Small-cell lung cancer in never-smokers: A case series.

Small-cell lung cancer (SCLC) is closely correlated with smoking and only sporadic cases have been reported in non-smoking patients. Environmental tobacco smoke and/or occupational risk factors have been suggested as possible causes of lung cancer in this subset of patients. However, particularly in relation to SCLC there is not enough reliable information. All patients with lung cancer in follow-up for a period of three-months at the Pulmonology Unit of Coimbra University Hospital were retrospectively assessed. From a total of 303 patients, 35 had SCLC, 4 of which were never-smokers and their clinical cases are hereby presented. A detailed questionnaire was given to all patients, which excluded second-hand smoking or occupational hazards. They were all female with a mean age of 63.0 ± 15.7 years. The most frequent complaints were cough, dyspnoea, anorexia and significant weight loss. Diagnosis was obtained by transbronchial biopsies in all cases. Two patients had locally advanced disease and the other two had extensive-disease due to distant metastases. Treatment approaches included first-line chemotherapy with platin and etoposide duplet and partial remission was achieved in half the cases. All patients died; mean survival was 15.8 ± 3.8 months. Further studies are needed for a better understanding of the pathogenicity of non-smoking related SCLC and we hope that this case series with its meticulous exclusion of potential risk factors will be a useful contribution.

Efficacy and safety of percutaneous radiofrequency thermal ablation in the treatment of lung cancer lesions.

INTRODUCTION: In this study, we reviewed a clinical series composed by all malignant lung lesions submitted to computed tomography-guided percutaneous thermal radiofrequency ablation, in our hospital, a rather recent technique that has been gaining scientific recognition. MATERIAL AND METHODS: For data purposes, all radiofrequency ablation and corresponding clinical records were retrospectively analysed. A computed tomography scan was performed before and after each procedure to evaluate the tumour's features, and at a second step to assess results and complications. The frequency of local recurrence and disease progression were determined based on imaging follow-up. Kaplan-Meier analysis was used to estimate survival. Univariate analysis recognized clinical and pathological factors affecting survival. These were also tested by multivariate analysis. RESULTS: A total of 28 malignant lung lesions, 20 primary and 8 metastatic, from 28 patients (78.6% male; mean age 62 ± 17 years old), were submitted to computed tomography-guided radiofrequency ablation between January 2004 and July 2010. Total necrosis was achieved in 74.1% of the lesions. Immediate radiofrequency ablation-related complications were observed in half of the procedures. Among major complications, death occurred in one patient only. Median overall survival was 43.0 months for a mean 2-years follow-up.Median progression-free survival was 31.6 months. Lesion's size smaller than 35 mm, stage III disease by the TNM classification and previous treatment attempts were significantly associated with better outcomes. Disease-related mortality was 46.4%. DISCUSSION: This procedure proved to be efficient to treat lung cancerous lesions, with a low-rate of major complications. CONCLUSIONS: Computed tomography-guided percutaneous radiofrequency ablation is a minimally invasive procedure that appears to be valuable in the treatment of lung cancer lesions.

Introdução: Neste estudo foram caracterizados e avaliados todos os tumores malignos do pulmão no nosso hospital submetidos a termoablação percutânea por radiofrequência guiada por tomografia computadorizada, uma técnica relativamente recente com crescente evidência científica. Material e Métodos: Os registos clínicos referentes a todas as termoablações percutâneas por radiofrequência realizadas na nossa instituição foram retrospectivamente analisados. Realizou-se uma tomografia computadorizada antes e depois de cada procedimento para avaliar as características do tumor e, numa segunda fase, para avaliar os resultados e complicações. A recorrência e progressão da doença foram determinados através do seguimento imagiológico. A análise Kaplan-Meier foi usada para calcular a sobrevivência. A análise univariada identificou os fatores clínicos e patológicos que afetaram a sobrevivência. Resultados: Um total de 28 lesões pulmonares malignas, 20 carcinomas primários e oito lesões metastáticas, de 28 doentes (78,6% do género masculino, com idade média de 62 ± 17 anos), foram submetidos a termoablação percutânea por radiofrequência entre janeiro de 2004 e julho de 2010. Obteve-se necrose total em 74,1% das lesões. Observaram-se complicações imediatas em metade dos procedimentos. Das principais complicações, ocorreu a morte em apenas um doente. A sobrevivência mediana global foi de 43,0 meses para uma média de dois anos de acompanhamento. A sobrevivência mediana sem progressão da doença foi de 31,6 meses. Os fatores que mostraram correlação estatisticamente significativa com melhores resultados foram: tamanho da lesão menor que 35 mm, doença no estádio III da classificação TNM e realização de tratamentos prévios. A mortalidade por progressão da doença foi de 46,4%. Discussão: Este procedimento provou ser eficaz no tratamento de lesões pulmonares cancerígenas, com uma baixa incidência de complicações graves. Conclusões: A termoablação percutânea por radiofrequência é um procedimento minimamente invasivo, que aparenta ser vantajoso no tratamento de lesões cancerígenas do pulmão.