Customizing systemic therapy in patients with advanced non-small cell lung cancer.

Lung cancer is the leading cause of cancer deaths worldwide. Standard chemotherapy has been shown to improve quality of life and has a modest influence on overall survival. This modest improvement in survival is partly due to the choice of chemotherapy regimens that have been based on prognostic factors such as age, performance status and comorbidities of the patient. This underlines the importance of developing a more personalized therapy for patients with non-small cell lung cancer. Such an approach may reduce the variation in how individual patients respond to medications by tailoring therapies to their genetic profile. In this review we focus on several aspects of customized therapy, looking not only at patient characteristics but also to tumor histology and specific tumor biomarkers.

MRI in patients with otovestibular complaints of unknown origin.

OBJECTIVES: The place of MRI in the diagnostic work-up of patients with bilateral perceptive hearing loss, tinnitus and vertigo is under discussion. The purpose of this study is to investigate the role of MRI in patients with otovestibular and cranial nerve complaints of unknown aetiology. METHODOLOGY: After thorough otologic examination, 430 patients were consecutively referred for an MR examination of the cerebellopontine angle. RESULTS: The detection rate for essential lesions was 4.9%. Two groups of retrocochlear lesions were frequently observed: central WMLs/atrophy and neurovascular conflict affecting a cranial nerve. CONCLUSIONS: MR imaging of the cerebellopontine angle, fossa posterior and petrous bones makes it possible to observe abnormalities of the vestibulocochlear nerve and inner ear. Additional T2-weighted FSE images of the whole brain make it possible to evaluate the occurrence of early central lesions. This imaging protocol can diagnose essential lesions relating directly to the complaint in 4.9% of the patients with hearing loss, subjective tinnitus or vertigo. We frequently observed two groups of lesions of uncertain significance in our study population. WMLs are present in 50% of patients with a mean age of 59 years. In the younger subpopulation aged under 51 years the prevalence of WMLs is 24%. It remains unclear whether these lesions can be accounted for by the diversity of symptoms with which the patients presented. In addition, we found a high number of neurovascular conflicts involving different cranial nerves.

Does the location of a vascular loop in the cerebellopontine angle explain pulsatile and non-pulsatile tinnitus?

The purpose was to investigate patients with unexplained pulsatile and non-pulsatile tinnitus by means of MR imaging of the cerebellopontine angle (CPA) and to correlate the clinical subtype of tinnitus with the location of a blood vessel (in the internal auditory canal or at the cisternal part of the VIIIth cranial nerve). Clinical presentation of tinnitus and perceptive hearing loss were correlated. In 47 patients with unexplained tinnitus, an MR examination of the CPA was performed. Virtual endoscopy reconstructions were obtained using a 3D axial thin-section high-resolution heavily T2-weighted gradient echo constructive interference in steady state (CISS) data-set. High-resolution T2-weighted CISS images showed a significantly higher number of vascular loops in the internal auditory canal in patients with arterial pulsatile tinnitus compared to patients with non-pulsatile tinnitus (P<0.00001). Virtual endoscopy images were used to investigate vascular contacts at the cisternal part of the VIIIth cranial nerve in patients with low pitch and high pitch non-pulsatile tinnitus. A significantly different distribution of the vascular contacts (P=0.0320) was found. Furthermore, a correlation between the clinical presentation of non-pulsatile tinnitus (high pitch and low pitch) and the perceptive hearing loss was found (P=0.0235). High-resolution heavily T2-weighted CISS images and virtual endoscopy of the CPA can be used to evaluate whether a vascular contact is present in the internal auditory canal or at the cisternal part of the VIIIth cranial nerve and whether the location of the vascular contact correlates with the clinical subtype of tinnitus. Our findings suggest that there is a tonotopical structure of the cisternal part of the VIIIth cranial nerve. A correlation between the clinical presentation of tinnitus and hearing loss was found.