Thoracic Cancer最新文献

Objective: This study evaluates the effectiveness and safety of C-arm cone beam CT (CBCT)-guided microcoil localization combined with uniportal video-assisted thoracoscopic surgery (VATS) for the management of small, difficult-to-localize ground-glass opacities (GGOs) and sub-solid nodules in the lungs.

Methods: We retrospectively analyzed data from 13 patients with single, small, peripheral, non-subpleural GGOs or SSN. All patients underwent successful microcoil localization using CB-CT guidance followed by uniportal VATS resection. A microcoil was positioned partly in the lung parenchyma and partly in the extra-pleural space to assist in intraoperative localization. We evaluated the rate of correct microcoil placement and the technical success of the resection.

Results: Microcoil placement was successfully performed in all patients, with an average procedure time of 28.8 ± 10.8 min. The mean nodule size was 9.9 ± 5.4 mm, and 76.9% of the nodules were classified as ground-glass opacities. No intraparenchymal bleeding was observed, and four patients (30.8%) experienced pneumothorax, all of which were self-limited and required no intervention or coil repositioning. The uniVATS resection success rate was 100%.

Conclusion: CBCT-guided microcoil localization, with partial placement of the coil in the extra-pleural space, proved to be a highly effective technique for the localization and resection of small pulmonary nodules. The procedure demonstrated high accuracy, minimal complications, reduction of procedural time, and short hospital stays. Intraoperative fluoroscopy was never necessary, with a high reduction in radiation exposure for the patient and the operator. Further studies with larger populations and longer follow-ups are needed to validate these findings.

Introduction: Lung cancer accounts for 9% of all cancer diagnoses in Australia with a 5-year survival rate of 26%. Small cell lung cancer (SCLC) is a more aggressive subtype of lung cancer, representing 15% of all lung cancer cases and a 5-year survival of 11.1%. This study aims to assess the extent of guideline concordant treatment (GCT) delivery for SCLC in Victoria, identify patient, clinical, and hospital factors influencing GCT receipt, and evaluate its impact on survival.

Methods: Data were obtained from the Victorian Lung Cancer Registry (VLCR) in Victoria, Australia (n = 1769). Descriptive statistics were used to summarie patient and disease characteristics by treatment type, including GCT, non-GCT, and no/declined treatment. Statistical analyses included multiple logistic regression, Cox regression, and Kaplan-Meier survival estimates.

Results: 78.1% received GCT, 10.5% received non-GCT, and 11.5% had no treatment. Older age, poor performance status, and advanced cancer stage were associated with a lower likelihood of receiving GCT. Patients who received stage-specific GCT had a 60% lower mortality risk compared to those who received non-GCT treatment.

Conclusion: This study highlights significant variation in the receipt of guideline concordant treatment for SCLC, with older age, poorer performance status, and advanced cancer stage reducing the likelihood of GCT. Given the survival benefits associated with GCT, addressing barriers to its delivery is essential to improving outcomes for SCLC patients in Victoria.

Trastuzumab deruxtecan (T-DXd) significantly improves outcomes in HER2-positive or low metastatic breast cancer (MBC), but systematic documentation of its myotoxicity is lacking. A 45-year-old woman with HER2-low MBC and normal body composition (BMI 22.9 kg/m², visceral adipose area [VAT] 69.1 cm²) developed T-DXd myopathy. She experienced dysphagia, Grade III myalgia, and creatine kinase (CK) peak of 1755 U/L, with MRI confirming lumbar subcutaneous edema and paraspinal muscle swelling. T-DXd was discontinued. Supportive therapy included hydration, urine alkalization by sodium bicarbonate, glutathione, and magnesium isoglycyrrhizinate. By Day 8, CK decreased to 539 U/L with myalgia improvement. After 13 days off therapy, CK rebounded to 1735 U/L with Grade III myalgia, which resolved upon reinitiating support. This case report presents the first documented instance of severe T-DXd-related myopathy in a patient with normal body composition. The observed case outcomes suggest that the combination of glutathione and magnesium isoglycyrrhizinate could potentially reduce CK levels and alleviate T-DXd-associated muscle pain. However, the observed clinical efficacy is based on an individual case. Extrapolation of these clinical outcomes requires large-scale randomized controlled trials with rigorous covariate adjustment.

Sublobar resection is gaining popularity for the treatment of early stage lung adenocarcinoma, often presenting as a ground glass nodule on CT. Ground glass nodules are, however, a heterogeneous group of lesions, and they are too often equated with in situ or lepidic pattern adenocarcinoma. Many of these lesions actually harbor high grade micropapillary pattern and display spread through air spaces (STAS) on histology; features that are associated with increased recurrence following sublobar resection. Post hoc analysis of the impact of STAS in the JCOG0802 and CALGB140503 trials is currently ongoing and has yet to be published. This brief report aims to raise awareness of these pertinent issues that should be considered when approaching the management of early stage lung adenocarcinoma.

This review presents a comprehensive overview of recent advancements and clinical applications of three-dimensional (3D) reconstruction technology in thoracic surgery, with a focus on lung cancer surgery. The widespread adoption of chest computed tomography (CT) screening has increased the detection rates of early-stage lung cancers, facilitating a transition from traditional lobectomy to parenchymal-sparing sublobar resections, such as segmentectomy, which demand higher anatomical precision. 3D reconstruction technology significantly improves tumor localization, as well as vascular and bronchial visualization, thereby enhancing surgical accuracy and safety. Its key applications encompass preoperative planning, intraoperative navigation, real-time localization, vascular and airway visualization, and postoperative pulmonary function assessment, collectively contributing to improved surgical outcomes and patient prognosis. Recent innovations in artificial intelligence have streamlined and automated the reconstruction process, leading to reduced operative times and increased accuracy. However, challenges persist, including image quality limitations, algorithm robustness, and limited high-quality clinical evidence. Future integration with emerging technologies such as virtual reality and augmented reality holds promise for achieving personalized, intelligent thoracic surgical procedures. This review aims to systematically evaluate the clinical value of 3D reconstruction technology and explore its future development directions.

Objectives: Timely discovery and adequate patient management are crucial in non-small cell lung cancer (NSCLC) since long-term survival is only achievable in early-stage disease. In our study, we aimed to elucidate the effects of time to surgery on survival and to assess the impact of the COVID-19 pandemic on elapsed time until surgery.

Methods: In total, 2536 Caucasian NSCLC patients who underwent curative-intent lung resection surgery were included in this study. 1 month, 2 months, 77 days, and 91.06 days between CT-based diagnosis and surgery were evaluated as possible cut-off values for worse outcome. Survival curves were estimated by Kaplan-Meier plots, and the differences between groups were compared using the log-rank test. Multivariate analysis was performed using a Cox regression model.

Results: Patients with time-to-surgery ≥ 2 months had significantly impaired overall survival (OS) (vs. those with < 2 months; p = 0.002). In our multivariate model, time-to-surgery (p = 0.011), age (p = 0.02), diabetes mellitus (p = 0.02), disease stage (p = 0.0001) and vascular invasion (p < 0.001) all had a significant impact on OS. Importantly, during the COVID-19 pandemic, the elapsed time between diagnosis and surgery increased with a median of 12 days, resulting in a significant delay in time-to-surgery compared to the pre-pandemic period (p < 0.001). Post hoc tests showed, however, that there were no significant differences in time-to-surgery concerning the major waves of COVID-19 infections.

Conclusions: Time-to-surgery is an independent predictor of long-term survival in surgically treated NSCLC. In general, the COVID-19 pandemic caused a significant delay in the elapsed time until surgery, but the specific COVID-19 waves had no significant impact on time-to-surgery.

Background: This study aimed to characterize longitudinal trajectories of tumor burden and treatment-related symptoms following immune checkpoint inhibitor (ICI) therapy in patients with advanced lung cancer, based on electronic patient-reported outcomes (ePRO).

Methods: Using the MD Anderson Symptom Inventory-Lung Cancer module and an immune-related adverse event symptom item scale, we collected the ePRO data of patients undergoing first-line immunotherapy-based combination treatment for advanced unresectable primary lung cancer. Evaluating trajectories of primary symptoms and symptom differences between treatment groups using linear mixed-effects models.

Results: A total of 168 patients were included in the study. The top five symptoms with the highest severity before treatment were coughing, distress, shortness of breath, disturbed sleep, and pain. Coughing was gradually attenuated with ongoing treatment. Symptoms of distress, shortness of breath, disturbed sleep, and pain also showed an overall decreasing trend. The top five immunotherapy-related symptoms, with the highest severity, were early satiety, abdominal distension, night sweats, altered sense of taste, and bloated pain, which demonstrated a cyclical gradual increase throughout treatment. Compared to the ICIs + chemotherapy group, the ICIs + chemotherapy + VEGFR-TKIs group showed significantly lower burden in four of the top five immunotherapy-related symptoms, with the exception of night sweats, which demonstrated no significant difference.

Conclusions: Patients with advanced lung cancer experienced reduced severity of lung cancer-related symptoms after receiving immunotherapy-based combination treatment, and immune-specific symptoms showed cyclical exacerbation with ongoing treatment. The addition of VEGFR-TKIs to ICIs + chemotherapy did not increase the associated toxicity burden.

Chest wall sarcomas are rare and may exhibit aggressive behavior, posing diagnostic challenges-particularly in young adults. Although multidisciplinary treatments involving chemotherapy, radiotherapy, and surgery are recommended, prognosis remains poor. We report a case of a 43-year-old man referred with left-sided chest pain, dyspnea, and massive pleural effusion. Cytological analysis of the effusion and biopsy revealed small, round, atypical cells, and initial immunohistochemistry suggested Ewing sarcoma. During workup, the patient's symptoms worsened, tumor lysis syndrome developed, and he died on hospital day 28. Autopsy and extended immunohistochemical testing indicated small round cell sarcoma. Molecular analysis identified an echinoderm microtubule-associated protein-like 4 (EML4)-anaplastic lymphoma kinase (ALK) fusion gene. The final diagnosis was small round cell sarcoma with EML4-ALK fusion originating from the thoracic wall. This case highlights the importance of early presentation and timely diagnosis using next generation sequencing to facilitate targeted therapy for ALK-rearranged chest wall sarcomas and improve patient outcomes.

A 47-year-old woman was diagnosed with invasive thymoma 13 years ago. She had undergone repeated surgeries, as well as chemotherapy and radiation therapy. Chemotherapy was discontinued after the patient developed normocytic anemia, which was unresponsive to repeated blood transfusions. Bone marrow biopsy results revealed pure red cell aplasia (PRCA). Cyclosporine treatment led to improvement in PRCA; however, the patient died 3 years later from an invasive pneumococcal infection. The onset of thymoma-associated PRCA remains unpredictable, and a significant delay may occur between the diagnosis of the two conditions.

Background: Immune checkpoint inhibitors (ICIs) improve outcomes in non-small cell lung cancer (NSCLC) with high PD-L1 expression, but biomarkers beyond PD-L1 are limited. Smoking-related immune activation may enhance ICI efficacy, yet evidence in non-squamous NSCLC, especially among non-smokers, is sparse.

Methods: We retrospectively analyzed 74 patients with Stage IIIB-IV non-squamous NSCLC, PD-L1 ≥ 50%, and no EGFR/ALK/ROS1 mutations, treated at a tertiary center in Taiwan (2017-2023). Patients were stratified by smoking status. Treatment responses, progression-free survival (PFS), and overall survival (OS) were evaluated using RECIST v1.1, Kaplan-Meier, and Cox regression.

Results: Among 74 patients, 54 (72.9%) were smokers and 20 (27.1%) were non-smokers. Compared with non-smokers, smokers had a higher partial response rate (66.7% vs. 25.0%, p = 0.001), longer median PFS (12.8 vs. 1.4 months, p = 0.001), and improved OS (47.1 vs. 10.0 months, p = 0.011). In the non-smoker subgroup, chemoimmunotherapy significantly prolonged PFS compared with ICI monotherapy (not reached vs. 1.4 months, p = 0.034). In multivariate analysis, smoking independently predicted better PFS (HR = 0.234, p = 0.001) and OS (HR = 0.229, p = 0.011).

Conclusion: Non-smokers with PD-L1-high non-squamous NSCLC showed significantly poorer outcomes with ICI monotherapy. Chemoimmunotherapy may be preferred in this group. Smoking history may provide a simple and clinically relevant stratification factor when considering ICI-based treatment.