ABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Pulmonary Disease, Chronic Obstructive , Papilloma/diagnostic imaging , Papilloma/diagnosis , BronchiABSTRACT
BACKGROUND: In non-small-cell lung cancer patients, high peak oxygen uptake (peak VÌO2 ) predicts lower rates of postoperative complications and better long-term survival. Neoadjuvant chemotherapy (NAC) may negatively impact peak VÌO2 . METHODS: Cardiopulmonary exercise testing (CPET) was performed in 34 consecutive stage IIIA/IIIB non-small-cell lung cancer subjects scheduled for elective lung surgery. Using multivariate linear regression adjusted for potential confounders, we compared CPET results in subjects receiving or not receiving NAC (NAC+, n = 19; NAC-, n = 15). RESULTS: Adjusted peak VÌO2 was lower in NAC + compared with NAC- subjects (-5.3 mL/min/kg [95% CI -8.3 to -2.2], P = .01). Likewise, oxygen pulse, maximal work load, and ventilatory threshold were also lower in NAC+ subjects, whereas peak heart rate and breathing reserve were similar. NAC+ subjects presented lower values of diffusion capacity for carbon monoxide (DLCO) (P = .035) and hemoglobin concentrations (P < .001). DLCO was strongly correlated with peak VÌO2 (r(2) = 0.56). Adjustment for DLCO reduced the effect of NAC on peak VÌO2 without suppressing it. CONCLUSIONS: NAC was associated with lower preoperative peak VÌO2 in subjects with non-small-cell lung cancer. This lower aerobic fitness may result from NAC-induced reduction in pulmonary gas exchange or heart toxicity. Since lower fitness is linked to poorer outcome, the decision for NAC may have to be balanced with its possible toxicity.
Subject(s)
Carcinoma, Non-Small-Cell Lung/physiopathology , Inspiratory Capacity/drug effects , Neoadjuvant Therapy/adverse effects , Oxygen Consumption/drug effects , Pulmonary Gas Exchange/drug effects , Aged , Carcinoma, Non-Small-Cell Lung/pathology , Carcinoma, Non-Small-Cell Lung/therapy , Chemotherapy, Adjuvant/adverse effects , Chemotherapy, Adjuvant/methods , Cross-Sectional Studies , Exercise Test , Exercise Tolerance/drug effects , Female , Humans , Logistic Models , Lung/physiopathology , Lung/surgery , Male , Middle Aged , Multivariate Analysis , Neoadjuvant Therapy/methods , Neoplasm Staging , Preoperative Period , Treatment OutcomeABSTRACT
A 38 year old woman with a medical history of left pleurectomy and thoracic duct ligation for a recurrent chylothorax at age 21 was hospitalized for evaluation and treatment of a right sided pleural effusion and a pericardial effusion. A diffuse pulmonary lymphangiomatosis was diagnosed based on evidence obtained from a thoracic CT scan and from pleural and pericardial biopsies. The patient underwent drainage of these effusions and received systemic corticosteroids. Although both effusions initially recurred and required subsequent drainage and treatment by colchicine, evolution at 19 months of diagnosis is favorable. This case illustrates the fact that the prognosis of diffuse pulmonary lymphangiomatosis in adults may be characterized by a less aggressive evolution and by a more favorable prognosis than that observed in children.
