A 48-year-old woman with extensive clarithromycin-resistant Mycobacterium avium complex pulmonary disease (MAC-PD) was successfully treated by left lower lobectomy and lingulectomy following ...combination treatment of intravenous/inhaled amikacin plus bronchial occlusion by Endobronchial Watanabe Spigots (EWSs). A left pneumonectomy was initially indicated for removing all the lesions, but the procedure would have been barely tolerated by the patient. However, her preoperative combination treatment sufficiently reduced the lesions requiring resection to allow surgical preservation of the left upper division. This novel approach might be promising for patients with Mycobacterium avium complex lung disease whose pulmonary reserve will not allow an extensive parenchymal resection.
Purpose: To investigate the exercise capacity and health-related quality of life (HRQOL) of surgical patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) preoperatively versus 6 ...months postoperatively.Methods: This prospective observational study included patients with NTM-PD and was conducted at a single center. The intervention was surgical resection plus perioperative and post-discharge physical therapy. The physical function was assessed preoperatively and 6 months postoperatively using the 6-minute walk test (6MWT). HRQOL was assessed preoperatively and 6 months postoperatively using the Short-Form 36 (SF-36) health survey questionnaire and St. George’s Respiratory Questionnaire. The postoperative HRQOL was compared between patients with and without preoperative clinical symptoms.Results: In total, 35 patients were analyzed. The preoperatively symptomatic group had significantly lower preoperative HRQOL than the preoperatively asymptomatic group (p <0.05). Compared with preoperatively, there were significant improvements at 6 months postoperatively in the 6MWT (p <0.01) and HRQOL, mainly in the SF-36 mental component summary (p <0.01). The SF-36 mental component summary in the preoperatively symptomatic group was very significantly improved from preoperatively to 6 months postoperatively (p <0.05).Conclusion: The combination of surgical treatment and physical therapy for NTM-PD contributes to improvements in physical function and HRQOL.
Background. The treatment of pulmonary nontuberculous mycobacteria (NTM) involves the long-term use of multiple drugs. Adjuvant pulmonary resection is indicated for recurrent or refractory cases if ...the disease is localized and resectable. However, if surgery is contraindicated due to a poor cardiopulmonary reserve or extensive disease, treatment and disease control become very difficult, and the prognosis is dismal. Following the concept of lobar collapse therapy as a new endobronchial complementary approach to treating cavitary lesions of multidrug-resistant tuberculosis in Europe, we are eagerly awaiting new approaches for managing refractory cavities of pulmonary NTM. Purpose. To clarify the safety and effectiveness of endobronchial treatment using an Endobronchial Watanabe Spigot (EWS) for managing pulmonary cavitary lesion of NTM. Methods. We conducted endobronchial occlusion for 7 refractory unresectable cavities of 5 pulmonary NTM cases (2 men, 3 women, average age 51.6 years old). The clinical, microbiological and radiological courses were followed. Results. The follow-up period was 12-33 months (median 19 months), and no serious adverse events were observed. Subjective symptoms, such as cough and sputum, were improved in all cases. Two cases achieved sputum-negative conversion and became eligible for surgery after this procedure. Four cavities respectively in 4 cases showed radiological improvement, but no cases achieved complete cavity collapse. Conclusion. Bronchial occlusion with EWS can be an effective option especially as the preoperative management in cases with refractory cavity of pulmonary NTM.
Thymic carcinoma is a rare mediastinal neoplasm, and the prognosis of patients with advanced thymic carcinoma is poor. No standard chemotherapeutic regimen has yet been established for the disease. ...This is the first report to evaluate the role of amrubicin, a novel anthracycline anticancer drug, in second-line and beyond treatment for patients with platinum-refractory advanced thymic carcinoma.
This study was a review of thymic carcinoma patients who had received amrubicin monotherapy between June 2003 and December 2011 for the progression of disease previously treated with platinum-based chemotherapy. Amrubicin was administered at 35 or 40 mg/m(2) for three consecutive days every 3 weeks, until progression.
Nine patients with recurrent thymic carcinoma were registered. Their median age was 61 years (range 45-72), and the patients included five males and four females. All nine patients had Masaoka's Stage IVb disease. There were three squamous cell carcinomas, one adenocarcinoma, one small-cell carcinoma and two other histological types. The mean number of chemotherapy cycles was five (range 2-13). Grade 3 or higher toxicities included mainly neutropenia (55.5%), anemia (25.0%) and febrile neutropenia (11.1%). No treatment-related deaths were observed. The response rate was 44.4% (95% confidence interval: 19-73). The median progression-free survival after the amrubicin monotherapy was 4.9 months, while the median overall survival was 6.4 months.
Single-agent amrubicin was found to be potentially useful as second-line and beyond chemotherapy for patients with advanced thymic carcinoma. Further multi-institutional prospective studies are warranted.
OBJECTIVES
The impact of epidermal growth factor receptor (EGFR) status and the use of EGFR-tyrosine kinase inhibitor (EGFR-TKI) therapy have not been well discussed only in recurrent non-small-cell ...lung cancer (NSCLC). The purpose of this study was to identify the prognostic factors associated with post-recurrence survival after surgical resection of NSCLC in terms of the EGFR mutation status and the use of EGFR-TKI therapy.
METHODS
From 2000 through 2011, 1237 consecutive patients with NSCLC underwent pulmonary resection at our institution. Of these patients, 280 experienced postoperative recurrence by the end of 2012. We reviewed the cases of recurrence and analysed the predictors and length of post-recurrence survival.
RESULTS
The median post-recurrence survival time and the 5-year survival rate of all patients were 25 months and 20.8%, respectively. A multivariate analysis identified the Eastern Cooperative Oncology Group (ECOG) performance status (PS), brain metastasis, number of sites of recurrence and EGFR mutation status to be independent prognostic factors for post-recurrence survival. Among all cases, the median post-recurrence survival time according to the use of EGFR-TKI therapy was as follows: 49 months in the EGFR mutation-positive patients treated with EGFR-TKI therapy, 20 months in the EGFR wild or unknown cases treated with EGFR-TKI therapy and 17 months in the patients not treated with EGFR-TKI therapy. As to EGFR mutation-positive cases, the patients treated with EGFR-TKIs exhibited significantly longer post-recurrence survival time than the patients treated without EGFR-TKIs (49 vs 12 months).
CONCLUSIONS
It is essential for recurrent NSCLC patients to be examined for the EGFR mutation status. Patients with a positive EGFR mutation status receive significant benefits from EGFR-TKI therapy.
Background
Malignant pleural mesothelioma (MPM) is an aggressive neoplasm that responds poorly to chemotherapy. Although treatment with pemetrexed in combination with cisplatin serves as first-line ...chemotherapy for MPM, the optimal second-line and beyond therapy has not yet been fully examined.
Methods
Between March 2008 and October 2011, 17 consecutive Japanese patients pretreated with at least one regimen of platinum plus pemetrexed chemotherapy received gemcitabine and vinorelbine. Responses, survival time, and toxicity were retrospectively evaluated.
Results
Response partial response (PR) + complete response (CR) and disease control stable disease (SD) + PR + CR rates were 18 and 82 %, respectively. The median progression-free survival (PFS) after combination chemotherapy was 6.0 months, whereas the median overall survival (OS) was 11.2 months. Grade 3 or 4 neutropenia and anemia were observed in 41 and 29 % of patients, respectively, and one patient experienced febrile neutropenia. Grade 3 or 4 nonhematologic toxicities included constipation (6 %) and phlebitis (6 %).
Conclusion
Combination chemotherapy using gemcitabine with vinorelbine was shown to have moderate activity in Japanese MPM patients pretreated with platinum plus pemetrexed chemotherapy. A further multicenter phase II trial is warranted to confirm the efficacy and safety of this combination treatment.
We investigated alkenones recorded in suspended particles and a settling particle time series collected at three stations, 40N (40°N, 165°E), KNOT (44°N, 155°E), and 50N (50°N, 165°E), in the ...northwestern North Pacific from December 1997 to May 1999.
Emiliania huxleyi, the most abundant alkenone producer in this area, is present in surface to subsurface (to ∼50
m depth) waters. The alkenone concentrations recorded in the suspended particles indicated that the seasonal alkenone particle distribution differed significantly interannually. Alkenone export fluxes at the three sediment-trap stations ranged from 0.16 to 49.3
μg
m
−2
day
−1, and the maximum export flux, which occurred in summer to fall (July–November), was associated with a high organic carbon export flux. The amount of alkenone produced during the maximum export season accounted for 60–80% of the total annual amount of alkenone, and the alkenones accumulated in the sediment below the traps had characteristics corresponding to subsurface waters during the summer–autumn season. Alkenone-derived temperatures recorded in suspended particles corresponded to the in situ temperature within ∼2
°C. Although alkenone-derived temperatures corresponded approximately to the temperatures observed in the stratified subsurface waters at the three trap stations during the high-export season, large differences were observed during the low-export (winter–spring) period. For example, the alkenone-derived temperatures observed at stations KNOT and 50N were much higher than the in situ subsurface temperatures reported in the World Ocean Atlas 2001. Relatively large differences between alkenone-derived temperatures and in situ temperatures in the subarctic might be due to (1) a low-light limitation or (2) contributions of allochthonous alkenones in particulate material transported from subtropical areas within a warm-core ring.
The purpose of this study was to demonstrate our surgical experience for focal bronchiectasis in the setting of modern diagnostic modalities and state-of-the-art medical treatment in a developed ...country.
Thirty-one patients undergoing 33 lung resections for the treatment of focal bronchiectasis from 1991 to 2009 were reviewed. The mean age was 54 years. Twenty-nine patients (94%) were female; 21 patients (68%) had nontuberculous mycobacterial infection; and 22 patients (71%) received preoperative multiple-drug regimens containing clarithromycin. Five patients (16%) were in an immunocompromised status. All were diagnosed by chest computed tomography scan, and either the right middle lobe or left lingula were involved in 29 (94%). The curve for relapse-free interval was estimated by Kaplan-Meier methods. The factors that affected this curve were examined using Cox's regression analysis.
Operative morbidity and mortality were 18% and 0%, respectively. All patients became asymptomatic postoperatively. During the median follow-up of 48 months (11 to 216), 8 patients (26%) experienced recurrence, and the mean relapse-free interval was 34 months (3 to 216). By univariate analysis, an immunocompromised status (p=0.017), Pseudomonas aeruginosa infection (p=0.040), the preoperative extent of bronchiectatic lesion (p=0.013), and the extent of residual bronchiectasis after surgery (p=0.003) were significantly associated with the shorter relapse-free interval. By multivariate analysis, an immunocompromised status (p=0.039), Pseudomonas aeruginosa infection (p=0.033), and the extent of residual bronchiectasis (p=0.009) were independent and significant factors.
Complete resection of bronchiectasis while the disease is localized and is free from Pseudomonas aeruginosa infection is the key for a success. Also, immunocompromised status was suggested to be a risk factor.
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