Lung cancer requires multidisciplinary treatment to improve patient survival: A case report

Abstract

Abstract. The present study reports two cases of lung cancer with the involvement of the pleura. The diagnosis of adenocarcinoma with epidermal growth factor receptor (EGFR) mutation was made following repeated thoracentesis with cytology of pleural fluid and thoracoscopy with pleural biopsies. Talc pleurodesis was successfully performed in both cases subsequent to diagnosis. Following talc pleurodesis, the first patient (62 years old; male; non-smoker) underwent 3 cycles of cisplatin/vinorelbine chemotherapy, with a poor response. Concurrently, due to the presence of an EGFR mutation, treatment with gefitinib was initiated, with the patient achieving a good response for ~12 months. The residual tumor was treated with stereotactic radiotherapy and the patient continued gefitinib treatment. The patient is presently in good health, has not exhibited any signs of relapse and is continuing gefitinib treatment without side effects. The second patient (53 years old; male ex-smoker) underwent treatment with gefitinib subsequent to talc pleurodesis for a total of 15 months. In addition, radiotherapy (60 Gy) on the residual lesion was performed. Subsequently, second-line therapy with cisplatin/premetrexed was prescribed and followed by maintenance treatment with premetrexed. Three years after diagnosis, the patient did not exhibit any signs of recurrence. These two cases highlight the difficulty in treating advanced stage lung cancer, despite the presence of EGFR mutation. Each lung cancer is different and requires the physician to possess a wide range of knowledge of the therapeutic options available, in addition to careful monitoring in order to adjust the treatment over time. A multidisciplinary approach, involving surgeons, radiation oncologists, pulmonologists and oncologists, is required to optimize the survival and quality of life of patients with lung cancer.

Postoperative Severe Lung Failure and Functional Variations in Lung Cancer Patients with Different Extent of Resection: A Pilot Study .

“…As far as surgery techniques is concerned one possible approach in lung cancer surgery treatment is the video assisted thoracoscopy (VATS) approach that has a signi cantly lower rate of complications compared with thoracotomy (28% vs 45%, p = 0.04) (24).Other valid approaches that we used are minithoracotomy or lateral muscle sparing thoracotomy suitable for different extent of resection. Our study is the result of an interdisciplinary cooperation notably between pulmonologist and thoracic surgeon allows to better manage the patient undergoing lung cancer treatment consistently with previous studies (25)Greater loss of function in the sense of a decrease of FEV1 and FVC was observed in patients treated with lobectomy leading to a greater lung failure percentage and longer hospitalization time. A recovery from lung failure after three months along with a lower hospitalization time was observed notably in patients treated with sub-lobar resection.…”

“…The overall data were: mean age 71.5, hospitalization time 7.8 days, pack-year 34, body mass index (BMI) 25.4, chronic obstructive pulmonary disease(COPD) assessment test (CAT) mean value was 16.5, forced expiratory one second volume (FEV1) at baseline 1.6 l corresponding to 73.6% of predicted.…”

Concordancia diagnóstica entre la broncoscopia y la histopatología en pacientes con neoplasias pulmonares

“…Desafortunadamente, en países como Colombia los trámites administrativos pueden hacer del proceso diagnóstico un camino largo y tortuoso, por lo que se vuelve indispensable crear estrategias locales rentables, eficaces, eficientes, multidisciplinarias, al alcance de los pacientes y con evidencia suficiente para adelantar y priorizar los estudios de detección temprana, caracterización y estratificación de cáncer de pulmón tales como marcadores de inmunohistoquímica y pruebas moleculares específicos basados en los hallazgos fibrobroncoscópicos e histológicos. [28][29][30][31] Esto permitiría realizar un diagnóstico oportuno y por consiguiente dar un tratamiento dirigido en un menor tiempo.…”

Different recovery from respiratory failure and functional changes after lung cancer surgery depending on the extent of resection, the influence of COPD

“…The techniques followed the American Thoracic Society and European Respiratory Society task force guidelines (5). sub-analysis included a group who underwent lobectomy (25) and group with sub-lobar resection (40)…”

“…Indeed, the video assisted thoracoscopy (VATS) approach has a signi cantly lower rate of complications compared with thoracotomy (28% vs 45%, p = 0.04) with a lower hospitalization time (24).Our approach consisted of either mini-thoracotomy or lateral muscle sparing thoracotomy suitable for different extensive resection. Further consideration is that the interdisciplinary cooperation notably between pulmonologist and thoracic surgeon allows to better manage the patient affected by lung cancer as demonstrated by previous studies (25)Greater loss of function in the sense of a decrease of FEV1 and FVC was observed in patients treated with lobectomy leading to a greater lung failure percentage and longer hospitalization time. A recovery from lung failure after three months along with a lower hospitalization time was observed notably in patients treated with sub-lobar resection.…”