Nasal-type NK/T cell lymphoma is an increasingly recognised disease entity of aggressive clinical behaviour. The objective of this study was to investigate clinical features and treatment outcomes in patients with nasal-type NK/T cell lymphoma. From January 1991 to December 2003, 26 patients diagnosed as nasal-type NK/T cell lymphoma were included in the analysis. One half of patients presented with poor performance status (ECOG X2); 46% of patients were categorised as high intermediate or high-risk group according to IPI; and 46% of patients were diagnosed at advanced stage. The median survival for 26 patients with nasal-type NK/T cell lymphoma was 7.4 months (95% CI, 0.1, 16.9). The treatment outcome of primary anthracycline-based chemotherapy was poor: 60% CR rate in localised disease and 0% CR rate in advanced disease. After a median follow-up of 24.4 months (range 3.1 -99.0) in patients with localised disease who had achieved a CR (range 29.6 -165.7), three patients (50.0%) developed disease recurrence at 6.1, 21.8, and 52.1 months, respectively, and all patients presented with locoregional failure. The predictive factors for poor survival were of age greater than 60, advanced stage and poor performance in multivariate analysis. In conclusion, Nasal-type NK/T cell lymphomas showed a poor response to the conventional anthracycline-based chemotherapy, and thus an investigation for an innovative therapy is urgently needed to improve survival in these patients.

Pulmonary resection remains the best curative option for patients with localised non small cell lung carcinoma 1 . Despite advances in surgical technique, anaesthesia and perioperative care, the morbidity and mortality rates for lung resection remain significant 2 . The majority of postoperative complications after lung resection are cardiopulmonary in nature; however, pulmonary complications are the main cause of postoperative death 3-6 . Although the causes of postoperative respiratory failure vary and include pneumonia, aspiration, atelectasis and pulmonary emboli, the most dreaded pulmonary complication after lung resection is acute lung injury/acute respiratory distress syndrome (ALI/ARDS) 7 .Pneumonectomy, surgical removal of an entire lung, is associated with higher rates of postoperative respiratory failure and death, compared with lesser resections 2 . The reported rates of respiratory failure following pneumonectomy for SUMMARY Acute lung injury/acute respiratory distress syndrome (ALI / ARDS) is the most serious pulmonary complication after lung resection. This study investigated the incidence and outcome of patients with ALI / ARDS who required mechanical ventilation within one week of undergoing pneumonectomy for primary lung cancer and analysed the risk factors. We retrospectively reviewed the medical records of 146 patients who underwent pneumonectomy for primary lung cancer between May 2001 and April 2006. Preoperative, perioperative and postoperative clinical data were analysed. Post-pneumonectomy ALI / ARDS developed within the first postoperative week in 18 (12%) patients. Patients who developed ALI / ARDS had a longer hospital duration of stay (median [interquartile range], 26 [18 to 75] vs. 8 [7 to 11] days; P <0.001) and higher in-hospital mortality (12 [67%] vs. 0 [0%]; P <0.001). In an univariate analysis, post-pneumonectomy ALI / ARDS was associated with larger tidal volume (V T ) and higher airway pressure (P aw ) during one-lung ventilation (V T , 8.2 [7.5 to 9.0] vs. 7.7 [6.9 to 8.2] ml/kg predicted body weight, P=0.016; P aw , 28.9 [27.6 to 30.0] vs. 27.2 [25.6 to 28.5] cmH 2 O, P=0.001). V T during two-lung ventilation was also greater in patients who developed ALI / ARDS (P=0.014) than in those who did not, but P aw during two-lung ventilation did not differ (P=0.950). In a multiple logistic regression analysis, post-pneumonectomy ALI / ARDS was independently associated with a larger V T (OR 3.37 per 1 ml/kg predicted body weight increase; 95% confidence interval 1.65 to 6.86) and higher P aw (OR 2.32 per 1 cmH 2 O increase; 95% confidence interval 1.46 to 3.67) during the period of one-lung ventilation. In conclusion, a large V T and high P aw during one-lung ventilation were associated with an increased risk of post-pneumonectomy ALI / ARDS in primary lung cancer patients.

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