Levels of Vascular Endothelial Growth Factor in Serum and Pleural Fluid are Independent Predictors of Survival in advanced NSCLC: Results of a Prospective Study

Δημιουργηθηκε στις Τετάρτη, 25 Φεβρουαρίου 2015 09:25

Aim: To further evaluate the prognostic significance of pretreatment serum and pleural fluid levels of vascular endothelial growth factor VEGF in patients with non-small cell lung cancer (NSCLC) presenting with malignant pleural effusion (MPE). Patients and Methods: Forty consecutive newly diagnosed patients with NSCLC with MPE at presentation but without distant metastases were prospectively enrolled. The prognostic value of serum and pleural fluid VEGF levels for overall survival (OS) and progression-free survival (PFS) was assessed by Cox regression analysis. Results: The median serum VEGF level was significantly higher in patients as compared to healthy controls (p<0.001). Serum VEGF higher than 375 pg/ml, pleural fluid VEGF greater than the median value and the presence of progressive disease were all significantly associated with reduced OS and PFS, both in univariate and multivariate analyses. Conclusion: The results of our study suggest that increased pretreatment serum and pleural fluid levels of VEGF may be independent predictors of a worse survival in patients with advanced-stage NSCLC.

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Clinical Significance of Smoking Cessation in Patients With Cancer: A 30-Year Review

Δημιουργηθηκε στις Δευτέρα, 02 Φεβρουαρίου 2015 09:58

Despite the established causal relationship between tobacco smoking and cancer, many cancer patients continue to smoke after diagnosis. This partly reflects ignorance of the beneficial effects of smoking cessation, even after diagnosis. The aim of this study was to demonstrate the effects of continuing or quitting smoking in patients with diagnosed cancer. METHODS: The study was based on a review of medical databases (PubMed Central, MEDLINE, Cochrane Library) in the last 30 y.

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The Intercellular Cell Adhesion Molecule-1 (ICAM-1) in Lung Cancer: Implications for Disease Progression and Prognosis

Δημιουργηθηκε στις Κυριακή, 07 Δεκεμβρίου 2014 11:47

Abstract. The intercellular cell-adhesion molecule-1 (ICAM-1) is a transmembrane molecule and a distinguished member of the Immunoglobulin superfamily of proteins that participates in many important processes, including leukocyte endothelial transmigration, cell signaling, cell-cell interaction, cell polarity and tissue stability. ICAM-1and its soluble part are highly expressed in inflammatory conditions, chronic diseases and a number of malignancies. In the present article we present the implications of ICAM-1 in the progression and prognosis of one of the major global killers of our era: lung cancer.

Lung cancer, despite all therapeutic efforts, remains the leading cause of cancer-related death worldwide, with approximately 160,340 deaths in the United States in 2012 (1). Its high mortality is largely attributed to early local expansion and metastasis, as most patients present with locally advanced or metastatic (up to 75%) disease at the time of diagnosis (2, 3), while in a large percentage of the remaining patients, early stage disease rapidly progresses to metastatic. Since early-diagnosis provides the only chance for a potentially curative treatment, several studies have focused on the identification of serum biomarkers who could be used as diagnostic, staging, prognostic or predictive markers in lung cancer. Adhesion molecules have been the subject of many of these studies.

Correspondence to: Konstantinos N. Syrigos, MD, Ph.D., Oncology Unit GPP, Sotiria General Hospital, Athens School of Medicine, 152 Mesogion Avenue, 115 27 Athens, Greece.

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Developments in the Treatment of Non-small Cell Lung Cancer

Δημιουργηθηκε στις Κυριακή, 27 Απριλίου 2014 11:49

Lung cancer remains the leading cause of cancerrelated deaths among men and women in the civilized world. Although there have been major improvements over the recent decades in surgical techniques and the role of chemotherapyradiotherapy in the treatment of non-small cell lung cancer (NSCLC), the long-term outlook for these patients has not changed significantly. The median survival for patients with advanced-stage NSCLC treated with platinum-based chemotherapy is a disappointing 8-10 months. In current clinical practice, chemotherapy is used as a combined modality with radiotherapy as an adjuvant or neoadjuvant therapy. Moreover, combination chemotherapy is regarded as the standard care in the treatment of unresectable locally advanced (stage IIIb), metastatic (stage IV), or recurrent disease. The recent developments in the treatment of NSCLC have been focused on the emerging role of adjuvant therapy in the early stages of NSCLC. The clinical activity of pemetrexed, a multitargeted antifolate anticancer agent, as a second-line chemotherapy agent and the impact of new biological agents, such as bevacizumab and erlotinib, have been investigated in phase III trials in the first- and second-line setting. Even though these options have been available in the last few years, there is a clear need for improvement in the current standard of care. No definite survival benefit has yet been demonstrated. An abundant amount of research is still required in the field of lung cancer therapy with well-designed clinical trials and appropriate patient selection.
There are multiple levels of approaching lung cancer management in our medical scientific society, such as thoracic surgery for early stages of NSCLC, chemoradiation therapy of locally advanced NSCLC or systemic chemotherapy of metastatic NSCLC. It was estimated in the United States that in 2007 there will be approximately 174,000 new diagnoses of lung cancer from which 162,000 deaths would result (1). Regardless of the cancerous cell origin, prognosis is uniformly dismal in any advanced disease, even though 80% of lung cancer cases are of the non-small cell type and the primary therapy is systemic chemotherapy. Moreover, the 5-year survival for lung cancer has remained at &lt;15% for the past 20 years (2). Given the above data, it is realized that a number of therapeutic strategies have to be investigated to improve the overall survival, symptoms and quality of life of lung cancer patients. The recent developments in the treatment of NSCLC have been focused on the emerging role of adjuvant therapy in the early stages of NSCLC. The clinical activity of pemetrexed, a multi-targeted antifolate anticancer agent, as a second-line chemotherapy agent and the impact of new biological agents, such as bevacizumab and erlotinib have been investigated in phase III trials in the first- and secondline setting.

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Carboplatin-Pemetrexed Adjuvant Chemotherapy in Resected Non-small Cell Lung Cancer (NSCLC): A Phase II Study

Δημιουργηθηκε στις Σάββατο, 26 Απριλίου 2014 11:47

Background: The aim of this study was to determine the progression-free survival (PFS) and toxicity associated with adjuvant administration of carboplatin and pemetrexed for completely resected patients with stage IB, II and IIIA non-small cell lung cancer (NSCLC). Patients and Methods: Forty-five eligible NSCLC patients received surgical resection for pathological stage IB, II or IIIA followed by postoperative adjuvant chemotherapy with carboplatin AUC5 and pemetrexed administered on days 1 and 14 on a 28-day cycle. Recombinant human granocyte colony-stimulating factor (rhG-CF) was given prophylactically. Results: The mean time to disease progression of patients was 26 months. Toxicities were generally mild to moderate and entirely manageable. Conclusion: The administration of carboplatin and pemetrexed is a safe, well-tolerated and convenient regimen in the adjuvant setting of completely resected NSCLC, with efficacy similar to that reported in other regimens but less toxicity.
Although complete surgical resection is the optimal management of patients with operable non-small cell lung cancer (NSCLC), the five-year overall survival rate is poor, ranging from 23% to 67% , and dependent on the size of the primary tumor and the lymph node involvement (1). Postoperative radiotherapy reduces the rate of local recurrence in stage IIIA disease but it has a questionable, if not detrimental, effect in patients with stage I and II (2).

Correspondence to: Kostas N. Syrigos, MD, Ph.D., Professor of Oncology in Medicine, Head, Oncology Unit, Third Department of Medicine, Athens University School of Medicine, Sotiria General Hospital, Building Z, 152 Mesogion Avenue, 115 27 Athens, Greece. Tel: +30 2107475034, Fax: +30 2107781035, e-mail: Αυτή η διεύθυνση ηλεκτρονικού ταχυδρομείου προστατεύεται από τους αυτοματισμούς αποστολέων ανεπιθύμητων μηνυμάτων. Χρειάζεται να ενεργοποιήσετε τη JavaScript για να μπορέσετε να τη δείτε. / Αυτή η διεύθυνση ηλεκτρονικού ταχυδρομείου προστατεύεται από τους αυτοματισμούς αποστολέων ανεπιθύμητων μηνυμάτων. Χρειάζεται να ενεργοποιήσετε τη JavaScript για να μπορέσετε να τη δείτε. Key Words: Adjuvant chemotherapy, operable non-small cell lung cancer, carboplatin, pemetrexed.

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Docetaxel plus Gemcitabine as First-line Treatment in Mlignant Pleural Mesothelioma: A Single Institution Phase II Study

Δημιουργηθηκε στις Πέμπτη, 24 Απριλίου 2014 11:44

Background: The cisplatin-pemetrexed and cisplatin-gemcitabine combinations are considered the standard treatment for malignant pleural mesothelioma. The purpose of this study was to examine the efficacy of gemcitabine plus docetaxel in the first-line setting, as this combination has not been investigated in mesothelioma before. Patients and Methods: Twenty-five consecutive patients with malignant pleural mesothelioma were enrolled. They received 80 mg/m2 of docetaxel and 1,000 mg/m2 of gemcitabine on days 1 and 14 of a 28-day cycle. The treatment was scheduled for a maximum of 6 cycles or until disease progression or unacceptable toxicity. Results: A total of 7 out of our 25 patients (28% ) responded to treatment. In 14 patients (56% ), the disease remained stable, while in 4 (16% ) it progressed. The median time to progression was 7 months (range: 5.4-8.6 months) and the median overall survival was 15 months (range: 12.4-17.5 months). Conclusion: The administration of gemcitabine and doctaxel appears to be promising first-line therapy for patients with mesothelioma, as it is well tolerated and appears to improve survival. Malignant pleural mesothelioma (MPM) is a rare aggressive tumor caused mainly by occupational asbestos exposure. Its incidence reaches 100 cases/million/year in occupationally exposed populations as opposed to 1 case/million/year in the general population and data show that it will continue to increase until 2020-2030 (1).

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Sampling versus systematic full lymphatic dissection in surgical treatment of non-small cell lung cancer

Δημιουργηθηκε στις Τρίτη, 22 Απριλίου 2014 11:32

The extent of mediastinal lymph node assessment during surgery for non-small cell cancer remains controversial. Different techniques are used, ranging from simple visual inspection of the unopened mediastinum to an extended bilateral lymph node dissection. Furthermore, different terms are used to define these techniques. Sampling is the removal of one or more lymph nodes under the guidance of pre-operative findings. Systematic (full) nodal dissection is the removal of all mediastinal tissue containing the lymph nodes systematically within anatomical landmarks. A Medline search was conducted to identify articles in the English language that addressed the role of mediastinal lymph node resection in the treatment of non-small cell lung cancer. Opinions as to the reasons for favoring full lymphatic dissection include complete resection, improved nodal staging and better local control due to resection of undetected micrometastasis. Arguments against routine full lymphatic dissection are increased morbidity, increase in operative time, and lack of evidence of improved survival. For complete resection of non-small cell lung cancer, many authors recommend a systematic nodal dissection as the standard approach during surgery, and suggest that this provides both adequate nodal staging and guarantees complete resection. Whether extending the lymph node dissection influences survival or recurrence rate is still not known.

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Ομιλία 21ο Πανελλήνιο Πνευμονολογικό Συνέδριο

Δημιουργηθηκε στις Τετάρτη, 16 Απριλίου 2014 19:15

Ομιλία στο 21ο Πανελλήνιο Πνευμονολογικό Συνέδριο

http://www.livemedia.gr/video/31387

Pleural lavage cytology:Where do we stand

Δημιουργηθηκε στις Τρίτη, 15 Απριλίου 2014 20:49

 Although a malignant pleural effusion is considered a manifestation of an advanced stage disease not amenable to curative resection in patients with non-small cell lung cancer, the same is not true in the case of the presence of malignant cells in the pleural cavity without an accompanying effusion, discovered incidentally during the operation with pleural lavage cytology (PLC). PLC is a diagnostic technique used to detect tumor cells and translate this finding to a prognostic index. Various reports have attempted to utilize the results of PLC and draw inferences regarding the origins of malignant cells in the pleural cavity, the association of these results with various disease characteristics and, most importantly, their impact on disease recurrence and survival. However, due to non-consistent techniques and protocols used to acquire the samples for cytological evaluation and assess their significance, results are inhomogeneous. Nevertheless, the entrance of malignant cells in the pleural cavity follows the rules posed by the natural disease process when discovered before pulmonary resection takes place, while surgical manipulations certainly play an important role in the case malignant cells are checked over after pulmonary resection. In addition, although the prognostic significance of a positive PLC result is indisputable and significantly decreases long-term survival in the majority of studies, this factor has not yet been incorporated into the TNM staging system. Lastly, some authors have advocated the use of some form of adjuvant treatment for those patients found with positive PLC results, based on the assumption that a curative resection followed by multiple pleural washings will not remove the entirety of the population of malignant cells present in the pleural space.

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THE CLINICAL SIGNIFICANCE OF HISTOPATHOLOGICAL GRADING ON EARLY STAGE NSCLC

Δημιουργηθηκε στις Δευτέρα, 03 Μαρτίου 2014 15:29

Histopathological grading (pdf) and Intratumoral invasion (pdf)