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Is radiofrequency ablation or stereotactic ablative radiotherapy the best treatment for radically treatable primary lung cancer unfit for surgery?

A best evidence topic was constructed according to a structured protocol. The question addressed was whether radiofrequency (RF) offers better results than stereotactic ablative therapy in patients suffering from primary non-small-cell lung cancer (NSCLC) unfit for surgery. Of the 90 papers found using a report search for RF, 5 represented the best evidence to answer this clinical question.

Concerning stereotactic ablative therapy, of the 112 papers found, 10 represented the best evidence to answer this clinical question. A manual search of the reference lists permitted us to include seven more articles. The authors, journal, date, country of publication, study type, group studied, relevant outcomes and results of these papers are given.

We conclude that, on the whole, the 23 retrieved studies clearly support the use of stereotactic ablative therapy rather than RF in patients suffering from primary NSCLC unfit for surgery. Indeed, stereotactic ablative therapy offered a 5-year local control rate varying between 83 and 89.5%, whereas the local control rate after RF ranges from 58 to 68%, with a short follow-up of ∼18 months. Furthermore, both overall survival and cancer-specific survival were better with stereotactic ablative therapy, with a 3-year overall survival ranging from 38 to 84.7% and the 3-year cancer-specific survival from 64 to 88%, whereas the 3-year OS, only reported in two studies, ranged from 47 to 74% for RF. Moreover, the post-interventional morbidity was superior for RF ranging from 33 to 100% (mainly composed by pneumothorax), whereas radiation pneumonitis and rib fracture, ranging, respectively, from 3 to 38% and 1.6 to 4%, were the primary complications following stereotactic ablative therapy. Hence, the current evidence shows that stereotactic ablative therapy is a safe and effective procedure and should be proposed first to patients suffering from primary NSCLC unfit for surgery.

However, the published evidence is quite limited, mainly based on small studies of <100 patients. Moreover, so far there is no blind, prospective control, randomized study comparing these two techniques. Consequently, despite the encouragement of these preliminary results, they must be interpreted with caution.

Completion pneumonectomy for lung cancer treatment: early and long term outcomes

Conclusions: Completion pneumonectomy for lung cancer is a safe surgical procedure for the skilled surgeon though it has a relatively higher complications and the long-term survival is acceptable. (Source: Journal of Cardiothoracic Surgery)

Safety And Effectiveness Of Inhaled Medications Studied In Critically Ill Patients On Mechanical Ventilation

Essential medications can be delivered as inhaled drugs to critically ill patients in the Intensive Care Unit (ICU) who require mechanical ventilation to breathe. Aerosol drug delivery is highly complex, however, and if not done properly the medication will not reach the lungs and therapy will be ineffective... (Source: Health News from Medical News Today)

Update on acute respiratory illness associated with a new coronavirus

In two reports published in Eurosurveillance on 4 October 2012, the Health Protection Agency (HPA) confirms that since the first case of severe respiratory illness associated with a new type of coronavirus was reported on 22 September 2012, there have been no new, cases reported in the UK. The patient being treated in the UK with confirmed coronavirus infection continues to receive intensive care treatment in a London hospital. (Source: Health Protection Agency)

Swimming pool attendance and respiratory symptoms and allergies among Dutch children

Conclusions Measured trichloramine levels were comparable with other studies but lower than in an earlier Dutch study. Swimming pool attendance was not associated with respiratory symptoms. The association between sensitisation and swimming during the first 2 years of life suggests that early-life exposures might be important, although this needs further study. The interpretation of transient and chronic changes of CC16 and other inflammatory markers in relation to the pool environment and health impacts warrants further investigation. Detailed comparisons with other studies are limited as few studies have measured trichloramine levels. (Source: Occupational and Environmental Medicine)

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