patients with pathological N2 disease was 806 days, with 30 day survival of 99% and 1 year survival 76%. Conclusions Lung cancer patients with stage IIIA disease make up a very small proportion of the overall lung cancer population. Only a small proportion of these patients receive surgery and there is significant discrepancy between the recorded pre and post operative nodal status. In patients with pathological confirmed N2 disease survival is similar to the 713 days reported in the Albain study. The automated collection of detailed radiotherapy/chemotherapy treatment data in future will allow a more reliable comparison between surgical and non-surgical treatments. Background Three months after radical radiotherapy for lung cancer, 50-60% of patients have radiation pneumonitis (RP) on CT thorax. Our aim was to assess the clinical and dosimetric factors associated with radiologically-defined RP. Our primary endpoint was the development of new infiltrates on CT thorax at 3 months following radiotherapy. Methods 161 patients with lung cancer were referred for radical radiotherapy during 2009-2010. Exclusion criteria were previous thoracic radiotherapy or surgery, palliative radiotherapy, or missing dosimetric or CT data. S108Information on medical history, lung function and date of death were taken retrospectively from electronic notes. Dosimetric parameters V20-Lung (percentage normal lung exposed to more than 20Gy), V5-Lung and Mean Lung Dose were derived from treatment planning dose-volume histograms. Development of RP was defined as an increase in the percentage lung volume occupied by consolidation or ground glass on post-radiotherapy CT. Student's t-test and Fisher's Exact Test were used to define variables which were associated with RP prior to logistic regression analysis. Results 98 cases were included in analysis. 86% had non-small cell lung cancer, 44% had chronic obstructive pulmonary disease (COPD), and 27% smoked. 49/98 (50%) patients developed RP on CT at median 90 days post-radiotherapy.The factors which had a significant positive correlation with RP on univariate analysis were V20-lung, V5-lung and MLD: these were best represented using V20-Lung ≥22%. Current smoking, poor performance status and having COPD had a significant inverse correlation with RP. Use of statins or inhaled Long Acting b2 Agonists, and the presence of moderate-severe radiological emphysema also approached significance: these were included in regression analysis.After logistic regression, the factors which had a significant correlation with RP were V20≥22% (OR 6.45, 95%CI 2.22-18.08), current smoking (OR 0.23, 95%CI 0.07-0.79), and statin use (OR 0.30,.Neither RP nor any other variable was associated with postradiotherapy mortality. Conclusions This study confirms that V20≥22% is associated with the radiological development of RP. In addition, patients who smoked, and those taking statins were significantly less likely to develop RP. A potential role for statins in modifying radiotherapy side effects deserves further attention.
Introduction Current NICE guidance indicates that lung cancer should be staged by a contrast enhanced chest CT scan which includes the liver and adrenals, and to look for distant metastases those with potentially curable disease should be offered PET-CT scanning. However, the latter is expensive and limited in availability, and it has been suggested that including the pelvic area in the staging CT scan might obviate the need (Botchua et al 2012). We looked at 284 PET-CT scans performed for the staging of lung cancer in our unit to test this further. Method We selected all PET-CT scans that showed distant metastases (and therefore upstaged the disease) for further scrutiny. In those where pelvic deposits were visible on the PET component, the CT element was reviewed to establish whether the diagnosis of pelvic metastases could have been made by CT scan alone. Results 23 PET-CT scans (8.1%) identified distant metastatic disease, in 3 (1.1%) cases in the pelvic area. Of these, 2 had bony metastases that were visible on the CT element of the scan: in the remaining case the PET element demonstrated increased uptake around a joint replacement and CT component demonstrated a pathological fracture. Conclusion This study has shown that if the pelvic area was included in the CT staging scan for lung cancer, in our cohort of 284 patients, only 3 (1.1%) would not have required a subsequent PET scan. In the remaining patients, the additional burden of pelvic CT in terms of radiation exposure and financial expense cannot be justified and therefore we do not recommend that the protocol for a staging CT scan in lung cancer is altered to include the pelvis.
Methods We studied 8 patients, identified from our anticoagulation database, who had been previously established on warfarin, and then commenced azathioprine or mercaptopurine for inflammatory bowel disease (2), systemic lupus erythematosus (1), nephritic syndrome (1), Wegener's granulomatosis (1), polyarteritis nodosa (1), dermatomyositis (1) and renal transplant (1). The effect of thiopurine on international normalised ratio (INR), and warfarin dose prior to and following commencement of thiopurine was recorded. Results In 6/8 patients, following introduction of azathioprine or mercaptopurine, the warfarin dose had to be significantly increased (100% [18-500], Median [range]) in order to maintain a therapeutic INR. Any subsequent reductions in thiopurine dose were mirrored by a rise in INR and lower requirement for warfarin.In 2 IBD patients, each with a high warfarin requirement, thiopurine metabolites were measured. In both patients MeMP: TGN ratio was >11. Thiopurine dose was reduced to 25% and allopurinol 100 mg added. INR was carefully monitored. In both cases INR increased within a week (to 6.9 and 11.2) and warfarin doses were subsequently reduced by ½ and 2/3 respectively to regain therapeutic INR. Conclusion It is important for clinicians to be aware of the potential inhibitory action of thiopurines on warfarin's anticoagulant effect. Close INR monitoring is essential when initiating thiopurines and especially when reducing their dose and/or adding allopurinol. Failure to recognise the latter could result in bleeding due to over-anticoagulation. The high MeMP:TGN ratio in 2 of our patients also raises the possibility that thiopurine metabolites may play a role in the interaction between thiopurines and warfarin.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.