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OBJECTIVE: A risk of tumor seeding after percutaneous needle biopsy has been reported in various organs, including the lung. This study retrospectively evaluated the proportion of ipsilateral pleural recurrence after computed tomography-guided needle biopsy (CTNB) in p-stage I lung cancer patients.

METHODS: Of the 321 patients diagnosed with p-stage I lung cancer, 124 underwent CTNB before surgery, while 197 underwent non-CTNB procedures, including bronchoscopic biopsy in 188 patients and thoracoscopic wedge resection in 9. These patients were retrospectively analyzed.

RESULTS: While the tumor size was significantly larger in the non-CTNB group (25±9 mm) in comparison to the CTNB group (19±9 mm) (p<0.001), percentage of pleural, vascular, or lymphatic invasions were comparable between the two groups. Eight patients developed ipsilateral pleural recurrences, one (1%) in the CTNB group, and 7 (4%) in the non-CTNB group. Of these, 3 patients developed pleural recurrence only at first, 1 (1%) in the CTNB group, and 2 (1%) in the non-CTNB group. The differences in the proportions of these pleural recurrences between the 2 groups were not significant. Subgroup analyses by baseline characteristics such as tumor size, pT stage, or microscopic pleural invasion, showed that proportions of pleural recurrences in CTNB group were not high compared with non-CTNB group in each subgroup. Analysis of progression-free survival showed that recurrences in CTNB were not high compared with non-CTNB.

CONCLUSIONS: The pleural recurrence was not significantly increased after CTNB in p-stage I lung cancer patients in this particular study.

Although neoadjuvant chemotherapy (NCT) is widely used, it is not clear which subgroup of locally advanced non-small-cell lung cancer (NSCLC) patients should be treated with this approach, and if a particular benefit associated with NCT exists. In this study, we aimed to investigate the potential correlates of benefit from NCT in patients with NSCLC.

METHODS: All randomized clinical trials (RCTs) utilizing a NCT arm (without radiotherapy) versus a control arm before surgery were included for metaregression analysis. All regression analyses were weighed for trial size. Separate analyses were conducted for trials recruiting patients with different stages of disease. Previously published measures of treatment efficacy were used for the purpose of this study, regardless of being published in full text or abstract form.

RESULTS: A total of 14 RCTs, consisting of 3,615 patients, were selected. Histology, stage, various characteristics of the NCT protocol, and different trial features including trial quality score were not associated with the benefit of NCT. However, in trials of stage 3 disease only, there was a greater benefit in terms of reduction in mortality from NCT, if protocols with three chemotherapeutics were used (B = 0.18, t = 5.25, P = 0.006).

CONCLUSIONS: We think that patients with stage 3 NSCLC are served better with NCT before surgery if protocols with three chemotherapy agents or equally effective combinations are used. In addition, the effect of neoadjuvant chemotherapy is consistent with regard to disease and patient characteristics. This finding should be tested in future RCTs or individual patient data meta-analyses.

The optimal strategy to achieve palliation of malignant pleural effusions (MPEs) is unknown. This multi-institutional, prospective, randomized trial compares 2 established methods for controlling symptomatic unilateral MPEs. Patients with unilateral MPEs were randomized to either daily tunneled catheter drainage (TCD) or bedside talc pleurodesis (TP).

This trial is patterned after a previous randomized trial that showed that bedside TP was equivalent to thoracoscopic TP (CALGB 9334). The primary end point of the current study was combined success: consistent/reliable drainage/pleurodesis, lung expansion, and 30-day survival. A secondary end point, survival with effusion control, was added retrospectively.

This trial randomized 57 patients who were similar in terms of age (62 years), active chemotherapy (28%), and histologic diagnosis (lung, 63%; breast, 12%; other/unknown cancers, 25%) to either bedside TP or TCD. Combined success was higher with TCD (62%) than with TP (46%; odds ratio, 5.0; P = .064). Multivariate regression analysis revealed that patients treated with TCD had better 30-day activity without dyspnea scores (8.7 vs. 5.9; P = .036), especially in the subgroup with impaired expansion (9.1 vs. 4.6; P = .042). Patients who underwent TCD had better survival with effusion control at 30 days compared with those who underwent TP (82% vs. 52%, respectively; P = .024).

In this prospective randomized trial, TCD achieved superior palliation of unilateral MPEs than TP, particularly in patients with trapped lungs.

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Bronchodilator Use and the Risk of Arrhythmia in COPD: Part 1: Saskatchewan Cohort Study.

Chest. 2012 Aug 1;142(2):298-304

Authors: Wilchesky M, Ernst P, Brophy JM, Platt RW, Suissa S

Abstract
BACKGROUND: Bronchodilators are first-line therapy for COPD. There is some evidence that they may increase the risk of cardiac arrhythmias.
METHODS: We used the computerized health-care databases of the Province of Saskatchewan, Canada, to identify a cohort of subjects with COPD, aged ≥ 55 years, between 1990 and 1999. The subjects were followed until December 2003 for a hospital admission for, or death from, arrhythmia. A nested case-control approach was used to match each arrhythmia case on age, sex, and calendar time to 20 control subjects selected from the corresponding cohort risk set. Conditional logistic regression was used to estimate the rate ratio (RR) of arrhythmia associated with new use of bronchodilators, adjusted for disease severity and comorbidity.
RESULTS: The cohort included 6,018 patients with COPD in whom 469 arrhythmia cases occurred, including 56 deaths, for an overall rate of 1.37 arrhythmias per 100 per year. The rate of arrhythmia was elevated with the new use of ipratropium (RR, 2.4; 95% CI, 1.4-4.0) and of long-acting β-agonists (LABAs) (RR, 4.5; 95% CI, 1.4-14.4). It was not elevated with new use of short-acting β-agonists (RR, 0.9; 95% CI, 0.5-1.6) or methylxanthines (RR, 1.6; 95% CI, 0.7-3.7).
CONCLUSIONS: The new use of bronchodilators, particularly ipratropium and LABAs, may increase the risk of cardiac arrhythmias in patients with COPD. Although these results raise concerns regarding LABAs, they were based on few cases and require confirmation in larger cohorts.From the Donald Berman Maimonides Geriatric Centre (Dr Wilchesky), the Department of Medicine (Drs Ernst, Brophy, and Suissa), the Department of Epidemiology, Biostatistics and Occupational Health (Drs Brophy, Platt, and Suissa), the Division of Clinical Epidemiology, McGill University Health Centre (Dr Brophy), and the Department of Pediatrics (Dr Platt), McGill University; and the Centre for Clinical Epidemiology (Drs Wilchesky, Ernst, and Suissa), Jewish General Hospital-Lady Davis Research Institute, Montreal, QC, Canada.Correspondence to: Samy Suissa PhD, Centre for Clinical Epidemiology, Jewish General Hospital-Lady Davis Research Institute, 3755 Côte Ste-Catherine, H-461, Montreal, QC H3T 1E2, Canada; e-mail: samy.suissa@mcgill.caAuthor contributions: Dr Wilchesky had full access to all of the data in the study and takes responsibility for its integrity and the accuracy of the data analyses. Dr Wilchesky: contributed to the study design, data analysis and interpretation, and writing manuscript. Dr Ernst: contributed to funding acquisition, study design, data interpretation, and writing of the manuscript. Dr Brophy: contributed to study design, data interpretation, and writing of the manuscript. Dr Platt: contributed to study design, data interpretation, and writing of the manuscript. Dr Suissa: contributed to funding acquisition, study design, data interpretation, writing of the manuscript, and acts as guarantor of this entire manuscript. Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Ernst has received speaker fees and has attended advisory boards for Astra-Zeneca; Boehringer Ingelheim GmbH; GlaxoSmithKline plc; Merck & Co, Inc; Novartis AG; and Nycomed GmbH. Dr Suissa has received research grants from AstraZeneca, Boehringer Ingelheim GmbH, and GlaxoSmithKline plc and has participated in advisory board meetings and as speaker for AstraZeneca; Boehringer Ingelheim GmbH; Forest Laboratories, Inc; GlaxoSmithKline plc; Merck & Co, Inc; Novartis AG; Nycomed GmbH; and Pfizer, Inc. Drs Wilchesky, Platt, and Brophy have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article. Role of sponsors: This study is based on de-identified data provided by the Saskatchewan Department of Health. The interpretation and conclusions contained herein do not necessarily represent those of the Government of Saskatchewan or the Saskatchewan Department of Health. The funding institutes were not involved in the design or conduct of the study; the collection, management, analysis, or interpretation of the data; or the preparation, review, or approval of the manuscript. For editorial comment see page 271 For related article see page 305Funding/Support: This study was funded by a grant from the Canadian Institutes for Health Research (CIHR) and from the Canadian Foundation for Innovation (CFI) that permitted data acquisition. Dr Wilchesky was the recipient of a CIHR Doctoral Research Award. Dr Suissa is the recipient of the James McGill Professorship award. Drs Brophy and Platt are Research Scholars of le Fonds de Recherche en Santé du Québec. Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

PMID: 22871755 [PubMed - in process]