Treatment Strategy for Chylothorax after Resection for Lung Cancer—16 Case Report

OBJECTIVE To review the experience of iatrogenic chylothorax after pul- monary resections for lung cancer and to evaluate our treatment strategy. METHODS From July 1997 through December 2003, a total of 1,546 pa- tients underwent pulmonary resection (at least lobectomy) and systematic mediastinal lymph node dissection for lung cancer in our division. Sixteen patients had a postoperative chylothorax complication. All of these pa- tients in this study were conservatively treated (closed drainage) with complete oral intake cessation and total parenteral nutrition. RESULTS All patients had their condition cured with conservative treat- ment. The duration of the treatment was 6-21 days. The patients were given normal diet for a mean of 9.8 days after chylothorax diagnosis. CONCLUSION If the correct treatment strategy is selected, most cases of chylothorax after pulmonary resection with systematic mediastinal lymph node dissection can be cured with a conservative strategy.

Efficacy of gefitinib as a first-line single agent treatment in patients with advanced non-small cell lung cancer

Objective： To assess the efficacy and toxicity of gefitinib as a single agent treatment in Chinese patients with advanced non-small cell lung cancer （NSCLC）. Methods： Forty-five patients with advanced NSCLC were treated with gefitinib at 250 mg daily until the disease progressed or the patient could not tolerate the toxicity. Results： None of the patients achieved a complete response （CR）, while 15 patients achieved a partial remission （PR） and 17 experienced a stable disease （SD）. Thirteen patients continued to have a progressive disease （PD）. The response rate and the disease control rate were 33.3% and 71.1%, respectively. The symptom remission rate was 72.5%, and the median remission time was 8 days. The median survival time was 15.3 months. The median progression-free survival time was 6.0 months. The most common toxicities included rash （53.3%） and diarrhea （33.3%）. Dehydration and pruritus of the skin developed in 26.7% and 22.2% of the patients, respectively. Hepatic toxicity occurred in 6.7% of patients and oral ulceration occurred in 4.4% of patients. Conclusion： Single agent treatment with gefitinib is effective against advanced NSCLC, and is well tolerated in Chinese patients.

Adaptive treatment:肺癌治疗的加加减减

抗肿瘤治疗方案的创新驱动力始于当前治疗方案未满足的需求,这些需求主要集中在提高治疗效果和降低毒副反应两个方面,其中,前者是主导因素。通过探索不同的治疗方式、研发新的药物以及新的生物标志物,努力寻找解决这些问题的关键。“adaptive”,英文原意是指能够适应变化或者改变以适应新情况的能力,在抗肿瘤治疗中,“adaptive treatment(适应性治疗)”,即根据不同治疗场景的特征,在原有标准治疗方案的基础上做出适应性改变,在毒性可耐受的基础上获得更好的疗效。

Multisegmental Lobe Bronchoplasty for the Treatment of Non-small-cell Lung Cancer

Bronchoplasty was extended to the segmental level and the effect of the multi-segmental surgery for the central non-small lung cancer was observed. The involved lobular bronchi and part of main bronchi were resected and single-layer continuous suture with 5-0 Prolene was used for suturing of the carina of the reconstructed segmental bronchi to form lobular bronchi. Then, single-layer continuous suture with 4-0 Prolene was employed to anastomose the ＂lobular bronchi＂ with main bronchi Our results showed that the 15 bronchoplasties were successfully performed. The tumors were completely removed and postoperatively, the pulmonary functions of the patients were substantially improved. No broncho-pleural fistula and stomal stenosis took place in all the cases. The quality of life of the patients were obviously improved. It is concluded that multisegmental bronchoplasty can completely remove the tumor of central non-small-cell lung cancer and conserve more non-involved lung. The procedure is especially suitable for those patients with severely impaired lung functions and it expands the indications of surgical resection of lung cancer.

Palliative Treatment of Locally Advanced Non Metastatic Lung Cancer

Introduction: To determine the proportion and the reasons which lead to palliative treatment in patients initially a candidate for concomitant chemoradiotherapy (CCRT). Methods: A retrospective study including patients followed for locally advanced lung cancer newly diagnosed from April 1, 2016, to 12/31/2017 in the radiotherapy department of the National Oncology Institute who received palliative treatment. Results: We collected 52 patients out of a total of 225 stage III patients (23%) followed by lung cancer candidates for CCRT who had undergone palliative treatment. The mean age in our series was 61.23 years [22 - 81] with 86% male. The majority of patients (71%) had Performance Status (PS) ≤ 2. Histological confirmation was obtained by pathological examination in all our patients. It was an adenocarcinoma (ADK) in 54% of cases;squamous cell carcinoma in 46% of cases. The reasons for palliative treatment were mainly due to dosimetric constraints: large tumor volume 22/52 (42%);the tumor location close to the bone marrow in 15 of 52 (29%) patients;and general Performance Status impairment (29%) in 15 of 52 patients. Palliative treatment consisted of palliative chemotherapy in 37 of 52 patients (71%), among whom 19 (51%) were stable after 2 months of chemotherapy, in palliative dose chest radiotherapy on the pulmonary parenchyma and/or mediastinum in 10 of 52 (19%) patients, and supportive care in 5 (10 %) patients. We observed 40/52 (77%) cases of stationary course, 04/52 (8%) cases of progress to metastases, and 08/52 (15%) deaths before radiotherapy. Conclusion: A large proportion of patients followed for locally advanced non-metastatic lung cancer are not eligible for curative treatment. The reasons for the palliative treatment of patients followed for lung cancer candidates for CCRT are variable but for a large proportion of patients due to the deterioration of their state of health during their diagnostic journey. Hence, there is the need to improve the early diagnosis and early management of patients with lung cancer to avoid delayed care.

Process of Decision-Making of Anti-Cancer Treatment in Elderly Patients with Advanced Lung Cancer

The aim of this study was to identify the decision-making process of anti-cancer treatment in elderly patients with advanced lung cancer. Semi-structured interviews were conducted with 17 patients aged 70 and above to collect data on their feelings and thoughts from the time of diagnosis till they made treatment decisions. The data was analyzed using the Modified Grounded Theory Approach that was modified by Prof. Yasuhito Kinoshita. We found the process to be composed of six categories. The results showed that elderly patients with advanced lung cancer were panicked over unavoidable death when informed of stage IV lung cancer and offered suggestions about anti-cancer treatment. However, trying to accept the situation where death is imminent, patients reconsidered having cancer in older age and recognized a desire to survive even in older age. This process diverged into two paths: one group of patients changed their ideas from radical to life-prolonging treatment by recognizing a desire to survive even in older age and then made anti-cancer treatment decisions by carefully choosing treatment that would allow to carry on their usual way of life;the other group of patients made treatment decisions by carefully choosing physicians to whom they could entrust their life in older age. These findings suggest that it is important for nurses to: 1) encourage patients to talk in order to have them think about what they have valued and want to value in the rest of their life;2) assess if patients prefer to decide on their own by carefully choosing treatment or entrust treatment decisions to physicians;and 3) offer support according to patients’ preferences.

Non-Small Cell Lung Cancer: Treatment, Diagnosis, and Life after Treatment

Lung cancer is becoming the most common cancer globally. In China, Lung cancer has become prevalent among preceding compared to present smokers. There are many treatments for lung cancer globally like Chemotherapy, Radiotherapy, Surgery, and Targeted therapy [1] [2]. Generally, lung cancer starts in the lungs. The spongy lungs in the chest inhale oxygen and exhale carbon dioxide. Those who smoke regularly have the highest risk of lung cancer than nonsmokers. This risk increases with an increase in length, time, and the number of cigarettes smoked. Immediate treatment will help in reducing the severity of cancer. The complications of lung cancer include shortness of breath, coughing up blood, pain, and fluid in the chest. Therefore, the primary step in preventing lung cancer is quitting smoking [3].

First-line pemetrexed-platinum doublet chemotherapy with or without bevacizumab in non-squamous non-small cell lung cancer: A real-world propensity score-matched study in China

Objective: To evaluate the efficacy and safety profile of first-line bevacizumab(Bev)-containing pemetrexedplatinum chemotherapy in a real-world Chinese cohort with advanced non-squamous non-small cell lung cancer(NS-NSCLC).Methods: A total of 415 eligible patients with NS-NSCLC who received first-line pemetrexed-platinum chemotherapy at National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between February 2010 and September 2017 were reviewed retrospectively: 309 Bev(-) and 106 Bev(+) cases. Bev was administered at 7.5 mg/kg every 3 weeks in the Bev(+) group. To reduce the risk of a selection bias, a propensity score-matching(PSM) was conducted and 105 pairs of Bev(-) and Bev(+) cases were identified.Results: The median duration of follow-up was 15.8 months. The median progression-free survival(PFS) was prolonged significantly in the Bev(+) group than in the Bev(-) group in overall(9.8 vs. 7.8 months, P=0.006) and PSM pairs(9.8 vs. 6.6 months, P<0.001). Moreover, patients receiving maintenance therapy with pemetrexed plus Bev had longer PFS than those interrupted after induction chemotherapy, or those receiving mono-maintenance with pemetrexed(12.3 vs. 4.8 vs. 8.6 months;P<0.001). Multivariate analyses revealed Bev to be one of the favorable prognostic factors for PFS, along with the predictor of maintenance therapy.Conclusions: First-line induction and maintenance therapy with Bev(7.5 mg/kg every 3 weeks) combined with pemetrexed-platinum chemotherapy was efficacious and superior to non-Bev chemotherapy in Chinese patients with advanced NS-NSCLC.

Paraneoplastic syndromes associated with lung cancer

Paraneoplastic syndromes are signs or symptoms that occur as a result of organ or tissue damage at locations remote from the site of the primary tumor or metastases. Paraneoplastic syndromes associated with lung cancer can impair various organ functions and include neurologic, endocrine, dermatologic, rheumatologic, hematologic, and ophthalmological syndromes, as well as glomerulopathy and coagulopathy(Trousseau's syndrome). The histological type of lung cancer is generally dependent on the associated syndrome, the two most common of which are humoral hypercalcemia of malignancy in squamous cell carcinoma and the syndrome of inappropriate antidiuretic hormone secretion in small cell lung cancer. The symptoms often precede the diagnosis of the associated lung cancer, especially when the symptoms are neurologic or dermatologic. The proposed mechanisms of paraneoplastic processes include the aberrant release of humoral mediators, such as hormones and hormone-like peptides, cyto-kines, and antibodies. Treating the underlying cancer is generally the most effective therapy for paraneoplastic syndromes, and treatment soon after symptom onset appears to offer the best potential for symptom improvement. In this article, we review the diagnosis, potential mechanisms, and treatments of a wide variety of paraneoplastic syndromes associated with lung cancer.

Highly Efficient Labeling of Human Lung Cancer Cells Using Cationic Poly-L-lysine-Assisted Magnetic Iron Oxide Nanoparticles

Cell labeling with magnetic iron oxide nanoparticles(IONPs)is increasingly a routine approach in the cellbased cancer treatment.However,cell labeling with magnetic IONPs and their leading effects on the biological properties of human lung carcinoma cells remain scarcely reported.Therefore,in the present study the magnetic c-Fe2O3nanoparticles(MNPs)were firstly synthesized and surface-modified with cationic poly-L-lysine(PLL)to construct the PLL-MNPs,which were then used to magnetically label human A549 lung cancer cells.Cell viability and proliferation were evaluated with propidium iodide/fluorescein diacetate double staining and standard 3-(4,5-dimethylthiazol-2-diphenyl-tetrazolium)bromide assay,and the cytoskeleton was immunocytochemically stained.The cell cycle of the PLL-MNPlabeled A549 lung cancer cells was analyzed using flow cytometry.Apoptotic cells were fluorescently analyzed with nuclear-specific staining after the PLL-MNP labeling.The results showed that the constructed PLL-MNPs efficiently magnetically labeled A549 lung cancer cells and that,at low concentrations,labeling did not affect cellular viability,proliferation capability,cell cycle,and apoptosis.Furthermore,the cytoskeleton in the treated cells was detected intact in comparison with the untreated counterparts.However,the results also showed that at high concentration(400 lg m L-1),the PLL-MNPs would slightly impair cell viability,proliferation,cell cycle,and apoptosis and disrupt the cytoskeleton in the treated A549 lung cancer cells.Therefore,the present results indicated that the PLL-MNPs at adequate concentrations can be efficiently used for labeling A549 lung cancer cells and could be considered as a feasible approach for magnetic targeted anti-cancer drug/gene delivery,targeted diagnosis,and therapy in lung cancer treatment.

Therapeutic strategy for postoperative recurrence in patients with non-small cell lung cancer

Postoperative recurrence occurs in approximately half of patients with non-small cell lung cancer(NSCLC), even after complete resection. Disease recurrence after surgical resection reduces the patient's life expectancy sharply. The prognosis after postoperative recurrence is considered to largely depend on both the mode of first recurrence(distant, locoregional or combined) and the treatment modality:(1) The majority of cases of postoperative recurrence involve distant metastasis with or without locoregional recurrence. Platinum-based systemic chemotherapy is practically accepted as the treatment for these diseases on the basis of evidence for original stage Ⅳ disease. The advent of both pemetrexed and molecular-targeted drugs has improved the survival of nonsquamous NSCLC and changed the chemotherapeutic algorithm for NSCLC;(2) Among patients with distant metastatic recurrence without locoregional recurrence at the primary tumor site, the metastasis is often limited in both organ and number. Such metastases are referred to as oligometastases. Local therapy, such as surgical resection and radiotherapy, has been suggested to be the first-line treatment of choice foroligometastatic recurrence; and(3) While locoregional recurrence is likely to cause troublesome symptoms, it is a potentially limited disease. Therefore, providing local control is important, and radiation is usually beneficial for treating local recurrence. In order to obtain better control of the disease and provide treatment with curative intent in patients with limited disease, the administration of concurrent platinum-based chemoradiotherapy is recommended according to the results of originally nonresectable stage ⅢA and ⅢB disease.

Analysis of prognostic factors for overall survival in patients with advanced non-small cell lung cancer treated with second line chemotherapy

Aim: The aim of this study was to investigate prognostic factors for survival in patients with advanced NSCLC who receiving second-line chemotherapy. Methods: We retrospectively reviewed data of 116 patients with NSCLC receiving second-line treatments from October 2010 to December 2012 in Clinic for Lung Diseases of Clinical center Nis, Department for Pulmonary Oncology. Thirteen potential prognostic factors were chosen for analysis. Univariate analysis was conducted to identify prognostic factors associated with progression free survival and overall survival. Multivariate analysis included the prognostic significance factors in univariate analysis. Results: The univariate analysis for progression free survival (PFS) and overall survival (OS) was identified to have prognostic significance: performance status, smoking, weight loss, comorbidity, number of meta localization, first-line chemotherapy regimen and response to first-line chemotherapy. Nevertheless, multivariate Cox prortional hazard regression analysis showed that performance status (PFS: p = 0.000, OS: p = 0.000) weight loss ≥ 5% (PFS: p = 0.000, OS: p = 0.002), comorbidity (PFS: p = 0.001, OS: p = 0.012) and four places of meta localization (PFS: p = 0.021, OS: p = 0.021) were considered independent prognostic factors for both, progression free survival and overall survival. Conclusion: Performance status, weight loss ≥ 5%, comorbidity and higher number of meta localization were identified as prognostic factors for survival in advanced NSCLC patients receiving second-line chemotherapy treatment. These findings may help pretreatment prediction of survival and may facilitate in the future integration new agents into second-line treatment.

Quality of life and management project for patients with advanced lung cancer

Compared with best supportive care,chemotherapy can prolong survival a nd improve quality of life,and symptoms associated with society activities and disease.Chemotherapy can improve quality of life of patients with effective treatme nt and stable treatment.Treatment benefit was often underestimated using clin ical relief rate,so which should not chosen as index for evaluating effec t of palliative treatment.So for pat ients with poor status ,and objective of re lieving symptoms,short term,low-d ose chemotherapy should be suggeste d due to its characteristic of low cost,short inhospitalization time,and f avorable improvement of quality of l ife.For patients with good conditio n in limited advanced stage,radical treatment is objective,and hence single chemotherapy of standard dose o r chemotherapy combining radiotherapy should be suggested.

Study of the Peripheral Blood CD44 Expression in the Patients with Non-Small Cell Lung Cancer

Previous study has demonstrated that the peripheral blood CD44 expression level is related with the clinical stage and lymph node metastasis of lung cancer. The present comment was to investigate the relationship between the peripheral blood CD44 expression level and clinic pathological change in 50 patients with non-small cell lung cancer (NSCLC) by flow cytometry method. The results showed that 1) the peripheral blood CD44 expression level in the NSCLC group was higher than that in the benign group (467 ± 15) or the normal group (448 ± 15);2) operation decreased the peripheral blood CD44 expression level in the NSCLC group (533 ± 10 vs. 324 ± 11);3) it also showed same results in NSCLC patients with and without lymph node metastasis (559 ± 12 vs. 477 ± 15) or before and after chemotherapy (550 ± 13 vs. 372 ± 10);4) there were significant differences in the peripheral blood CD44 expression level in non-small cell lung cancer patients of the clinical stage I, II, III and IV (474 ± 14, 526 ± 12, 528 ± 16 and 599 ± 20);And the peripheral blood CD44 expression level was not associated with the clinical pathology parameter including the patient age, gender and tumor size. The data suggested that the peripheral blood CD44 expression level was related with the NSCLC progress, lymphatic metastasis and clinical treatment, and the peripheral blood CD44 expression level as the clinical regular examination should evaluate the progress, lymphatic metastasis and clinical treatment for the patients with NSCLC.

Safety and Efficacy of Racotumomab-Alum Vaccine as Second-Line Therapy for Advanced Non-Small Cell Lung Cancer

Despite extensive clinical research in non-small cell lung cancer (NSCLC), overall survival is still poor. Racotumomab-alum is an anti-idiotypic cancer vaccine that targets NeuGcGM3 tumor associated ganglioside. The aim of this study was to evaluate safety and efficacy of racotumomab-alum in advanced NSCLC patients with progressive disease. This expanded access program included 86 histologically confirmed NSCLC patients, 18 years or older age, with advanced disease and without therapeutic option, with ECOG performance status ≤3, adequate organ functions and signed informed consent. The primary endpoint was overall survival and toxicity was measure assessed treatment-related toxicity according CTCAEv3. The study was approved by ethical review boards of participant institutions. Racotumomab-alum treatment consisted in 5 biweekly intradermal doses (1 mg/mL) during the induction phase of treatment (2 months). The maintenance phase consisted in monthly re-immunizations until unacceptable toxicity or PS worsening. The median overall survival time of all patients treated with racotumomab-alum was 8.96 months. The survival rates at 12 and 24 months were 42.8% and 28.0%, respectively. Patients that completed the induction phase of treatment (five doses or more) reached a median OS of 12.1 months. The most common adverse events were injection site reaction, bone pain, cough and asthenia. Racotumomab-alum cancer vaccine could be considered an effective and safe treatment option as second-line therapy for advanced NSCLC. Further clinical studies should be conducted to confirm this result.

线粒体在肺癌发生中的作用机制及治疗研究进展

肺癌具有高发生率、高侵袭性和高致亡率的特点,其发生发展受多方面因素影响。线粒体作为普遍存在于人体内的细胞器,通过调节细胞代谢、信号转导、氧化应激和基因组不稳定性等过程,影响肺癌的发生和发展。本文总结近年来有关线粒体靶向药物、线粒体转移和线粒体基因疗法等治疗肺癌的研究进展,探讨线粒体治疗肺癌的原理和前景,以期为肺癌的治疗提供新的思路。

复方红豆杉胶囊维持治疗气虚痰瘀证晚期非小细胞肺癌的多中心、大样本、前瞻性队列研究

目的:探讨复方红豆杉胶囊维持治疗气虚痰瘀证晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)的临床疗效和安全性。方法:采用多中心、大样本、前瞻性队列研究方法,纳入一线化疗4~6周期后疗效评价疾病稳定以上进入维持治疗阶段患者,根据患者意愿分为治疗组160例,对照组109例。对照组根据鳞癌和非鳞癌分别给予吉西他滨和培美曲塞单药化疗维持治疗,治疗组给予复方红豆杉胶囊维持治疗。均以21天为1个疗程,两组干预至少2个疗程,每周期进行生活质量评价,每2疗程进行影像学疗效评价。比较两组疾病无进展生存时间(progression-free survival time,PFS)、生活质量,同时进行药物安全性评价。结果:269例入组患者中,246例患者出现PFS终点事件(91.45%),其中治疗组145例,中位PFS为106天,对照组101例,中位PFS为120天,两组PFS比较差异无统计学意义(P>0.05)。采用美国肺癌生存质量量表(FACT-L4.0版)和欧洲五维健康量表中视觉模拟量表(EQ-5D-VAS)对两组患者生活质量评分进行比较,两种生活质量评价量表均提示治疗组较对照组在提高生活质量方面存在优势(P<0.05)。治疗期间两组共有19例患者出现ADR,治疗组7例(占治疗组人数4.38%),对照组12例(占对照组人数11.01%),ADR发生率在治疗组中更低,尤其表现在骨髓抑制不良反应的发生率方面。结论:在延长PFS方面,复方红豆杉胶囊维持治疗气虚痰瘀证晚期NSCLC的疗效非劣于现代医学单药维持化疗,且在高生活质量、低不良反应方面,复方红豆杉胶囊更具有一定优势。

2023年度非小细胞肺癌外科治疗进展

肺癌是当前世界各地最普遍和最致命的癌症,严重威胁人们的生命健康。外科手术切除是最早治疗肺癌的手段,也是目前肺癌最主要的治疗手段。随着医学技术的进步,外科手术方法和辅助治疗策略不断革新,这为肺癌患者带来了新的希望。因此总结肺癌外科治疗领域的最新研究进展具有重要意义。本文旨在综述2023年度非小细胞肺癌(non-small cell lung cancer,NSCLC)外科治疗的主要进展,包括手术技术的创新、微创手术、辅助分子靶向治疗及免疫治疗在NSCLC围手术期的应用等。

从“气舍于脾”论治肺癌

基于《黄帝内经》中“五脏气舍于其所生”的理论,从“气舍于脾”论治肺癌,认为肺癌可责之肺脾,基本病机是正气亏虚、气血阴阳失调。并基于肺与脾胃的关系,针对肺癌气虚、气机失调、津液代谢失常等病机,以培土生金为关键治法,辨证论治。另外,以《黄帝内经》的思想为基础,论述如何调理肺脏、顾护脾胃。在现已诊治的肺癌病例中对改善患者的临床症状和生存质量疗效肯定。

乳腺癌合并间质性肺疾病患者的临床特征及治疗情况

目的分析乳腺癌合并间质性肺疾病(ILD)患者的临床特征及治疗情况。方法收集76例乳腺癌患者的病历资料,分析其临床特征、检查结果、抗肿瘤药物的使用、ILD的发生及治疗情况。结果76例乳腺癌合并ILD患者中,9例患者无明显症状,其余67例均存在呼吸道等方面的症状;胸部CT检查均呈现不同程度的间质改变,其中52例患者表现为不同程度的低氧血症和呼吸衰竭;患者接受系统性化疗46例,靶向药物27例,恩美曲妥珠单抗2例,内分泌药物氟维司群1例;紫杉类药物ILD发生情况最多,靶向药物中依维莫司ILD发生情况最多,内分泌药物ILD发生情况最少;9例患者不良事件通用术语标准(CTCAE)分级为1级,59例CTCAE分级为2级,8例患者CTCAE分级为3级;所有患者经过治疗后ILD情况均明显好转。结论引起ILD的抗肿瘤药物主要以紫杉类及吉西他滨等细胞毒性药物和雷帕霉素靶蛋白(MTOR)抑制剂靶向药物为主。掌握ILD患者的临床特征及治疗方法,并有针对性地为乳腺癌合并ILD患者选择适宜的治疗方案,既可以增加药物疗效,也可以减少药物的不良反应,改善患者预后。