Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.oa494
O. C. Añón, R. Mercer, R. Asciak, D. McCracken, E. Bedawi, Maged Hassan, A. Dudina, Qianj Lu, M. Tsikrika, R. Varatharajah, G. Shepherd, A. Thayanandan, R. Hallifax, J. Wrightson, N. Rahman
{"title":"Negative predictive value of pleural fluid cytology in patients with a background of cancer","authors":"O. C. Añón, R. Mercer, R. Asciak, D. McCracken, E. Bedawi, Maged Hassan, A. Dudina, Qianj Lu, M. Tsikrika, R. Varatharajah, G. Shepherd, A. Thayanandan, R. Hallifax, J. Wrightson, N. Rahman","doi":"10.1183/13993003.congress-2019.oa494","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.oa494","url":null,"abstract":"","PeriodicalId":20113,"journal":{"name":"Pleural and Mediastinal Malignancies","volume":"220 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76283801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa3087
Narendrababu Rampura Chinnappa, Amir Mushtaq, Joy M. Thomas
Introduction: Pleural diseases are recognized as important subspecialty in respiratory medicine as the incidence rises internationally. Pleural daycase services offer one-stop clinical assessments, imaging and intervention aiding early diagnosis, improved patient care and admission avoidance. They offer educational benefits including procedural skills and clinical research opportunities. Method: A retrospective analysis of patients presenting to the Ambulatory Pleural Procedure Services (APPS) between September 2015 to November 2018 was conducted. Patient characteristics, source of referral, diagnosis, outcome and intervention conducted were evaluated including patient satisfaction survey. Results: 721 patients were reviewed during this time. Total pleural procedures performed were 378. 106 were therapeutic, 219 diagnostic and therapeutic, 29 diagnostic only and 24 Indwelling Pleural Catheters. Majority of the referrals are from the secondary care (70%) and 30% are from the primary care. With this service we saved 2443 days of hospital bed days. On average referral to appointment time for urgent suspected cancer was 8 days and for others it was 13 days indicating the efficiency of this service, feedback survey from the patients was very positve. Conclusion: Our dedicated pleural services have resulted in improved patient outcomes and positive feedback from the patients. It has facilitated early diagnosis, appropriate MDT referral and avoided prolonged inpatient admissions. In addition it has had educational benefits to junior doctors in improving their pleural procedure competencies. Reference: Hooper CE, Welham SA, Maskell NA. Pleural procedures and patient safety: a national BTS audit of practice. Thorax 2013;70(2):189-191.
导读:随着胸膜疾病发病率的上升，胸膜疾病已被公认为呼吸医学的重要亚专科。胸膜日间病例服务提供一站式临床评估、影像和干预，有助于早期诊断、改善病人护理和避免住院。他们提供包括程序技能和临床研究机会在内的教育好处。方法:回顾性分析2015年9月至2018年11月在门诊胸膜手术服务(APPS)就诊的患者。评估患者特征、转诊来源、诊断、结果及干预措施，包括患者满意度调查。结果:721例患者在此期间被审查。胸膜手术共计378例。治疗性106例，诊断性和治疗性219例，单纯诊断性29例，留置胸膜导管24例。大多数转诊来自二级保健(70%)，30%来自初级保健。通过这项服务，我们节省了2443天的住院天数。紧急疑似癌症的平均转诊预约时间为8天，其他为13天，表明这项服务的效率，来自患者的反馈调查是非常积极的。结论:我们的专业胸膜服务改善了患者的预后，并获得了患者的积极反馈。它促进了早期诊断，适当的MDT转诊，避免了长期住院。此外，它还具有教育效益，以提高初级医生的胸膜手术能力。参考文献:Hooper CE, Welham SA, Maskell NA。胸膜手术和患者安全:国家防弹少年团审计实践。胸腔2013;70(2):189 - 191。
{"title":"Three Year Retrospective analysis of Pleural Procedure Services","authors":"Narendrababu Rampura Chinnappa, Amir Mushtaq, Joy M. Thomas","doi":"10.1183/13993003.congress-2019.pa3087","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa3087","url":null,"abstract":"Introduction: Pleural diseases are recognized as important subspecialty in respiratory medicine as the incidence rises internationally. Pleural daycase services offer one-stop clinical assessments, imaging and intervention aiding early diagnosis, improved patient care and admission avoidance. They offer educational benefits including procedural skills and clinical research opportunities. Method: A retrospective analysis of patients presenting to the Ambulatory Pleural Procedure Services (APPS) between September 2015 to November 2018 was conducted. Patient characteristics, source of referral, diagnosis, outcome and intervention conducted were evaluated including patient satisfaction survey. Results: 721 patients were reviewed during this time. Total pleural procedures performed were 378. 106 were therapeutic, 219 diagnostic and therapeutic, 29 diagnostic only and 24 Indwelling Pleural Catheters. Majority of the referrals are from the secondary care (70%) and 30% are from the primary care. With this service we saved 2443 days of hospital bed days. On average referral to appointment time for urgent suspected cancer was 8 days and for others it was 13 days indicating the efficiency of this service, feedback survey from the patients was very positve. Conclusion: Our dedicated pleural services have resulted in improved patient outcomes and positive feedback from the patients. It has facilitated early diagnosis, appropriate MDT referral and avoided prolonged inpatient admissions. In addition it has had educational benefits to junior doctors in improving their pleural procedure competencies. Reference: Hooper CE, Welham SA, Maskell NA. Pleural procedures and patient safety: a national BTS audit of practice. Thorax 2013;70(2):189-191.","PeriodicalId":20113,"journal":{"name":"Pleural and Mediastinal Malignancies","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87105040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa3083
B. Vijayakumar, T. Hosack
Background: Malignant pleural effusions (MPE) are very common and infer a poor prognosis, with a median survival of 3-12 months. The pleural intervention chosen to manage symptomatic MPE is determined by the clinician involved, patient preferences and services available. The LENT score is a validated tool to help predict mortality in those with MPE. Objective: The clinical usefulness of the LENT score is unclear and we aimed to evaluate this at our district general hospital. Methods: We performed a retrospective analysis of patients who underwent pleural intervention for MPE at Royal Berkshire Hospital between May 2015 - September 2017. The LENT score was calculated retrospectively. Data was gathered for the number of patients undergoing talc pleurodesis and subsequent success rates, as well as the number underdoing IPC insertion and subsequent complication rates. Results: 40 patients were identified. Only 19 had a full data set to calculate the LENT score. Most patients had a primary diagnosis of lung cancer (30%), breast cancer (25%) or mesothelioma (18%). 26/40 patients underwent talc pleurodesis with 7 having further symptomatic fluid re-accumulation post talc (73% success rate). 25 patients had an IPC inserted, with the main complications being pleural infection (12%) and blocked catheter (8%). 5/19 (26%) patients were “high risk” as per LENT criteria. All “high risk” patients either died on the same admission or shortly post discharge. Conclusion: Using the LENT score will help risk-stratify patients with MPE to enable the most appropriate pleural intervention to be chosen from the outset, so as to alleviate breathlessness, whilst minimizing hospital stay and avoiding unnecessary procedure-related complications.
{"title":"LENT score - useful clinical tool?","authors":"B. Vijayakumar, T. Hosack","doi":"10.1183/13993003.congress-2019.pa3083","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa3083","url":null,"abstract":"Background: Malignant pleural effusions (MPE) are very common and infer a poor prognosis, with a median survival of 3-12 months. The pleural intervention chosen to manage symptomatic MPE is determined by the clinician involved, patient preferences and services available. The LENT score is a validated tool to help predict mortality in those with MPE. Objective: The clinical usefulness of the LENT score is unclear and we aimed to evaluate this at our district general hospital. Methods: We performed a retrospective analysis of patients who underwent pleural intervention for MPE at Royal Berkshire Hospital between May 2015 - September 2017. The LENT score was calculated retrospectively. Data was gathered for the number of patients undergoing talc pleurodesis and subsequent success rates, as well as the number underdoing IPC insertion and subsequent complication rates. Results: 40 patients were identified. Only 19 had a full data set to calculate the LENT score. Most patients had a primary diagnosis of lung cancer (30%), breast cancer (25%) or mesothelioma (18%). 26/40 patients underwent talc pleurodesis with 7 having further symptomatic fluid re-accumulation post talc (73% success rate). 25 patients had an IPC inserted, with the main complications being pleural infection (12%) and blocked catheter (8%). 5/19 (26%) patients were “high risk” as per LENT criteria. All “high risk” patients either died on the same admission or shortly post discharge. Conclusion: Using the LENT score will help risk-stratify patients with MPE to enable the most appropriate pleural intervention to be chosen from the outset, so as to alleviate breathlessness, whilst minimizing hospital stay and avoiding unnecessary procedure-related complications.","PeriodicalId":20113,"journal":{"name":"Pleural and Mediastinal Malignancies","volume":"178 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83797133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.oa3795
J. Paajanen, I. Ilonen, H. Lauri, T. Järvinen, E. Sutinen, H. Ollila, E. Rouvinen, K. Lemström, J. Räsänen, O. Ritvos, K. Koli, M. Myllärniemi
{"title":"Elevated circulating activin A levels in malignant pleural mesothelioma patients are related to cancer cachexia and poor response to platinum-based chemotherapy","authors":"J. Paajanen, I. Ilonen, H. Lauri, T. Järvinen, E. Sutinen, H. Ollila, E. Rouvinen, K. Lemström, J. Räsänen, O. Ritvos, K. Koli, M. Myllärniemi","doi":"10.1183/13993003.congress-2019.oa3795","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.oa3795","url":null,"abstract":"","PeriodicalId":20113,"journal":{"name":"Pleural and Mediastinal Malignancies","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83369429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa3100
A. Kidd, S. Tsim, K. Blyth
Introduction: Volumetric tumour measurement of malignant pleural mesothelioma (MPM) using contrast-enhanced CT could be used to assess MPM tumour stage as an alternative to RECIST response reporting. Aims and Objectives: We attempted to deploy a recently reported semi-automated method of volumetric MPM tumour assessment developed using Magnetic Resonance Imaging (MRI) (Armato S, Lung Cancer In press) on CT images acquired in the same patients. The MRI method requires tumour regions to be grown from seed points placed within a pre-defined volume of parietal pleural tumour, based on differential tumour enhancement after contrast. Methods: 23 patients with MPM were studied. 15 regions of interest (ROI) were placed on visible areas of pleural tumour. Similar ROIs were placed on intercostal muscle, pleural fluid, diaphragm and liver and Hounsfield Units (HU) generated for all ROIs. Pleural volume contours were then drawn every 8–10 axial CT slices and propagated throughout the volume (Myrian, Intrasense, France). Tumour regions were then grown within these volumes based on the measured range HU of pleural tumour. Results: The median (range) HU of pleural tumour, intercostal muscle and diaphragm overlapped: 49 (15–127), 21 (4–55) and 38 (7–65), respectively. Inter-slice interpolation artefacts were common and tumour region growing often resulted in ‘bleeding’ of the tumour regions into adjacent normal structures. Conclusions: It was not possible to accurately deploy a semi-automated volumetric analysis method for MPM developed using MRI on contrast-enhanced CT images. Reduced definition between tumour and adjacent structures was a major contributor, manifested as overlapping HU values.
简介:使用增强CT对恶性胸膜间皮瘤(MPM)进行体积测量，可用于评估MPM肿瘤分期，作为RECIST反应报告的替代方案。目的和目的:我们试图采用最近报道的半自动化方法，利用磁共振成像(MRI)对同一患者的CT图像进行体积MPM肿瘤评估(Armato S, Lung Cancer In press)。MRI方法要求肿瘤区域从预先确定的胸膜壁肿瘤体积内的种子点生长，基于对比后肿瘤的鉴别增强。方法:对23例MPM患者进行分析。在胸膜肿瘤可见区域放置15个感兴趣区域(ROI)。在肋间肌、胸膜液、横膈膜和肝脏上放置类似的roi，并为所有roi生成Hounsfield单位(HU)。然后每隔8-10个轴向CT切片绘制胸膜容积轮廓，并在整个容积中传播(Myrian, Intrasense, France)。然后根据胸膜肿瘤的测量范围HU在这些体积内生长肿瘤区域。结果:胸膜肿瘤、肋间肌、横膈膜的HU中值(范围)重叠:49(15-127)、21(4-55)、38(7-65)。切片间插值伪影很常见，肿瘤区域的生长经常导致肿瘤区域“出血”到邻近的正常结构中。结论:利用MRI增强CT图像对MPM进行半自动化体积分析是不可能准确部署的。肿瘤和邻近结构之间的定义减少是主要原因，表现为重叠的HU值。
{"title":"Technical limitation of semi-automated volumetric analysis using CT in patients with Malignant Pleural Mesothelioma","authors":"A. Kidd, S. Tsim, K. Blyth","doi":"10.1183/13993003.congress-2019.pa3100","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa3100","url":null,"abstract":"Introduction: Volumetric tumour measurement of malignant pleural mesothelioma (MPM) using contrast-enhanced CT could be used to assess MPM tumour stage as an alternative to RECIST response reporting. Aims and Objectives: We attempted to deploy a recently reported semi-automated method of volumetric MPM tumour assessment developed using Magnetic Resonance Imaging (MRI) (Armato S, Lung Cancer In press) on CT images acquired in the same patients. The MRI method requires tumour regions to be grown from seed points placed within a pre-defined volume of parietal pleural tumour, based on differential tumour enhancement after contrast. Methods: 23 patients with MPM were studied. 15 regions of interest (ROI) were placed on visible areas of pleural tumour. Similar ROIs were placed on intercostal muscle, pleural fluid, diaphragm and liver and Hounsfield Units (HU) generated for all ROIs. Pleural volume contours were then drawn every 8–10 axial CT slices and propagated throughout the volume (Myrian, Intrasense, France). Tumour regions were then grown within these volumes based on the measured range HU of pleural tumour. Results: The median (range) HU of pleural tumour, intercostal muscle and diaphragm overlapped: 49 (15–127), 21 (4–55) and 38 (7–65), respectively. Inter-slice interpolation artefacts were common and tumour region growing often resulted in ‘bleeding’ of the tumour regions into adjacent normal structures. Conclusions: It was not possible to accurately deploy a semi-automated volumetric analysis method for MPM developed using MRI on contrast-enhanced CT images. Reduced definition between tumour and adjacent structures was a major contributor, manifested as overlapping HU values.","PeriodicalId":20113,"journal":{"name":"Pleural and Mediastinal Malignancies","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76071404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa3088
U. Bødtger, Karin Armbruster, S. Skaarup, Henrik Kirstein, C. Laursen
Background: Malignant pleural effusion (MPE) is common with an annual incidence of around 5000 cases in Denmark. Danish health-care is free for all citizens as it is fully financed by the government. MPE is associated with short survival and high disease burden. There is solid evidence for reduced symptom burden and hospital use by definitive pleural procedures: indwelling pleural catheders (IPC) or pleuradesis. Difficult access to definitive pleural procedures is associated with reduced use. We aimed at investigating national differences in delivery of this care. Materials and Methods: An anonymous, one-page, multiple choice paper survey on delivered pleural service completed by pulmonologists at the annual conference in the Danish Respiratory Society, 23 November 2018. Results: Responses from delegates representing the ten largest departments of respiratory medicine (and all five regions of Denmark) were collected. IPC service were available in eight and pleuradesis in six centres. All centres had implemented ultrasound-based pleural techniques, and five had a training program for pleural interventions. In a few centres, IPC were administered by non-pulmonologists (radiologists, anesthesiologists) without a supporting pleural service. Conclusion: Access to definitive interventions for MPE is highly heterogeneous and therefore a common challenge for patients and clinicians. There is an imminent need for improved collaboration between oncologists and pulmonologists to provide evidence-based care to patients with MPE. National differences in health-care organisation may hamper external validity.
{"title":"Heterogeneous delivery of definitive interventions in malignant pleural effusions – results from a Danish survey","authors":"U. Bødtger, Karin Armbruster, S. Skaarup, Henrik Kirstein, C. Laursen","doi":"10.1183/13993003.congress-2019.pa3088","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa3088","url":null,"abstract":"Background: Malignant pleural effusion (MPE) is common with an annual incidence of around 5000 cases in Denmark. Danish health-care is free for all citizens as it is fully financed by the government. MPE is associated with short survival and high disease burden. There is solid evidence for reduced symptom burden and hospital use by definitive pleural procedures: indwelling pleural catheders (IPC) or pleuradesis. Difficult access to definitive pleural procedures is associated with reduced use. We aimed at investigating national differences in delivery of this care. Materials and Methods: An anonymous, one-page, multiple choice paper survey on delivered pleural service completed by pulmonologists at the annual conference in the Danish Respiratory Society, 23 November 2018. Results: Responses from delegates representing the ten largest departments of respiratory medicine (and all five regions of Denmark) were collected. IPC service were available in eight and pleuradesis in six centres. All centres had implemented ultrasound-based pleural techniques, and five had a training program for pleural interventions. In a few centres, IPC were administered by non-pulmonologists (radiologists, anesthesiologists) without a supporting pleural service. Conclusion: Access to definitive interventions for MPE is highly heterogeneous and therefore a common challenge for patients and clinicians. There is an imminent need for improved collaboration between oncologists and pulmonologists to provide evidence-based care to patients with MPE. National differences in health-care organisation may hamper external validity.","PeriodicalId":20113,"journal":{"name":"Pleural and Mediastinal Malignancies","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75930192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-28DOI: 10.1183/13993003.congress-2019.pa3084
Yanika Gatt, Joanna Grech, James A. Farrugia, C. Zammit, Stephen Montfort
{"title":"Success rate of talc pleurodesis","authors":"Yanika Gatt, Joanna Grech, James A. Farrugia, C. Zammit, Stephen Montfort","doi":"10.1183/13993003.congress-2019.pa3084","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa3084","url":null,"abstract":"","PeriodicalId":20113,"journal":{"name":"Pleural and Mediastinal Malignancies","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75197920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-15DOI: 10.1183/13993003.congress-2018.oa499
Manuela Marenco, V. Frangipane, M. Hodolič, S. Inghilleri, G. Stella, F. Meloni, L. Lodola
{"title":"68Ga-DOTA-NT-20.3. An innovative probe for neurotensin receptor-positive tumor imaging in the diagnosis of malignant pleural mesothelioma","authors":"Manuela Marenco, V. Frangipane, M. Hodolič, S. Inghilleri, G. Stella, F. Meloni, L. Lodola","doi":"10.1183/13993003.congress-2018.oa499","DOIUrl":"https://doi.org/10.1183/13993003.congress-2018.oa499","url":null,"abstract":"","PeriodicalId":20113,"journal":{"name":"Pleural and Mediastinal Malignancies","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74009279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-15DOI: 10.1183/13993003.CONGRESS-2018.PA2862
L. Teixeira, V. Alvarenga, R. Sales, C. Silva, N. Almeida, L. Sousa, A. C. Santos, V. Capelozzi, E. Marchi, M. Acencio
Introduction: Malignant pleural effusion treatment is limited to primary tumor and control of pleural effusion (PE). Intrapleural therapy could lead to a less permissive microenvironment for the development of malignant pleural disease. Objectives: To evaluate anti-VEGF and anti-EGFR in malignant pleural disease and to study tumor gene expression in a model of lung adenocarcinoma. Methods: Mice received intrapleural injection of lung adenocarcinoma cells (Lewis). After 3, 7, 10 and 14 days they were treated intraplerally with anti-VEGF, anti-EGFR, anti-VEGF+anti-EGFR or saline. It was evaluated survival, gene expression of Akt1, Akt2, Bcl2, Erbb2, NF-kB, Nras and PDGF, and KRAS and EGFR mutation. Results: All animals developed malignant pleural disease with PE and tumor implants. There was no difference in survival times between the animals treated or untreated. We observed tumor overexpression of AKt1, Akt2, Bcl2, Grb2, NF-kB and Nras genes compared to normal mouse lung tissue. We did not observe differences in PDGF gene. Only treatment with anti-VEGF showed decreased expression of Erbb2. A mutation was identified in exon 2 of the KRAS gene in tumor tissue. No mutation of EGFR gene was observed. Conclusions: Anti-VEGF and/or anti-EGFR intrapleural did not have a positive impact on survival. Tumors from Lewis cells show gene overexpression of proto-oncogenes, genes related to growth and signaling cell and anti-apoptosis. It was observed KRAS mutation. Anti-VEGF had a discrete action in decrease of the Errb2 expression without impact in the survival. These findings characterize the high aggressiveness of this tumor, which could have influenced the ineffective action of these therapies.
{"title":"Treatment with Anti-VEGF and anti-EGFR in a model of malignant pleural effusion: Genic evaluation","authors":"L. Teixeira, V. Alvarenga, R. Sales, C. Silva, N. Almeida, L. Sousa, A. C. Santos, V. Capelozzi, E. Marchi, M. Acencio","doi":"10.1183/13993003.CONGRESS-2018.PA2862","DOIUrl":"https://doi.org/10.1183/13993003.CONGRESS-2018.PA2862","url":null,"abstract":"Introduction: Malignant pleural effusion treatment is limited to primary tumor and control of pleural effusion (PE). Intrapleural therapy could lead to a less permissive microenvironment for the development of malignant pleural disease. Objectives: To evaluate anti-VEGF and anti-EGFR in malignant pleural disease and to study tumor gene expression in a model of lung adenocarcinoma. Methods: Mice received intrapleural injection of lung adenocarcinoma cells (Lewis). After 3, 7, 10 and 14 days they were treated intraplerally with anti-VEGF, anti-EGFR, anti-VEGF+anti-EGFR or saline. It was evaluated survival, gene expression of Akt1, Akt2, Bcl2, Erbb2, NF-kB, Nras and PDGF, and KRAS and EGFR mutation. Results: All animals developed malignant pleural disease with PE and tumor implants. There was no difference in survival times between the animals treated or untreated. We observed tumor overexpression of AKt1, Akt2, Bcl2, Grb2, NF-kB and Nras genes compared to normal mouse lung tissue. We did not observe differences in PDGF gene. Only treatment with anti-VEGF showed decreased expression of Erbb2. A mutation was identified in exon 2 of the KRAS gene in tumor tissue. No mutation of EGFR gene was observed. Conclusions: Anti-VEGF and/or anti-EGFR intrapleural did not have a positive impact on survival. Tumors from Lewis cells show gene overexpression of proto-oncogenes, genes related to growth and signaling cell and anti-apoptosis. It was observed KRAS mutation. Anti-VEGF had a discrete action in decrease of the Errb2 expression without impact in the survival. These findings characterize the high aggressiveness of this tumor, which could have influenced the ineffective action of these therapies.","PeriodicalId":20113,"journal":{"name":"Pleural and Mediastinal Malignancies","volume":"97 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86347626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-09-15DOI: 10.1183/13993003.CONGRESS-2018.OA495
G. Martin, A. Kidd, S. Tsim, R. Woodward, T. Hopkins, J. Foster, P. McLoone, K. Blyth
Introduction: Non-expansile lung (NEL) is a common cause of talc pleurodesis (TP) failure in malignant pleural effusion (MPE), but is often occult prior to drainage. Reliable detection of NEL would allow patients to be allocated between IPC (required in NEL) and TP (often effective if NEL absent; avoids prolonged drainage). High Pleural Elastance (PEL) has been associated with NEL in observational studies. Pre-EDIT is a randomised feasibility trial of Elastance-Directed IPC or TP (EDIT) management using a novel, purpose-built digital pleural manometer (Rocket Medical, UK). Methods: Consecutive patients with symptomatic MPE, no prior evidence of NEL or preference for IPC are randomised 1:1 between standard care (attempt at TP) and EDIT management (see Figure 1). The primary objective is to determine whether it is feasible to recruit and randomise 30 patients within 12 months (or 15 within 6 months). Secondary objectives include safety and refinement of the EDIT design, including validation of the current PEL definition using 4D volumetric Magnetic Resonance Imaging pre- and post-fluid aspiration. Results: Recruitment is on target (14/30 at time of submission) and will close on 28/8/18. Conclusion: Pre-EDIT will determine whether a multi-centre Phase III trial of EDIT management of MPE is feasible. Results will be ready for presentation at ERS Congress 2018.
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