AIM: Percutaneous transthoracic needle biopsy (PTNB), an alternative to bronchoscopic confirmation of lung lesions, is today being associated with a risk of pneumothorax and hemorrhage. Further, there are no data on the possible risk of malignant disease spreading to the pleura at the site of the PTNB. Previous studies have dealt with this risk in stage I non-small cell lung cancer only. The aim of this study was thus to assess the risk of pleural recurrence for all types of lung lesions. Secondary objectives included assessment of diagnostic yield and safety with respect to the incidence of pneumothorax and hemorrhage. METHODS: Clinical data of all patients from the University Hospital in Pilsen who had undergone PTNB of lung lesions between 1.1.2018 and 31.12.2022 were included in this retrospective study. RESULTS: Following PTNB, ipsilateral pleural effusion occurred in 4.8% of patients without prior pleural infiltration. The effusion was confirmed as malignant in one patient (0.7%). Diagnostic yield of the method was 86.6%. We recorded pneumothorax or hemorrhage in the lung parenchyma or pleural space requiring medical intervention in 3.4% and 1.1% of patients, respectively. CONCLUSION: In our study, percutaneous transthoracic needle biopsy of lung lesions showed high sensitivity and low degree of acute complications requiring an invasive solution. The risk of pleural recurrence after a biopsy was very low. Consequently, we continue to consider this method to be an alternative to bronchoscopy biopsies.
- MeSH
- dospělí MeSH
- jehlová biopsie škodlivé účinky metody MeSH
- krvácení etiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory plic * patologie MeSH
- pleurální výpotek etiologie patologie MeSH
- plíce patologie MeSH
- pneumotorax * etiologie MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Resekce pokročilejších nemalobuněčných plicních karcinomů stadií II a III bez zajištění další léčbou vede k vysokému procentu recidiv. Samotná neo-/adjuvantní chemoterapie vede pouze k mírnému zlepšení přežití pacientů. Významný pokrok ve snížení šance na recidivu onemocnění přinesla až neoadjuvantní chemoimunoterapie (přičemž některé režimy pokračují i v adjuvantním podávání imunoterapie). Ačkoliv máme jasná data o účinnosti této léčby ze studií fáze III, pořád je řada otázek, na které známe jen částečnou či žádnou odpověď. Tento článek se snaží na některé z nich odpověď na podkladě současných poznatků.
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BACKGROUND/AIM: Targeted therapy has become increasingly important in treating lung adenocarcinoma, the most common subtype of lung cancer. Next-generation sequencing (NGS) enables precise identification of specific genetic alterations in individual tumor tissues, thereby guiding targeted therapy selection. This study aimed to analyze mutations present in adenocarcinoma tissues using NGS, assess the benefit of targeted therapy and evaluate the progress in availability of targeted therapies over last five years. PATIENTS AND METHODS: The study included 237 lung adenocarcinoma patients treated between 2018-2020. The Archer FusionPlex CTL panel was used for NGS analysis. RESULTS: Gene variants covered by the panel were detected in 57% patients and fusion genes in 5.9% patients. At the time of the study, 34 patients (14.3% of patients) were identified with a targetable variant. Twenty-five patients with EGFR variants, 8 patients with EML4-ALK fusion and one patient with CD74-ROS1 fusion received targeted therapy. Prognosis of patients at advanced stages with EGFR variants treated by tyrosine kinase inhibitors and patients with EML4-ALK fusion treated by alectinib was significantly favorable compared to patients without any targetable variant treated by chemotherapy (p=0.0172, p=0.0096, respectively). Based on treatment guidelines applicable in May 2023, the number of patients who could profit from targeted therapy would be 64 (27.0% of patients), this is an increase by 88% in comparison to recommendations valid in 2018-2020. CONCLUSION: As lung adenocarcinoma patients significantly benefit from targeted therapy, the assessment of mutational profiles using NGS could become a crucial approach in the routine management of oncological patients.
- MeSH
- adenokarcinom plic * farmakoterapie genetika MeSH
- erbB receptory genetika MeSH
- lidé MeSH
- mutace MeSH
- nádory plic * farmakoterapie genetika patologie MeSH
- protoonkogenní proteiny genetika MeSH
- tyrosinkinasové receptory genetika MeSH
- tyrosinkinasy genetika MeSH
- vysoce účinné nukleotidové sekvenování MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Purpose: To investigate potential association between selected tumor markers and laboratory parameters (lactate dehydrogenase [LDH], neutrophils, hemoglobin, neutrophils, lymphocytes, C-reactive protein, albumin, carcinoembryonic antigen, and cytokeratin 19 fragment 21-1 [CYFRA 21-1]) and circulating tumor DNA (ctDNA) with survival in patients with advanced non-small cell lung cancer (NSCLC). Patients and Methods: The study encompassed 82 patients from a single center. All patients had (localy-) advanced adenocarcinomas. ctDNA was determined before starting therapy and at 6 weeks follow-up. Laboratory parameters were measured before each cycle of therapy and oncomarkers before starting the therapy as standard clinical practice. Mann-Whitney U test, Cox proportional hazards model, Fisher's exact test, and Kaplan-Meier survival estimation with Gehan-Wilcoxon test were used for statistical analysis of the corresponding variables. Results: We have confirmed predictive or prognostic significance for some of the selected laboratory markers and oncomarkers. Above all, we demonstrate a significant relationship between the levels of LDH and the oncomarker CYFRA 21-1 and the presence or absence of ctDNA at the time of diagnosis. We also demonstrate significantly lower CRP levels in patients within whom the ctDNA disappeared during treatment. A similar but statistically insignificant trend was observed for LDH. Conclusions: CYFRA 21-1, LDH and probably CRP correlate with ctDNA levels in NSCLC. Repeated measurement of these markers could thus help in early detection of disease progression in the same way as does ctDNA monitoring.
- Publikační typ
- časopisecké články MeSH
I přes zlepšení vyšetření k určení klinického stadia, operační techniky a zavedení adjuvantní chemoterapie a případně radioterapie u stadií II a III nemalobuněčného plicního karcinomu (NSCLC) dochází u velkého počtu operovaných pacientů k recidivám onemocnění. Vzhledem k průlomovým výsledkům imunoterapie u pokročilých stadií NSCLC se logicky nabízely studie zkoumající její případný přínos i u operovaných nemocných. První studie se zabývaly jejím užitím v adjuvantním podání po chemoterapii, kde již prokázal přínos atezolizumab ve studii fáze III. V nedávné době bylo publikováno i tiskové prohlášení o pozitivních datech pro pembrolizumab ve stejné indikaci. Následovaly studie s neoadjuvantní imunoterapií, které ve stadiích fáze III přešly povětšinou na režim chemoimunoterapie (s případným pokračováním imunoterapie adjuvantně). Recentně vyšlo tiskové prohlášení o pozitivních výsledcích nivolumabu spolu s chemoterapií v neoadjuvantním podání. Je proto vysoce pravděpodobné, že se tyto léčebné modality v blízké době promítnou do standardních léčebných režimů.
Despite improvements in staging, surgical techniques, and the introduction of adjuvant chemotherapy for stage II and III non-small cell lung cancer (NSCLC), a large number of operated patients have recurrences of the disease. Due to the breakthrough results of immunotherapy in advanced stages of NSCLC, studies examining its potential benefits in operated patients were logically started. The first studies looked at the use of adjuvant immunotherapy after chemotherapy, where they had already shown the benefits of atezolizumab in a phase III study. A press release on positive data for pembrolizumab in the same indication has also been published recently. This was followed by studies with neoadjuvant immunotherapy, which in the phase III trials mostly switched to the chemoimmunotherapy regimen (with possible continuation of immunotherapy in adjuvant administration). Recently, there was a press release on the positive results of nivolumab with neoadjuvant chemotherapy. It is therefore highly likely that these treatment modalities will translate into standard treatment regimens in the near future.
- MeSH
- adjuvantní chemoterapie metody MeSH
- imunoterapie metody MeSH
- lidé MeSH
- nemalobuněčný karcinom plic * farmakoterapie MeSH
- neoadjuvantní terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
BACKGROUND/AIM: Circulating tumour DNA (ctDNA) represents an emerging biomarker in non-small cell lung cancer (NSCLC). We focused on the combination of ctDNA and positron emission tomography/computed tomography (PET/CT) in the follow-up monitoring of advanced-stage NSCLC patients treated with chemotherapy. PATIENTS AND METHODS: Eighty-four patients were enrolled in this study. 18F-fluorodeoxyglucose PET/CT and ctDNA assessments were performed at baseline and after two cycles of chemotherapy (follow-up). RESULTS: There was a correlation of ctDNA with metabolic tumour volume (MTV), total lesion glycolysis (TLG), and iodine concentration (IC) at baseline (p=0.001, p=0.001, p=0.003) and at follow-up (p=0.006, p=0.002, p=0.001). The objective response was associated with follow-up ctDNA (p<0.001) and the change of all PET/CT parameters. ROC analyses showed that the combination of follow-up ctDNA with changes in SUVmax is very promising for the estimation of objective response and progression-free survival. CONCLUSION: The combination of ctDNA assessment with PET/CT is a promising approach for the follow-up monitoring of therapy response and prognosis estimation of advanced-stage NSCLC patients.
- MeSH
- cirkulující nádorová DNA * genetika MeSH
- fluorodeoxyglukosa F18 metabolismus terapeutické užití MeSH
- glykolýza MeSH
- lidé MeSH
- nádory plic * diagnostické zobrazování farmakoterapie genetika MeSH
- nemalobuněčný karcinom plic * diagnostické zobrazování farmakoterapie genetika MeSH
- PET/CT metody MeSH
- prognóza MeSH
- prospektivní studie MeSH
- radiofarmaka terapeutické užití MeSH
- retrospektivní studie MeSH
- tumor burden MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Background/Aim: This study aimed at contributing to a better diagnosis of lung cancer by analyzing the patient's symptoms and their linkage to other characteristics. Patients and Methods: We analyzed the data of 3,322 patients from LUCAS (LUngCAncerfocuS) National Registry of the Czech Republic. Overall survival was assessed using the Kaplan-Meier method. Results: The most common symptoms were cough (47.5%), dyspnea (45.6%), pain (27.3%), and weight loss (25.7%). Among all patients, 16% were asymptomatic. We demonstrated the negative prognostic significance of increasing number of lung cancer symptoms, that was significant after adjustment for age, TNM stages, and performance status, and morphological types of the cancer. Conclusion: Monitoring the severity and type of symptoms in patients with lung cancer can help in the diagnostics of the disease and the estimation of prognosis.
- Publikační typ
- časopisecké články MeSH
Purpose: To investigate potential associations between selected laboratory markers (CRP, LDH, albumin, sodium, hemoglobin, neutrophils, and neutrophils/lymphocytes ratio [NLR]) and outcomes in patients with non-small cell lung cancer (NSCLC) treated with bevacizumab (BEV) plus chemotherapy. Patients and Methods: We retrospectively analyzed 105 patients with NSCLC from the Czech TULUNG registry treated at University Hospital in Pilsen with BEV + chemotherapy. Response to therapy was tested by Fisher's exact test. Survival statistics were evaluated using the Kaplan-Meier method and Cox analysis. Results: We showed significantly better disease control rate when CRP, albumin, hemoglobin, and NLR were within established "normal" values. In univariate analysis, normal values of CRP, LDH, albumin, sodium, hemoglobin, neutrophils, and NLR were associated with better overall survival (OS). Normal values of CRP, albumin, hemoglobin, neutrophils, and NLR were associated also with better progression-free survival (PFS). In a multivariate Cox model, normal values of LDH, albumin, and NLR were associated with significantly better OS while normal CRP, albumin, and NLR were associated with better PFS. Conclusions: LDH and sodium appear to be possible prognostic markers for BEV treatment in combination with chemotherapy in NSCLC. The parameters associated with inflammatory response (CRP, NLR, albumin, and possibly hemoglobin) appear to be promising predictive markers for this treatment combination.
- Publikační typ
- časopisecké články MeSH
