Subject(s)
Adenocarcinoma/diagnostic imaging , Bronchoscopy/methods , Carcinoid Tumor/diagnostic imaging , Lung Neoplasms/diagnostic imaging , Lung/pathology , Ultrasonography, Interventional/methods , Adenocarcinoma/pathology , Adenocarcinoma/surgery , Biopsy , Carcinoid Tumor/pathology , Carcinoid Tumor/surgery , Humans , Lung/diagnostic imaging , Lung/surgery , Lung Neoplasms/pathology , Lung Neoplasms/surgery , Male , Middle AgedABSTRACT
BACKGROUND AND PURPOSE: Radiotherapy of central lung tumors carries a higher risk of treatment-related toxicity and local failure. In the era of aggressive oligometastic management the exploration of the proper dose-fractionation for metastatic central lung tumors is essential. MATERIALS AND METHODS: Patients diagnosed with high-risk metastatic lesions of the central pulmonary tree comprised this single-institutional retrospective analysis. "High-risk" central pulmonary lesions were defined as those with abutment and/or invasion of the mainstem bronchus. All patients were treated using the CyberKnife SBRT system in 5 fractions to a total dose of 35 or 40 Gy. RESULTS: Twenty patients were treated from 2008 to 2011 at Georgetown University Hospital. At a median follow up of 19 months, 1-year Kaplan-Meier local control and overall survival was 70 and 75 %, respectively. Late grade 2 or higher atelectasis was the most common treatment-related toxicity and was significantly associated with maximum dose to the mainstem bronchus. Gross endobronchial involvement was associated with significantly lower overall survival. CONCLUSIONS: Five-fraction SBRT to a total dose of 35 or 40 Gy appears to be a safe and effective management strategy for high-risk central pulmonary metastatic lesions, though care should be taken to limit the maximum point dose to the mainstem bronchus.
Subject(s)
Lung Neoplasms/radiotherapy , Lung Neoplasms/secondary , Radiosurgery , Adult , Aged , Aged, 80 and over , Bronchi/radiation effects , Dose Fractionation, Radiation , Female , Humans , Kaplan-Meier Estimate , Lung Neoplasms/surgery , Male , Middle Aged , Neoplasm Metastasis , Neoplasm Recurrence, Local/pathology , Prognosis , Radiometry , Radiotherapy Dosage , Radiotherapy Planning, Computer-Assisted , Retrospective Studies , RiskABSTRACT
BACKGROUND AND OBJECTIVE: OSA is associated with increased incidence of cardiovascular diseases. Pathogenic mechanisms of vascular diseases include thickened vascular walls due to the increased number of smooth muscle cells (SMC). Retinoic acid (RA) suppresses the growth of SMC, and reduced retinoid levels are associated with vascular diseases. Oxidant signalling promotes SMC growth, thus antioxidant levels may also influence the development of cardiovascular diseases. The present study tested the hypothesis that plasmas from OSA patients contain altered levels of retinoids, carotenoids and tocopherols. METHODS: Plasma samples were taken before and after sleep from patients with OSA (mostly mild) without known cardiovascular diseases and from control subjects. Levels of retinoids, carotenoids and tocopherols were measured using sensitive gas chromatograph-mass spectrometry and high pressure liquid chromatography methods and total antioxidant capacity was assessed fluorometrically. RESULTS: Results showed that plasmas from patients with OSA had significantly lower retinyl palmitate and 9-cis RA compared with control subjects, while levels of retinol, all-trans RA and 13-cis RA were indifferent. All-transbeta-carotene and 9-cisbeta-carotene were also lower in OSA patients. Levels of all-trans RA and 13-cis RA in OSA patients were reduced after sleep compared with before sleep. OSA patients showed significantly higher delta-tocopherol compared with controls. Treatment of cultured human vascular SMC with post-sleep OSA patient plasmas promoted cell growth, but not in controls. CONCLUSIONS: Mild OSA exhibits altered levels of specific retinoids, carotenoids and tocopherols, which may be markers and/or mediators for the increased susceptibility of patients to vascular diseases.
