Green Gate, Bd. Tudor Vladimirescu nr. We present a case of a solitary pulmonary nodule discovered in a patient with resected rectal carcinoma, irradiated and chemotreated controlled disease. The initial management was CT follow-up; because the nodule dimensions cancer more aggressive after chemo, the surgical resection was performed: wedge pulmonary resection and lymphadenectomy.
The pathological diagnosis was stage IA lung adenocarcinoma. A newly appeared solitary pulmonary nodule in a patient with a history of malignancy could be a metastasis, however could also be a second primary cancer - lung cancer.
Wedge pulmonary resection and lymphadenectomy is an appropriate surgical management for stage IA lung cancer in selected patients; this approach impose close follow-up for early detection of a local relapse. Diagnosticul anatomopatologic a fost de adenocarcinom pulmonar stadiul IA. Solitary pulmonary nodules are usually asymptomatic and most frequently conceal lung cancer 2. Cancer risk increases with age, male gender and a smoking history.
The nonneoplastic benign nodules are most commonly due to granulomas from prior infections and in our country, in a significant number of patients, they are caused by Mycobacterium tuberculosis 4.
Solitary pulmonary nodules in patients with a history of malignancy other than lung cancer have a higher chance of being metastatic. Still, due diligence of a solitary pulmonary nodule is to treat it as an indeterminate nodule, with the possibility of being lung cancer more aggressive after chemo, metastasis or a benign lesion 2,5.
CT scan follow-up of the pulmonary nodule at 6 months revealed growth from 1.
(PDF) Modelling of tumour repopulation after chemotherapy | Loredana Marcu - asspub.ro
Figure 1. Native CT scan image of a left solitary pulmonary nodule presented case Figure 2. Contrast-enhanced CT scan image of the same solitary pulmonary nodule as in figure 1; the well-deligneated contour and the geographic area of endemic tuberculosis are benign criteria Results Following completion of clinical and paraclinical investigations and maintenance of her arterial hypertension we proceeded to surgery, performing a nonanatomic resection of the left superior lobe.
The intraoperative frozen section histopathology showed carcinomatous infiltration without being able to distinguish a histological origin. The final paraffin embedded histological sections and immunohistochemical tests confirmed lung cancer: a poorly differentiated G3 adenocarcinoma, without lymph node metastasis, pathological stage IA, pT1bN0M0. The postoperative recovery was uneventfull, facilitated following a nonanatomical resection.
The patient was forwarded towards the oncology ward.
Romania Cancer Oranisations and Resources | CancerIndex
The therapeutical decision was follow-up. Discussion Figure 3. Spiculated aspect of the nodule; this aspect and the upper lobe localization, the history of malignancy, age over 35 years, dimension over 2 cm and growth in enterobius vermicularis shqip summarize the malignant characteristics of the solitary pulmonary nodule 6 The prevalence of solitary pulmonary nodules in the general population is unknown.
Higher rates are found in the elderly population, among smokers, in patients cancer more aggressive after chemo nonthoracic neoplasms and in patients who are at risk for mycobacterial or fungal infections 2,6. In Romania, there is no protocol for screening solitary pulmonary nodules or lung cancer.
Owing to its superior resolution, high-resolution CT is a sensitive technique for identifying pulmonary nodules 4. The American College of Chest Physicians developed an evidence-based clinical guideline to help establish the probability of malignancy of a cancer more aggressive after chemo nodule 1. Predictors of malignancy include: older age, current or past smoking, history of extrathoracic cancer in the last 5 years, nodule diameter, spiculation and upper lobe location 2,5.
PET-CT is a noninvasive functional imaging modality used for diagnosis, staging and evaluation of treatment response of lung cancer. PET-CT is not indicated for nodules that are under 0. For lesions that are located in the center of the lung, we can use bronchoscopy with fluoroscopic guidance 9.
For cancer more aggressive after chemo situated in the outer third of the lung, transthoracic needle biopsy can help obtain a diagnosis.
With a higher number of biopsy samples taken and a good on-site cytopathologyst, one may obtain a higher rate of positive results However, the imaging characteristics figures 1, 2, 3 classified it as an indeterminate nodule, and therefore compelled us to also consider lung cancer as a possibility. Our thoracic surgery clinic in National Institute of Oncology proposed in a protocol for solitary nodule based on the existence of a CT scan available, 1.
American College of Chest Physicians. Evaluation of patients with pulmonary nodules: when is it lung cancer?
Solitary Pulmonary Nodule. Shileds TW.
Pathology of Carcinoma of the Lung. Nodulul pulmonar solitar nutrește cum să mănânce cazuri operate. Chirurgia, 2 : Cancerul bronhopulmonar. In: Popescu I, ed. Tratat de Chirurgie, Horvat T ed, Vol.
Horvat T, Nicodin A. Cancer more aggressive after chemo chirurgical in cancerul bronhopulmonar. The patient agreed to undergo our local protocol for a solitary pulmonary nodule: surveillance and CT scan follow-up after 6 months revealed a growth of 1cm in diameter.
Considering she had multiple predictors of malignancy: growth over time, extra thoracic cancer in cancer more aggressive after chemo last 5 years, the nodule was in an upper lobe of the left lungwe decided that the best conduct is surgery.
Conclusions A newly appeared solitary pulmonary nodule in a patient with a history of malignancy could be a metastasis, however could also be a second primary cancer - lung cancer. Wedge pulmonary resection and lymphadenectomy is an appropriate surgical management for stage IA lung cancer in selected patients; this approach imposes close follow-up for early detection of a local relapse.
Editura Universul, Bucuresti, ; Investigation and management of the indeterminate pulmonary nodule. Churchill-Livingstone, London, Radiologic Evaluation of Lung Cancer. Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis.
Solitary pulmonary nodule.
Aggressive variants of prostate cancer - Are we ready to apply specific treatment right now? Cancer Treat Rev. In most cases, prostate cancer essentially depends on androgen receptor signaling axis, even in castration-resistant setting, and hence may be targeted by second generation hormonal therapy. However, a subset of patients bears androgen-independent cancer biology with a short-term response to hormonal treatment, early and extensive visceral metastases, low PSA levels and poor outcomes. Identification and specific management of these rapidly fatal malignancies is of an unmet medical need since their classification and utilized therapeutic regimens vary significantly.
Updated: Apr 30,accessed at Nov 17, Until trastuzumab erathe HER-2 overexpression was a negative prognostic factor and lead to a poor treatment outcome.
Modern treatment is represented by combination of chemotherapy and therapies addressed to HER-2 - among classic trastuzumab, lapatinib, TDM -1 trastuzumab etamsine and pertuzumab, new options arise - neoadjuvant pertuzumab, cancer more aggressive after chemo a new potential treatment with a another TKI tyrosine kinase inhibitor - Neratinib.
In our country there is only trastuzumab available after submission of documents and approval from National Health Insurance Housewith 2 routes of administration IV-intravenous and SC- subcutanein adjuvant, metastatic and recently in neoadjuvant setting. For Romania, breast cancer is still a major problem, taking in account the lack of a consistent national health screening program, late stage diagnosis and high mortality rates. Data regarding safety profile are also shown especially concerning cardiac toxicity.
Considering that efficient screening programs and multidisciplinary teams are available, by using neoadjuvant treatment, best survival and esthetic results are obtained; this option will be more detailed. A mention will be made for the surgical interventions needed.
Cancer aggressive radiation
Some treatment options are only available in certain countries. As always recommended by guidelines, patient case must be discussed in multidisciplinary team and, if possible, after evaluation, and if needed and available, patient should be encouraged to participate in a clinical trial.
A possible evaluation of the patient before any course of treatment in a multidisciplinary team brings more cancer more aggressive after chemo for the patient. Of course, neoadjuvant treatment is in many cases cancer more aggressive after chemo and a close collaboration with the surgeon, radiotherapist, anatomopathologist, interventional radiologist if taking in account image guided clip insertion harvests best results.
The Phare study did not manage to demonstrate the non-inferiority of Trastuzumab administration for 6 month instead cancer more aggressive after chemo 12 month 8. None of the guidelines recommend in neoadjuvant setting the association of trastuzumab and lapatinib 1,2. The studies which showed the benefits of double HER-2 therapy in neoadjuvant treatment are NeoSpere almost double complete pathologic response - pCR vs.
Although severe cardiac events like congestive heart failure are rare and usually reversible after stopping the treatment, there are studies which try to asses new markers that reflect earlier the dysfunction of left ventricle.
Association of concomitant trastuzumab and taxane is safe and beneficial when compared to subsequent treatment As expected, after neoadjuvant chemotherapy it is very possible that the tumor would be difficult to be found by the surgeon at the moment of excision. Usual option in this case would be placing, under guided imaging, of clips before chemotherapy treatment, which will facilitate correct conservative removal of tumor afterwards. Also at the moment of surgery, after the removal of the tumor, another set of toxine coquelucheuse clips may be placed, which will facilitate the radiotherapy doctor in planning an efficient localized treatment.
Metastatic setting Pertuzumab is approved in combination with trastuzumab and chemotherapy as a first-line therapy for metastatic HERpositive breast cancer patients In patients who have progression after initial therapy, anti-HER-2 therapy should be continued by either switching to TDM-1 preffered 9 breast cancer or continuing trastuzumab and changing cytotoxic therapy or switching to lapatinib plus capecitabine 2.
Patients who received T-DM1 treatment lived cancer more aggressive after chemo 6 months longer compared with patients receiving lapatinib plus capecitabine, the previous standard cancer more aggressive after chemo care median overall survival There are ongoing studies investigating TDM-1 in adjuvant setting.
There was a significant improvement in disease-free survival DFS with an absolute benefit of 2. Of great interest, patients with HR-positive breast cancer had even greater benefit from neratinib 4. There was no protocol-mandated antidiarrheal prophylaxis in place.
Like lapatinib, neratinib is orally available, and pharmacokinetic studies have suggested that once-daily dosing is acceptable. Senkus, S. Kyriakides, S. Ohno, F. Penault-Llorca, P.
Poortmans, E. Rutgers, S.
Breast cancer: care advices for the skin affected by the oncology treatment effects PDF Modelling of tumour repopulation after chemotherapy Loredana Marcu - bebe-strumf.
Nccn Invasive Breast Cancer ver 3. Genentech, Inc. Efficacy and safety of neoadjuvant pertuzumab and trastuzumab in women with locally advanced, inflammatory, or early HER-2positive breast cancer NeoSphere : a randomised multicentre, open-label, phase 2 trial.
Lancet Oncol. Ann Oncol. Fluorouracil, epirubicin, and cyclophosphamide with either docetaxel or vinorelbine, with or without trastuzumab, as adjuvant treatments of breast cancer: final results of the FinHer Trial.
Slamon D, Pegram M.
For instance, hair loss, which is one of the major concerns for some patients, such as a young lady with BM of breast cancer, is a less frequently encountered problem with SRS than WBRT as a result of the smaller irradiated field size and focalized dose distribution Figure 2.
Rationale for trastuzumab Herceptin in adjuvant breast cancer trials. Semin Oncol. Randomized phase II trial of the efficacy and safety of trastuzumab combined with docetaxel in patients with human epidermal growth factor receptor cancer more aggressive after chemo metastatic breast cancer administered as first-line treatment: the M study group.
J Clin Oncol. N Engl J Med. Geyer, M. Neratinib after adjuvant chemotherapy and trastuzumab in HERpositive early breast cancer: Primary analysis at 2 years of a phase 3, randomized, placebo-controlled trial ExteNET.
Abstract For a very long period of time, the only treatment option available for fit patients was chemotherapy with Docetaxel associated with Prednisone. The recent approval in our country of new therapies like Abiraterone, will offer new treatment options which will enhance disease control and safety profile for selected patients. We have reviewed over 50 articles published in international journals, to offer an extensive view of therapeutic agents used in the management of CRPC, from chemotherapy agents, hormonal treatment, to new androgen receptor inhibitors, immunotherapy and prevention and palliative treatment of bone metastasis and SRE skeletal related events with bisphosphonates, radiotherapy and radiopharmaceuticals.
The average age at diagnosis is 71 years.