Metastasis to intraocular structures is a serious problem in lung cancer. Due to its rarity, however, limited information is available regarding the outcomes of treatment and prognosis. Literature ...often suggests a poor prognosis. We review current literature on the outcomes of systemic therapy and prognostic factors.
We conducted a systematic review of English literature published during 2009 to 2022 identified via Medline and Google Scholar search. Publications reporting on tumor response in the eyes or overall survival of patients with intraocular metastasis due to lung cancer were included. Pooled analysis of patients receiving systemic therapy was performed, utilizing individual-level patient data.
A total of 79 publications contributed 92 patients into the analysis. Choroid was the most affected intraocular structure, in 82% of patients. Histology was small cell in 13% and non-small cell in 87%. Targeted therapy was utilized in 45% of patients. A pooled analysis demonstrated that the median overall survival was 27 months (95% CI: 21.8-32.2). Visual response among those with reported assessment showed that 92% of them had stable or improved vision while 8% experienced worsening of vision. Several factors including the year of treatment, age, targeted therapy, and radiation showed a significant association with survival. The strongest predictor of improved survival was the receipt of targeted therapy, with a hazard ratio of 0.31 (95% CI: 0.14-0.71), P = .005.
For lung cancer patients with intraocular metastasis, systemic therapy can produce a favorable outcome. Particularly when a targeted therapy is feasible, long-term survival can be achieved.
The authors performed a systematic review and pooled analysis of patients with lung cancer and intraocular metastasis. Among 92 patients who received systemic therapy, the median overall survival was 27 months. The use of targeted therapy was the strongest predictor of favorable survival.
Persistent carcinoma of the trachea is an uncommon thoracic malignancy with limited treatment options. To our knowledge pembrolizumab, an immunotherapy targeting programmed death 1, has not been ...previously reported as an effective therapy for tracheal carcinoma. Here we describe a case of recurrent tracheal squamous cell carcinoma refractory to photodynamic therapy, radiotherapy, and cryotherapy. Programmed death ligand 1 was positive in 90% to 95% of tumor cells. A complete tumor response was observed after three months of treatment with pembrolizumab. No adverse events were reported at the 11-month follow-up. Based on our experience, pembrolizumab represents another viable treatment option for tracheal carcinoma.
Abstract Background Inverted papilloma (IP) is an uncommon sinonasal tumor. Squamous cell carcinoma (SCC) is associated with IP in about 7% of cases. To date, there has been no pooled analysis to ...formulate a survival outcome associated with this rare condition. Patients and methods We retrospectively reviewed the medical records of patients with IP and SCC treated at our institution during 1999–2007. Including our series, a systematic review of literature on Medline database and pooled analysis were performed to establish a survival estimate. Results Six patients were identified. Squamous cell carcinoma was metachronous to the initial diagnosis of IP in 1 case and synchronous in 5 cases. Of 5 patients who had completed therapy at the time of this report, only 1 remained disease-free at 74 months. The median overall survival in our series was 33 months. Three patients developed distant metastases in brain, lung, bone, and liver. Literature review and pooled survival analysis consisting of 76 cases indicated a median overall survival of 126 months with 3- and 5-year survival rates of 63% and 61%, respectively. Conclusion Although the survival outcome of SCC arising from IP seems comparable with sinonasal SCCs, some patients with this disease do have a highly aggressive disease, including hematogenous distant metastasis. Overall, about 40% of patients will die of the disease within the first 3 years.
Ipilimumab and nivolumab are immune-checkpoint inhibitors commonly used for melanoma. The combination is being investigated for its efficacy against several types of cancer, including malignant ...pleural mesothelioma. Although immune-related adverse events have been reported in patients receiving immune-checkpoint inhibitors, opsoclonus-myoclonus-ataxia syndrome has never been previously described.
We describe a 74-year-old male with malignant pleural mesothelioma who presented with opsoclonus and marked truncal ataxia ∼10 weeks following immunotherapy with ipilimumab and nivolumab. No myoclonus was present. Oligoclonal bands were detected in cerebrospinal fluid. Treatment with methylprednisolone and intravenous immunoglobulin along with clonazepam and valproic acid resulted in a rapid clinical improvement. A follow-up visit 2 months afterward showed a resolution of opsoclonus and he was able to walk with cane.
A variant of opsoclonus-myoclonus-ataxia syndrome may occur following treatment with ipilimumab and nivolumab.
Abstract Objectives We investigated whether advanced age affects peri-operative outcomes after robotic-assisted pulmonary lobectomies. Materials and Methods We retrospectively analyzed patients who ...underwent robotic-assisted lobectomy by one surgeon over a 5-year period. Rates of postoperative complications were compared according to age group. Other outcomes, such as intraoperative complications, hospital length of stay (LOS), and in-hospital mortality, were also compared. Results A total of 287 patients were included (mean age 67.1 yr). Group A had 65 patients of advanced age ≥ 75 yr (range 75–87 yr; 37 men, 28 women); Group B had 222 patients aged < 75 yr (range 29–74 yr; 95 men, 127 women). Group A had 10/65 (15.4%) patients with robotic-related intraoperative complications, compared to 10/222 (4.5%) for Group B ( p = 0.002), with the most frequent intraoperative complications being bleeding from a pulmonary vessel (10.8% vs. 4.5%, p = 0.06), bronchial injury (3.1% vs. 0.9%, p = 0.18), and injury to the phrenic or recurrent laryngeal nerve (1.5% vs. 0.4%, p = 0.33). There were 28/65 (43.1%) patients in Group A with postoperative complications compared to 76/222 (34.2%) in Group B ( p = 0.19). While operative times were similar ( p = 0.42), Group A had longer median hospital LOS of 6 ± 0.9 days compared to 4 ± 0.3 days for Group B ( p = 0.02). Conclusion While younger patients have lower risk of robotic-related intraoperative complications and shorter hospital LOS, elderly patients do not have increased overall or emergent conversion rates to open lobectomy, overall postoperative complications rates, or in-house mortality compared to younger patients. Thus, robotic-assisted pulmonary lobectomy is feasible and relatively safe for patients of advanced age.
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Background: In 2013, the USPTF recommended low-dose CT (LDCT) screening for individuals at high risk of lung cancer based on data from the National Lung Screening Trial. However, ...the trial excluded participants with cancer diagnosis < 5 years except for non-melanoma skin cancer, making it unclear whether the data will be generalizable to cancer survivors. This population, while at increased risk of secondary lung cancer, may be prone to false positive results due to anatomic defects or recurrent cancers. Our NCCN institution serves a large number of cancer survivors. We evaluated the outcomes of LDCT screening and the adherence to annual screening among cancer survivors, compared with individuals without cancer history (IWC). Methods: Prospectively maintained database of LDCT screening participants was analyzed. Eligibility was per NCCN criteria and cancer survivors needing regular chest CT were not offered LDCT. Participants were asked to complete a self-administered questionnaire on risk factors. Positive result was defined as Lung-RADS ≥3, corresponding to nodule ≥6 mm. Adherence to LDCT screening was defined as having T1 screening, excluding those < 18 months from T0 at time of analysis. Predicted risk of lung cancer was calculated per PLCOm2012 model. Results: To date, 454 subjects have undergone LDCT screening. Positive results occurred in 60 subjects (13.2%) at T0; lung cancer was diagnosed in 10 subjects (2.2%); and other cancers were diagnosed in 5 subjects (1.1%). There were 152 cancer survivors, including survivors of breast (52), prostate (26), bladder or kidney (19), lung (14), and head and neck cancer (13). The median time from cancer treatment to LDCT screening was 6 years (range 0-55). Cancer survivors were older than IWC: median age 67.4 vs. 63.5 years ( p< 0.001) and more likely to be active smokers: 37.5% vs. 29.5%, ( p= 0.09). The median predicted risk of lung cancer at 6 year was 5.5% vs. 3.2%, ( p= 0.15). No significant difference in the screening outcomes was found between groups. Among cancer survivors (N = 152), positive screening occurred in 15 (9.9%); lung cancer was diagnosed in 1 (0.7%); and other cancers were diagnosed in 3 subjects (1.9%). Non-adherence to LDCT screening occurred in 31 out of 152 cancer survivors (20.4%), compared with 81 out of 262 (30.9%) IWC, ( p= 0.02). Conclusions: About one-third of LDCT screenings at this NCCN institution occurred among cancer survivors. We found no evidence of increased false positive results. However, a higher rate of adherence to annual screening was observed among cancer survivors than IWC.
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