van den Brink
- Department of Hyperbaric Medicine, Academic Medical Centre, Amsterdam
| | - Marinus A Paul
- Department of Cardiothoracic Surgery, VU University Medical Centre, Amsterdam
| | - Ad F T M Verhagen
- Department of Cardiothoracic Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Postmus PE, Johannesma PC, Menko FH, Paul MA. In-flight pneumothorax: diagnosis may be missed because of symptom delay. Am J Respir Crit Care Med 2015; 190:704-5. [PMID: 25221882 DOI: 10.1164/rccm.201404-0698le] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Pieter E Postmus
- 1 Vrije Universiteit (VU) University Medical Center Amsterdam, The Netherlands
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16
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Brokx HAP, Paul MA, Postmus PE, Sutedja TG. Long-term follow-up after first-line bronchoscopic therapy in patients with bronchial carcinoids. Thorax 2015; 70:468-72. [PMID: 25777586 DOI: 10.1136/thoraxjnl-2014-206753] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 02/23/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Carcinoid of the lung is considered to be a low-grade malignancy. A subgroup presents as an endobronchial tumour. Surgical resection is considered the standard approach because of its metastatic potential and the possibility of an iceberg phenomenon for the endobronchial subgroup. Advances in non-invasive and minimally invasive technologies seem to justify a more lung parenchyma-sparing approach. METHODS In patients presenting with bronchial carcinoids, initial bronchoscopic treatment (IBT) is first attempted for complete tumour eradication and sufficient tissue sampling for the proper differentiation of typical (TC) versus atypical (AC) histological type. Furthermore in cases with postobstruction problems the desobstruction is aimed at improving the patient's condition and by that alleviate surgery if that is needed. High resolution CT is performed 6 weeks post IBT to determine local tumour growth. Surgical resection follows in case of extraluminal disease, residual carcinoid inaccessible for IBT, or late recurrences not salvaged by repeat IBT. RESULTS Minimum follow-up was 5 years from start of treatment for 112 patients (65 women, 47 men), with a median age of 47 years (range 16-77 years). Eighty-three patients (74%) had TC, and 29 (26%) AC. IBT only was ultimately curative in 42% of the cases (47/112): 42 TC, 5 AC. Disease-specific mortality including surgical mortality has been 2.6% (3/112) in patients with extraluminal carcinoids (3 AC). CONCLUSIONS IBT, if with unsuccessful rescue surgery, is justifiable with excellent long-term outcome. IBT made surgery unnecessary in 42% of the cases. Iceberg phenomenon and metastatic potential in this group of patients with bronchial carcinoids are clinically insignificant.
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Affiliation(s)
- Hes A P Brokx
- Department of Surgery, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Marinus A Paul
- Department of Surgery, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Pieter E Postmus
- Clatterbridge Cancer Centre, Liverpool Heart & Chest Hospital, University of Liverpool, Liverpool, UK
| | - Thomas G Sutedja
- Department of Pulmonology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
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17
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Kuiper JL, Bahce I, Voorhoeve C, Yaqub M, Heideman DA, Thunnissen E, Paul MA, Postmus PE, Hendrikse NH, Smit EF. Detecting resistance in EGFR-mutated non-small-cell lung cancer after clonal selection through targeted therapy. Per Med 2015; 12:63-66. [PMID: 29754538 DOI: 10.2217/pme.14.64] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Tumor heterogeneity plays an important role in the development of treatment-resistance, especially in the current era of targeted therapies. Although tumor heterogeneity is a widely recognized phenomenon, it is at present unclear how this knowledge should be incorporated into daily clinical practice. In this report, we describe an innovative nuclear imaging method that may play a role in detecting tumor heterogeneity in the future.
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Affiliation(s)
- Justine L Kuiper
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands
| | - Idris Bahce
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands
| | - Charlotte Voorhoeve
- Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Maqsood Yaqub
- Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Daniëlle Am Heideman
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Erik Thunnissen
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Marinus A Paul
- Department of Cardiothoracic Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Pieter E Postmus
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands
| | - N Harry Hendrikse
- Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Department of Clinical Pharmacology & Pharmacy, VU University Medical Center, Amsterdam, The Netherlands
| | - Egbert F Smit
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands
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18
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Griffioen GHMJ, Louie AV, de Bree R, Smit EF, Paul MA, Slotman BJ, Leemans CR, Senan S. Second primary lung cancers following a diagnosis of primary head and neck cancer. Lung Cancer 2015; 88:94-9. [PMID: 25662386 DOI: 10.1016/j.lungcan.2015.01.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 01/09/2015] [Accepted: 01/16/2015] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Second primary lung cancers (SPLC) are not uncommon in survivors of squamous cell head and neck cancer (HNSCC), and carry a worse prognosis than when patients present with a primary lung cancer. We reviewed our institutional experience on the treatment and prognosis of SPLC patients, both at the time of diagnosis, and following treatment of HNSCC, in order to explore treatment outcomes. MATERIALS AND METHODS Our institutional database was queried for patients with a diagnosis of HNSCC and lung cancer, between 2000 and 2013. Only HNSCC patients with tumors of the oral cavity, oropharynx, hypopharynx and larynx were eligible. Patients were stratified between synchronous and metachronous HNSCC and SPLC. Cox regression analysis was performed to determine factors predictive of overall survival (OS) in metachronous presentations. RESULTS 181 eligible patients were identified for analysis, comprising 40 synchronous and 141 metachronous HNSCC-SPLC. Patients presenting with synchronous SPLC were more likely to have early-stage disease, as compared to patients with metachronous SPLC (45% vs. 28%, respectively; p=0.036). Patients with early stage SPLC had a significantly better survival compared to those with locally advanced (p<0.001) and metastatic disease (p<0.001), with a median OS of 95.4 months vs. 11.0 and 4.6 months, respectively. CONCLUSIONS Although the survival of patients treated for early-stage NSCLC were good, the OS of the entire cohort of SPLC after HNSCC was poor as a majority of patients presented with advanced disease. The use of CT screening strategies in this patient population warrants further investigation.
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Affiliation(s)
| | - Alexander V Louie
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Remco de Bree
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Egbert F Smit
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands
| | - Marinus A Paul
- Department of Cardiothoracic Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Ben J Slotman
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - C Rene Leemans
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Suresh Senan
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
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19
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Hooijman PE, Paul MA, Stienen GJM, Beishuizen A, Van Hees HWH, Singhal S, Bashir M, Budak MT, Morgen J, Barsotti RJ, Levine S, Ottenheijm CAC. Unaffected contractility of diaphragm muscle fibers in humans on mechanical ventilation. Am J Physiol Lung Cell Mol Physiol 2014; 307:L460-70. [PMID: 25038190 DOI: 10.1152/ajplung.00076.2014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Several studies have indicated that diaphragm dysfunction develops in patients on mechanical ventilation (MV). Here, we tested the hypothesis that the contractility of sarcomeres, i.e., the smallest contractile unit in muscle, is affected in humans on MV. To this end, we compared diaphragm muscle fibers of nine brain-dead organ donors (cases) that had been on MV for 26 ± 5 h with diaphragm muscle fibers from nine patients (controls) undergoing surgery for lung cancer that had been on MV for less than 2 h. In each diaphragm specimen we determined 1) muscle fiber cross-sectional area in cryosections by immunohistochemical methods and 2) the contractile performance of permeabilized single muscle fibers by means of maximum specific force, kinetics of cross-bridge cycling by rate of tension redevelopment, myosin heavy chain content and concentration, and calcium sensitivity of force of slow-twitch and fast-twitch muscle fibers. In case subjects, we noted no statistically significant decrease in outcomes compared with controls in slow-twitch or fast-twitch muscle fibers. These observations indicate that 26 h of MV of humans is not invariably associated with changes in the contractile performance of sarcomeres in the diaphragm.
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Affiliation(s)
| | | | - Ger J M Stienen
- Departments of Physiology, Faculty of Science, Department of Physics and Astronomy, Vrije Universiteit, Amsterdam, The Netherlands
| | - Albertus Beishuizen
- Intensive Care, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
| | - Hieronymus W H Van Hees
- Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Sunil Singhal
- Department of Surgery, University of Pennsylvania and Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Muhammad Bashir
- Department of Surgery, University of Pennsylvania and Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Murat T Budak
- Department of Surgery, University of Pennsylvania and Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Jacqueline Morgen
- Department of Surgery, University of Pennsylvania and Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Robert J Barsotti
- Department of Physiology, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Sanford Levine
- Department of Surgery, University of Pennsylvania and Veterans Affairs Medical Center, Philadelphia, Pennsylvania; Gift of Life Donor Program, Philadelphia, Pennsylvania; and
| | - Coen A C Ottenheijm
- Departments of Physiology, Department of Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona
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Abstract
Lymphangiomas are rare benign neoplasms derived from portions of lymph sacs. They most often occur in children in the cervical region and 90% have manifested by the end of the second year of life. An isolated mediastinal lymphangioma in an adult is an uncommon disease entity. We report the case of a mediastinal lymphangioma in a 29-year-old man presenting as a suprasternal lump, which was resected through a partial sternotomy/hemiclamshell thoracotomy.
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21
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Johannesma PC, van den Borne BEEM, Gille JJP, Nagelkerke AF, van Waesberghe JTM, Paul MA, van Moorselaar RJA, Menko FH, Postmus PE. Spontaneous pneumothorax as indicator for Birt-Hogg-Dubé syndrome in paediatric patients. BMC Pediatr 2014; 14:171. [PMID: 24994497 PMCID: PMC4088368 DOI: 10.1186/1471-2431-14-171] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 06/27/2014] [Indexed: 12/12/2022] Open
Abstract
Background Birt-Hogg-Dubé syndrome (BHD) is a rare autosomal dominantly inherited disorder caused by germline mutations in the folliculin (FLCN) gene. Clinical manifestations of BHD include skin fibrofolliculomas, renal cell cancer, lung cysts and (recurrent) spontaneous pneumothorax (SP). All clinical manifestations usually present in adults > 20 years of age. Case presentations Two non-related patients with (recurrent) pneumothorax starting at age 14 accompanied by multiple basal lung cysts on thoracic CT underwent FLCN germline mutation analysis. A pathogenic FLCN mutation was found in both patients confirming suspected BHD. The family history was negative for spontaneous pneumothorax in both families. Conclusion Although childhood occurrence of SP in BHD is rare, these two cases illustrate that BHD should be considered as cause of SP in children.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Pieter E Postmus
- Department of Pulmonary Diseases, VU University Medical Center, PO Box 7057, 1007, MB Amsterdam, The Netherlands.
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Hooijman PE, Beishuizen A, de Waard MC, de Man FS, Vermeijden JW, Steenvoorde P, Bouwman RA, Lommen W, van Hees HWH, Heunks LMA, Dickhoff C, van der Peet DL, Girbes ARJ, Jasper JR, Malik FI, Stienen GJM, Hartemink KJ, Paul MA, Ottenheijm CAC. Diaphragm fiber strength is reduced in critically ill patients and restored by a troponin activator. Am J Respir Crit Care Med 2014; 189:863-5. [PMID: 24684359 DOI: 10.1164/rccm.201312-2260le] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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23
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Ter Avest MJ, Schook RM, Koudstaal LG, Grünberg K, Paul MA, Smit EF, Postmus PE. Benefit of a second opinion for lung cancer: no metastasis to the kidney but a synchronous primary renal neoplasm. Case Rep Oncol 2014; 7:122-5. [PMID: 24707259 PMCID: PMC3975755 DOI: 10.1159/000359996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background The finding of a renal mass on imaging is suggestive of metastatic non-small cell lung cancer in the presence of a lung tumor but can also have another origin. Case Report We describe the case of a patient diagnosed with stage IV lung cancer based on a renal metastasis. A second opinion including review of histopathological data and additional imaging followed by lung surgery and cryoablation of the kidney lesion revealed two tumors of different origins, non-small cell lung cancer and a renal cell carcinoma. Discussion The presence of a renal mass diagnosed on a CT scan in a patient with lung cancer is not always synonymous with metastatic disease. Confirmation of diagnosis by tissue sampling is mandatory, especially if a synchronous primary tumor is possible.
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Affiliation(s)
- Marleen J Ter Avest
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands
| | - Romane M Schook
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands
| | - Lyan G Koudstaal
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Katrien Grünberg
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Marinus A Paul
- Department of Cardiothoracic Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Egbert F Smit
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands
| | - Pieter E Postmus
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands
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24
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Schook RM, Koudstaal L, Comans EF, Postmus PE, Grünberg K, Paul MA, Smit EF, Sutedja TG. Benefit of a second opinion: From metastatic disease to resectable lung cancer with sarcoid-like reaction. Respir Med Case Rep 2014; 13:26-7. [PMID: 26029554 PMCID: PMC4246249 DOI: 10.1016/j.rmcr.2014.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Mediastinal lymphadenopathy in combination with lung cancer is suggestive for lymph node metastases but can also have other origins. Case report We describe a patient diagnosed with stage IV lung cancer presenting with parenchymal lesions and enlarged mediastinal lymph nodes. A second opinion including FDG-PET scan review and a mediastinoscopy followed by surgery revealed tumor specimens originating from a single primary tumor with a sarcoid-like reaction in the mediastinal lymph nodes, changing the diagnosis from metastasized to resectable lung cancer. Discussion PET positive lesions are not always synonymous with metastatic disease in the presence of a malignant tumor. Conscientious review of FDG-PET scans and tissue sampling are therefore mandatory to determine definitive staging and subsequent interventions.
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Affiliation(s)
- Romane M Schook
- Department of Pulmonary Diseases, VU University Medical Center Amsterdam, The Netherlands
| | - Lyan Koudstaal
- Department of Pathology, VU University Medical Center Amsterdam, The Netherlands
| | - Emile F Comans
- Department of Radiology and Nuclear Medicine, VU University Medical Center Amsterdam, The Netherlands
| | - Pieter E Postmus
- Department of Pulmonary Diseases, VU University Medical Center Amsterdam, The Netherlands
| | - Katrien Grünberg
- Department of Pathology, VU University Medical Center Amsterdam, The Netherlands
| | - Marinus A Paul
- Department of Cardiothoracic Surgery, VU University Medical Center Amsterdam, The Netherlands
| | - Egbert F Smit
- Department of Pulmonary Diseases, VU University Medical Center Amsterdam, The Netherlands
| | - Thomas G Sutedja
- Department of Pulmonary Diseases, VU University Medical Center Amsterdam, The Netherlands
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Abstract
8065 Background: EGFR-TKI provides a clinical benefit in patients with EGFR-mutated NSCLC with median progression-free survival (PFS) of 12 months. Several resistance mechanisms (e.g. T790M mutation) have been described, however data are sparse. We analysed EGFR-mutation spectra in NSCLC patients with acquired resistance to TKI. Methods: Biopsies from patients with EGFR-mutation or TKI-response>24 weeks with both pre- and post TKI biopsy available were retrospectively analysed. Information was collected from the medical record. Response to TKI-treatment was assessed according to RECIST. PFS after TKI-treatment was calculated with a Kaplan-Meier curve. Results: 63 patients were included for analysis. Pre- and post TKI biopsy results are described in the Table. 32 patients received 1 (38%), 2 (10%) or 3 (3%) lines of chemotherapy before start of TKI and 18 patients received 1 (13%), 2 (11%), 3 (3%), or 5 (2%) lines of therapy after TKI treatment. Median PFS on TKI-treatment was 12,3 months (range: 1,4 – 43,2). Objective response rate was 61,9%. 47,6% of patients developed the T790M mutation. One patient developed transformation to SCLC with the original exon 19 deletion. One patient with pre-TKI an exon 18 + exon 21 mutation was found to have a KRAS-mutation post-TKI. Conclusions: In this cohort, frequency of development of T790M mutation was consistent with earlier reports. Transformation to SCLC occurred less than described earlier. Two patients did not retain their original mutation. Surprisingly, one patient developed a KRAS mutation: a second primary tumor is not excluded in this case. Rebiopsy in TKI-resistance provides important information on dynamic tumour characteristics and has management implications in certain patients. [Table: see text]
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Affiliation(s)
| | | | | | - M A Paul
- VU University Medical Center, Amsterdam, Netherlands
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Blaauwgeers JL, Kappers I, Klomp HM, Belderbos JS, Dijksman LM, Smit EF, Postmus PE, Paul MA, Oosterhuis JW, Hartemink KJ, Vos CG, Burgers JA, Dahele M, Phernambucq EC, Witte BI, Thunnissen E. Complete pathological response is predictive for clinical outcome after tri-modality therapy for carcinomas of the superior pulmonary sulcus. Virchows Arch 2013; 462:547-56. [DOI: 10.1007/s00428-013-1404-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 03/09/2013] [Accepted: 03/15/2013] [Indexed: 01/17/2023]
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Welvaart WN, Jak PMC, van de Veerdonk MC, Marcus JT, Ottenheijm CAC, Paul MA, Vonk Noordegraaf A. Effects of diaphragm plication on pulmonary function and cardiopulmonary exercise parameters. Eur J Cardiothorac Surg 2013; 44:643-7. [PMID: 23449864 DOI: 10.1093/ejcts/ezt094] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES Paralysis of the diaphragm is an uncommon condition, which may result in dyspnoea on excertion and in orthopnea. In patients who have symptoms, the paralysed diaphragm is often plicated to prevent its paradoxical movement on inspiration. This procedure brings relief to many patients, but the mechanism for this improvement is not well understood. METHODS Nine symptomatic patients who underwent plication of a unilateral paralysed hemidiaphragm were prospectively evaluated. All patients underwent pulmonary function tests and cardiopulmonary exercise tests before surgery and repeated them after surgery. RESULTS Patients with hemidiaphragm paralysis before surgery were found to have lower tidal volumes at any given ventilation rate during exercise than normal subjects. A clear and consistent change was found in the manner in which patients increased their ventilation during exercise after surgery. All patients showed an increase in tidal volume for a given ventilation rate, which was significant. The plication procedure reduced the respiratory rate for any exercise level in all patients, and this effect was more pronounced during exercise. CONCLUSIONS In patients with hemidiaphragm paralysis who underwent a diaphragm plication exercise, tidal volumes increased and the ventilatory frequency decreased. Despite this improvement, maximal exercise capacity remained unaltered.
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Affiliation(s)
- Willem N Welvaart
- Department of Surgery, VU University Medical Center/Institute for Cardiovascular Research, Amsterdam, Netherlands
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Freixa V, Paul MA, Francois A, Budhram-Mahadeo V, Heads RJ. COX-2 IN MYOCARDIAL INJURY AND REMODELLING: ELUCIDATING MECHANISMS OF INDUCTION BY FIBRONECTIN FRAGMENTS INCLUDING EXTRA-DOMAIN A. Heart 2012. [DOI: 10.1136/heartjnl-2012-303148a.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Gorter RR, Vos CG, Halmans J, Hartemink KJ, Paul MA, Oosterhuis JWA. Evaluation of arm function and quality of life after trimodality treatment for superior sulcus tumours. Interact Cardiovasc Thorac Surg 2012; 16:44-8. [PMID: 23049081 DOI: 10.1093/icvts/ivs394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Following trimodality treatment for superior sulcus tumours (SSTs), the 5-year survival rate has significantly improved. Quality of life and potential negative effects of this strategy have become more important. The objective of this study was to investigate the quality of life and the arm and shoulder function after the resection of superior sulcus tumours following neoadjuvant chemoradiation. METHODS Patients were selected from a thoracic surgery database. Between January 2002 and December 2010, 72 patients received trimodality treatment of whom 39 were alive at the start of this study in 2010. The following arm function tests were used: nine-hole peg test, range of motion test and action research arm test. Quality of life was assessed using the Disability of the arm and shoulder and SF-36 questionnaires. Analyses of the arm function were conducted comparing the treated side with the untreated side. For quality of life, patients treated on their dominant side were compared with those treated on their non-dominant side. RESULTS In total, 19 patients participated in this study (15 men and 4 women). The median age was 59 years (range 39-73), median radiation dose 50 Gy (range 39-66) and median follow-up 40 months (range 4-101). There was no statistically significant difference in arm and shoulder function between the treated and the untreated arm. However, statistically significantly less pain was found if patients were treated on their dominant side. CONCLUSIONS After the resection of SSTs following chemoradiotherapy, the arm and shoulder function on the affected side is comparable with the functions at the contralateral side. Patients treated for an SST on their dominant side are less affected in their quality of life regarding pain compared with those treated on their non-dominant side.
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Affiliation(s)
- Ramon R Gorter
- Department of Surgery, VU University Medical Center, Amsterdam, Netherlands
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Aman J, Thunnissen E, Paul MA, van Nieuw Amerongen GP, Vonk-Noordegraaf A. Successful treatment of diffuse pulmonary lymphangiomatosis with bevacizumab. Ann Intern Med 2012; 156:839-40. [PMID: 22665821 DOI: 10.7326/0003-4819-156-11-201206050-00016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Cardillo G, Rea F, Lucchi M, Paul MA, Margaritora S, Carleo F, Marulli G, Mussi A, Granone P, Graziano P. Primary neuroendocrine tumors of the thymus: a multicenter experience of 35 patients. Ann Thorac Surg 2012; 94:241-5; discussion 245-6. [PMID: 22632882 DOI: 10.1016/j.athoracsur.2012.03.062] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 03/20/2012] [Accepted: 03/22/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Primary neuroendocrine tumors of the thymus (NETT) are rare tumors and represent a distinct category of tumors collectively displaying morphologic and biological neuroendocrine features. We sought to evaluate factors influencing long-term survival in patients with primary NETT. METHODS From January 1990 to April 2011, 35 patients (27 male patients and 8 female patients) were surgically treated for primary NETT at 5 institutions. RESULTS No operative (30-day) mortality occurred. Morbidity was 37.14% (13/35 patients). All patients were followed for a total of 2,703 months. Fourteen patients had associated paraneoplastic syndrome. Twenty-four patients are alive, 19 of whom are free of disease and 5 of whom continue to have disease. The median overall survival was 153 months. The overall 5-year and 10-year actuarial survival rates were 84.34% and 60.82%, respectively. The 10-year survival was evaluated according to histologic type (typical carcinoid, 77.92%; atypical carcinoid, 54.55%; large-cell neuroendocrine carcinomas, 0%; Masaoka staging (stage I, 100%; stage II, 66.67%; stage III, 61.9%; stage Iva, 25%; stage IVb, 0%), presence of paraneoplastic syndrome (no = 70.67%; yes = 32.14%), postoperative radiotherapy (yes = 39.71%; no = 85.71.%), Surveillance, Epidemiology, and End Results (SEER) staging system (localized disease, 83.3%; regional disease, 53.3%; distant disease, 0%), tumor size (<7 cm = 90.9%; ≥7cm = 28.7%; p = 0.0007), and Ki67 expression, which was available in 23 patients (<10% = 85.71%; ≥10% = 0%; p = 0.0037). CONCLUSIONS The prognosis of primary NETT is statistically significantly related to tumor size >7 cm and to the proliferation index (evaluated by Ki67 expression >10%). The histologic type of the neoplasm, the presence of a paraneoplastic syndrome, the Masaoka staging, the evidence of distant disease, and postoperative radiotherapy also impact prognosis.
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Affiliation(s)
- Giuseppe Cardillo
- Department of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Carlo Forlanini Hospital, Rome, Italy.
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Vos CG, Hartemink KJ, Jiya TU, Feller RE, Oosterhuis JWA, Paul MA. Severe kyphosis with spinal cord compression after resection of a superior sulcus tumor. Ann Thorac Surg 2012; 94:1003-6. [PMID: 22579901 DOI: 10.1016/j.athoracsur.2012.01.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 01/07/2012] [Accepted: 01/12/2012] [Indexed: 10/28/2022]
Abstract
Vertebral involvement is no longer a contraindication for resection of superior sulcus tumors. We describe a patient who developed a kyphoscoliosis with spinal cord compression after resection of a superior sulcus tumor that invaded the vertebral column. Risk factors for spinal instability and indications for stabilization are discussed.
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Affiliation(s)
- Cornelis G Vos
- Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands.
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Lagerwaard FJ, Verstegen NE, Haasbeek CJ, Slotman BJ, Paul MA, Smit EF, Senan S. Outcomes of Stereotactic Ablative Radiotherapy in Patients With Potentially Operable Stage I Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2012; 83:348-53. [PMID: 22104360 DOI: 10.1016/j.ijrobp.2011.06.2003] [Citation(s) in RCA: 247] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 05/18/2011] [Accepted: 06/25/2011] [Indexed: 12/25/2022]
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van der Meij BS, Langius JAE, Spreeuwenberg MD, Slootmaker SM, Paul MA, Smit EF, van Leeuwen PAM. Oral nutritional supplements containing n-3 polyunsaturated fatty acids affect quality of life and functional status in lung cancer patients during multimodality treatment: an RCT. Eur J Clin Nutr 2012; 66:399-404. [PMID: 22234041 PMCID: PMC3303137 DOI: 10.1038/ejcn.2011.214] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background/Objectives: Our objective was to investigate effects of an oral nutritional supplement containing n-3 polyunsaturated fatty acids (FAs) on quality of life, performance status, handgrip strength and physical activity in patients with non-small cell lung cancer (NSCLC) undergoing multimodality treatment. Subjects/Methods: In a double-blind experiment, 40 patients with stage III NSCLC were randomised to receive 2 cans/day of a protein- and energy-dense oral nutritional supplement containing n-3 polyunsaturated FAs (2.02 g eicosapentaenoic acid+0.92 g docosahexaenoic acid/day) or an isocaloric control supplement, during multimodality treatment. Quality of life, Karnofsky Performance Status, handgrip strength and physical activity (by wearing an accelerometer) were assessed. Effects of intervention were analysed by generalised estimating equations. P-values <0.05 were regarded as statistically significant. Results: The intervention group reported significantly higher on the quality of life parameters, physical and cognitive function (B=11.6 and B=20.7, P<0.01), global health status (B=12.2, P=0.04) and social function (B=22.1, P=0.04) than the control group after 5 weeks. The intervention group showed a higher Karnofsky Performance Status (B=5.3, P=0.04) than the control group after 3 weeks. Handgrip strength did not significantly differ between groups over time. The intervention group tended to have a higher physical activity than the control group after 3 and 5 weeks (B=6.6, P=0.04 and B=2.5, P=0.05). Conclusion: n-3 Polyunsaturated FAs may beneficially affect quality of life, performance status and physical activity in patients with NSCLC undergoing multimodality treatment.
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Affiliation(s)
- B S van der Meij
- Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
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Vos CGN, Dickhoff C, Paul MA, Dahele M, Smit EF, Hartemink KJ. [Treatment and prognosis of superior sulcus tumours]. Ned Tijdschr Geneeskd 2012; 156:A5419. [PMID: 23218036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Superior sulcus tumours (or Pancoast tumours) are non-small-cell lung carcinomas presenting with specific symptoms and requiring a specific approach to treatment due to their location in the pulmonary apex. Early recognition is rare as a result of the low incidence and the relatively late occurrence of symptoms .Shoulder pain, with or without radiation to the ipsilateral arm or hand, and Horner's syndrome are often presenting symptoms. The current standard of care for patients with resectable tumours is pre-operative chemoradiotherapy, followed by resection of the tumour and affected surrounding structures. This is associated with 5-year survival rates of more than 50%. Invasion of local structures, the presence of mediastinal lymph node metastases and, in a select group of patients, distant metastasis, are not necessarily contra-indications for surgical resection. Patients who have undergone complete resection, or demonstrate a pathologically complete response after induction therapy, have significantly higher survival rates. Treatment of superior sulcus tumours requires a multidisciplinary approach; considering the complexity of the treatment, patients should be referred to a specialised centre.
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Welvaart WN, Paul MA, Kuster DW, van Wieringen W, Rustenburg F, Stienen GJ, Vonk-Noordegraaf A, Ottenheijm CA. Gene expression profile in the diaphragm following contractile inactivity during thoracic surgery. Int J Physiol Pathophysiol Pharmacol 2011; 3:167-175. [PMID: 21941608 PMCID: PMC3175743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Accepted: 08/29/2011] [Indexed: 05/31/2023]
Abstract
Introduction. Recent work revealed the development of marked muscle fiber weakness in the diaphragm, but not in the non-respiratory latissimus dorsi, during thoracic surgery. To disentangle the molecular processes that underlie the development of diaphragm muscle fiber weakness during thoracic surgery, we studied changes in the gene expression profile. Methods. Serial biopsies from the diaphragm and the latissimus dorsi muscle were obtained from four patients during thoracotomy for resection of a tumor in the right lung. Biopsies were taken as soon as the diaphragm had been exposed (t0) and again after two hours (t2). Gobal differences in gene expression in diaphragm biopsies were assessed by microarray analysis. Results. 346 differentially expressed gene transcripts were found in the diaphragm at t2 vs. t0. Pathway analysis revealed that genes associated with inflammation (83 genes; p<0.0001) and cell death (118 genes, p<0.0001) pathways were significantly overexpressed at t2. Of the 346 differentially expressed genes in the diaphragm at t2, 258 were also differential in the latissimus dorsi muscle, with the direction of change being identical for all differentially expressed genes. In addition, latissimus dorsi showed exclusive upregula-ton of negative regulators of cell death. Conclusions. Two hours of thoracic surgery result in rapid and profound changes in expression of inflammatory response and apoptotic genes in the diaphragm. The apoptotic response was stronger in the diaphragm than in the latissiums dorsi. These findings suggest that the development of selective diaphragm muscle fiber weakness in these patients might be related to an exaggerated apoptotic response.
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van der Heijden M, van Nieuw Amerongen GP, van Bezu J, Paul MA, Groeneveld ABJ, van Hinsbergh VWM. Opposing effects of the angiopoietins on the thrombin-induced permeability of human pulmonary microvascular endothelial cells. PLoS One 2011; 6:e23448. [PMID: 21858121 PMCID: PMC3156229 DOI: 10.1371/journal.pone.0023448] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 07/18/2011] [Indexed: 01/25/2023] Open
Abstract
Background Angiopoietin-2 (Ang-2) is associated with lung injury in ALI/ARDS. As endothelial activation by thrombin plays a role in the permeability of acute lung injury and Ang-2 may modulate the kinetics of thrombin-induced permeability by impairing the organization of vascular endothelial (VE-)cadherin, and affecting small Rho GTPases in human pulmonary microvascular endothelial cells (HPMVECs), we hypothesized that Ang-2 acts as a sensitizer of thrombin-induced hyperpermeability of HPMVECs, opposed by Ang-1. Methodology/Principal Findings Permeability was assessed by measuring macromolecule passage and transendothelial electrical resistance (TEER). Angiopoietins did not affect basal permeability. Nevertheless, they had opposing effects on the thrombin-induced permeability, in particular in the initial phase. Ang-2 enhanced the initial permeability increase (passage, P = 0.010; TEER, P = 0.021) in parallel with impairment of VE-cadherin organization without affecting VE-cadherin Tyr685 phosphorylation or increasing RhoA activity. Ang-2 also increased intercellular gap formation. Ang-1 preincubation increased Rac1 activity, enforced the VE-cadherin organization, reduced the initial thrombin-induced permeability (TEER, P = 0.027), while Rac1 activity simultaneously normalized, and reduced RhoA activity at 15 min thrombin exposure (P = 0.039), but not at earlier time points. The simultaneous presence of Ang-2 largely prevented the effect of Ang-1 on TEER and macromolecule passage. Conclusions/Significance Ang-1 attenuated thrombin-induced permeability, which involved initial Rac1 activation-enforced cell-cell junctions, and later RhoA inhibition. In addition to antagonizing Ang-1, Ang-2 had also a direct effect itself. Ang-2 sensitized the initial thrombin-induced permeability accompanied by destabilization of VE-cadherin junctions and increased gap formation, in the absence of increased RhoA activity.
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Affiliation(s)
- Melanie van der Heijden
- Department of Intensive Care, Institute for Cardiovascular Research, VU University Medical Centre, Amsterdam, The Netherlands
- Department of Physiology, Institute for Cardiovascular Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Geerten P. van Nieuw Amerongen
- Department of Physiology, Institute for Cardiovascular Research, VU University Medical Centre, Amsterdam, The Netherlands
- * E-mail:
| | - Jan van Bezu
- Department of Physiology, Institute for Cardiovascular Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Marinus A. Paul
- Department of Cardiothoracic Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | - A. B. Johan Groeneveld
- Department of Intensive Care, Institute for Cardiovascular Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Victor W. M. van Hinsbergh
- Department of Physiology, Institute for Cardiovascular Research, VU University Medical Centre, Amsterdam, The Netherlands
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Snaebjornsson P, Vos CG, Hartemink KJ, Lely RJ, Samii SM, Grünberg K, Paul MA. Fatal hemothorax caused by pseudomesotheliomatous carcinoma of the lung. Patholog Res Int 2011; 2011:836054. [PMID: 21789266 PMCID: PMC3135183 DOI: 10.4061/2011/836054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Accepted: 04/24/2011] [Indexed: 01/15/2023]
Abstract
We present a case of a poorly differentiated pseudomesotheliomatous carcinoma originating in the lung, which was manifested with the distinctly rare complication of massive true hemothorax and persistent blood loss that proved rapidly fatal in spite of surgery. Pseudomesotheliomatous carcinoma of the lung and neoplasia-associated hemothorax are reviewed and discussed.
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Affiliation(s)
- Petur Snaebjornsson
- Department of Pathology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Welvaart WN, Paul MA, van Hees HWH, Stienen GJM, Niessen JWM, de Man FS, Sieck GC, Vonk-Noordegraaf A, Ottenheijm CAC. Diaphragm muscle fiber function and structure in humans with hemidiaphragm paralysis. Am J Physiol Lung Cell Mol Physiol 2011; 301:L228-35. [PMID: 21622847 DOI: 10.1152/ajplung.00040.2011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Recent studies proposed that mechanical inactivity of the human diaphragm during mechanical ventilation rapidly causes diaphragm atrophy and weakness. However, conclusive evidence for the notion that diaphragm weakness is a direct consequence of mechanical inactivity is lacking. To study the effect of hemidiaphragm paralysis on diaphragm muscle fiber function and structure in humans, biopsies were obtained from the paralyzed hemidiaphragm in eight patients with hemidiaphragm paralysis. All patients had unilateral paralysis of known duration, caused by en bloc resection of the phrenic nerve with a tumor. Furthermore, diaphragm biopsies were obtained from three control subjects. The contractile performance of demembranated muscle fibers was determined, as well as fiber ultrastructure and morphology. Finally, expression of E3 ligases and proteasome activity was determined to evaluate activation of the ubiquitin-proteasome pathway. The force-generating capacity, as well as myofibrillar ultrastructure, of diaphragm muscle fibers was preserved up to 8 wk of paralysis. The cross-sectional area of slow fibers was reduced after 2 wk of paralysis; that of fast fibers was preserved up to 8 wk. The expression of the E3 ligases MAFbx and MuRF-1 and proteasome activity was not significantly upregulated in diaphragm fibers following paralysis, not even after 72 and 88 wk of paralysis, at which time marked atrophy of slow and fast diaphragm fibers had occurred. Diaphragm muscle fiber atrophy and weakness following hemidiaphragm paralysis develops slowly and takes months to occur.
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Affiliation(s)
- W N Welvaart
- Department of Surgery, Vrije Universiteit University Medical Center/Institute for Cardiovascular Research, The Netherlands
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Vos CG, Hartemink KJ, Golding RP, Oosterhuis JWA, Paul MA. Bronchogenic cysts in adults: frequently mistaken for a solid mass on computed tomography. Wien Klin Wochenschr 2011; 123:179-82. [PMID: 21350827 DOI: 10.1007/s00508-011-1541-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 12/06/2010] [Indexed: 01/23/2023]
Abstract
BACKGROUND Bronchogenic cysts are congenital malformations and are often detected in asymptomatic patients as an incidental finding. Growth can cause compression of airways and vessels, resulting in clinical symptoms and possible complications. On computed tomography (CT) scans, bronchogenic cysts frequently have the appearance of a solid tumor. We describe diagnostic strategy and management for patients with bronchogenic cysts. METHODS Retrospective case study of 11 adults diagnosed with a bronchogenic cyst. The CT scan of all patients was revised and localization, size, Hounsfield Units (HU), and appearance (cystic or solid) of the lesions were reported. Lesions were arbitrarily considered cystic or solid when the radiographic density was below or above 20 HU, respectively. RESULTS Eleven adults with a bronchogenic cyst were followed for at least 2 years after diagnosis. Eight of 11 detected lesions were judged as a solid lesion, based on the radiographic density (in HU) on CT images. Nine of 11 patients were treated by surgical resection. Two asymptomatic patients were not operated and remained asymptomatic without enlargement of the cysts during 2 years follow-up. Complications of resection were post-operative bleeding (n = 1), recurrent pneumothorax (n = 1), and recurrence of the cyst (n = 1). No mortality was observed. CONCLUSION Bronchogenic cysts are frequently mistaken for a solid mass on CT scans. Further differentiation can be made by MRI or EUS when CT is inconclusive.
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Affiliation(s)
- Cornelis G Vos
- Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands.
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Welvaart WN, Hartemink KJ, Paul MA, Oosterhuis JWA. A rare complication indeed. Ann Thorac Surg 2010; 90:2087. [PMID: 21095382 DOI: 10.1016/j.athoracsur.2010.02.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Revised: 02/01/2010] [Accepted: 02/17/2010] [Indexed: 11/24/2022]
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Maas KW, El Sharouni SY, Phernambucq ECJ, Stigt JA, Groen HJM, Herder GJM, Van Den Borne BEEM, Senan S, Paul MA, Smit EF, Schramel FMNH. Weekly chemoradiation (docetaxel/cisplatin) followed by surgery in stage III NSCLC; a multicentre phase II study. Anticancer Res 2010; 30:4237-4243. [PMID: 21036747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND This prospective study analyzed the feasibility and efficacy of weekly concurrent chemoradiation (docetaxel/cisplatin) followed by surgery. The primary endpoint was radiological response. PATIENTS AND METHODS Six chemotherapy (docetaxel/cisplatin) cycles were administered on days 1, 8, 15, 22, 29 and 36 with concurrent thoracic radiotherapy in fractions of 1.8 Gy, to a total dose of 45 Gy. Patients underwent surgery depending on results of invasive mediastinal re-staging. RESULTS Forty-two out of 45 NSCLC stage III patients were evaluable. Nineteen patients showed partial/complete response (46%), 14 stable disease (34%) and eight (20%) progressive disease. Toxicity was mild. The 30-day postoperative mortality was 4.2%. Twenty-four patients (59%) proceeded to surgery and 20 (49%) underwent a complete resection (R0). CONCLUSION Weekly concurrent chemoradiation (docetaxel/cisplatin) in stage III NSCLC results in a radiological response rate of 46% and mediastinal downstaging in 56%. Complete resection in downstaged patients was achieved in 49% of all patients.
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Affiliation(s)
- Klaartje W Maas
- Department of Pulmonary Diseases, St. Antonius Hospital Nieuwegein, Nieuwegein, the Netherlands.
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van der Meij BS, Langius JAE, Smit EF, Spreeuwenberg MD, von Blomberg BME, Heijboer AC, Paul MA, van Leeuwen PAM. Oral nutritional supplements containing (n-3) polyunsaturated fatty acids affect the nutritional status of patients with stage III non-small cell lung cancer during multimodality treatment. J Nutr 2010; 140:1774-80. [PMID: 20739445 DOI: 10.3945/jn.110.121202] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), (n-3) fatty acids from fish oil, have immune-modulating effects and may improve nutritional status in cancer. The objective of this study was to investigate the effects of an oral nutritional supplement containing (n-3) fatty acids on nutritional status and inflammatory markers in patients with non-small cell lung cancer (NSCLC) undergoing multimodality treatment. In a double-blind experiment, 40 patients with stage III NSCLC were randomly assigned to receive 2 cans/d of a protein- and energy-dense oral nutritional supplement containing (n-3) fatty acids (2.0 g EPA + 0.9 g DHA/d) or an isocaloric control supplement. EPA in plasma phospholipids, energy intake, resting energy expenditure (REE), body weight, fat free mass (FFM), mid-upper arm circumference (MUAC), and inflammatory markers were assessed. Effects of intervention were analyzed by generalized estimating equations and expressed as regression coefficients (B). The intervention group (I) had a better weight maintenance than the control (C) group after 2 and 4 wk (B = 1.3 and 1.7 kg, respectively; P < 0.05), a better FFM maintenance after 3 and 5 wk (B = 1.5 and 1.9 kg, respectively; P < 0.05), a reduced REE (B = -16.7% of predicted; P = 0.01) after 3 wk, and a trend for a greater MUAC (B = 9.1; P = 0.06) and lower interleukin-6 production (B = -27.9; P = 0.08) after 5 wk. After 4 wk, the I group had a higher energy and protein intake than the C group (B = 2456 kJ/24 h, P = 0.03 and B = 25.0 g, P = 0.01, respectively). In conclusion, a protein- and energy-dense oral nutritional supplement containing (n-3) fatty acids beneficially affects nutritional status during multimodality treatment in patients with NSCLC.
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Affiliation(s)
- Barbara S van der Meij
- Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
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Biere SSAY, Belt EJT, Paul MA. Acute dyspnoea in a 52-year-old man. Emerg Med J 2010; 28:541. [PMID: 20798085 DOI: 10.1136/emj.2010.092106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- S S A Y Biere
- Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands.
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Cardillo G, Treggiari S, Paul MA, Carleo F, De Massimi AR, Remotti D, Graziano P, Martelli M. Primary neuroendocrine tumours of the thymus: a clinicopathologic and prognostic study in 19 patients☆. Eur J Cardiothorac Surg 2010; 37:814-8. [DOI: 10.1016/j.ejcts.2009.10.026] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 10/10/2009] [Accepted: 10/19/2009] [Indexed: 12/01/2022] Open
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Phernambucq EC, Spoelstra FO, Paul MA, Senan S, Melissant CF, Postmus PE, Smit EF. Evaluation of a treatment strategy for optimising preoperative chemoradiotherapy in stage III non-small-cell lung cancer☆☆☆. Eur J Cardiothorac Surg 2009; 36:1052-7. [DOI: 10.1016/j.ejcts.2009.05.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Revised: 05/14/2009] [Accepted: 05/20/2009] [Indexed: 10/20/2022] Open
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Abstract
Objective This study was designed to review the diagnostic performance of sentinel node (SN) detection for assessment of the nodal status in thyroid carcinoma patients and to determine the technique (using blue dye or Technetium-99m colloid (99mTc)) that demonstrated the highest success rate with regard to the detection rate and sensitivity. Methods A comprehensive computer literature search of studies published in English language through December 2007 and regarding SN procedures in patients with thyroid disorders was performed in MEDLINE. Pooled values regarding the SN detection rate and the pooled sensitivity values of the SN procedure were presented with a 95% confidence interval (CI) for the different SN detection techniques. Results Ultimately, we identified 14 studies comprising a total of 457 patients. Of these, ten studies (n = 329 patients) used the blue dye technique with a pooled SN detection of 83% (95% CI, 79–87%). The remaining four studies (n = 128) used 99mTc-colloid with a pooled SN detection of 96% (95% CI, 91–99%; p < 0.05 vs. blue dye technique). Conclusion In patients with suspected thyroid carcinoma, SN biopsy demonstrated a higher SN detection rate when 99mTc was used (96%) instead of the blue dye technique (83%).
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Affiliation(s)
- P G H M Raijmakers
- Department of Nuclear Medicine & PET Research, VU University Medical Center, Amsterdam, The Netherlands.
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El Sharouni SY, Aerts JGJV, Senan S, De Ruysscher DKM, Groen HJM, Paul MA, Smit EF, Vonk EJA, Verhagen AF, Schramel FMNH. [Treatment of patients with stage III non-small cell lung cancer: concurrent high-dose chemotherapy and radiotherapy]. Ned Tijdschr Geneeskd 2008; 152:2714-2717. [PMID: 19192584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The treatment of patients with locally advanced non-small cell lung cancer (stage III) has changed significantly in the past few years. Patients with a non-resectable stage IIIA/B tumour are given combined treatment consisting ofchemotherapy and radiotherapy. These can be administered sequentially or concurrently. It has been shown recently that concurrent chemoradiotherapy gives a survival advantage in comparison with sequential chemoradiotherapy. Cisplatin and etoposide are usually the drugs of choice for chemotherapy in patients with stage III cancer. A biologically effective dose of radiotherapy equivalent to 60-66 Gy, over a maximum of 6.5 weeks, should be given. Surgery is possible for a selected group of patients, provided a complete objective mediastinal response has been achieved after chemoradiotherapy and a complete resection appears to be technically feasible. It is recommended to apply this treatment in a research setting. High-dose concurrent chemoradiotherapy is advised as the standard treatment for stage III non-small cell lung cancer in patients in good physical condition.
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Affiliation(s)
- S Y El Sharouni
- Universitaire Medisch Centrum Utrecht, afd. Radiotherapie, Q00.118, Heidelberglaan 100, 3584 CX Utrecht.
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Kamminga SK, Boer C, Rijkeboer AA, Paul MA, Vonk Noordegraaf A, Strack van Schijndel RJ. Occult pleural cryptococcosis in an immunocompromised patient. Intensive Care Med 2008; 35:961-2. [PMID: 18979084 DOI: 10.1007/s00134-008-1347-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2008] [Indexed: 11/30/2022]
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Kunst PWA, Lee P, Paul MA, Senan S, Smit EF. Restaging of mediastinal nodes with transbronchial needle aspiration after induction chemoradiation for locally advanced non-small cell lung cancer. J Thorac Oncol 2007; 2:912-5. [PMID: 17909353 DOI: 10.1097/jto.0b013e3181560a85] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Selecting the appropriate treatment strategy for patients with locally advanced non-small cell carcinoma (NSCLC) is of utmost importance to determine patient outcome. Previous studies have shown that nodal down-staging after induction therapy and definitive local irradiation in these patients better predict survival when combined with surgery. However, nodal restaging can be technically difficult. We investigated the role of transbronchial needle aspiration (TBNA) in mediastinal restaging of patients who had completed induction cytotoxic therapy. METHODS A total of 14 patients with proven stage IIIa-N2 NSCLC who received chemotherapy or chemo-radiotherapy as induction regimen between 2005 and 2006 were studied. Outpatient flexible bronchoscopy with TBNA was performed in all patients under local anesthesia, and 17 TBNA procedures were performed. TBNA results were matched against the histopathology of surgical specimens. RESULTS Seventeen lymph nodes in 14 patients who had undergone induction therapy were sampled. Positron emission tomography (PET) scan results of 11 patients were also available for comparison. All positive TBNA procedures had positive PET scans. However, for five patients with lymph nodes measuring 9 to 17 mm, the PET scans were falsely positive, as mediastinoscopy and subsequent surgically resected lymph nodes revealed no tumor. TBNA achieved a correct diagnosis in 71% of patients who underwent mediastinal restaging and obviated further need for invasive procedures in 35%. CONCLUSION For patients presenting with locally advanced NSCLC who are surgical candidates after induction chemo- and/or radiotherapy, TBNA should be considered as the initial procedure of choice for restaging of the mediastinum.
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Affiliation(s)
- Peter W A Kunst
- Department of Pulmonology, HAGA Hospital, Den Haag, The Netherlands.
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