Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer
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Case Reports
An unusual case of non-small cell lung cancer presenting with renal angle pain and hematuria.
A 53-year-old woman was referred urgently to the urology department with a history of worsening right renal angle pain and associated hematuria. Further investigations revealed the presence of a primary non-small cell lung cancer (NSCLC) invading the posterior chest wall with an associated vaginal metastasis. To our knowledge, this is only the second case report in the literature of a vaginal metastasis from NSCLC.
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Tumor molecular biology is an increasingly important consideration when choosing therapy for patients with advanced non-small cell lung cancer (NSCLC). A number of potential biological markers are under active investigation in the hope that it will be possible to identify markers that assist in patient selection for specific therapies. Distinguishing prognostic from predictive makers is crucial to the development of customized drug therapy. ⋯ Patients with an elevated DNA repair capacity, evidenced by increased tumor expression of excision repair cross-complementing 1 or ribonucleotide reductase subunit M1 messenger RNA, may benefit less from cisplatin and gemcitabine, respectively, than from other agents. Increased levels of class III beta-tubulin are associated with taxane-resistance, and K-ras mutations have been associated with a lack of survival benefit from adjuvant chemotherapy in early stage NSCLC. It is likely that in the future, clinicians will evaluate a panel of biological markers in order to customize therapy for individual patients with NSCLC.
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The design and analysis of clinical trials are crucial if we are confidently to answer important questions regarding the treatment of patients with non-small cell lung cancer. Survival, response, and quality of life (QoL) are considered the key endpoints of oncology clinical trials. Survival is the primary endpoint of most randomized, phase III clinical trials, but small improvements in survival are difficult to detect without a sufficiently large sample size. ⋯ Several validated QoL tools are available for use both in trials and in daily practice, but many clinicians do not routinely assess QoL when evaluating an individual patient's response to treatment. Recent advances in electronic technology make capturing QoL data at each office visit not only possible but practical, reliable, and useful for both patients and clinicians. Therefore, although survival, response, and QoL can all be relevant clinical trial endpoints, QoL may be the most relevant endpoint to assess in the clinic.
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The survival of patients with lung cancer in New Zealand is poor compared with Australia and the United States. To determine whether these poorer outcomes were related to secondary care management or to other factors, we documented stage of disease, comorbidities, and initial secondary care management for patients diagnosed with lung cancer in 2004, in Auckland and Northland (New Zealand). These data were compared with international data. ⋯ This cohort was characterized by high comorbidity and advanced disease. Although similar to the United Kingdom, initial treatment rates were low in comparison with Australia and the United States, despite similar stage distributions. Overall, 50% of patients, including 30% with early-stage disease, did not receive initial anticancer treatment. Low anticancer treatment rates may contribute to poorer survival outcomes in New Zealand.