Completeness of TNM staging of small-cell and non-small-cell lung cancer in the Danish cancer registry, 2004-2009.

OBJECTIVE: We examined the completeness of TNM staging of small-cell (SCLC) and nonsmall- cell (NSCLC) lung cancer in the national Danish Cancer Registry (DCR) and whether staging varied by year of diagnosis, gender, age, degree of comorbidity, or presence of histopathological diagnosis. METHODS: We identified all patients with SCLCs and NSCLCs registered in the DCR during 2004-2009 and examined the completeness of their TNM registrations. Completeness was defined as the number of recorded individuals with TNM divided by the total number of patients. Completeness was calculated for TNM, T, N, and M individually, overall, and by year of diagnosis, gender, age at diagnosis, and comorbidity. Data regarding comorbidity was obtained from the Danish National Patient Register (DNPR). We performed separate analyses for patients with a histopathologically verified diagnosis of NSCLC. Finally, we designed an algorithm to categorize tumors with missing TNM components as limited, extensive, or distant disease. RESULTS: Overall TNM staging completeness was 77.5% (95% confidence interval (CI): 76.1%-78.8%) for SCLC and 77.9% (95% CI: 77.3%-78.4%) for NSCLC. Completeness did not vary by gender and increased during the study period. The proportion of staged patients was lower among patients above 80 years of age or with medium to high levels of comorbidity. CONCLUSION: Overall TNM completeness for SCLC and NSCLC in the Danish Cancer Registry is high, but decreases with increasing levels of comorbidity and at ages greater than 80 years. Researchers should be aware of these potential sources of bias.

A new lung stent tested as fiducial marker in a porcine model.

INTRODUCTION: The aim of the present study was to test the feasibility of a Nickel-Titanium (Ni-Ti) stent technique (Memocore™) in a porcine model. The stent is intended as a new fiducial for gated image guided radiotherapy in the lung. The study included test of an improved insertion system and respiratory gated treatments with this new technique. METHODS AND MATERIALS: Tests were carried out in a porcine model using Göttingen mini-pigs. The study included 10 animals. Planning CT was performed as 4 dimensional CT (4DCT) using the Varian RPM system. Respiratory gated radiotherapy treatments were simulated using the Brainlab ExacTrac system. Reproducibility of stent position during treatment was analyzed off-line using an experimental version of the ExacTrac software. The experimental version has a dedicated algorithm for segmentation of the stent in the planning CT and subsequent registration to X-ray position images. RESULTS: A total of 23 stents were inserted in the 10 animals. Stents could be placed in all parts of the lungs. No stent migrated within the four weeks the experiment lasted. Stent trajectories in the lung were not reproducible, even though respiration was highly standardized using a respirator. The best accuracy of stent position in the gating window was obtained using gating at the half_max amplitude as reference level. The smallest stent movement within the gating window was observed in the exhale phase. Further success of human application will depend on the possibility to insert the stent within or close to lung tumors. CONCLUSIONS: This new technique based on the Memocore™ lung stent used in connection with respiratory gated radiotherapy was demonstrated to be feasible in a porcine model. The study demonstrated lack of reproducibility in lung trajectories of inserted stents. The technique gave the best accuracy when applied to the exhale phase of respiration.

[Prevalence of chronic obstructive pulmonary disease--secondary publication]. / Praevalensen af kronisk obstruktiv lungesygdom--sekundaerpublikation.

We investigated the prevalence of chronic obsctuctive pulmonary disease (COPD) and the proportion of affected patients receiving medical treatment. A total of 155 general practitioners examined 4,757 persons aged 45-84 years. All had a spirometry performed. Obstruction was defined as a forced expired volume in the first second (FEV 1 )/forced vital capacity (FVC) ratio < 0.70 after bronchodilation, and severity was defined according to Global Initiative for Obstructive Lung Disease (GOLD) guidelines. The determined prevalence was 12%. Standardized to the Danish population the true prevalence of COPD was 9% (95% confidence interval, 8-10%). The majority had mild or moderate COPD. Among persons with severe COPD, 42% did not receive medical treatment.