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Revisions to the TNM Staging of Non-Small Cell Lung Cancer: Rationale, Clinicoradiologic Implications, and Persistent Limitations.

The International Association for the Study of Lung Cancer proposed changes to the 7th edition of the Tumor, Node, and Metastasis (TNM) staging manual of non-small cell lung cancer (NSCLC) to improve the prognostic relevance of its descriptors.

These changes include the subdivision of T1 and T2 disease according to size cut points; reassignment of the T and M categories of same-lobe, ipsilateral, and contralateral malignant pulmonary nodules; reassignment of pleural disease to metastatic disease; and introduction of intra- and extrathoracic metastatic disease. Because of movement between T and M descriptors and resultant stage migration, new stage groupings that contain TNM subsets different from those of the previous edition were created. The new staging classification was created on the basis of statistical analysis of a large international database of cases of NSCLC. The new classification has many advantages; however, limitations remain.

Problems with routine radiologic staging of NSCLC have not been addressed, the varied survival rates for patients with the different histologic subtypes is not reflected, the new classification is not compatible with the previous system, and application of treatment algorithms on the basis of evidence from the previous edition is less clear. © RSNA, 2011.

[Treatment of small-cell lung cancer.]

Treatment of small cell lung cancer (SCLC) is based on the stage of disease. While combination of chemo- and radiotherapy preferably as concomitant chemoradiotherapy represents standard treatment in patients with locally advanced tumors (UICC stage I-III), patients with metastatic disease (stage IV) should be treated with an established platinum based chemotherapy regimen. After chemotherapy and in case of an achieved tumor response treatment should be completed by an adjuvant radiation of the brain in patients with adequate performance status. In patients with a very early stage of disease without involvement of lymph node metastasis a surgical approach in combination with an adjuvant chemotherapy can be discussed. In patients with relapsed tumors second line therapies like the topoisomerase I inhibitor Topotecan have proven efficacy.

Up to now neither molecular targeted therapies nor cytotoxic or immunological maintenance strategies have provided any benefit to patients with SCLC.

Survival of pulmonary cancer patients treated surgically.

The aim of the study is to investigate the survival of patients treated surgically for lung cancer.

151cases treated during the years 2000-03 are reviewed. The average age was 56.6 ± 9.9 years (from 19 to 83 years old).

The histological type was: 80 (53%) Squamous-cell carcinoma, 27 (17.9%) adenocarcinoma, 10 (6.6%) bronchioalveolar carcinoma, 5 (3.3%) small-cell carcinoma, and others - 29 (19.2%). The post-surgical stage was often advanced; 92 (63%) of the patients were at stage IIIA. With 5 (3.3% of total operated cases) of the patients had limited disease of SCLC. Most of the patients had lobectomy (64.9%) and pneumonectomy (16.6%) Performed. Neoadjuvant treatment was carried out on 37 (24.5%) of the patients. Only half of the patients were alive after 1 year, and 11.9% after 2 years of the postoperative period. Survival was highly significantly better in patients with an early stage of the disease. Survival resulted decreasingly with the extent of the surgical intervention; lower survival resulted in the patients treated with pneumonectomy, but this was not statistically significant. Significantly better results of survival were seen in correlation with higher values of pre-surgical FEV1. There are significant differences in survival (p < 0.05) in relation to diagnosis, group-age, histology, and highly significant differences (p < 0.01) regarding definition N, M, stage of disease, FEV1. There were no significant differences in the survival of patients according to sex, type of intervention, site of intervention, FVC, definition T.

Key words: Pulmonary carcinoma, surgery, survival

Omalizumab: Anti-IgE Therapy in Allergy.

Omalizumab is a humanized, monoclonal anti-IgE antibody that binds specifically to circulating IgE molecules, thus interrupting the allergic cascade. Omalizumab has been shown to be highly effective in treating children and adults with moderate to severe allergic asthma.

Beyond this indication, the mode of action itself suggests that omalizumab is not only an antiasthmatic drug but also a promising therapeutic option for various allergic conditions, including allergic rhinitis, food allergy, urticaria, allergic bronchopulmonary aspergillosis, insect hypersensitivity, and atopic dermatitis. However, data from double-blind, placebo-controlled clinical trials are only available for allergic rhinitis and moderate to severe bronchial asthma.

The aim of this review is to discuss the current clinical data as well as possible further indications of omalizumab treatment.

Misuse of Respiratory Inhalers in Hospitalized Patients with Asthma or COPD.

Patients are asked to assume greater responsibility for care, including use of medications, during transitions from hospital to home. Unfortunately, medications dispensed via respiratory inhalers to patients with asthma or chronic obstructive pulmonary disease (COPD) can be difficult to use.

OBJECTIVES: To examine rates of inhaler misuse and to determine if patients with asthma or COPD differed in their ability to learn how to use inhalers correctly.

DESIGN: A cross-sectional and pre/post intervention study at two urban academic hospitals.

PARTICIPANTS: Hospitalized patients with asthma or COPD.

INTERVENTION: A subset of participants received instruction about the correct use of respiratory inhalers.

MAIN MEASURES: Use of metered dose inhaler (MDI) and Diskus® devices was assessed using checklists. Misuse and mastery of each device were defined as <75% and 100% of steps correct, respectively. Insufficient vision was defined as worse than 20/50 in both eyes. Less-than adequate health literacy was defined as a score of <23/36 on The Short Test of Functional Health Literacy in Adults (S-TOFHLA).

KEY RESULTS: One-hundred participants were enrolled (COPD n = 40; asthma n = 60). Overall, misuse was common (86% MDI, 71% Diskus®), and rates of inhaler misuse for participants with COPD versus asthma were similar. Participants with COPD versus asthma were twice as likely to have insufficient vision (43% vs. 20%, p = 0.02) and three-times as likely to have less-than- adequate health literacy (61% vs. 19%, p = 0.001). Participants with insufficient vision were more likely to misuse Diskus® devices (95% vs. 61%, p = 0.004). All participants (100%) were able to achieve mastery for both MDI and Diskus® devices.

CONCLUSIONS: Inhaler misuse is common, but correctable in hospitalized patients with COPD or asthma. Hospitals should implement a program to assess and teach appropriate inhaler technique that can overcome barriers to patient self-management, including insufficient vision, during transitions from hospital to home.

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