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40 Patient-reported outcomes from the CodeBreaK 200 phase III trial comparing sotorasib versus docetaxel in KRAS G12C-mutated NSCLC. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00258-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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186P Elevated CXCL10:IL-8 ratio in bronchoalveolar lavage fluid of immune checkpoint inhibitor-related pneumonitis. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00439-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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3
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Neratinib efficacy in patients with EGFR exon 18-mutant non-small-cell lung cancer: findings from the SUMMIT basket trial. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01017-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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994P Efficacy and safety of capmatinib plus spartalizumab in treatment-naïve patients with advanced NSCLC harboring MET exon 14 skipping mutation. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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5
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LBA52 Tepotinib + osimertinib for EGFRm NSCLC with MET amplification (METamp) after progression on first-line (1L) osimertinib: Initial results from the INSIGHT 2 study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.08.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Results of screening in early and advanced thoracic malignancies in the EORTC pan-European SPECTAlung platform. Sci Rep 2022; 12:8342. [PMID: 35585228 PMCID: PMC9117328 DOI: 10.1038/s41598-022-12056-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/18/2022] [Indexed: 11/16/2022] Open
Abstract
Access to a comprehensive molecular alteration screening is patchy in Europe and quality of the molecular analysis varies. SPECTAlung was created in 2015 as a pan-European screening platform for patients with thoracic malignancies. Here we report the results of almost 4 years of prospective molecular screening of patients with thoracic malignancies, in terms of quality of the program and molecular alterations identified. Patients with thoracic malignancies at any stage of disease were recruited in SPECTAlung, from June 2015 to May 2019, in 7 different countries. Molecular tumour boards were organised monthly to discuss patients' molecular and clinical profile and possible biomarker-driven treatments, including clinical trial options. FFPE material was collected and analysed for 576 patients with diagnosis of pleural, lung, or thymic malignancies. Ultimately, 539 patients were eligible (93.6%) and 528 patients were assessable (91.7%). The turn-around time for report generation and molecular tumour board was 214 days (median). Targetable molecular alterations were observed in almost 20% of cases, but treatment adaptation was low (3% of patients). SPECTAlung showed the feasibility of a pan-European screening platform. One fifth of the patients had a targetable molecular alteration. Some operational issues were discovered and adapted to improve efficiency.
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121P Treatment of unresectable stage III NSCLC: Real-world study and literature review. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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P47.09 Tepotinib + Osimertinib for EGFR-Mutant NSCLC with Resistance to First-Line Osimertinib Due to MET amplification: INSIGHT 2. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Monocyte-driven atypical cytokine storm and aberrant neutrophil activation as key mediators of COVID-19 disease severity. Nat Commun 2021; 12:4117. [PMID: 34226537 PMCID: PMC8257697 DOI: 10.1038/s41467-021-24360-w] [Citation(s) in RCA: 128] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 06/14/2021] [Indexed: 02/06/2023] Open
Abstract
Epidemiological and clinical reports indicate that SARS-CoV-2 virulence hinges upon the triggering of an aberrant host immune response, more so than on direct virus-induced cellular damage. To elucidate the immunopathology underlying COVID-19 severity, we perform cytokine and multiplex immune profiling in COVID-19 patients. We show that hypercytokinemia in COVID-19 differs from the interferon-gamma-driven cytokine storm in macrophage activation syndrome, and is more pronounced in critical versus mild-moderate COVID-19. Systems modelling of cytokine levels paired with deep-immune profiling shows that classical monocytes drive this hyper-inflammatory phenotype and that a reduction in T-lymphocytes correlates with disease severity, with CD8+ cells being disproportionately affected. Antigen presenting machinery expression is also reduced in critical disease. Furthermore, we report that neutrophils contribute to disease severity and local tissue damage by amplification of hypercytokinemia and the formation of neutrophil extracellular traps. Together our findings suggest a myeloid-driven immunopathology, in which hyperactivated neutrophils and an ineffective adaptive immune system act as mediators of COVID-19 disease severity.
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Early lung ultrasound assessment for the prognosis of patients hospitalized for COVID-19 pneumonia. A pilot study. Respir Med Res 2021; 80:100832. [PMID: 34130209 PMCID: PMC8177497 DOI: 10.1016/j.resmer.2021.100832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/14/2021] [Accepted: 05/26/2021] [Indexed: 01/19/2023]
Abstract
Objective SARS CoV-2 is an epidemic viral infection that can cause mild to severe lung involvement. Newly apprehended knowledge on thoracic imaging abnormalities and the growing clinical experience on the evolution of this disease make the radiographic follow-up of hospitalized patients relevant. The value of consecutive bedside lung ultrasonography in the follow-up of hospitalized patients with SARS CoV-2 pneumonia and its correlation with other clinical and laboratory markers needs to be evaluated. Methods We assessed 39 patients [age: 64 y(60.1–68.7)] with confirmed SARS CoV-2 pneumonia. A total of 24 patients were hospitalized until the follow-up test, 9 were discharged early and 6 required a transfer to critical care unit. Two ultrasound scans of the lung were performed on day 1 and 4 of patients’ hospitalization. Primary endpoint was the magnitude of association between a global lung ultrasound score (LUS) and clinical and laboratory markers. Secondary endpoint was the association between the evolution of LUS with the corresponded changes in clinical and laboratory outcomes during hospitalization period. Results LUS score on admission was higher among the deteriorating patients and significantly (P = 0.038–0.0001) correlated (Spearman's rho) with the levels of C-reactive protein (0.58), lymphocytes (−0.33), SpO2 (−0.48) and oxygen supplementation (0.48) upon admission. The increase in LUS score between the two scans was significantly correlated (0.544, P = 0.006) with longer hospital stay. Conclusion Lung ultrasound assessment can be a useful as an imaging modality for SARS CoV-2 patients. Larger studies are needed to further investigate the predictive role of LUS in the duration and the outcome of the hospitalization of these patients.
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OA04.06 Neratinib in Pretreated EGFR Exon 18-Mutant Non-Small Cell Lung Cancer (NSCLC): Initial Findings From the SUMMIT Basket Trial. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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LBA78 A microsimulation model to assess the impact of SARS-CoV-2 on cancer outcomes, healthcare organization and economic burden. Ann Oncol 2020. [PMCID: PMC7506428 DOI: 10.1016/j.annonc.2020.08.2319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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ES07.04 Predictive Molecular Testing on Small Biopsy Samples. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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OA 16.06 Mediastinal Staging by Videomediastinoscopy in Clinical N1 Non-Small Cell Lung Cancer: a Prospective Multicenter Study. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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P1.13-007 Is Central Lung Tumor Location Really Predictive for Occult Mediastinal Nodal Disease in (Suspected) NSCLC Staged cN0 on PET-CT? J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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P-106SURVIVAL ANALYSIS IN PATIENTS WITH cSTAGE-I SUSPECTED NON-SMALL CELL LUNG CANCER REFERRED TO SURGERY BUT WHO WERE ALSO CANDIDATES FOR STEREOTACTIC BODY RADIATION THERAPY. Interact Cardiovasc Thorac Surg 2017. [DOI: 10.1093/icvts/ivx280.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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P-264DOES DIAGNOSIS OF SINGLE LEVEL N2 NON-SMALL CELL LUNG CANCER BY ENDOBRONCHIAL ULTRASOUND RESULT IN LESS FREQUENT INCOMPLETE RESECTIONS AFTER INDUCTION THERAPY COMPARED TO MEDIASTINOSCOPY? Interact Cardiovasc Thorac Surg 2017. [DOI: 10.1093/icvts/ivx280.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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F-014MULTICENTRIC EVALUATION OF THE IMPACT OF CENTRAL TUMOUR LOCATION WHEN COMPARING N1 UPSTAGING BETWEEN VIDEO-ASSISTED THORACOSCOPIC SURGERY AND OPEN SURGERY FOR CLINICAL STAGE I NON-SMALL CELL LUNG CANCER. Interact Cardiovasc Thorac Surg 2017. [DOI: 10.1093/icvts/ivx280.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Endoscopic advanced imaging of the respiratory tract: exploring probe-based confocal laser endomicroscopy in emphysema. Thorax 2017; 73:188-190. [PMID: 28411249 DOI: 10.1136/thoraxjnl-2016-209746] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 03/15/2017] [Accepted: 03/27/2017] [Indexed: 11/04/2022]
Abstract
: Probe-based confocal laser endomicroscopy (pCLE) was performed in 15 patients with emphysema and 15 healthy subjects to visualise small airways in a direct and dynamic way. Morphometry shows that the median cross-sectional area of the alveolar openings at the level of the alveolar ducts is significantly larger in emphysema (7.2×104 µm2) as compared with healthy subjects (5.2×104 µm2) (p=0.0002). Normalised autofluorescence intensity histograms show a decrease in median autofluorescence intensity (mAFI) in emphysema (p=0.001). mAFI correlates well with Tiffeneau index (r=0.66, p=0.007, 95% CI 0.21 to 0.88). Autofluorescence intensity in emphysema correlates with corresponding data of CT-based quantification. pCLE-based morphometry and autofluorescence intensity analysis in emphysema is able to detect regional changes inside the 'quiet zone'. TRIAL REGISTRATION NUMBER Results, NCT01204970.
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EP-1246: Is there a different dose-effect relation between the tumour and involved lymph nodes in NSCLC? Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32496-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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OC-0047: PD-L1/PD-L2 gene expression differs in tumor vs. lung tissue in non-small cell lung cancer patients. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31296-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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126P: Outcome after post-operative radiotherapy (PORT) in ypN2 or R1/R2 versus no PORT in ypN0 stage III-N2 non-small cell lung cancer after induction chemotherapy and resection. J Thorac Oncol 2016. [DOI: 10.1016/s1556-0864(16)30239-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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PO-0688: Patterns of LR for stage III N2 NSCLC patients after chemotherapy and surgery: implications for PORT. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31938-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Pulmonary alveolar (phospholipo)proteinosis (PAP) is a rare lung disease, predominantly autoimmune in nature. This case report describes a patient with insidious dyspnoea since 5 years and a milky appearance of her bronchoalveolar fluid, leading to the diagnosis of PAP. The onset of symptoms coincided with an exchange of her silicone breast implants. Giant cell reaction in axillary adenopathies pointed towards silicone leakage. Adjuvants, such as silicone, might boost pre-existing antigen reactions of the immune system, potentially leading to autoimmune phenomena.
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O-024TUMOUR LOCATION SHOULD BE CONSIDERED WHEN COMPARING N1 UPSTAGING BETWEEN VIDEO-ASSISTED THORACOSCOPIC SURGERY AND OPEN SURGERY FOR CLINICAL STAGE I NON-SMALL CELL LUNG CANCER. Interact Cardiovasc Thorac Surg 2015. [DOI: 10.1093/icvts/ivv204.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Postoperative Radiotherapy in Resected Ypn2 Stage Iii-N2 Non-Small Cell Lung Cancer: Can Modern Conformal Radiotherapy Compensate for the Poor Outcome? Ann Oncol 2014. [DOI: 10.1093/annonc/mdu348.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Selective Mediastinal Node Irradiation in Nsclc in the Imrt/Vmat Era: Added Value of Ebus-Tbna-Mapping to Pet-Ct. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu348.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Optimal Assessment of an Additional Lung Nodule in a Patient with Potential for Cure. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu305.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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2nd ESMO Consensus Conference on Lung Cancer: early-stage non-small-cell lung cancer consensus on diagnosis, treatment and follow-up. Ann Oncol 2014; 25:1462-74. [PMID: 24562446 DOI: 10.1093/annonc/mdu089] [Citation(s) in RCA: 337] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
To complement the existing treatment guidelines for all tumour types, ESMO organises consensus conferences to focus on specific issues in each type of tumour. The 2nd ESMO Consensus Conference on Lung Cancer was held on 11-12 May 2013 in Lugano. A total of 35 experts met to address several questions on non-small-cell lung cancer (NSCLC) in each of four areas: pathology and molecular biomarkers, first-line/second and further lines in advanced disease, early-stage disease and locally advanced disease. For each question, recommendations were made including reference to the grade of recommendation and level of evidence. This consensus paper focuses on early-stage disease.
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EP-1149: Influence of histology and smoking status on PD-L1, PD1 and CTLA4 expression of tumor vs. normal lung tissue in NSCLC. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31267-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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OC-0064: Selective mediastinal node irradiation in NSCLC in the IMRT/VMAT era: added value of EBUS-TBNA-mapping to PET-CT. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30169-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Probe-based confocal laser endomicroscopy of the respiratory tract: A data consistency analysis. Respir Med 2013; 107:1234-40. [DOI: 10.1016/j.rmed.2013.04.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Revised: 04/17/2013] [Accepted: 04/19/2013] [Indexed: 10/26/2022]
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Abstract
The greatest news of the past year in this field was the first large-scale early detection trial that could prove a 20% reduction in lung cancer-related mortality by screening high-risk individuals with low-dose computed tomography (LDCT). Several expert groups and medical societies have assessed the data and concluded that LDCT screening for lung cancer is, however, not ready for large-scale population-based implementation. Too many open questions remain, such as definition of the at-risk population, timing and intervals of screening, optimal method of acquisition and interpretation of the images, how to handle (false) positive findings, and especially cost-effectiveness in relation to other lung cancer prevention strategies, mainly smoking cessation. Further analyses and several ongoing European trials are eagerly awaited. Much hope also resides in the use of biomarkers, as their use in, e.g., blood or exhaled air may provide more easy-to-use tests to better stratify high-risk populations for screening studies. While exciting research is ongoing in this domain--e.g. with microRNAs--none of the tests has yet reached sufficient validation for clinical use. Early central lung cancers are more difficult to visualise by CT. For these patients, standard bronchoscopy, complemented by autofluoresence endoscopy, has been studied in different screening and follow-up settings.
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Abstract
The first vascularized tracheal allotransplantation was performed in 2008. Immunosuppression was stopped after forearm implantation and grafting of the recipient mucosa to the internal site of the transplant. Nine months after forearm implantation, the allograft was transplanted to the tracheal defect on the radial blood vessels. Since then, four additional patients have undergone tracheal allotransplantation, three (patients 2-4) for long-segment stenosis and one (patient 5) for a low-grade chondrosarcoma. Our goal was to reduce the time between forearm implantation and orthotopic transplantation and to determine a protocol for safe withdrawal of immunosuppressive therapy. Following forearm implantation, all transplants became fully revascularized over 2 months. Withdrawal of immunosuppression began 4 months after graft implantation and was completed within 6 weeks in cases 2-4. Repopulation of the mucosal lining by recipient cells, to compensate for the necrosis of the donor mucosa, was not complete. This resulted in partial loss of the allotransplant in patients 2-4. In patient 5, additional measures promoting recipient cell repopulation were made. The trachea may be used as a composite tissue allotransplant after heterotopic revascularization in the forearm. Measures to maximize recipient cell repopulation may be important in maintaining the viability of the transplant after cessation of immunosuppression.
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Prevalence and Clinical Outcomes for Patients With ALK Gene Rearrangement in Europe: Preliminary Results from the European Thoracic Oncology Platform Lungscape Project. Ann Oncol 2012. [DOI: 10.1093/annonc/mds391] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Clinical effectiveness and cost-effectiveness of endobronchial and endoscopic ultrasound relative to surgical staging in potentially resectable lung cancer: results from the ASTER randomised controlled trial. Health Technol Assess 2012; 16:1-75, iii-iv. [PMID: 22472180 DOI: 10.3310/hta16180] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the clinical effectiveness and cost-effectiveness of endosonography (followed by surgical staging if endosonography was negative), compared with standard surgical staging alone, in patients with non-small cell lung cancer (NSCLC) who are otherwise candidates for surgery with curative intent. DESIGN A prospective, international, open-label, randomised controlled study, with a trial-based economic analysis. SETTING Four centres: Ghent University Hospital, Belgium; Leuven University Hospitals, Belgium; Leiden University Medical Centre, the Netherlands; and Papworth Hospital, UK. PARTICIPANTS INCLUSION CRITERIA known/suspected NSCLC, with suspected mediastinal lymph node involvement; otherwise eligible for surgery with curative intent; clinically fit for endosonography and surgery; and no evidence of metastatic disease. EXCLUSION CRITERIA previous lung cancer treatment; concurrent malignancy; uncorrected coagulopathy; and not suitable for surgical staging. INTERVENTIONS Study patients were randomised to either surgical staging alone (n = 118) or endosonography followed by surgical staging if endosonography was negative (n = 123). Endosonography diagnostic strategy used endoscopic ultrasound-guided fine-needle aspiration combined with endobronchial ultrasound-guided transbronchial needle aspiration, followed by surgical staging if these tests were negative. Patients with no evidence of mediastinal metastases or tumour invasion were referred for surgery with curative intent. If evidence of malignancy was found, patients were referred for chemoradiotherapy. MAIN OUTCOME MEASURES The main clinical outcomes were sensitivity (positive diagnostic test/nodal involvement during any diagnostic test or thoracotomy) and negative predictive value (NPV) of each diagnostic strategy for the detection of N2/N3 metastases, unnecessary thoracotomy and complication rates. The primary economic outcome was cost-utility of the endosonography strategy compared with surgical staging alone, up to 6 months after randomisation, from a UK NHS perspective. RESULTS Clinical and resource-use data were available for all 241 patients, and complete utilities were available for 144. Sensitivity for detecting N2/N3 metastases was 79% [41/52; 95% confidence interval (CI) 66% to 88%] for the surgical arm compared with 94% (62/66; 95% CI 85% to 98%) for the endosonography strategy (p = 0.02). Corresponding NPVs were 86% (66/77; 95% CI 76% to 92%) and 93% (57/61; 95% CI 84% to 97%; p = 0.26). There were 21/118 (18%) unnecessary thoracotomies in the surgical arm compared with 9/123 (7%) in the endosonography arm (p = 0.02). Complications occurred in 7/118 (6%) in the surgical arm and 6/123 (5%) in the endosonography arm (p = 0.78): one pneumothorax related to endosonography and 12 complications related to surgical staging. Patients in the endosonography arm had greater EQ-5D (European Quality of Life-5 Dimensions) utility at the end of staging (0.117; 95% CI 0.042 to 0.192; p = 0.003). There were no other significant differences in utility. The main difference in resource use was the number of thoracotomies: 66% patients in the surgical arm compared with 53% in the endosonography arm. Resource use was similar between the groups in all other items. The 6-month cost of the endosonography strategy was £9713 (95% CI £7209 to £13,307) per patient versus £10,459 (£7732 to £13,890) for the surgical arm, mean difference £746 (95% CI -£756 to £2494). The mean difference in quality-adjusted life-year was 0.015 (95% CI -0.023 to 0.052) in favour of endosonography, so this strategy was cheaper and more effective. CONCLUSIONS Endosonography (followed by surgical staging if negative) had higher sensitivity and NPVs, resulted in fewer unnecessary thoracotomies and better quality of life during staging, and was slightly more effective and less expensive than surgical staging alone. Future work could investigate the need for confirmatory mediastinoscopy following negative endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), the diagnostic accuracy of EUS-FNA or EBUS-TBNA separately and the delivery of both EUS-FNA or EBUS-TBNA by suitably trained chest physicians. TRIAL REGISTRATION Current Controlled Trials ISRCTN 97311620. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 16, No. 18. See the HTA programme website for further project information.
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Should we abandon standard forceps biopsy to diagnose an endobronchial lesion? Eur Respir J 2012; 39:513-4. [PMID: 22379143 DOI: 10.1183/09031936.00150511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
A 37-year-old woman presented at casualty with a 1-day history of progressive spontaneous left iliac fossa pain. She was having her menstruations for 4 days. She had no respiratory symptoms. Her medical history consisted of laparoscopic surgery for endometriosis and ovarian cysts. A very small right basal pneumothorax with visualisation of a hypervascular nodular lesion on the right diaphragm was incidentally noticed on the right diaphragm. We suspected here a catamenial pneumothorax. During video-assisted thoracoscopy the surgeon observed in the centrum tendineum of the diaphragm a small and a large perforation with partial intrathoracic herniation of the liver, but without visible diaphragmatic or pleural endometriosis. The surgeons converted to a small anterior thoracotomy in order to reinforce the large perforation with interrupted non-absorbable sutures and plication of the smaller perforation, and finally performed a mechanical pleural abrasion with a surgical pad.
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S55 Cost-effectiveness and quality of life results from the ASTER study: endobronchial and endoscopic ultrasound vs surgical staging in potentially resectable lung cancer. Thorax 2011. [DOI: 10.1136/thoraxjnl-2011-201054b.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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12IN A PATIENT WITH RESECTABLE RIGHT-SIDED NSCLC AND SUSPECT RIGHT PARATRACHEAL LYMPH NODES. Lung Cancer 2011. [DOI: 10.1016/s0169-5002(11)70149-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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S35 A randomised controlled trial comparing combined EBUS/EUS followed by surgical staging versus surgical staging alone in non-small cell lung cancer: the ASTER study. Thorax 2010. [DOI: 10.1136/thx.2010.150912.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Endoscopy: a clinical state of the art. Eur Respir Rev 2010; 19:212. [PMID: 20956194 DOI: 10.1183/09059180.00005210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Early stage non-small-cell lung cancer: challenges in staging and adjuvant treatment: evidence-based staging. Ann Oncol 2010; 21 Suppl 7:vii189-95. [DOI: 10.1093/annonc/mdq424] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Endobronchial ultrasound-guided transbronchial needle biopsy for M1 staging of extrathoracic malignancies. Ann Oncol 2010; 22:127-131. [PMID: 20603434 DOI: 10.1093/annonc/mdq311] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND extrathoracic malignancies metastasize to the mediastinum and/or pulmonary hilum. Mediastinoscopy and thoracoscopy are standard to obtain tissue proof of metastatic spread but are invasive. Endobronchial ultrasound with real-time-guided transbronchial fine-needle aspiration (EBUS-TBNA) is a minimally invasive alternative for surgical staging of lung cancer. METHODS we analysed the test characteristics of EBUS-TBNA in consecutive patients with a suspicion of mediastinal or hilar metastases of various extrathoracic malignancies. RESULTS ninety-two patients with concurrent (n = 33) or previously diagnosed and treated (n = 59) extrathoracic malignancies were evaluated. EBUS-TBNA detected mediastinal or hilar metastatic spread in 52 patients (57%) [metastasis of extrathoracic tumour in 40 (44%) and second malignancies (lung cancer) in 12 (13%)]. Subsequent surgical staging showed malignancy in another nine patients. With EBUS-TBNA, an alternate diagnosis was found in four. Sensitivity and negative predictive value for mediastinal or hilar metastatic spread were 85% [95% confidence interval (CI) 73-93] and 76% (95% CI 59-88). EBUS-TBNA prevented an invasive surgical procedure in 61% of the patients. One patient had a respiratory arrest during EBUS-TBNA; abortion lead to full recovery without further intervention. CONCLUSIONS EBUS-TBNA is a minimally invasive method for M staging of patients with extrathoracic malignancies to confirm mediastinal or hilar spread. EBUS-TBNA therefore may qualify as an alternative for surgical staging.
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The value of endoscopic ultrasound after bronchoscopy to diagnose thoracic sarcoidosis. Eur Respir J 2009; 35:1329-35. [PMID: 19897553 DOI: 10.1183/09031936.00111509] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A clinicoradiological presentation of thoracic sarcoidosis requires histopathology in order to establish the diagnosis. Flexible bronchoscopy has a reasonable diagnostic yield and is the procedure of first choice for diagnosis. Endoscopic ultrasound (endoscopic ultrasound-guided fine needle aspiration/endobronchial ultrasound-guided transbronchial needle aspiration) can help in the diagnosis of sarcoidosis. An implementation strategy of endoscopic ultrasound for the diagnosis of sarcoidosis following negative flexible bronchoscopy results was examined prospectively in 15 clinics. A total of 137 patients (92 males; median age 43 yrs) were included, and sarcoidosis was found in 115 (84%). Alternative diagnoses were tuberculosis, lymphangitis carcinomatosa, pneumoconiosis and alveolitis. All patients were sent for flexible bronchoscopy, which was performed in 121 (88%), resulting in a definite diagnosis in 57 (42%). A total of 80 patients were sent for endoscopic ultrasound, which could be performed in 72 (90%), yielding a definite diagnosis in 47 (59%). Endoscopic ultrasound following negative flexible bronchoscopy avoided a surgical procedure in 47 out of 80 patients. The sensitivity of flexible bronchoscopy for sarcoidosis was 45% (95% confidence interval 35-54%), but 62% (50-72%) if biopsy specimens were taken. The sensitivity of endoscopic ultrasound following negative flexible bronchoscopy results was 71% (58-82%). With this strategy, 97 out of 115 (84% (76-90%)) of proven sarcoidosis was diagnosed using endoscopy. This large prospective implementation study (trial number NCT00888212; ClinicalTrials.gov) shows that endoscopic ultrasound is valuable for diagnosing sarcoidosis after negative flexible bronchoscopy results.
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Association between FDG-PET and tumor vitality: Understanding the prognostic value of FDG uptake in early stage non-small cell lung cancer. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.22211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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48. Int J Radiat Oncol Biol Phys 2006. [DOI: 10.1016/j.ijrobp.2006.07.1347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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