Maciej Dancewicz

Quantitative analysis of free- circulating DNA in plasma of patients with resectable NSCLC

Objective: Minute amounts of free-circulating DNA are present in plasma of healthy individuals, whereas its increased concentration was observed in patients with malignant tumors including non-small cell lung cancer (NSCLC). This study aimed at demonstrating the potential usefulness of plasma DNA concentration monitoring in NSCLC patients for therapy effectiveness assessment throughout the treatment and follow-up period. Methods: Plasma DNA concentration was assessed in 50 NSCLC patients (stage I – IIIA) prior and following the radical treatment using real-time quantitative PCR method. 10 orthopedic patient undergoing hip joint surgery and 40 healthy volunteers comprised control groups. Results: NSCLC patients (8.02 ng/ml) demonstrated significantly higher mean plasma DNA concentration with respect to healthy controls (2.27 ng/ml; p < 0.0000). Drastic increase in plasma DNA levels up to mean 68.74 ng/ml was detected a week after primary tumor resection. Still, similar phenomenon was observed in patients subjected to orthopedic surgical treatment (from 3.00 to 28.38 ng/ml, p < 0.0015). Most resected NSCLC patients with no disease recurrence during 3- to 6-month follow-up demonstrated reduced plasma DNA levels (mean 2.77 ng/ml) with respect to their presurgical values, whereas in relapsed subjects plasma DNA levels were significant higher. Conclusion: Free-circulating DNA concentration in plasma was significantly higher in NSCLC patients versus healthy controls. Its drastic increase following radical NSCLC treatment was most likely due to the surgical trauma. Importantly, the kinetics of plasma free-circulating DNA seems to be a promising marker of long-term effects of radical surgery in NSCLC.

Pneumonectomy due to lung cancer results in a more pronounced activation of coagulation system than lobectomy.

UNLABELLED Surgical treatment of lung cancer is associated with an elevated risk of thrombo-embolic complications. The question is whether the extent of pulmonary resection influences the concentration of serum coagulation system proteins. OBJECTIVE This study aims to compare the blood coagulation activation parameters among patients undergoing pneumonectomy and lobectomy due to primary lung cancer. METHODS A prospective study was carried out in 40 patients. Of whom, 30 underwent lobectomy and 10 treated with pneumonectomy. Serum concentrations of tissue factor (TF), tissue factor pathway inhibitor (TFPI), tissue factor pathway inhibitor-activated factor X complex (TFPI/Xa), thrombin-antithrombin complex (TAT), L-selectin, E-selectin and P-selectin were measured on the first and seventh postoperative days. RESULTS On the first postoperative day, the results of selected proteins concentrations were similar in both groups. However, on the seventh postoperative day, significantly higher concentrations of TF, TAT complex and E-selectin were found in patients who underwent pneumonectomy (median values: TF: 182.4 pg ml(-1) vs 116.6 pg ml(-1), P=0.031; TAT: 6.2 mg ml(-1) vs 3.9 mg ml(-1), P=0.048; E-selectin 40.24 ng ml(-1) vs 26.54 ng ml(-1), P=0.049). CONCLUSIONS Pneumonectomy was associated with significantly higher activation of coagulation system on the seventh postoperative day than lobectomy. TAT complex, TF and E-selectin are promising markers of extensive postoperative activation of coagulation and efficacy of antithrombotic prophylaxis.

Carcinome mucoépidermoïde chez une femme de 20 ans

INTRODUCTION Muco-epidermoid carcinoma is a rare primary malignancy of the tracheo-bronchial tree. It presents mainly in young patients and is located in the proximal large airways. The tumour is composed of epithelial cells, mucus-secreting cells and cells of an intermediate type identical to those occurring in the salivary glands. There is no standard treatment for these tumours. The prognosis depends on the histological grade and may be poor, particularly in older subjects. CASE REPORT We report the case of a 20-year-old woman with a tumour in the intermediate bronchus. Mechanical resection of the tumour was performed with the tip of the rigid bronchoscope. Histological examination revealed muco-epidermoid carcinoma. We performed a right middle and lower sleeve lobectomy with mediastinal lymphadenectomy. The patient remains in remission after 12 months follow-up. CONCLUSIONS Muco-epidermoid carcinoma is a rare primary malignancy of the tracheobronchial tree which is difficult to diagnose by limited biopsy. The prognosis is variable and depends upon the histological type. Owing to its rare occurrence the possibility of a primary muco-epidermoid carcinoma of the salivary glands with pulmonary metastases should be considered.

Time-Dependent Changes of Plasma Concentrations of Angiopoietins, Vascular Endothelial Growth Factor, and Soluble Forms of Their Receptors in Nonsmall Cell Lung Cancer Patients Following Surgical Resection

Even when patients with nonsmall cell lung cancer undergo surgical resection at an early stage, recurrent disease often impairs the clinical outcome. There are numerous causes potentially responsible for a relapse of the disease, one of them being extensive angiogenesis. The balance of at least two systems, VEGF VEGFR and Ang Tie, regulates vessel formation. The aim of this study was to determine the impact of surgery on the plasma levels of the main angiogenic factors during the first month after surgery in nonsmall cell lung cancer patients. The study group consisted of 37 patients with stage I nonsmall cell lung cancer. Plasma concentrations of Ang1, Ang2, sTie2, VEGF, and sVEGF R1 were evaluated by ELISA three times: before surgical resection and on postoperative days 7 and 30. The median of Ang2 and VEGF concentrations increased on postoperative day 7 and decreased on day 30. On the other hand, the concentration of sTie2 decreased on the 7th day after resection and did not change statistically later on. The concentrations of Ang1 and sVEGF R1 did not change after the surgery. Lung cancer resection results in proangiogenic plasma protein changes that may stimulate tumor recurrences and metastases after early resection.

Results of surgical treatment of primary lung cancer with synchronous brain metastases.

Introduction The surgical treatment of non-small cell lung cancer (NSCLC) with synchronous brain matastases is more effective than other therapeutic options, but this management is still controversial. The aim of the study The aim of the study was to evaluate the survival of patients after pulmonary resection NSCLC preceded by resection of brain metastases. Material and methods From 2007 to 2012, 645 patients underwent pulmonary resection for NSCLC at our department. In 25 of them (3.87%) thoracic surgery was preceded by resection of a single brain metastasis of NSCLC and a PET CT scan. No signs of nodal involvement or distant metastases were detected. Results The group consisted of 18 men (72%) and 7 women (28%). Average age was 57.62 years (46-70). In all cases, whole brain radiotherapy (5 × 4 Gy) was performed. The average interval between excision of brain metastasis and lung resection was 31.4 days (27-41). Pneumonectomy was performed in 1, lobectomy/bilobectomy in 17 and wedge resection in 7 cases. Pathological stage N0 was diagnosed in 17, N1 in 5 and N2 in 3 patients. Average survival was 18.68 months (4-74). Survival at 1, 2 and 5 years was 64%, 28% and 28% respectively. Average disease-free survival was 17.52 months. Histological type (p = 0.57) and G (p = 0.82) have no influence on survival. All the patients with hilar lymph node involvement died within 26 months and with mediastinal one within 12 months. Conclusions Surgical treatment of patients with NSCLC with synchronous brain metastases may prove beneficial in selected patients after excluding other distant metastases and lymph node involvement.

Mediastinal lymphadenectomy influences postoperative immune response after lung cancer surgery.

The aim of the study was to calculate the amount of surgical injury caused by systematic lymphadenectomy of mediastinum in patients operated on due to non-small cell lung cancer,with uneventful postoperative course.The study group consisted of 11 patients with cancer of the right lung(Group 1).The control group consisted of 12 patients with left lung cancer(Group 2).In patients with right lung cancer systematic lymphadenectomy,while in patients with left lung cancer systematic sampling was performed.Serum I...

188. Wyniki leczenia chorych po makroskopowo radykalnej resekcji miąższu płucnego z powodu NDRP z obecnością nacieku mikroskopowego w linii cięcia chirurgicznego

Cel Ocena wynikow uzupelniającej radioterapii u pacjentow poddanych radykalnej resekcji miązszu plucnego z powodu NDRP, u ktorych stwierdzono mikroskopowo obecnośc komorek nowotworowych w linii ciecia na oskrzelu. Material i metody Od czerwca 1999 do maja 2003 przeprowadzono 428 radykalnych zabiegow operacyjnych z powodu NDRP. W 30 przypadkach (7%) w badaniu mikroskopowym materialu operacyjnego stwierdzono w linii ciecia chirurgicznego obecnośc komorek nowotworowych. W grupie tej bylo 26 mezczyzn i 4 kobiety. W 21 przypadkach histopatologicznie rozpoznano raka plaskonablonkowego, w 6 przypadkach gruczolakoraka i w 3 przypadkach raka olbrzymiokomorkowego. Wszyscy chorzy poddani byli leczeniu uzupelniającemu – kojarząc teleterapie (dawka 60 Gy w 30 frakcjach) z brachyterapią na obszar kikuta oskrzela dawka 6–15 Gy w 1–2 frakcjach). U czterech pacjentow leczenie przerwano z powodu – wystąpienia przerzutow do CUN (2), zawal mieśnia sercowego (1), przerzutow do wątroby (1). Wyniki Analizie poddano 26 pacjentow. Okres obserwacji od 4 do 48 miesiecy. Siedemnastu pacjentow po otrzymaniu pelnego cyklu leczenia uzupelniającego zyje bez cech wznowy miejscowej i rozsiewu nowotworowego. Trzech pacjentow zyje z cechami przerzutow do CUN, bez cech wznowy miejscowej. Jeden pacjent zyje z przerzutami do koścca, bez cech wznowy miejscowej. Los trzech chorych jest nieznany. Dwoch chorych zmarlo wskutek rozsiewu choroby. Wniosek Leczenie uzupelniające w postaci teleradioterapii skojarzonej z brachyterapią w przypadku nacieku mikroskopowego w linii ciecia oskrzela po radykalnej resekcji miązszu plucnego z powodu NDRK moze zapobiegac wznowie procesu nowotworowego w kikucie oskrzela.