Intrathoracic Cancer Research Articles

Biomarkers suitable for early detection of intrathoracic cancers in primary care: a systematic review.

Intrathoracic cancers, including lung cancer, mesothelioma, and thymoma, present diagnostic challenges in primary care. Biomarkers could resolve some challenges. We synthesized evidence on biomarkers performance for intrathoracic cancer detection in low-prevalence settings. A search in EMBASE and MEDLINE included studies that recruited participants with suspected intrathoracic cancer and reported on at least one diagnostic measure for a validated, non-invasive biomarker. Studies were excluded if participants were recruited based on a pre-established diagnosis. Fifty-two studies were included, reporting on 108 individual biomarkers and panels. CEA, CYFRA 21.1, and VEGF were evaluated for lung cancer and mesothelioma. For lung cancer, CEA and CYFRA 21.1 were most studied, with AUCs of 0.48-0.90 and 0.48-0.83, respectively. Pro-GRP and NSE had the highest NPVs (98.2%, 96.9%), while Early-CDT and MSC panels showed NPVs of 99.3% and 99.0% in smokers. For mesothelioma, Fibrillin-3 and mesothelin plus osteopontin had AUCs of 0.93 and 0.91, respectively. Thymoma panels (Binding AcHR + StrAb) and (Binding AcHR + Modulating AcHR + StrAb) had 100% NPVs in myasthenia gravis patients. The review highlights the performance of some biomarkers. However, few were evaluated in low-prevalence settings. Further evaluation is necessary before implementing these biomarkers for intrathoracic cancers in primary care.

Prediction factors in surgical treatment of intragrawn kidney cancer metastasis

Background . The incidence of distant metastases of intrathoracic localization in kidney cancer, including intrathoracic lymph nodes, makes the problem of identifying and introducing knowledge about prognostic factors into clinical practice when using the surgical treatment of this disease urgent. Aim . To identify prognostic factors in the surgical treatment of intrathoracic metastases of renal cancer. Materials and methods . In this work, a retrospective analysis was carried out of a group of 100 patients with intrathoracic cancer metastases, almost who underwent surgical treatment in the form of removal of distant metastases. We analyzed the clinically significant factors associated with the prevalence of the tumor process in the lungs, which could affect the long-term results of treatment, as well as the influence of various instrumental research methods on the frequency of detection of intrathoracic lesions. In addition, the influence of the choice of surgical approach and the volume of surgery on the long-term survival of this group of patients was analyzed. Results . 40 (40 %) patients had synchronous and 60 (60 %) had metachronous lung metastases. 63 (63 %) had open and 36 (36 %) – thoracoscopic surgery, 1 (1 %) patient underwent a transdiaphragmatic resection. 70 (70 %) patients had atypical lung resections. 5-year overall survival was 53.4 %, 5-year progression-free survival – 43.1 %. There was no postoperative mortality and no grade 3–4 morbidity. Following factors were associated with an overall survival during a single-factor analysis: bilateral lung lesions (р <0.0001), R0 resection (р = 0.002), Munich scale (р = 0.007). Only bilateral lung lesion were associated with an overall survival during a multifactor analysis (р = 0.001). Conclusions . Removal of intrathoracic metastases of kidney cancer in the lung can lead to long-term survival in a significant number of patients. Achieving R0 resection is the main goal of surgical treatment.

The Incidence of Clinical Covid-19 Infection in Patients Undergoing Radiotherapy During the Two First Waves in a University Hospital in Iran

Background and Objective: During the COVID-19 epidemic, concerns about cancer patients undergoing radiotherapy have increased because of the numerous hospital visits, which may increase the risk of contracting COVID-19. We aimed to investigate the incidence of COVID-19 among patients visiting our radiation oncology department during the first and second peaks of the epidemic.
 Methods: In this cross-sectional study, we included all patients who underwent radiotherapy from November 2019 to September 2020. We contacted the patients and asked if they had COVID-19 during this time and how they were diagnosed. Clinical signs and a positive PCR test were acceptable as COVID-19 diagnostic criteria. We also gathered cancer and treatment status data from the patients’ records in the ward medical library. This study was approved by the institutional review board and ethics committee (code: IR.TUMS.VCR.REC.1399.104).
 Results: During the study period, 687 patients were admitted to our radiation oncology ward. The patients’ median age was 55 (IQR: 44-65), of whom 424 (61.7%) were females. Twenty-three (3.3%) patients developed COVID-19, 15 (65.2%) of whom were diagnosed with clinical symptoms and 8 (34.8%) with PCR. Twelve and 11 patients contracted COVID-19 in the first and second epidemic peaks, respectively. Even though no patients with skin cancer or sarcomas of the bone or soft tissue contracted COVID-19, the highest frequency of COVID-19 was seen among patients with intrathoracic or lung cancer with 38 times the odds of patients with head and neck cancer to develop COVID-19. Highly susceptible patients were those with hematologic and upper gastrointestinal (GI) and gynecologic cancers, respectively. We found a significant association between intrathoracic (mainly lung) cancers and infection with COVID-19 (P-value = 0.02).
 Conclusion: Patients undergoing intrathoracic cancer radiotherapy are at a higher risk of developing COVID-19. We believe these patients should be prioritized in cancer patients’ screening, case-finding, or vaccination programs.

Malignant Central Airway Obstruction: What's New?

Malignant central airway obstruction (MCAO) is a debilitating and life-limiting complication that occurs in an unfortunately large number of individuals with advanced intrathoracic cancer. Although the management of MCAO is multimodal and interdisciplinary, the task of providing patients with prompt palliation falls increasingly on the shoulders of interventional pulmonologists. While a variety of tools and techniques are available for the management of malignant obstructive lesions, advancements and evolution in this therapeutic venue have been somewhat sluggish and limited when compared with other branches of interventional pulmonary medicine (e.g., the early diagnosis of peripheral lung nodules). Indeed, one pragmatic, albeit somewhat uncharitable, reading of this article's title might suggest a wry smile and shug of the shoulders as to imply that relatively little has changed in recent years. That said, the spectrum of interventions for MCAO continues to expand, even if at a less impressive clip. Herein, we present on MCAO and its endoscopic and nonendoscopic management-that which is old, that which is new, and that which is still on the horizon.

History of esophagectomy for cancer of the esophagus and the gastroesophageal junction.

The introduction of anesthesia in 1846 created unseen opportunities for surgeons. By the end of the 19th century limited esophageal resection outside the chest had already been performed and the race for successful intrathoracic esophagectomy was on. The credit for the first successful esophagectomy for an intrathoracic cancer goes to Franz Torek of New York in 1913. But it was the introduction of double lumen intubation that really boosted the number of successful esophagectomies all over the world. In the second half of the 20th century progress in surgical techniques and perioperative management resulted in a substantial reduction of postoperative mortality. Introduction of multimodality therapies has further improved long term survival. The turn of the millennium saw the development of minimally invasive esophagectomy (MIE) improving postoperative quality of life. Undoubtly new technologies and newer drugs (e.g., immunotherapy) will further allow for refinements and more personalized targeted therapies. In this manuscript, the authors provide a deep dive into the history and development of esophageal surgery, with emphasis on the innovative pioneers that brought the field of esophageal surgery to the front line of surgery.

Abstract S10-03: Increased risk of COVID-19-related death among cancer survivors

Abstract Significant variations in experience of the COVID-19 pandemic have been observed in the United States. Increased risk of COVID-19-related death has been reported among cancer survivors, but due to limited sample size in those studies, to what extent the previous cancer diagnosis may play a role in the determination of COVID-19-related death is still unclear. In this study, using aggregated real-world data extracted from TriNetx electronic medical record data from 34 hospitals around United States, we assessed the relationship between prior cancer diagnosis in the past 5 years and COVID-19-related death within one month after the diagnosis of virus contraction. A total of 24,534 patients aged 18-80 years old who contracted COVID-19 were identified from January 20th to May 4th, 2020. Among them, 3,619 were cancer survivors. In the univariate analysis, we found that cancer patients had 2.55-fold increased risk ratio (RR) of death than those without cancer (RR=2.55, 95% Confidence Interval (CI): 2.25, 2.88), although the risk was decreased but still significant (RR=1.42, 95% CI: 1.21, 1.67) after adjustment for demographics (e.g., age, gender, and race) and other pre-existing chronic diseases, including obesity, diabetes, hypertension, chronic ischemic heart disease, chronic kidney disease, asthma, and COPD. When stratified by cancer sites, significant associations were observed between respiratory and intrathoracic, oral, digestive, breast, male genital, urinary, blood, and skin cancers with COVID-19-related death in the univariate analysis. As expected, the most significant cancer site was respiratory and intrathoracic cancer with an RR of 6.49 (95% CI: 5.21, 8.07). However, after adjustment for demographics and other pre-existing chronic diseases, the significant associations remained for respiratory and intrathoracic, digestive, and blood cancers (RR=1.89, 95% CI: 1.31, 2.73; RR=1.59, 95% CI: 1.06, 2.38; RR=2.08, 95% CI: 1.51, 2.86, respectively). In addition, among cancer survivors, men were found to have higher RR of death than women (RR=1.41, 95% CI: 1.12, 1.78), but the RR did not differ between Blacks and Whites. In summary, our data show significant increased COVID-19-related death among cancer survivors. The elevated risk was particularly evident among those who had respiratory and intrathoracic, digestive, and blood cancers. Citation Format: Jie Shen, Hua Zhao. Increased risk of COVID-19-related death among cancer survivors [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr S10-03.

Readmission with venous thromboembolism after surgical treatment by primary cancer site

BackgroundVenous thromboembolism (VTE) is a common, high-mortality condition among surgical cancer patients. Comprehensive analyses of VTE among postoperative cancer patients are lacking. We sought to determine the association between readmission with VTE and primary cancer diagnosis in a nationwide database at 90- and 180-days after initial admission for cancer surgery. MethodsRetrospective analyses of post-surgical cancer patients readmitted with VTE were conducted using data from the Nationwide Readmissions Database (NRD) (2010–2014). Multivariate logistic regression models adjusting for patient and hospital factors were used to determine 90- and 180-day readmission rates for VTE by cancer type. Patient factors associated with readmission were also examined. ResultsAmong a sample of 535,992 cancer patients undergoing tumor resection, readmission with VTE occurred in 1.7% within 90-days and 2.3% within 180-days. Patients readmitted for VTE experienced a 7% mortality rate. Highest rates of VTE readmission at 180 days occurred in brain (6.7%), pancreatic (5.6%), and respiratory and intrathoracic cancers (4.4%). Using pancreatic cancer as reference, brain cancer had the highest odds of readmission at 180-days (OR 2.23, 95% CI [1.95–2.55]). ConclusionReadmission with VTE among surgical cancer patients occurred in 2.3% of patients within 180 days. Among cancer types, primary brain cancer was independently associated with readmission with VTE.

Openness Personality Trait Associated With Benefit From a Nonpharmacological Breathlessness Intervention in People With Intrathoracic Cancer: An Exploratory Analysis

ContextBreathlessness is common in people with lung cancer. Nonpharmacological breathlessness interventions reduce distress because of and increase mastery over breathlessness. ObjectivesIdentify patient characteristics associated with response to breathlessness interventions. MethodsExploratory secondary trial data analysis. Response defined as a one-point improvement in 0–10 Numerical Rating Scale of worst breathlessness/last 24 hours (response—worst) or a 0.5-point improvement in the Chronic Respiratory Questionnaire (CRQ) mastery (response—mastery) at four weeks. Univariable regression explored relationships with plausible demographic, clinical, and psychological variables followed by multivariable regression for associated (P < 0.05) variables. ResultsAbout 158 participants with intrathoracic cancer (mean age 69.4 [SD 9.35] years; 40% women) were randomized to one or three breathlessness training sessions. About 91 participants had evaluable data for response—worst and 107 for response—mastery. In the univariable analyses, the personality trait openness was associated with response—worst (odds ratio [OR] 1.99 [95% CI 1.08–3.67]; P = 0.028) and response—mastery (OR 1.84 [95% CI 1.04–3.23]; P = 0.035). Higher CRQ—fatigue (OR 0.61 [95% CI 0.41–0.91]; P = 0.015), CRQ—emotion (OR 0.68 [95% CI 0.47–0.96]; P = 0.030), and worse CRQ—mastery (OR 0.61 [95% CI 0.42–0.88]; P = 0.008), and the presence of metastases and fatigue were associated with reduced odds of response—mastery. In the adjusted response—mastery model, only openness remained (OR 1.73 [95% CI 0.95–3.15]; P = 0.072). ConclusionWorse baseline health, worse breathlessness mastery, but not severity, and openness were associated with a better odds of response. Breathlessness services must be easy to access, and patients should be encouraged and supported to attend.

National prevalence, trends and outcomes of takotsubo syndrome in hospitalizations with prior history of mediastinal/intrathoracic cancer and radiation therapy

BackgroundRadiation therapy (RT) for cancers in thoracic/mediastinal region has been linked with heart damage following years of radiation exposure. However, prevalence of takotsubo syndrome (TTS) in patients with prior intrathoracic/mediastinal malignancies treated with RT has never been analyzed on a large scale. MethodsWe identified adult hospitalizations with prior mediastinal/intrathoracic cancer and RT and TTS using ICD-9 CM codes and the National Inpatient Sample (2007–2014) after excluding current admissions for chemotherapy. We then assessed the prevalence, odds, trends and in-hospital outcomes of TTS-related admissions in patients with vs. without prior intrathoracic cancer and RT. ResultsWe identified a total of 5,991,314 hospitalizations with prior intrathoracic/mediastinal malignancies and RT (~73 yrs., 85.2% female), of which 7663 (0.13%, 128 per 100,000) were diagnosed with TTS (~74 yrs., 95.8% females, 88.1% white). Higher odds and rising trends in TTS per 100,000 hospitalizations (from 31 to 241) were seen among patients with prior intrathoracic malignancies and RT as compared to those without (from 19 to 104) (ptrend < 0.001). All-cause in-hospital mortality (4.6% vs 2.8%; OR 1.45; 95%CI 1.29–1.63, p < 0.001), cardiogenic shock (4.3% vs 0.2%), cardiac arrest (3.1% vs 0.9%), arrhythmia (34.3% vs 24.6%), stroke (3.6% vs 2.8%), respiratory failure (14.5% vs 4.6%), and median length of stay and hospital charges were significantly higher in the TTS cohort. ConclusionsThis study showed higher odds and increasing trends in TTS-related admissions with worse in-hospital outcomes among patients with prior intrathoracic/mediastinal cancer and RT, irrespective of the time interval from cancer diagnosis or RT to TTS occurrence.

Surgical treatment of giant thymoma complicated by intrathoracic compression syndrome

The problem of giant chest tumors is still actual despite the progress in diagnostics of intrathoracic cancer. Surgical treatment of giant tumors should always be considered as a part of combined antitumor treatment. Large tumor is not a contraindication for surgery per se. The results of explorative thoracotomy may be assessed in expert centers once again if redo surgery may be followed by favorable outcome. These operations require the coordinated work of the entire operating team.

PS01.214: METASTATIC YIELD OF SUPERIOR MEDIASTINAL LYMPHADENECTOMY AND ASSOCIATION WITH PET IN INTRATHORACIC OESOPHAGEAL CARCINOMA TREATED WITH MINIMALLY INVASIVE OESOPHAGECTOMY

Abstract Background Lymph node status in oesophageal carcinoma is an important prognostic factor and predictor of survival. However, specific metastatic distribution patterns, especially for superior mediastinal lymph nodes, are not defined; they may be dependent on tumour location, histology and use of neoadjuvant treatment. Consensus for an optimal surgical strategy with regards to superior mediastinal lymphadenectomy (SML) has therefore not been formed. We aim to assess the metastatic yield of superior mediastinal nodes in intra-thoracic oesophageal cancer while correlating results with preoperative PET-CT. Methods Data from 39 consecutive 2-stage and 3-stage fully Minimally Invasive Oesophagectomies (MIO) performed by a single surgical team for intra-thoracic oesophageal or gastro-oesophageal junction carcinoma (Siewert I/II) between September 2016 and December 2017 were analysed. In n = 7 (18%), SML was performed. Of these n = 1 was for mid-oesophageal adenocarcinoma (ACA) and n = 6 were for squamous cell carcinoma (SCC) (5 for mid-oesophageal and 1 for distal oesophageal, which had a 2-stage procedure). Histological superior mediastinal nodal analysis was correlated with pre-operative PET-CT. Results Median total lymph node count was 45 (IQR, 37–68), with median SML count of 8 (IQR, 5–22). Of 7 SML’s, n = 1 (14.2%) revealed metastasis in 1/5 right paratracheal nodes. The patient had 3-stage MIO with no neo-adjuvant treatment for mid-oesophageal SCC. Final staging was pT3N2(6/45)M0. Preoperative PET-CT showed low avidity in right paratracheal nodes. Of the rest, 5 had negative PET-CT and 1 showed PET-positive paratracheal nodes, not confirmed histologically. The latter patient had neoadjuvant chemoradiotherapy for distal oesophageal ACA. Conclusion Although a small sample-sized study it demonstrates that PET-CT has a role in identifying metastatic superior mediastinal nodes. It can aid in the decision of resecting avid nodes but it should be born in mind that PET could have false positive results due to surrounding inflammation not uncommonly found in the lungs. False positivity (not confirmed histologically) may be also attributed to complete pathological lymph node response post neo-adjuvant treatment. SML’s role is not as clear in distal oesophageal/GOJ cancer compared to mid-oesophageal, but PET-CT seems a useful adjunct. In the West, SML shows a low metastatic yield for intra-thoracic oesophageal cancer. Disclosure All authors have declared no conflicts of interest.

OA 03.02 Comprehensive Characterization of Thymic Epithelial Tumor Subtypes Through an Analysis of Somatic Mutations and Copy Number Alterations

Thymic epithelial tumors (TETs) are rare and under-researched intrathoracic cancers. So far the only significant finding is a recurrent (43%) missense mutation in GTF2I. In addition to validating this finding, we set out to expand our understanding of the molecular changes underlying TETs through whole exome sequencing (WES) and detection of copy number alterations (CNAs) following SNP genotyping.

A randomised controlled trial of three or one breathing technique training sessions for breathlessness in people with malignant lung disease.

BackgroundAbout 90 % of patients with intra-thoracic malignancy experience breathlessness. Breathing training is helpful, but it is unknown whether repeated sessions are needed. The present study aims to test whether three sessions are better than one for breathlessness in this population.MethodsThis is a multi-centre randomised controlled non-blinded parallel arm trial. Participants were allocated to three sessions or single (1:2 ratio) using central computer-generated block randomisation by an independent Trials Unit and stratified for centre. The setting was respiratory, oncology or palliative care clinics at eight UK centres. Inclusion criteria were people with intrathoracic cancer and refractory breathlessness, expected prognosis ≥3 months, and no prior experience of breathing training. The trial intervention was a complex breathlessness intervention (breathing training, anxiety management, relaxation, pacing, and prioritisation) delivered over three hour-long sessions at weekly intervals, or during a single hour-long session. The main primary outcome was worst breathlessness over the previous 24 hours (‘worst’), by numerical rating scale (0 = none; 10 = worst imaginable). Our primary analysis was area under the curve (AUC) ‘worst’ from baseline to 4 weeks. All analyses were by intention to treat.ResultsBetween April 2011 and October 2013, 156 consenting participants were randomised (52 three; 104 single). Overall, the ‘worst’ score reduced from 6.81 (SD, 1.89) to 5.84 (2.39). Primary analysis [n = 124 (79 %)], showed no between-arm difference in the AUC: three sessions 22.86 (7.12) vs single session 22.58 (7.10); P value = 0.83); mean difference 0.2, 95 % CIs (–2.31 to 2.97). Complete case analysis showed a non-significant reduction in QALYs with three sessions (mean difference –0.006, 95 % CIs –0.018 to 0.006). Sensitivity analyses found similar results. The probability of the single session being cost-effective (threshold value of £20,000 per QALY) was over 80 %.ConclusionsThere was no evidence that three sessions conferred additional benefits, including cost-effectiveness, over one. A single session of breathing training seems appropriate and minimises patient burden.Trial registrationRegistry: ISRCTN; Trial registration number: ISRCTN49387307; http://www.isrctn.com/ISRCTN49387307; registration date: 25/01/2011Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-015-0453-x) contains supplementary material, which is available to authorized users.

Risk of cancer among HIV-infected patients from a population-based nested case-control study: implications for cancer prevention.

BackgroundThe burden of cancer is likely to increase among the human immunodeficiency virus (HIV)-positive population as it ages due to successful antiretroviral therapy (ART). The purpose of this study was to determine the risk of cancer in HIV-infected patients.MethodsThis study was a matched nested case–control study. It was performed using the National Health Insurance Research Database of Taiwan. The control group included non–HIV-infected patients matched by sex, age, and year of enrollment. Logistic regression analyses were performed and simultaneously adjusted for potential confounders (income, urbanization, and Charslon index of comorbidity to evaluate HIV infection as an independent risk of cancer. We calculated the overall and sex-specific standardized incidence ratios (SIR) to investigate the pattern of cancer risk and overall cancer risk in the patients with HIV infection.ResultsOf the 1,115 HIV-infected patients, 104 (9.33%) developed cancer during the 11-year follow-up period. The risk of cancer for patients with HIV infection was significant (adjusted odds ratio = 3.89, 95% confidence interval [CI] = 2.92–5.19) after adjustment for potential confounders. There was a significantly increased risk of developing non-Hodgkin lymphoma (SIR = 25.73, 95% CI = 6.83-90.85), cervical cancer (SIR = 4.01, 95% CI = 1.0-16.06), lymphoma (SIR = 20.26, 95% CI = 5.86-70.10), and respiratory and intrathoracic cancer (SIR = 20.09, 95% CI = 2.34-172.09) compared with the control group. In addition, HIV-infected patients were at significant risk for renal, oral, breast, liver, skin, and colorectal cancer.ConclusionsPatients with HIV infection are at increased risk for several specific cancers. Our results support the implementation of an active and accelerated cancer screening schedule for patients with HIV infection to increase their life span.

Randomized trial of high- versus low-intensity breathing training for dyspnea due to intrathoracic cancer: Cost-effectiveness.

54 Background: About 90% of patients with lung cancer experience dyspnea. Breathing training is helpful, but multiple sessions may be onerous. Methods: UK multisite phase 3 RCT, comparing three weekly sessions of breathing training to a single session for refractory dyspnea due to intrathoracic cancer. Primary outcome: self-report “worst” dyspnea/24 hours, (0–10 numerical rating scale [NRS], 0=none; 10=worst imaginable). Secondary outcomes: “average”, distress due to dyspnea (NRS); quality of life (QoL) (CRQ-SAS; EQ-5D); health service utilisation. Primary analysis point: 4 weeks for dyspnea/QoL. An economic analysis addressed cost-effectiveness from the perspective of UK National Health Service (NHS) and personal social services in a budget constrained system; costs at NHS 2012/13 prices. Primary outcome: Quality Adjusted Life Year (QALY) over 8 weeks. Results: 156 were randomized: age 69 (SD 9.4); 40% women; Karnofsky performance status 71% (SD 9.5); 133 primary lung. “Worst” score improved, 6.8 (SD1.9) at baseline to 5.8 (SD 2.4) at week 4. There was no detected difference in area under curve (AUC): three 22.9(SD 7.1) versus single 22.7(SD 7.1); P = 0.83; 95% difference CI (-2.3, 2.9), or for AUC “average”, or CRQ-SAS. AUC “distress” was less in the single group (16.2 versus 12.3; P = 0.01). Using complete cases, three sessions were associated with a QALY reduction of 0.006 (95% CI -0.18 to +0.006) over 8 weeks and 0.008 (95% CI -0.022 to 0.006) with multiple imputation, and showed increase in costs when adjusted for baseline health related QoL (Mean increased cost £37; 95% CI -506 to +581). Conclusions: Three sessions conferred no benefits over one and had a worse QALY profile. Though statistically insignificant, a single session seems to be a cost-effective way to provide breathing training, minimising the burden of healthcare visits. Clinical trial information: ISRCTN49387307.

Intracardiac Metastasis from Epitheloid Sarcoma: Rare Localization and Difficult Management

The involvement of the heart in metastatic cancer is a very rare clinical diagnosis with poor prognosis given to the major risk of cardiac failure. They are frequently asymptomatic or symptoms, when present, may be attributed to other causes. The most common, among the latter, are intrathoracic cancers, lymphomas, leukemias, melanoma, and rarely sarcomas. The echocardiography is the gold standard for diagnosis, but scanner and magnetic resonance imaging (MRI) can be helpful for determination of exact location and composition of lesions. Cardiac metastases occur generally in advanced stage in poly-metastatic patients. Treatment is often in a palliative strategy but should be discussed in multidisciplinary approach for each case. We report a case of cardiac metastasis occurring in a 47 years old woman, treated for epitheloid sarcoma of the buttock. The aim of this work is to show the rarity of the heart location, describing the epidemiological, clinical, radiological, and prognostic features of these metastases and finally discussing the therapeutic strategy.

Circulating DBP level and prognosis in operated lung cancer: an exploration of pathophysiology

Vitamin D stimulates transcription of antiangiogenic and apoptotic factors that may suppress tumours, while vitamin D binding protein (DBP) may be a biomarker in murine lung cancer models. We sought to ascertain whether the vitamin D axis is altered in lung cancer or influences prognosis. 148 lung cancer patients, 68 other intrathoracic cancer patients and 33 noncancer controls were studied for up to 5 yrs. Circulating DBP and vitamin D levels were compared between groups and their effect on survival assessed by Cox regression analysis. Expression of DBP and vitamin D receptor (VDR) was examined in lung cancer cell lines and in normal and tumour lung tissue by Western blot and immunohistochemistry. Low serum DBP levels predicted lung cancer-specific death (p=0.04), and DBP was poorly expressed in lung cancer cells on Western blot and immunohistochemistry. Vitamin D did not predict cancer survival and VDR expression was variable in tumours. Preservation of serum DBP is a significant independent factor associated with better cancer outcome in operated lung cancer patients. Given the established role of DBP in macrophage activation and clearance of abnormal cells, further study on its involvement in lung cancer is merited.

Esophageal cancer initially thought to be accompanied by a solitary metastasis to an intrathoracic paraaortic lymph node.

Esophageal cancers usually exhibit lymph-node metastases. Although a solitary lymph-node metastasis is occasionally found, the involvement of an intrathoracic paraaortic node is rare. We present here an intrathoracic mid-esophageal cancer case in which an accompanying solitary retroaortic mass was found within the posterior mediastinum by integrated positron emission tomography/computed tomography. For diagnosis, thoracoscopic resection of the mass was performed from a left thoracic approach, and histology revealed it to be a squamous cell carcinoma metastasized from the esophageal cancer. Upon radical esophagectomy after neoadjuvant therapy as a T3N1M0 Stage IIIa (AJCC/UICC) cancer, the esophageal cancer was found to have invaded unexpectedly deeply in the vicinity of the descending aorta. Another lymph node within the paraaortic region was also involved (T4N1M0 Stage IIIc). The present case and other cases we review here inform our understanding of metastasis to intrathoracic paraaortic nodes as follows:1) its existence may indicate extensive lymph-node metastasis or direct tumor invasion nearby, and 2) it may be accompanied by other lymph-node involvements in this region, even if it appears solitary upon preoperative investigation. Thus, for radical esophagectomy, sufficient lymph-node dissection is required, even at locations not reached by the usual right thoracic approach. Definitive chemoradiotherapy may be a better choice for preoperatively recognized T3 esophageal cancer when the cancer is accompanied by paraaortic lymph node metastasis.

Computed Tomography-Guided Interstitial High-Dose-Rate Brachytherapy in the Local Treatment of Primary and Secondary Intrathoracic Malignancies

Image-guided interstitial (IRT) brachytherapy (BRT) is an effective treatment option as part of a multimodal approach to the treatment of isolated lung tumors. In this study, we report our results of computed tomography-guided IRT high-dose-rate (HDR) BRT in the local treatment of inoperable primary and secondary intrathoracic malignancies. Between 1997 and 2007, 55 patients underwent a total of 68 interventional procedures for a total of 60 lung lesions. The median tumor volume was 160 cm³ (range, 24-583 cm³). Thirty-seven patients were men and 18 were women, with a median age of 64 years (range, 31-93 years). The IRT-HDR-BRT delivered a median dose of 25.0 Gy (range, 10.0-32.0 Gy) in twice-daily fractions of 4.0 to 15.0 Gy in 27 patients and 10.0 Gy (range, 7.0-32.0 Gy) in once-daily fractions of 4.0 to 20.0 Gy in 28 patients. The median follow-up was 14 months (range, 1-49 months). The overall survival rate was 63% at 1 year, 26% at 2 years, and 7% at 3 years. The local control rate for metastatic tumors was 93%, 82%, and 82% and for primary intrathoracic cancers 86%, 79%, and 73% at 1, 2, and 3 years, respectively. Pneumothoraces occurred in 11.7% of interventional procedures, necessitating postprocedural drainage in one (1.8%) patient. In patients with inoperable intrathoracic malignancies, computed tomography-guided IRT-HDR-BRT is a safe and effective alternative to other locally ablative techniques.

One Case of a Primary Papillary Thyroid Carcinoma in the Intrathoracic Lymph Node

A primary papillary thyroid carcinoma in the intrathoracic lymph node is very rare. There are two potential explanations of the lesion. The first possibility of the lesion is metastatic disease from an occult primary thyroid papillary microcarcinoma. Other possibility is malignant transformation of the aberrant thyroid tissue within the intrathoracic lymph node, which is the favored etiology in this case. We experienced an extremely rare case of true intrathoracic thyroid cancer in a 78-year-old woman, presenting with an intrathoracic malignancy. We confirmed it as papillary thyroid cancer, but there were no primary sites of thyroid glands. So, we report this rare case of a primary papillary thyroid carcinoma in the intrathoracic lymph node. � Korean J Otorhinolaryngol-Head Neck Surg 2011;54:300-3 Key WordsZZIntrathoracic lymph node ㆍPapillary thyroid carcinoma ㆍAberrant thyroid tissue.