scholarly journals Bevacizumab-induced esophageal pleural fistula during maintenance therapy without radiation in lung cancer

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ting Wang ◽  
Asmitananda Thakur ◽  
Baoqing Chen
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Septic Shock ◽  
Chest Pain ◽  
Stage Iv ◽  
Chest Tightness ◽  
Fatal Complication ◽  
Case Presentation ◽  
X Ray ◽  
Upper Gastrointestinal

Abstract Background Esophageal pleural fistula (EPF) is a rare but fatal complication associated with bevacizumab use; however, cases reports of EPF caused by bevacizumab have not been previously published. Case presentation A 66-year-old male patient diagnosed with stage IV lung adenocarcinoma on April 24, 2020 received 6 cycles of platinum-containing dual chemotherapy combined with bevacizumab followed by three cycles of bevacizumab monotherapy. Five days before admission, he experienced chest tightness, dyspnea, and right chest pain. Bed-side X-ray examination revealed a massive right hydrothorax, and food was found in the extracted pleural effusion. EPF was further confirmed by upper gastrointestinal radiography after oral administration of iohexol. The patient underwent jejunostomy as the distal esophagus could not be identified on gastroscopy, and eventually died of septic shock on January 16, 2021. Conclusions It is necessary to pay attention to EPF during bevacizumab use in patients with or without risk factors.

Differential diagnosis of hemoptysis

2021 ◽  
pp. 47-55
Author(s):  
Petr Arkadievich Ilyin
Keyword(s):  
Infectious Disease ◽  
Computed Tomography ◽  
Lung Cancer ◽  
Differential Diagnosis ◽  
Correct Interpretation ◽  
Diagnostic Investigation ◽  
Detailed History ◽  
X Ray ◽  
Chest X Ray ◽  
Upper Gastrointestinal

Blood expectoration or hemoptysis is the coughing up of sputum with blood from the larynx, bronchi or lungs. Hemoptysis is most often caused by diseases of the respiratory tract and lungs — bronchitis or pneumonia, as well as lung cancer, aspergilloma, tuberculosis, bronchiectasis, pulmonary embolism, etc. In the diagnostic investigation of the cause of hemoptysis, it is important to take a detailed history (in the case of an epidemiological history, a laboratory analysis of the secreted sputum for the detection of the causative agent of an infectious disease is necessary), to make the correct interpretation of the patient’s complaints and an assessment of the nature of the sputum (differential diagnosis with bleeding from the upper gastrointestinal tract). A chest X-ray is performed and, then, if indicated, computed tomography, bronchoscopy, and other studies are made. The article presents an algorithm for differential diagnostic investigation of hemoptysis in a patient

scholarly journals 1.2 Cm Lung Nodule Developed into Metastatic Lung Adenocarcinoma in Two Years in Patient Low Socioeconomic Status

2020 ◽  
Vol 2 (2) ◽  
pp. 1-2
Author(s):  
Mukesh Kumar ◽  
◽  
Fnu Sonia ◽  
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Socioeconomic Status ◽  
Lung Adenocarcinoma ◽  
Low Socioeconomic Status ◽  
Lung Nodule ◽  
Stage Iv ◽  
Metastatic Lung ◽  
Size Growth

Lung cancer is number one cause of cancer mortality in United States both in men and women. Lung cancer is uncommon in patients younger than 35 years with no smoking and family history. Malignancy from lung nodule depends on size, growth rate, borders, calcification and location. Appropriate follow up for lung nodules in older patient with risk factors has been well described in literature based on various researches. However there is very limited data regarding follow up and management of lung nodule in younger patient with risk factors. We describe a patient who was 30 year old when he presented with acute appendicitis and incidentally found to have lung nodule of 1.2 cm. It was decided that patient should follow up as an outpatient for lung nodule. As patient was uninsured with poor socioeconomic he never followed up as outpatient. After 2 years patient was diagnosed with stage IV lung adenocarcinoma and died shortly after. Guidelines should be used in the proper clinical context as a tool to help with patient management, though exceptions always exist. Some expert believe lung nodule between 8-30 mm in patient with poor follow-up due to socioeconomic status, psychological issues, or young age should get complete resection of nodule.

Topiramate-Induced Chest Pain: A Case Report

2018 ◽  
Vol 32 (2) ◽  
pp. 236-239 ◽  
Author(s):  
Jared L. Ostroff ◽  
Jessica N. LeClair (Barnet) ◽  
Marissa L. Ostroff ◽  
Corey S. Laskey
Keyword(s):  
Adverse Effect ◽  
Case Report ◽  
Chest Pain ◽  
Probability Scale ◽  
Case Presentation ◽  
X Ray ◽  
Chest X Ray ◽  
Basic Metabolic Panel ◽  
Complete Blood Counts ◽  
Electrocardiogram Ecg

Background: Topiramate, an anticonvulsant used for prophylaxis of migraines and epilepsy, is commonly associated with adverse effects of cognitive dulling and fatigue. Chest pain is a potential adverse effect that to our knowledge has not been reported with the use of topiramate. Case Presentation: We present the case of a 38-year-old female with a seizure disorder who experienced chest pain after the first dose of topiramate. On day 1, she presented to the emergency department, was admitted, and over the course of 3 days had a chest X-ray, electrocardiogram (ECG), and echocardiogram, and her vitals, basic metabolic panel, complete blood counts, troponin, and d-dimer levels were monitored. The chest pain improved when the topiramate was held. No identifiable causes of chest pain were apparent, other than the topiramate. Discussion: The Naranjo probability scale was utilized to determine the causality of topiramate. The resulting score of 3 indicates that it is possible that the chest pain was due to the topiramate. Conclusion: This report demonstrates an example of a patient who experienced chest pain possibly caused by the initiation of topiramate. The objective of this case report is to increase the awareness of chest pain as an adverse effect of topiramate.

scholarly journals Clinical Characteristics and Risk Factors of Lung Cancer-Associated Acute Ischemic Stroke

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Jiacai Lin ◽  
Siting Wu ◽  
Rui Xu ◽  
Qiang Shi ◽  
Chenglin Tian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Ischemic Stroke ◽  
Confidence Interval ◽  
Acute Ischemic Stroke ◽  
Survival Time ◽  
Clinical Characteristics ◽  
Area Under The Curve ◽  
Stage Iv ◽  
Neurological Deficits

Objective. To research the clinical characteristics and risk factors of lung cancer-associated acute ischemic stroke (LCA-AIS). Methods. Patients diagnosed with LCA-AIS, simple lung cancer, and simple AIS were enrolled. The primary information, laboratory results, tumor histopathology, neurological deficits, and survival time of the patients were collected and analyzed. Results. (1) In the LCA-AIS group, the pathology of 69.56% patients were adenocarcinoma, and the proportion of poorly differentiated patients was significantly more than that in moderately differentiated or highly differentiated. The number of stage IV lung cancer patients in the LCA-AIS group was significantly more common than in other stages. (2) 56.52% of patients with lung cancer were diagnosed before AIS, and the peak of AIS attack was 1–6 months after the diagnosis of lung cancer. (3) The independent risk factors of LCA-AIS were CYFRA-211 (OR 1.070; 95% confidence interval 1.005, 1.139; p=0.035), TT (OR 1.275; 95% confidence interval 1.089, 1.493; p=0.003), and Hct (OR 0.878; 95% confidence interval 0.779, 0.990; p=0.034), making ROC curve, suggesting the area under the curve is 0.871. (4) The neurological deficit of patients in the LCA-AIS group was similar to the simple AIS group and could not be identified by the severity of neurological deficits. (5) The median survival time of LCA-AIS group patients was five months (95% confidence interval 3.796, 6.204). There were statistical differences in survival time between LCA-AIS group and simple AIS group patients (p<0.001).Conclusions. The interaction between lung cancer and AIS may shorten patients’ life expectancy and worsen their quality of life.

scholarly journals Smoking is associated with pneumonia development in lung cancer patients

2020 ◽  
Author(s):  
Jung Won Heo ◽  
Chang Dong Yeo ◽  
Chan Kwon Park ◽  
Sung Kyoung Kim ◽  
Ju Sang Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Cancer Patients ◽  
Medical Center ◽  
Clinical Stage ◽  
Stage Iv ◽  
Ground Glass Opacity ◽  
Radiation Toxicity ◽  
Lung Cancer Patients ◽  
Independent Risk Factors

Abstract Background: Various host factors can promote pneumonia susceptibility of lung cancer patients. However, data about risk factors for pneumonia in lung cancer patients receiving active treatments such as chemotherapy, radiotherapy, and surgical intervention are limited. Thus, the purpose of this study was to identify risk factors for pneumonia development in lung cancer patients. Methods: The present study used a lung cancer cohort of the Catholic Medical Center at the Catholic University of Korea from January 2015 to December 2018. Pneumonia was defined by the presence of a new or progressive infiltration on chest imaging together with any of the following: new onset purulent sputum, change in character of chronic sputum, and fever. We ruled out noninfectious infiltration such as drug or radiation toxicity and hydrostatic pulmonary edema. We especially excluded those if computed tomography revealed sharp demarcation consolidation or ground glass opacity limited radiation field. Results: A total of 413 patients were enrolled in this study. Pneumonia occurred in 118 (28.6%) patients. The pneumonia group had significantly worse overall survival (OS) than the non -pneumonia group (456.7 ± 35.0 days vs. 813.4 ± 36.1 days, log rank p < 0.001). In patients with pneumonia, OS was shorter in ex-smokers and current smokers than in never smokers (592.0 ± 101.0 days vs. 737.0 ± 102.8 days vs. 1357.0 days, log rank p < 0.001). Age (hazard ratio [HR]: 1.046; 95% confidence interval [CI]: 1.019­–1.074; p = 0.001), clinical stage IV (HR: 1.759; 95% CI: 1.004–3.083; p = 0.048), neutropenia (HR: 2.620; 95% CI: 1.562–4.396; p < 0.001], and smoking (HR: 2.040; 95% CI: 1.100–3.784; p = 0.024) were independent risk factors of pneumonia development in lung cancer patients in multivariate analysis. In subgroup analysis for patients treated with chemotherapy, age (HR: 1.043; 95% CI: 1.012–1.074; p = 0.006), neutropenia (HR: 3.199; 95% CI: 1.826–5.605; p < 0.001), and smoking (HR: 2.125; 95% CI: 1.071–4.216; p = 0.031) were independent risk factors of pneumonia development. Conclusions: Smoking and neutropenia were risk factors affecting pneumonia development in the total group and subgroup of patients with lung cancer.

Risk factors for atrophic gastritis in the Japanese young and middle-aged: a study using double-contrast upper gastrointestinal barium X-ray radiography

2018 ◽  
Vol 36 (12) ◽  
pp. 706-711 ◽  
Author(s):  
Kimihiko Endo ◽  
Hiroshi Nakada ◽  
Yoshihito Kadota ◽  
Youichi Mizutani ◽  
Norihiro Shinkawa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrophic Gastritis ◽  
Middle Aged ◽  
Double Contrast ◽  
X Ray ◽  
Upper Gastrointestinal

scholarly journals Risk factors for esophagitis after hypofractionated palliative (chemo)radiotherapy for non-small cell lung cancer

2020 ◽  
Author(s):  
Carsten Nieder ◽  
Kristian S. Imingen ◽  
Bård Mannsåker ◽  
Rosalba Yobuta ◽  
Ellinor Haukland
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Stage Iv ◽  
Palliative Radiotherapy ◽  
Treatment Interruption ◽  
Small Cell ◽  
Oral Steroid ◽  
Small Cell Lung

Abstract Introduction: Esophagitis influences quality of life and might cause treatment interruption and hospitalization. Previous studies of risk factors focused on curative treatment for non-small cell lung cancer (NSCLC), which often involves concomitant chemoradiation (CRT). Given the uncertainty around extrapolation of dose constraints, we analyzed risk factors in patients treated with hypofractionated palliative regimens. Patients and Methods: A retrospective review of 106 patients treated with palliative radiotherapy or CRT between 2009 and 2017 was performed. Inclusion criteria: prescribed total dose 30-54 Gy, dose per fraction 2.5-4 Gy, esophageal dose >1 Gy. Uni- and multivariate analyses were performed in 97 eligible patients to identify predictive factors for acute esophagitis grade ≥1 (CTCAE 5.0). Results: Forty percent of patients were treated with 15 fractions of 2.8 Gy (42 Gy) and 28% also received chemotherapy according to the CONRAD study regimen (induction and concomitant Carboplatin/Vinorelbine) published by the Norwegian Lung Cancer Group. Thirty-four percent were treated with 10 fractions of 3 Gy. Stage IV NSCLC was present in 47%. Esophagus Dmax was 39 Gy (population median) and Dmean 15 Gy. Overall 31% of patients developed esophagitis (26% grade 2-3, no grade 4-5). Several dosimetric parameters correlated with the risk of esophagitis (Dmax, Dmean, D5cc, V20, V30, V35, V40). Dmax outperformed other dosimetric variables in multivariate analysis. Furthermore, concomitant chemotherapy significantly increased the risk of esophagitis, while oral steroid medication reduced it. In patients with Dmax ≥40 Gy a reduced Dmean (≤20 Gy) was beneficial.Conclusion: In order to reduce esophagitis after hypofractionated palliative treatment lower doses than those recommended in curative NSCLC settings are preferable. Besides esophageal dose, CRT is the main risk factor for esophagitis. Additional work is needed to confirm that steroids are able to modify the risk (or to rule out confounding effects of baseline variables not included in our database).

scholarly journals Successful treatment of gastric cancer after complete response of lung cancer by nivolumab: a case report

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Shunji Endo ◽  
Yoshinori Fujiwara ◽  
Koji Kurose ◽  
Masaharu Higashida ◽  
Hisako Kubota ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lung Cancer ◽  
Laparoscopic Gastrectomy ◽  
Cancer Recurrence ◽  
Stage Iv ◽  
Complete Response ◽  
Resected Specimen ◽  
Case Presentation ◽  
Stage Ia ◽  
Synchronous Gastric Cancer

Abstract Background Nivolumab is effective for gastric cancer and lung cancer, but complete response is rare. We experienced a case of synchronous gastric cancer and lung cancer who was treated by nivolumab and laparoscopic gastrectomy. Case presentation A 63-year-old male consulted our institution and was found to have gastric cancer cT1(SM)N0M0 Stage IA and lung cancer cT2N2M1(PUL) Stage IV. He received eight chemotherapy treatments plus radiation, but the lung disease remained progressive. Finally, he received nivolumab therapy and complete response of both cancers was obtained. The gastric cancer recurred, but was successfully treated by laparoscopic gastrectomy. The resected specimen revealed three lesions, each being pT1aN0M0 Stage IA. The primary gastric cancer seemed to have completely vanished without scarring. Conclusions This was thought to be a rare case of gastric cancer recurrence after complete response of gastric cancer and lung cancer to nivolumab.

scholarly journals Risk factors for esophagitis after hypofractionated palliative (chemo)radiotherapy for non-small cell lung cancer

2020 ◽  
Author(s):  
Carsten Nieder ◽  
Kristian S. Imingen ◽  
Bård Mannsåker ◽  
Rosalba Yobuta ◽  
Ellinor Haukland
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Stage Iv ◽  
Palliative Radiotherapy ◽  
Treatment Interruption ◽  
Small Cell ◽  
Oral Steroid ◽  
Small Cell Lung

Abstract Introduction Esophagitis influences quality of life and might cause treatment interruption and hospitalization. Previous studies of risk factors mainly related to curative treatment for non-small cell lung cancer (NSCLC), which often involves concomitant chemoradiation (CRT). Given the uncertainty around extrapolation of dose constraints, we analyzed risk factors in patients treated with hypofractionated palliative regimens. Patients and Methods A retrospective review of 106 patients treated with palliative radiotherapy or CRT between 2009 and 2017 was performed. Inclusion criteria: prescribed total dose 30-54 Gy, dose per fraction 2.5-4 Gy, esophageal dose >1 Gy. Uni- and multivariate analyses were performed in 97 eligible patients to identify predictive factors for acute esophagitis grade ≥1 (CTCAE 5.0). Results Forty percent of patients were treated with 15 fractions of 2.8 Gy (42 Gy) and 28% also received chemotherapy according to the CONRAD study regimen (induction and concomitant Carboplatin/Vinorelbine) published by the Norwegian Lung Cancer Group. Thirty-four percent were treated with 10 fractions of 3 Gy. Stage IV NSCLC was present in 47%. Esophagus Dmax was 39 Gy (population median) and Dmean 15 Gy. Overall 31% of patients developed esophagitis (26% grade 2-3, no grade 4-5). Several dosimetric parameters correlated with the risk of esophagitis (Dmax, Dmean, D5cc, V20, V30, V35, V40). Dmax outperformed other dosimetric variables in multivariate analysis. Furthermore, concomitant chemotherapy significantly increased the risk of esophagitis, while oral steroid medication reduced it. In patients with Dmax ≥40 Gy a reduced Dmean (≤20 Gy) was beneficial. Conclusion In order to reduce esophagitis after hypofractionated palliative treatment lower doses than those recommended in curative NSCLC settings are preferable. Besides esophageal dose, CRT is the main risk factor for esophagitis. Additional work is needed to confirm that steroids are able to modify the risk (or to rule out confounding effects of baseline variables not included in our database).

scholarly journals Smoking is associated with pneumonia development in lung cancer patients

2020 ◽  
Author(s):  
Jung Won Heo ◽  
Chang Dong Yeo ◽  
Chan Kwon Park ◽  
Sung Kyoung Kim ◽  
Ju Sang Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Cancer Patients ◽  
Medical Center ◽  
Clinical Stage ◽  
Stage Iv ◽  
Ground Glass Opacity ◽  
Radiation Toxicity ◽  
Lung Cancer Patients ◽  
Independent Risk Factors

Abstract Background: Various host factors can promote pneumonia susceptibility of lung cancer patients. However, data about risk factors for pneumonia in lung cancer patients receiving active treatments such as chemotherapy, radiotherapy, and surgical intervention are limited. Thus, the purpose of this study was to identify risk factors for pneumonia development in lung cancer patients. Methods: The present study used a lung cancer cohort of the Catholic Medical Center at the Catholic University of Korea from January 2015 to December 2018. Pneumonia was defined by the presence of a new or progressive infiltration on chest imaging together with any of the following: new onset purulent sputum, change in character of chronic sputum, and fever. We ruled out noninfectious infiltration such as drug or radiation toxicity and hydrostatic pulmonary edema. We especially excluded those if computed tomography revealed sharp demarcation consolidation or ground glass opacity limited radiation field. Results: A total of 413 patients were enrolled in this study. Pneumonia occurred in 118 (28.6%) patients. The pneumonia group had significantly worse overall survival (OS) than the non -pneumonia group (456.7 ± 35.0 days vs. 813.4 ± 36.1 days, log rank p < 0.001). In patients with pneumonia, OS was shorter in ex-smokers and current smokers than in never smokers (592.0 ± 101.0 days vs. 737.0 ± 102.8 days vs. 1357.0 days, log rank p < 0.001). Age (hazard ratio [HR]: 1.046; 95% confidence interval [CI]: 1.019­–1.074; p = 0.001), clinical stage IV (HR: 1.759; 95% CI: 1.004–3.083; p = 0.048), neutropenia (HR: 2.620; 95% CI: 1.562–4.396; p < 0.001], and smoking (HR: 2.040; 95% CI: 1.100–3.784; p = 0.024) were independent risk factors of pneumonia development in lung cancer patients in multivariate analysis. In subgroup analysis for patients treated with chemotherapy, age (HR: 1.043; 95% CI: 1.012–1.074; p = 0.006), neutropenia (HR: 3.199; 95% CI: 1.826–5.605; p < 0.001), and smoking (HR: 2.125; 95% CI: 1.071–4.216; p = 0.031) were independent risk factors of pneumonia development. Conclusions: Smoking and neutropenia were risk factors affecting pneumonia development in the total group and subgroup of patients with lung cancer.

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