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Solitarysplenicmetastasis is extremelyrarewithfewreportedcases in literature. Currentstudyreportsthecase of a 74-year-old, femalepatientwhowasdiagnosedisolatedspleenmetastasisafterlungadenocarcinoma, in thepostoperativecourse. Shepresentedwiththeincidentaldetection of nodularliverandcentralspleniclesions in a follow-upabdominalcomputedtomography (CT) scanafter 5 yearsfromtheleftlowerlobectomyduetolungadenocarcinoma. By MRI examination, lesion in theliverwascharacterized as cysticandthecentralspleniclesionwasfoundhavinga heterogeneoushypoechoicnodularcharacter. Tru-cutbiopsy of spleenconfirmedmetastasis of lungadenocarcinoma. Thepatientunderwentsplenectomy. Althoughliverbiopsycouldn’tdetectanymalignanttissue, lungcanceradenocarcinomametastasiswasdiagnosed in splenectomymaterial. Herein, we report a case of incidentallyfoundsolitarysplenicmetastasis, 5 yearsafterleftlobectomyforlungadenocarcinoma.
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Objective ToexplorethevalueofspectralCTimaginginmultiGparameterquantitativeanalysisoflungcancerwithdifferent pathologicaltypes.Methods SpectralCTimagesof72patientswithlungcancerprovedbypathologywereanalyzed,includingadenocarcinoma (ADC)in44cases,squamouscellcarcinoma(SQCC)in23casesandsmallcelllungcancer(SCLC)in5cases.Theslopeof40－100keVspectralattenuationcurve(λH),effectiveatomicnumber(EffectiveGZ),Calciumconcentration,hydroxyapatite(HAP)concentration, normalizediodineconcentration(NIC)and Waterconcentration were measuredandcomparedrespectively.The O n eG W a y analysisof variance (ANOVA ) was used and a value of P＜0.05 was considered statistically significant.Results (1 )O n plain C T ,there were statisticallysignificantdifferencesinEffectiveGZandλHamongthreeGdiseasegroups(F＝3.423,P＝0.04,F＝3.476,P＝0.038,respectively). (2)IncontrastGenhancedarterialphase,theWaterconcentrationandλHshowedstatisticallysignificantdifferencesamongthreegroups (F＝6.303,P＝0.003,F＝5.833,P＝0.005,respectively).(3)Invenousphase,thedifferenceinNICandλH wasstatisticallysignificant amongthegroups(F＝3.974,P＝0.023,F＝6.766,P＝0.002,respectively).(4)Apairwisecomparisonshowedtherewerestatistically significantdifferencesinallquantitativeparametersofspectralCTbetweenADCandSQCCgroups.ROCcurveanalysisshowedthat thosequantitativeparametersinvenousphaseappearedtohavehighdiagnosticefficiencyindifferentiatingADCfromSQCC,especiallyfor theλHinVP,withaAUCof0.754,sensitivityof79.5%,specificityof69.6%andthresholdvalueof1.78.Conclusion CTSpectral multiGparameterimagingprovidesanewsupplementarymethodforpreoperativediagnosisofADCandSQCC,andλHinvenousphase hasthehighestvalueindifferentiatingADCfromSQCC.
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Objective ToevaluatetheefficacyandsafetyofCT-guidedmicrowaveablation (MWA)forstageIVlungcanceraccompanied withcontrolledsingleintracranialmetastasis.Methods From November2011toOctober2016,78patientsinourhospitaldiagnosed withstageIVnon-smallcelllungcanceraccompaniedwithcontrolledsingleintracranialmetastasiswerestudied.Patientsweredividedintotwo groupsaccordingtowhethertheywerewillingtoacceptlocalMWAtreatmentornot:thegeneralgroup (groupA)with42cases, and MWAgroup(groupB)with36cases.Aftertheintracranialmetastasiswascontrolled,patientsingroupAweretreatedwithGP regimenforsimplechemotherapy,whilepatientsingroupB weretreatedwithlocalMWAcombinedwithGPregimen(gemcitabine combinedwithcisplatin).Allthepatientswerefollowed-upevery3monthsafterthesurgerytoassesstheefficacyandsafetyofthe correspondingtreatment.Thedeadlineofthefollow-upwasJune2017orwhenthetumorrestarteditsdevelopment.Results Thesuccessrateof theMWAofthe39lesionsinthe36patientsingroupBwas100%.TheKaplan-Meiersurvivalanalysisofthefollow-updataofthe twogroupsshowedthattheaverageprogressionfreesurvival(PFS)ofgroupA was(9.9 ± 0.8)monthsandthemedianPFSwas (8.0±0.5)months,whilethePFSofgroupB was (14.1±1.1)monthsandthe medianPFS was (15.0±1.5)months.The Log Rank testshowedthatχ2=8.780andP=0.03<0.05,whichreflectedthatthereweresignificantdifferencesinsurvivaltimebetweenthe twogroups.Theoverallsurvival(OS)ofgroupA was(20.5±1.1)months,andthemedianOSwas(21.0±1.3)months.TheOSof group B was (24.1±1.5)months,andthe median OS was (25.0±3.6)months.The Log Rank testshowedthat χ2=10.57and P=0.02<0.05, whichprovedthattheOSdifferencesbetweenthetwogroupshadstatisticalsignificance.ThemainadverseeffectsofMWA werepain,pleural effusion,pneumothorax,hemoptysis,infectionandsoon.There werenoseriouslife-threateningcomplicationsingroupB.Conclusion LocalMWAtreatmentforstageⅣnon-smallcelllungcancer withcontrolledsingleintracranialmetastasisisasafeandeffective method.Itisworthyofporularizing.
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The Chinese medicine could alleviate clinical symptoms, improve the quality of life in the treatment of lung cancer with malignant pleural effusion. TCM showed its certain characteristics and advantages. This paper summarized the literatures about the treatment of lung cancer with malignant pleural effusion with Chinese medicine in recent years in the light of oral Chinese herbal medicine, external use of Chinese medicine, pleural perfusion with traditional Chinese medicine.
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ObjectiveTo explore the role of autofluorescence bronchoscopy in lung cancer operation and the meaning of choice lung cancer operation mode.MethodsTo retrospectively analyze 32 non-small cell lung cancer patients.Before lung cancer operation,white light bronchoscopy (WLB) and autofluorescence bronchoscopy (AFB) had been done routinely.Compared the different invasive tumor conditions by WLB and AFB,operation modes were decided by the edge of the tumor which were proved by biopsy pathology.ResultsIn 32 cases,19 cases underwent pulmonary lobectomy.One case underwent carinal resection and reconstruction.8 cases underwent sleeve lobectomy.4 cases underwent other therapy because of tumor airway metastasis.In 8 cases which underwent sleeve lobectomy,3 ca ses were found by WLB and AFB together,5 cases were found only by AFB.In 4 cases who had no operation chance,2 cases were found by WLB and AFB together,2 cases were only by AFB.The sensitivity for the detection of bronchial premalignant lesions was extremelyhigher withthe addition of AFB than WLBalone ( P ＜ 0.05 ).ConclusionAutofluorescence bronchoscopy is a safe and efficient technique which could improve the sensitivity of diagnosis in lung cancer than WLB.It is important to select operation mode.
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Background and purpose: The ataxia-telangiectasia mutated (ATM) gene results in ataxia-telangiectasia (A-T) and it is closely associated with tumors. ATM is an important signal transducer that is involved in the repair of DNA double-strand break damage by phosphorylating numerous target proteins . This study was aimed to investigate the correlation between a single nucleotide polymorphism (SNP) in ATM gene (IVS62+60G>A) and the risk of non-small cell lung cancer(NSCLC) in a case-control study. Methods: From June 2004 to December 2005, a total of 264 patients with NSCLC were recruited, 264 healthy people as control. All of specimens were collected from Zhejiang Tumor Hospital. DNA was extracted from peripheral blood and then was used to determine. ATM genotype by Taqman SNP genotyping assays. Logistic regression model was employed to analyze the relationship between SNP and NSCLC risk. Results: The percentage of NSCLC patients in 86 patients with A/A genotype, 139 patients with A/G and 39 patients with G/G were 32.6% (86/264), 52.6% (139/264), 14.8% (39/264), respectively. The percentage in 68 healthy people with A/A genotype, 139 healthy people with NG and 55 healthy people with G/G were 26.0% (68/262), 53.0% (139/262) and 21.0% (55/262), respectively. The proportion of G/G genotype in 264 patients was obviously lower than that in the 264 healthy control (14.8% vs 21.2%, P<0.05). The people with G/G genotype had lower risk to NSCLC than there with A/A genotype (OR=0.561, 95% CI=0.334-0.942, P=0.029). Conclusion: The ATM SNP(IVS62+60G>A)was associated with the NSCLC risk, and homozygous G alleles may be a protective factor to NSCLC.
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Objective:To observe the clinical features ofblood supply arterial of non-small cell lung cancer(NSCLC)by the multi-slice spiral CT angiography(MSCTA).Methods:92 patients with confirmed NSCLC conducted blood supply arterial examination by the MSCTA,38 patients with chronic lung inflammation of the same period as control group.Two experienced physicians analyzed the results though double-blind method.Results:In 92 NSCLC patients,only 78 patients(84.8%)supplied by the bronchial arteries;9 patients (9.8%)supplied by he extra-pulmonary arterial;5 patients(5.4%)supplied by mixed blood vessels.MSCTA performance for all the tumor feeding artery were distorted,and tumor area showed chaotic vascular shadow.And chronic lung inflammation were easier to have extra-pulmonary circulation arterial blood supply compared with NSCLC(?2=14.981,P=0.000 1),the rates were 47.4%and 15.2%, respectively;the number of blood supply arteries in patients with chronic lung inflammation and NSCLC were quite(t=1.542,P=0.126); but the blood supply artery diameter in patients with chronic inflammation significantly thicker than that of the NSCLC group(t=5.805, P=0.000 1).And,MSCTA also showed that vascular often coincide with each other to form a broad network in chronic lung inflammatory group.Conclusion:The multi-slice spiral CT angiography have a good identification for non-small cell lung cancer arterial blood supply, which can provide the basis for their interventional therapy;and,the blood supply arteries become more evident,more to stimulate the outside pulmonary arterial in chronic lung inflammation,so that,it can provide references for non-small cell lung cancer differential diagnosis.
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0.05).Conclusion There is no significant difference of short-term effect between the two groups in treating advanced NSCLC,and the method has mild digestive reactions and nephrotoxicity.
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Purpose:To analyze the dependence of a cu te esophagitis (AE) on the dose and volume of irradiated esophagus during concur rent chemoradiation therapy of NSCLC.Methods:39 NSCLC patients previously treated with concurrent ch emoradiation therapy were studied , a subset of 62 patients who were recruited e arlier in a randomized phase Ⅲ study designed to evaluate the effect of amifost ine. The radiotherapy regimen was 1.2 Gy/fraction, Bid to a total dose of 69.6 G y. In this study 19 and 20 patients were in the control arm and amifostine arm, respectively. The AE score, evaluated by the RTOG acute morbidity criteria, was collected for each treatment week and one month following radiotherapy. DVH of t he esophagus was computed. A multivariate random-effect logistic model was used to investigate the correlation between the incidence of AE and various dose-vo lume factors among these 39 patients. The variables analyzed included total tumo r dose (TD), the mean and maximum dose to esophagus, the volume of esophagus tre ated above certain dose, and the dose of the esophagus treated to certain volume .Results:Among the 39 patients studied, two patients of the amif ostine arm (11%) and six patients of the non-amifostine arm (30%) experienced g rade Ⅲ AE. Grade Ⅲ AE was first seen at week 4th after a cumulative tumor dose to 36 Gy. However after week 4, it did not increase significantly with dose. Th e cumulative TD and patient sensitivity were found to have the strongest and sta tistically significant influence on the risk of AE in all dose and volume factor s.Conclusions:The risk of severe (grade Ⅲ) AE was associated wit h the cumulative dose to tumor and intrinsic patient sensitivity. Due to the tim e course of the development of AE, the daily dose rate or the cumulative dose by the 4th week of the treatment may be more predicative for the risk of AE rather than the total dose from the entire treatment course. Current clinical practice in using the total dose to assess the normal-tissue toxicity may need to be ad justed to account for the onset time of the acute end-point.
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60,treated with high dose rmhTNF and low quantity of pleural effusion)present fine clinical effect.