Proceedings of the American Thoracic Society
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The diagnosis of indeterminate mediastinal lymph nodes, masses, and peripheral pulmonary nodules constitutes a significant challenge. Options for tissue diagnoses include computed tomography-guided percutaneous biopsy, transbronchial fine-needle aspiration, mediastinoscopy, left anterior mediastinotomy, or video-assisted thoracoscopic surgery; however, these approaches have both advantages and limitations in terms of tissue yield, safety profile, and cost. Endobronchial ultrasound (EBUS) is a new minimally invasive technique that expands the view of the bronchoscopist beyond the lumen of the airway. ⋯ The radial probe EBUS allows for evaluation of central airways, accurate definition of airway invasion, and facilitates the diagnosis of peripheral lung lesions. Linear EBUS guides transbronchial needle aspiration of hilar and mediastinal lymph nodes, improving diagnostic yield. This article will review the principles and clinical applications of EBUS, and will highlight the role of this new technology in the diagnosis and staging of lung cancer.
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Lung cancer is the leading cause of cancer-related mortality in the United States. Patients with advanced disease have a median survival of approximately 10 months when treated with standard platinum-based therapy. Improvements in our understanding of cancer biology have led to the development of novel agents that more precisely affect the target of interest, allowing for a more rational approach to clinical trial design. ⋯ A large randomized trial demonstrated an improvement in overall survival when bevacizumab, a monoclonal antibody against vascular endothelial growth factor (VEGF), was combined with chemotherapy in patients with advanced non-small cell lung cancer (NSCLC). Small molecule inhibitors targeting both the VEGF receptor (VEGFR) and the tyrosine kinase receptor have also shown promise when combined with standard chemotherapy, but their role in the treatment of patients with NSCLC remains to be determined. This paper reviews clinical trials that have incorporated antiangiogenic agents in the treatment of patients with NSCLC.
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Lung cancer remains the leading cause of cancer mortality in the United States, and the majority of patients will have non-small cell lung cancer (NSCLC) and will present with locally advanced or metastatic disease. In the United States, the most common histology is adenocarcinoma, followed by squamous cell, large cell, and not otherwise specified. For patients with a preserved performance status (PS), double agent platinum-based therapy extends survival, improves quality of life (Qol), and reduces disease-related symptoms. ⋯ This patient population appears to have unique clinical and molecular characteristics, and may benefit from initial therapy with an EGFR tyrosine kinase inhibitor. Once patients have progressed on first-line therapy there are three agents available (docetaxel, pemetrexed, and erlotinib), but the efficacy of pemetrexed appears to be limited to patients with nonsquamous histology. Despite the improvements in care and number of therapeutic agents available, the survival for patients with advanced-stage NSCLC remains modest; novel approaches are required and participation in clinical trials should be encouraged.
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The Division of Lung Diseases of the National Heart, Lung, and Blood Institute (NHLBI) recently held a workshop to identify gaps in our understanding and treatment of childhood lung diseases and to define strategies to enhance translational research in this field. Leading experts with diverse experience in both laboratory and patient-oriented research reviewed selected areas of pediatric lung diseases, including perinatal programming and epigenetic influences; mechanisms of lung injury, repair, and regeneration; pulmonary vascular disease; sleep and control of breathing; and the application of novel translational methods to enhance personalized medicine. This report summarizes the proceedings of this workshop and provides recommendations for emphasis on targeted areas for future investigation. The priority areas identified for research in pediatric pulmonary diseases included: (1) epigenetic and environmental influences on lung development that program pediatric lung diseases; (2) injury, regeneration, and repair in the developing lung; (3) pulmonary vascular disease in children; (4) development and adaptation of ventilatory responses to postnatal life; (5) nonatopic wheezing: aberrant large airway development or injury?; (6) strategies to improve assessment, diagnosis, and treatment of pediatric respiratory diseases; and (7) predictive and personalized medicine for children.
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Lung transplantation is still limited by the shortage of suitable donor organs. This results in long waiting times for listed patients with a substantial risk (10-15%) of dying before transplantation. ⋯ Donor lung utilization can be further improved by careful selection of extended criteria donors, by active participation of transplant teams in donor management, and by verifying as often as possible the quality of lungs in the donor hospital by a member of the transplant team. This article aims to update the current evidence from the literature to identify and select potential lung donors and to manage cadaveric donors to maximally increase the organ yield for lung transplantation.