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2.
Medicine (Baltimore) ; 99(44): e22933, 2020 Oct 30.
Article in English | MEDLINE | ID: mdl-33126358

ABSTRACT

RATIONALE: Increasing evidence has shown that immune checkpoint inhibitors are associated with hyperprogressive disease (HPD). HPD usually resulted in dramatically reduced survival duration, which limited the opportunity to administer other therapies. PATIENT CONCERNS: A heavily pretreated lung adenocarcinoma patient experienced rapid progression of rib metastasis soon after immune checkpoint inhibitor -based combination therapy. DIAGNOSES: On the basis of radiographic and pathological findings, the patient was diagnosed with HPD. INTERVENTIONS: We treated the patient with iodine-125 radioactive particle implantation to the metastatic lesions in the chest wall. OUTCOMES: The metastatic lesions shrank significantly 1 month later. LESSONS: Early detection and adequate treatment are essential for prolonged survival when HPD occurs.


Subject(s)
Adenocarcinoma of Lung/radiotherapy , Antineoplastic Agents, Immunological/therapeutic use , Bevacizumab/therapeutic use , Immunotherapy/methods , Iodine Radioisotopes/therapeutic use , Lung Neoplasms/radiotherapy , Adenocarcinoma of Lung/diagnostic imaging , Adenocarcinoma of Lung/drug therapy , Adenocarcinoma of Lung/pathology , Antineoplastic Agents/administration & dosage , Antineoplastic Agents/therapeutic use , Antineoplastic Agents, Immunological/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bevacizumab/administration & dosage , Combined Modality Therapy , Disease Progression , Humans , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/drug therapy , Lung Neoplasms/pathology , Male , Middle Aged , Tomography, X-Ray Computed
3.
Medicine (Baltimore) ; 98(44): e17700, 2019 Nov.
Article in English | MEDLINE | ID: mdl-31689797

ABSTRACT

RATIONALE: Anlotinib, a novel orally administered multitargeted tyrosine kinase inhibitor, inhibiting tumor angiogenesis and growth, significantly prolonged overall survival, and progression-free survival with a manageable safety profile as a third-line therapy among refractory advanced nonsmall cell lung cancer (NSCLC) patients in ALTER 0303 trail (NCT02388919). PATIENT CONCERNS: Two squamous cell lung cancer patients with mediastinal metastasis undergoing the treatment of anlotinib developed clinical symptom of cough, which was worse upon ingestion. DIAGNOSES: On the basis of patients' clinical symptoms and radiographic findings, they were diagnosed with acquired esophago-tracheobronchial fistula. INTERVENTIONS: We treated them with fully covered self-expandable metallic stents. OUTCOMES: The clinical symptom of cough was immediately relieved after palliative treatment. Both patients elected to discontinue anlotinib treatment. LESSONS: These 2 cases imply that a close follow-up schedule for esophago-tracheobronchial fistula should be established when squamous cell lung cancer patients with mediastinal metastasis are undergoing anlotinib therapy. Early detection and adequate treatment are essential for patient symptom relief and survival.


Subject(s)
Carcinoma, Squamous Cell/pathology , Esophageal Diseases/etiology , Indoles/adverse effects , Lung Neoplasms/pathology , Mediastinal Neoplasms/secondary , Quinolines/adverse effects , Respiratory Tract Fistula/etiology , Esophageal Diseases/surgery , Female , Humans , Male , Middle Aged , Respiratory Tract Fistula/surgery , Self Expandable Metallic Stents
4.
Tumori ; 101(3): 328-33, 2015.
Article in English | MEDLINE | ID: mdl-25908032

ABSTRACT

AIMS AND BACKGROUND: Subsequent primary cancers (SPCs) have been demonstrated to be the major causes of death among patients with thoracic esophageal squamous cell cancer (ESCC) negative for lymph node involvement. We designed this study to investigate clinical characteristics and risk patterns of SPCs following esophagectomy in patients with early-stage thoracic ESCC. METHODS: We retrospectively analyzed clinical factors in 512 patients with early-stage thoracic ESCC collected from 3 independent hospitals over a 10-year interval. RESULTS: The overall standard incidence rate (SIR) of SPCs was 3.84 (95% confidence interval 2.98-4.95). The most common SPCs were head and neck cancers, lung cancer, and stomach cancer. The risk patterns of SPCs varied across organs. A 3-phase risk pattern with a U-shaped curve between 2 rising phases was seen for head and neck cancers, while for the other cancers, the risk patterns all displayed as an approximately linear upward trend. It was further noted that sex, smoking habits, and cancer histories among first-degree relatives were 3 significant independent risk factors in the development of SPCs. CONCLUSIONS: We observed significant associations between early-stage ESCC and SPCs arising from anatomically adjacent sites. The different risk patterns of SPCs indicated that follow-up strategies should be established accordingly in different organs at different times, with particularly close follow-up for head and neck cancers in the first 5 years and beyond 15 years after diagnosis of ESCC.


Subject(s)
Carcinoma, Squamous Cell/complications , Carcinoma, Squamous Cell/pathology , Esophageal Neoplasms/complications , Esophageal Neoplasms/pathology , Esophagectomy , Neoplasms, Second Primary/epidemiology , Adult , Aged , Carcinoma, Squamous Cell/surgery , China/epidemiology , Esophageal Neoplasms/surgery , Esophageal Squamous Cell Carcinoma , Female , Head and Neck Neoplasms/etiology , Humans , Lung Neoplasms/etiology , Male , Middle Aged , Neoplasm Grading , Neoplasm Staging , Neoplasms, Second Primary/etiology , Retrospective Studies , Risk Assessment , Risk Factors , Stomach Neoplasms/etiology , Time Factors
5.
Chin Med J (Engl) ; 124(7): 1010-4, 2011 Apr.
Article in English | MEDLINE | ID: mdl-21542959

ABSTRACT

BACKGROUND: Carcinoma of unknown primary (CUP) encompasses a heterogeneous group of tumors with varying clinical features. The management of patients of CUP remains a clinical challenge. The purpose of this study was to evaluate the clinical applications of integrated (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) information in patients with CUP, including detecting the occult primary tumor and effecting on disease therapy. METHODS: One hundred and forty-nine patients with histologically-proven metastases of CUP were included. For all patients, the conventional diagnostic work-up was unsuccessful in localizing the primary site. Whole-body PET/CT images were obtained approximately 60 minutes after intravenous injection of 350 - 425 MBq of (18)F-FDG. RESULTS: In 24.8% of patients, FDG PET/CT detected primary tumors that were not apparent after conventional workup. In this group of patients, the overall sensitivity, specificity, and accuracy rates of FDG PET/CT in detecting unknown primary tumors were 86.0%, 87.7%, and 87.2%, respectively. FDG PET/CT imaging also led to the detection of previously unrecognized metastases in 29.5% of patients. Forty-seven (31.5%, 47 of 149) patients underwent a change in therapeutic management. CONCLUSIONS: FDG PET/CT is a valuable tool in patients with CUP, because it assisted in detecting unknown primary tumors and previously unrecognized distant metastases, and optimized the management of these patients.


Subject(s)
Carcinoma/diagnostic imaging , Carcinoma/pathology , Fluorodeoxyglucose F18 , Positron-Emission Tomography/methods , Adult , Aged , Female , Humans , Male , Middle Aged , Radiography , Reproducibility of Results
6.
Zhonghua Zhong Liu Za Zhi ; 30(4): 306-9, 2008 Apr.
Article in Chinese | MEDLINE | ID: mdl-18788639

ABSTRACT

OBJECTIVE: To explore the diagnostic value of dual-time-point 18F-FDG PET-CT imaging in detecting hilar and mediastinal lymph node metastasis in non-small-cell lung cancer (NSCLC). METHODS: Forty-six patients with NSCLC underwent standard whole body single-time 18F-FDG PET-CT scans and a delayed imaging for the thorax alone before surgery, meanwhile, the standard uptake value (SUV) and retention index (RI) were calculated. RESULTS: A total number of 584 lymph nodes were excised in the 46 patients. Of these, 134 metastatic lymph nodes were pathologically confirmed in 31 patients. There were 189 lymph nodes detected and suspected to be metastatic by standard single-time 18 F-FDG PET-CT imaging, and 161 by dual-time-point imaging. Therefore, the sensitivity, specificity, diagnostic accuracy, positive predictive value and negative predictive value in the detection of hilar and mediastinal lymph node metastasis were 87.3%, 84.0%, 84.8%, 61.9% and 95.7% by standard single-time 18F-FDG PET-CT imaging, versus 94.8%, 92.2%, 92.8%, 78.9% and 98.1%, respectively, by dual-time-point imaging. There was a statistically significant difference in the detection of lymph node metastasis between the standard single-time imaging and dual-time-point 18F-FDG PET-CT imaging. CONCLUSION: Dual-time-point 18F-FDG PET-CT imaging is more sensitive, specific and accurate than standard single-time 18F-FDG PET-CT imaging in the detection of hilar and mediastinal lymph node metastasis, and may provide more information for diagnosis, staging and treatment of non-small cell lung cancer.


Subject(s)
Carcinoma, Non-Small-Cell Lung/diagnostic imaging , Lung Neoplasms/diagnostic imaging , Lymph Nodes/diagnostic imaging , Lymphatic Metastasis/diagnostic imaging , Positron-Emission Tomography/methods , Adult , Aged , Carcinoma, Non-Small-Cell Lung/pathology , False Negative Reactions , False Positive Reactions , Female , Fluorodeoxyglucose F18 , Humans , Lung Neoplasms/pathology , Lymph Nodes/pathology , Male , Mediastinum/pathology , Middle Aged , Sensitivity and Specificity , Time Factors
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