: In non-small cell lung cancer (NSCLC), the presence of metastatic nodal disease has been shown to be the most important predictor of long-term disease-specific survival after surgical resection. In patients with early stage, node-negative NSCLC who undergo complete resection, the current standard of care, a significant portion have recurrence of disease within 24 months after surgery. This has raised interest in better understanding the lymphatic drainage of these cancers to determine the exact patterns of loco-regional spread, and whether sentinel lymph node (SLN) identification can be utilized to aid in management of these diseases. Anatomic studies that have attempted to map the lymphatic drainage of tumors from different locations within the lung have revealed patterns of direct mediastinal drainage, which may help explain the prevalence of skip metastases, which is the presence of N2 disease in the absence of N1 disease. This article will provide a narrative review of primary literature concerning the anatomy of the pulmonary lymphatic system, patterns of nodal metastasis in NSCLC as studied through various techniques (including blue dye, radiocolloid tracers, and near-infrared image-guided SLN mapping), and opportunities for improvement in our understanding of how lung tumors interact with the lymphatic system on a structural level.
{"title":"Narrative review of patterns of lymphatic drainage in early-stage non-small cell lung cancer","authors":"B. Lin","doi":"10.21037/amj-20-172","DOIUrl":"https://doi.org/10.21037/amj-20-172","url":null,"abstract":": In non-small cell lung cancer (NSCLC), the presence of metastatic nodal disease has been shown to be the most important predictor of long-term disease-specific survival after surgical resection. In patients with early stage, node-negative NSCLC who undergo complete resection, the current standard of care, a significant portion have recurrence of disease within 24 months after surgery. This has raised interest in better understanding the lymphatic drainage of these cancers to determine the exact patterns of loco-regional spread, and whether sentinel lymph node (SLN) identification can be utilized to aid in management of these diseases. Anatomic studies that have attempted to map the lymphatic drainage of tumors from different locations within the lung have revealed patterns of direct mediastinal drainage, which may help explain the prevalence of skip metastases, which is the presence of N2 disease in the absence of N1 disease. This article will provide a narrative review of primary literature concerning the anatomy of the pulmonary lymphatic system, patterns of nodal metastasis in NSCLC as studied through various techniques (including blue dye, radiocolloid tracers, and near-infrared image-guided SLN mapping), and opportunities for improvement in our understanding of how lung tumors interact with the lymphatic system on a structural level.","PeriodicalId":72157,"journal":{"name":"AME medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48501397","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}
P. Srikanth, H. Kay, A. Tijerina, A. V. Srivastava, A. Laviana, J. Wolf, E. Osterberg
Radiation therapy to the pelvis is indicated for cervical, prostate, rectal, and gastrointestinal (GI) malignancies. A rare, but known adverse effect of this treatment is radiation-induced ureteral stricture (RIUS). RIUS can cause infection, hydronephrosis, kidney stone formation, and ultimately, renal failure. Management of RIUS is a challenge to urologists as the strictures tend to be long, bilateral, and ischemic in etiology. Management of RIUS is divided into endoscopic, open, and minimally invasive techniques. Stents and percutaneous nephrostomy (PCN) tubes are generally used as temporizing measures until definitive repair, but they may be a long-term option for patients unfit for surgery. Balloon dilatation and endoureterotomy have shown efficacy between 60–80% but are less effective in radiation-induced stricture due to the ischemic nature of the insult. Ureteroureterostomy (UU) is best suited for short strictures in the mid-to-proximal ureter. Ureteroneocystostomy is better suited for longer strictures in the distal ureter and may be paired with psoas hitch or Boari flap to increase coverage length. Importantly, for radiation patients, bladder fibrosis may be a contraindication to these procedures. Buccal graft ureteroplasty is increasingly being used with success rates between 80–90%, although this number decreases to around 30% in longer strictures. Finally, bowel substitutes are suitable for longer strictures and bilateral disease. Most recently, appendiceal interposition has been studied for both rightand left-sided strictures around 3–5 cm, with success rates around 70%. More invasive and potentially morbid techniques like transureteroureterostomy (TUU) and renal autotransplantation are reserved for extremely long or pan-ureteral strictures and are usually unsuitable for cancer patients who have undergone radiotherapy. In general, minimally invasive approaches, while less studied, have demonstrated similar clinical outcomes and complication rates, with less pain and shorter hospital stays. In this review, we will summarize the most up-to-date literature in this field, detailing the current management of RIUS.
{"title":"Narrative review of the current management of radiation-induced ureteral strictures of the pelvis","authors":"P. Srikanth, H. Kay, A. Tijerina, A. V. Srivastava, A. Laviana, J. Wolf, E. Osterberg","doi":"10.21037/AMJ-21-5","DOIUrl":"https://doi.org/10.21037/AMJ-21-5","url":null,"abstract":"Radiation therapy to the pelvis is indicated for cervical, prostate, rectal, and gastrointestinal (GI) malignancies. A rare, but known adverse effect of this treatment is radiation-induced ureteral stricture (RIUS). RIUS can cause infection, hydronephrosis, kidney stone formation, and ultimately, renal failure. Management of RIUS is a challenge to urologists as the strictures tend to be long, bilateral, and ischemic in etiology. Management of RIUS is divided into endoscopic, open, and minimally invasive techniques. Stents and percutaneous nephrostomy (PCN) tubes are generally used as temporizing measures until definitive repair, but they may be a long-term option for patients unfit for surgery. Balloon dilatation and endoureterotomy have shown efficacy between 60–80% but are less effective in radiation-induced stricture due to the ischemic nature of the insult. Ureteroureterostomy (UU) is best suited for short strictures in the mid-to-proximal ureter. Ureteroneocystostomy is better suited for longer strictures in the distal ureter and may be paired with psoas hitch or Boari flap to increase coverage length. Importantly, for radiation patients, bladder fibrosis may be a contraindication to these procedures. Buccal graft ureteroplasty is increasingly being used with success rates between 80–90%, although this number decreases to around 30% in longer strictures. Finally, bowel substitutes are suitable for longer strictures and bilateral disease. Most recently, appendiceal interposition has been studied for both rightand left-sided strictures around 3–5 cm, with success rates around 70%. More invasive and potentially morbid techniques like transureteroureterostomy (TUU) and renal autotransplantation are reserved for extremely long or pan-ureteral strictures and are usually unsuitable for cancer patients who have undergone radiotherapy. In general, minimally invasive approaches, while less studied, have demonstrated similar clinical outcomes and complication rates, with less pain and shorter hospital stays. In this review, we will summarize the most up-to-date literature in this field, detailing the current management of RIUS.","PeriodicalId":72157,"journal":{"name":"AME medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45625659","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}
: Radiation therapy is a central treatment modality for the management of various pelvic malignancies and prior data has supported a relationship between radiation exposure and the development of long-term treatment sequelae. One of the most consequential long-term side effects of radiation therapy is the risk of developing a secondary malignancy. With advancements in radiotherapy delivery and a better appreciation of underlying tumor biology, additional considerations are needed when assessing the risk of radiation-mediated malignancies. Also, several adjacent normal structures within the pelvis may be affected by radiation-mediated toxicity, driven in part by acute and chronic inflammation. Depending on treatment modality and primary tumor location, various steps can be taken in radiation planning to reduce the risk of these side effects, which may negatively affect the patient’s quality of life. As cancer survivorship continues to increase, it is important to understand both the treatment and biologic variables which influence the risk of developing secondary malignancies in order to minimize the risk for treatment side effects and the late effect of secondary malignancy. Herein, we will provide an overview of secondary malignancies in the context of receiving therapeutic radiation to the pelvis and will highlight biologic considerations that may influence this risk. in rare, and direct comparisons of SMN risk in anatomically similar tumors between pediatric and adult patients are not robust enough to make definitive conclusions.
{"title":"A narrative review of radiation-related malignancy in the pelvis","authors":"L. Linkowski, B. Manley, P. Johnstone, G. Grass","doi":"10.21037/AMJ-20-179","DOIUrl":"https://doi.org/10.21037/AMJ-20-179","url":null,"abstract":": Radiation therapy is a central treatment modality for the management of various pelvic malignancies and prior data has supported a relationship between radiation exposure and the development of long-term treatment sequelae. One of the most consequential long-term side effects of radiation therapy is the risk of developing a secondary malignancy. With advancements in radiotherapy delivery and a better appreciation of underlying tumor biology, additional considerations are needed when assessing the risk of radiation-mediated malignancies. Also, several adjacent normal structures within the pelvis may be affected by radiation-mediated toxicity, driven in part by acute and chronic inflammation. Depending on treatment modality and primary tumor location, various steps can be taken in radiation planning to reduce the risk of these side effects, which may negatively affect the patient’s quality of life. As cancer survivorship continues to increase, it is important to understand both the treatment and biologic variables which influence the risk of developing secondary malignancies in order to minimize the risk for treatment side effects and the late effect of secondary malignancy. Herein, we will provide an overview of secondary malignancies in the context of receiving therapeutic radiation to the pelvis and will highlight biologic considerations that may influence this risk. in rare, and direct comparisons of SMN risk in anatomically similar tumors between pediatric and adult patients are not robust enough to make definitive conclusions.","PeriodicalId":72157,"journal":{"name":"AME medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47396567","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}
{"title":"AMJ series on radiation urologic reconstruction","authors":"L. Wiegand","doi":"10.21037/amj-2021-01","DOIUrl":"https://doi.org/10.21037/amj-2021-01","url":null,"abstract":"","PeriodicalId":72157,"journal":{"name":"AME medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44139881","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}
Sainath Asokan, Anthony Y. Cheung, Flaminio Pavesi, A. Bains
: Recurrence rates after complete resection of early-stage non-small cell lung cancer (NSCLC) remain high despite advances in earlier diagnosis with increased low-dose CT screening. While previous efforts have illustrated the role of the immune response in the tumor microenvironment, a thorough understanding of the impact of the systemic immune response in early-stage NSCLC is still lacking and needed. Elaborating on the associations between the peripheral immune response and clinical outcomes is essential for risk stratification and for developing effective immunotherapeutic strategies to improve long term patient outcomes. In addition, measuring the association between immune markers in the blood and patient’s response to the disease provides a valuable opportunity for caregivers to gain prognostic information by simple and inexpensive blood draws, without the need to invasively access the tumor microenvironment. The role of these peripheral blood biomarkers has been extensively studied in a variety of solid tumors; however, the prognostic value of many immune markers in NSCLC is less well-defined. Herein, we review the role of the immune cells involved in the peripheral immune response to NSCLC and the prognostic significance of clinical biomarkers that can be measured inexpensively without access to the tumor microenvironment. This comprehensive review lays the groundwork for further research into the prognostic utility of immune markers found in the peripheral blood of NSCLC.
{"title":"Prognostic significance of peripheral blood immune response in early-stage non-small cell lung cancer: a narrative review","authors":"Sainath Asokan, Anthony Y. Cheung, Flaminio Pavesi, A. Bains","doi":"10.21037/AMJ-20-122","DOIUrl":"https://doi.org/10.21037/AMJ-20-122","url":null,"abstract":": Recurrence rates after complete resection of early-stage non-small cell lung cancer (NSCLC) remain high despite advances in earlier diagnosis with increased low-dose CT screening. While previous efforts have illustrated the role of the immune response in the tumor microenvironment, a thorough understanding of the impact of the systemic immune response in early-stage NSCLC is still lacking and needed. Elaborating on the associations between the peripheral immune response and clinical outcomes is essential for risk stratification and for developing effective immunotherapeutic strategies to improve long term patient outcomes. In addition, measuring the association between immune markers in the blood and patient’s response to the disease provides a valuable opportunity for caregivers to gain prognostic information by simple and inexpensive blood draws, without the need to invasively access the tumor microenvironment. The role of these peripheral blood biomarkers has been extensively studied in a variety of solid tumors; however, the prognostic value of many immune markers in NSCLC is less well-defined. Herein, we review the role of the immune cells involved in the peripheral immune response to NSCLC and the prognostic significance of clinical biomarkers that can be measured inexpensively without access to the tumor microenvironment. This comprehensive review lays the groundwork for further research into the prognostic utility of immune markers found in the peripheral blood of NSCLC.","PeriodicalId":72157,"journal":{"name":"AME medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49130492","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}
: Current staging for lung cancer is primarily based on TNM staging, which is purely anatomical. This staging method has served an important purpose of stratifying patients into risk categories based on tumor physical characteristics including tumor size, nodal involvement and metastasis. Nonetheless, the TNM staging has its limitations. One such limitation is the fact that this staging method cannot prognostically discriminate within the same tumor stage. This issue may become relevant with the increasing number of stage I patients being detected as a result of lung cancer screening. As such, investigations for additional prognostic markers become important. The tumor immune microenvironment (IME), including infiltrating immune cells, cell surface markers of these infiltrating cells and of the tumor cells, and signaling proteins (specifically cytokines), could provide the opportunity to stratify patients with early-stage lung cancer based on prognosis (e.g., post-operative recurrence risk) and provide insight on therapeutic responses as well as therapeutic targets. Knowledge of the IME in cancers is important as it serves as a basis for research that attempts to study the possibility of employing the immune system to actively destroy cancer cells (i.e., cancer immunotherapy). This article aims to review recent findings as they relate to prognosticators in the IME of stage I lung cancer. 17 , a cell infiltration, OS, I–II CD8+ infiltration a cell showed a positive correlation with increased CD8+ infiltration in univariate (P=0.002, 95% CI: 0.217–0.714, HR: 0.393) and multivariate analyses (P=0.034, 95% CI: 0.053– 0.892. HR: 0.218). Similar findings were shown for OS in univariate analysis (P=0.044, 95% CI: 0.259–0.982, HR: multivariate analysis showed a trend between high CD8+ TILs and improved OS (P=0.070, 95% CI: 0.276–1.052, HR: 0.539) et the of cells in NSCLC
{"title":"Narrative review of the prognostic significance of immune cells in the tumor microenvironment of stage I lung cancer","authors":"Ogheneyoma Akpoviroro, Kei Suzuki","doi":"10.21037/AMJ-20-118","DOIUrl":"https://doi.org/10.21037/AMJ-20-118","url":null,"abstract":": Current staging for lung cancer is primarily based on TNM staging, which is purely anatomical. This staging method has served an important purpose of stratifying patients into risk categories based on tumor physical characteristics including tumor size, nodal involvement and metastasis. Nonetheless, the TNM staging has its limitations. One such limitation is the fact that this staging method cannot prognostically discriminate within the same tumor stage. This issue may become relevant with the increasing number of stage I patients being detected as a result of lung cancer screening. As such, investigations for additional prognostic markers become important. The tumor immune microenvironment (IME), including infiltrating immune cells, cell surface markers of these infiltrating cells and of the tumor cells, and signaling proteins (specifically cytokines), could provide the opportunity to stratify patients with early-stage lung cancer based on prognosis (e.g., post-operative recurrence risk) and provide insight on therapeutic responses as well as therapeutic targets. Knowledge of the IME in cancers is important as it serves as a basis for research that attempts to study the possibility of employing the immune system to actively destroy cancer cells (i.e., cancer immunotherapy). This article aims to review recent findings as they relate to prognosticators in the IME of stage I lung cancer. 17 , a cell infiltration, OS, I–II CD8+ infiltration a cell showed a positive correlation with increased CD8+ infiltration in univariate (P=0.002, 95% CI: 0.217–0.714, HR: 0.393) and multivariate analyses (P=0.034, 95% CI: 0.053– 0.892. HR: 0.218). Similar findings were shown for OS in univariate analysis (P=0.044, 95% CI: 0.259–0.982, HR: multivariate analysis showed a trend between high CD8+ TILs and improved OS (P=0.070, 95% CI: 0.276–1.052, HR: 0.539) et the of cells in NSCLC","PeriodicalId":72157,"journal":{"name":"AME medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46934622","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}
: The possibility to apply the knowledge of cell surface markers and cytokines in the tumor microenvironment of early lung cancer (LC) in clinical practice, is still a developing facet of oncological medicine, but may possibly be a very fertile, not wholly explored facet. Although early diagnosis of LC through the efforts of LC screening has served an important role in decreasing LC mortality, cancer recurrence is also an equally important clinical concern. Cell surface markers and cytokines in the tumor microenvironment of LC may serve a clinical prognostic purpose. This is specifically with regard to risk stratification and subsequent identification of patients that may most benefit from early postoperative adjuvant therapy, based on their risk of recurrence. These molecules could also potentially serve as therapeutic targets. However, the roles and effects of various cytokines and cell surface markers in the immune microenvironment (IME) of LC and other cancers, as well as the interplay between these molecules and infiltrating immune cells, have not been fully elaborated, and there remains work to be done in this respect. This article attempts to discuss some of these cell surface markers and cytokines that may, in the future, serve as prognosticators for the early LC, possibly in the forms of stratification scores and models. This carried out 2 separate analyses using data from stage I-III patients from institution and similar data extracted from TCGA (n=233). HLA-II was for using IHC, lymphocyte infiltration was determined by genetic analysis.
{"title":"Narrative review of cytokines and cell surface markers in the tumor microenvironment of stage I lung cancer","authors":"Ogheneyoma Akpoviroro","doi":"10.21037/AMJ-20-144","DOIUrl":"https://doi.org/10.21037/AMJ-20-144","url":null,"abstract":": The possibility to apply the knowledge of cell surface markers and cytokines in the tumor microenvironment of early lung cancer (LC) in clinical practice, is still a developing facet of oncological medicine, but may possibly be a very fertile, not wholly explored facet. Although early diagnosis of LC through the efforts of LC screening has served an important role in decreasing LC mortality, cancer recurrence is also an equally important clinical concern. Cell surface markers and cytokines in the tumor microenvironment of LC may serve a clinical prognostic purpose. This is specifically with regard to risk stratification and subsequent identification of patients that may most benefit from early postoperative adjuvant therapy, based on their risk of recurrence. These molecules could also potentially serve as therapeutic targets. However, the roles and effects of various cytokines and cell surface markers in the immune microenvironment (IME) of LC and other cancers, as well as the interplay between these molecules and infiltrating immune cells, have not been fully elaborated, and there remains work to be done in this respect. This article attempts to discuss some of these cell surface markers and cytokines that may, in the future, serve as prognosticators for the early LC, possibly in the forms of stratification scores and models. This carried out 2 separate analyses using data from stage I-III patients from institution and similar data extracted from TCGA (n=233). HLA-II was for using IHC, lymphocyte infiltration was determined by genetic analysis.","PeriodicalId":72157,"journal":{"name":"AME medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47487210","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}
Yusuke Takahashi, Ayako Demachi‐Okamura, Y. Oya, Takeo Nakada, N. Sakakura, H. Kuroda, H. Matsushita
Whether or not there are “tumor antigens” recognized by T cells had been controversial, until mouse and human tumor antigens have been identified one after another since the 1980s. In recent years, advances in genome sequencing technology has made possible to identify neo-antigens based on patientspecific gene mutations. Successful findings of immune checkpoint inhibitors (ICIs) in clinical trials have shed a light on tumor antigens which plays a key role so that they could be a candidate of novel therapeutic target. Since correlation between response to ICIs and neo-antigen has been clarified, it has become gradually clear that the immune response recognizing the neo-antigens plays a central role in anti-cancer immunity. Neo-antigens can elicit a strong immune response and are promising targets for novel cancer vaccine therapy or T-cell therapy, even though there are still some issues such as exhaustion and refractory state of T cells that they recognize. There are some types of tumor antigens with various specificity and immunogenicity to subject tumor. Several approaches utilizing tumor specific antigens are emerging as candidates of combination therapy together with ICI to maximize benefit from ICI treatment. Further studies of cancer antigens are expected to be the key to the next breakthrough in immunotherapy.
{"title":"Research advance in tumor specific antigens: a narrative review","authors":"Yusuke Takahashi, Ayako Demachi‐Okamura, Y. Oya, Takeo Nakada, N. Sakakura, H. Kuroda, H. Matsushita","doi":"10.21037/AMJ-20-121","DOIUrl":"https://doi.org/10.21037/AMJ-20-121","url":null,"abstract":"Whether or not there are “tumor antigens” recognized by T cells had been controversial, until mouse and human tumor antigens have been identified one after another since the 1980s. In recent years, advances in genome sequencing technology has made possible to identify neo-antigens based on patientspecific gene mutations. Successful findings of immune checkpoint inhibitors (ICIs) in clinical trials have shed a light on tumor antigens which plays a key role so that they could be a candidate of novel therapeutic target. Since correlation between response to ICIs and neo-antigen has been clarified, it has become gradually clear that the immune response recognizing the neo-antigens plays a central role in anti-cancer immunity. Neo-antigens can elicit a strong immune response and are promising targets for novel cancer vaccine therapy or T-cell therapy, even though there are still some issues such as exhaustion and refractory state of T cells that they recognize. There are some types of tumor antigens with various specificity and immunogenicity to subject tumor. Several approaches utilizing tumor specific antigens are emerging as candidates of combination therapy together with ICI to maximize benefit from ICI treatment. Further studies of cancer antigens are expected to be the key to the next breakthrough in immunotherapy.","PeriodicalId":72157,"journal":{"name":"AME medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42686722","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}
A bronchopleural fistula (BPF) is a pathological connection between the main stem, lobar, or segmental bronchus and the pleural space. This tract permits sterile pleural space to be contaminated, leading to a high risk of pleural space infections. In effect, morbidity and mortality remain high for this condition. There are quite a number of bronchoscopic interventions proposed to combat BPF’s. Even so, no technique has been found superior for closure of BPF’s to date. We present a challenging case report introducing the use of DuraSeal glue as a viable intervention for the termination of BPF’s. The glue has historically been used for the purpose of being a sealant and preventing cerebrospinal fluid leakage in cranial and spinal dural repair. Specifically, the material has provided a watertight seal allowing for the dura more time to heal compared to fibrin glue. To our knowledge, there have not been any previous reports of this specific glue being used to treat BPFs.
{"title":"Utilizing a neurosurgical hydrogel sealant (DuraSeal sealant) for the closure of bronchopleural fistulas: a case report of a novel technique","authors":"V. Pasricha, C. Hutchinson, D. Dibardino","doi":"10.21037/AMJ-20-104","DOIUrl":"https://doi.org/10.21037/AMJ-20-104","url":null,"abstract":"A bronchopleural fistula (BPF) is a pathological connection between the main stem, lobar, or segmental bronchus and the pleural space. This tract permits sterile pleural space to be contaminated, leading to a high risk of pleural space infections. In effect, morbidity and mortality remain high for this condition. There are quite a number of bronchoscopic interventions proposed to combat BPF’s. Even so, no technique has been found superior for closure of BPF’s to date. We present a challenging case report introducing the use of DuraSeal glue as a viable intervention for the termination of BPF’s. The glue has historically been used for the purpose of being a sealant and preventing cerebrospinal fluid leakage in cranial and spinal dural repair. Specifically, the material has provided a watertight seal allowing for the dura more time to heal compared to fibrin glue. To our knowledge, there have not been any previous reports of this specific glue being used to treat BPFs.","PeriodicalId":72157,"journal":{"name":"AME medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43793495","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}
Pulmonary lobectomy has been historically the gold standard oncologic resection for early stage non-small cell lung cancer (NSCLC). Pulmonary segmentectomy has gained popularity as technological advances and improved understanding of segmental anatomy have allowed the use of minimally invasive surgery for parenchymal sparing resections. Oncologic equivalency between segmentectomy and lobectomy remains under investigation. In this manuscript, we aim to review existing literature with regards to oncologic and functional outcomes comparing lobectomy vs. segmentectomy, and comparisons among different surgical approaches: open, traditional video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery. When compared with lobectomy, segmentectomy appears to provide equivalent oncologic outcomes in appropriately selected patients, as long as adequate lymphadenectomy and negative margins are achieved. The robotic platform, with its improved visualization and use of wristed instruments may allow for a more complete lymphadenectomy during a segmental resection. The following manuscript serves as a guide for clinicians on recent literature for open, video-assisted and robotic thoracoscopic pulmonary segmentectomy.
{"title":"Comprehensive narrative review of segmentectomy for lung cancer","authors":"Karishma Kodia, D. Nguyen, N. Villamizar","doi":"10.21037/AMJ-20-96","DOIUrl":"https://doi.org/10.21037/AMJ-20-96","url":null,"abstract":"Pulmonary lobectomy has been historically the gold standard oncologic resection for early stage non-small cell lung cancer (NSCLC). Pulmonary segmentectomy has gained popularity as technological advances and improved understanding of segmental anatomy have allowed the use of minimally invasive surgery for parenchymal sparing resections. Oncologic equivalency between segmentectomy and lobectomy remains under investigation. In this manuscript, we aim to review existing literature with regards to oncologic and functional outcomes comparing lobectomy vs. segmentectomy, and comparisons among different surgical approaches: open, traditional video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery. When compared with lobectomy, segmentectomy appears to provide equivalent oncologic outcomes in appropriately selected patients, as long as adequate lymphadenectomy and negative margins are achieved. The robotic platform, with its improved visualization and use of wristed instruments may allow for a more complete lymphadenectomy during a segmental resection. The following manuscript serves as a guide for clinicians on recent literature for open, video-assisted and robotic thoracoscopic pulmonary segmentectomy.","PeriodicalId":72157,"journal":{"name":"AME medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44735447","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}
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