Ο ρόλος της διαδερμικής τοποθέτησης ενδοπρόθεσης στην κλινική έκβαση των ασθενών με καρκίνο πνεύμονα και σύνδρομο άνω κοίλης φλέβας.

Εισαγωγή: Το σύνδρομο άνω κοίλης φλέβας (ΣΑΚΦ) είναι συνέπεια μερικής ή ολικής απόφραξης της άνω κοίλης φλέβας, η οποία οδηγεί σε ένα χαρακτηριστικό σύνολο συμπτωμάτων και σημείων, αποτελώντας μία επείγουσα κλινική κατάσταση που χρήζει άμεσης διάγνωσης και θεραπείας. Το πιο συχνό αίτιο εμφάνισης του συνδρόμου είναι οι κακοήθεις όγκοι του θώρακα, με συνηθέστερο τον καρκίνο του πνεύμονα. Οι βασικοί τρόποι αντιμετώπισης ειναι η χημειοθεραπεία, η ακτινοθεραπεία και η τοποθέτηση ενδοπρόθεσης εντός της άνω κοίλης φλέβας. Σκοπός: Η αναδρομική αυτή μελέτη έχει ως στόχο τη διερεύνηση της αποτελεσματικότητας της τοποθέτησης ενδοπρόθεσης εντός της άνω κοίλης φλέβας ως θεραπεία του ΣΑΚΦ στην κλινική έκβαση του ασθενή. Μέθοδος: Μελετήθηκαν συνολικά 41 ασθενείς με σύνδρομο άνω κοίλης φλέβας οφειλόμενο σε κακοήθεια πνεύμονα, από το 2007 έως το 2020, οι οποίοι εμφάνισαν ΣΑΚΦ σε οποιαδήποτε στιγμή της πορείας της νόσου τους και οδηγήθηκαν σε τοποθέτηση ενδοπρόθεσης ως θεραπεία του συνδρόμου. Τα περιστατικά προέρχονται από δύο πανεπιστημιακά νοσοκομεία, το ΓΝΝΘΑ ‘Η ΣΩΤΗΡΙΑ’ και το Πανεπιστημιακό Νοσοκομείου Ηρακλείου Κρήτης ΠΑ.Γ.Ν.Η. Αποτελέσματα: Μετά την τοποθέτηση ενδοπρόθεσης για την αντιμετώπιση του ΣΑΚΦ σε ασθενείς με καρκίνο πνεύμονα, η πιθανότητα επιβίωσης στους 6 μήνες ισούταν με 46%, στους 12 μήνες με 18%, στους 18 μήνες με 6% και στα 2 έτη με 3% . Ο μέσος χρόνος επιβίωσης ισούταν με 6,14 μήνες (95% CI= 4,31-7,97). Το 84,4% των ασθενών είχε άμεση κλινική βελτίωση μετά την τοποθέτηση ενδοπρόθεσης, με το 31,7% να παρουσιάζει υποχώρηση των συμπτωμάτων την πρώτη μέρα και το 41,5% την δεύτερη μέρα. Από το σύνολο των ασθενών, το 19,5% (n=8) παρουσίασε υποτροπή του ΣΑΚΦ περίπου 6,5 μήνες μετά την τοποθέτηση του 1ου stent και το 12,2% (n=5) οδηγήθηκε σε τοποθέτηση δεύτερου stent. Ο χρόνος επιβίωσης μετά την τοποθέτηση του 2ου stent ισούταν με 6 μήνες περίπου. Μόνο στο 7,3% των περιπτώσεων αναγκάστηκε να διακοπεί η λήψη αντιπηκτικών/αντιαιμοπεταλιακών λόγω αιμορραγικών παρενεργειών. Συμπεράσματα: Η τοποθέτηση ενδοπρόθεσης στην άνω κοίλη φλέβα αποτελεί μία αποτελεσματική και ασφαλή θεραπευτική επιλογή του συνδρόμου άνω κοίλης φλέβας σε ασθενείς με κακοήθεια πνεύμονα η οποία βελτιώνει άμεσα την κλινική εικόνα του ασθενή.Introduction: Superior vena cava syndrome (SVCS) is a constellation of signs and symptoms due to obstruction or thrombosis of superior vena cava and its branches. Thoracic malignancies is the most common cause of SVCS from which lung cancer is the dominant cause in 70-80% of cases. Therapy is based on the type of malignancy that led to SVCS and it includes chemotherapy, radiotherapy and superior vena cava stenting. Aim of the work: To investigate the efficacy of stent insertion in superior vena cava for SVCS treatment and its impact on patients’ quality of life. Methods: A total number of 41 patients from two university hospitals, Sotiria General Hospital in Athens and University Hospital of Heraklion in Crete, diagnosed with lung cancer and superior vena cava syndrome from 2007 up to 2020, were retrospectively studied for the efficacy of stent insertion as first line therapy for SVCS. Results: After stent placement the overall survival was 46% at 6 months, 18% at 12 months, 6% at 18 months and 3% at 2 years. The mean survival time was approximately 6 months. Most of the patients (84,4%) had instant symptomatic relief, with complete regression of symptoms at first or second day, 31,7% and 41,5% respectively. Eight patients (19,5%) had SCVS recurrence and a second stent was used as treatment of recurrence for 5 of them without complications. The survival time after the second stent placement was around 6 months. Only 7,3% of patients had hemorrhagic side effects that led to the discontinuation of anticoagulant / antiplatelet therapy. Conclusion: Superior vena cava stenting is an effective and safe therapeutic choice for SVCS treatment in lung cancer patients and improves their quality of life

Assessment of Seroconversion after SARS-CoV-2 Vaccination in Patients with Lung Cancer

Background: SARS-CoV-2 mortality rates are significantly higher in patients with lung cancer compared with the general population. However, little is known on their immunization status after vaccination. Methods: To evaluate the humoral response (seroconversion) of patients with lung cancer following vaccination against SARS-COV-2 (Group A), we obtained antibodies against SARS-CoV-2 spike (S) protein both at baseline and at different time points after the first dose of SARS-CoV-2 vaccine (two to three weeks [T1], six weeks ± one week [T2], 12 weeks ± three weeks [T3], and 24 weeks ± three weeks [T4]). Antibodies were also acquired from a control cohort of non-lung cancer patients (Group B) as well as a third cohort containing healthy controls (Group C) at all time points and at T4, respectively, to make comparisons with Group A. Analysis of antibody response at different time points, association with clinicopathologic parameters, and comparisons with control groups were performed. Results: A total of 125 patients with lung cancer were included in the analysis (96 males [74.3%], median age of 68 years [46–91]. All study participants received two vaccine doses (BNT162b2, mRNA-1273, AZD1222). Analysis of anti-SARS-CoV-2 S antibody titers showed minimal response at T1 (0.4 [0.4–48.6] IU/mL). Antibody response peaked at T2 (527.0 [0.4–2500] IU/mL) and declined over T3 (323.0 [0.4–2500] IU/mL) and T4 (141.0 [0.4–2500] IU/mL). Active smokers had lower antibody titers at T2 (p = 0.04), T3 (p = 0.04), and T4 (p < 0.0001) compared with former or never smokers. Peak antibody titers were not associated with any other clinicopathologic characteristic. No significant differences were observed compared with Group B. However, lung cancer patients exhibited significantly decreased antibody titers compared with Group C at T4 (p < 0.0001). Conclusions: Lung cancer patients demonstrate sufficient antibody response six weeks after the first dose of vaccine against SARS-CoV-2 when vaccinated with two-dose regimens. Rapidly declining antibody titers six weeks after the first dose underline the need for a third dose three months later, in patients with lung cancer, and especially active smokers

Assessment of Seroconversion after SARS-CoV-2 Vaccination in Patients with Lung Cancer

Background: SARS-CoV-2 mortality rates are significantly higher in patients with lung cancer compared with the general population. However, little is known on their immunization status after vaccination. Methods: To evaluate the humoral response (seroconversion) of patients with lung cancer following vaccination against SARS-COV-2 (Group A), we obtained antibodies against SARS-CoV-2 spike (S) protein both at baseline and at different time points after the first dose of SARS-CoV-2 vaccine (two to three weeks [T1], six weeks ± one week [T2], 12 weeks ± three weeks [T3], and 24 weeks ± three weeks [T4]). Antibodies were also acquired from a control cohort of non-lung cancer patients (Group B) as well as a third cohort containing healthy controls (Group C) at all time points and at T4, respectively, to make comparisons with Group A. Analysis of antibody response at different time points, association with clinicopathologic parameters, and comparisons with control groups were performed. Results: A total of 125 patients with lung cancer were included in the analysis (96 males [74.3%], median age of 68 years [46–91]. All study participants received two vaccine doses (BNT162b2, mRNA-1273, AZD1222). Analysis of anti-SARS-CoV-2 S antibody titers showed minimal response at T1 (0.4 [0.4–48.6] IU/mL). Antibody response peaked at T2 (527.0 [0.4–2500] IU/mL) and declined over T3 (323.0 [0.4–2500] IU/mL) and T4 (141.0 [0.4–2500] IU/mL). Active smokers had lower antibody titers at T2 (p = 0.04), T3 (p = 0.04), and T4 (p p Conclusions: Lung cancer patients demonstrate sufficient antibody response six weeks after the first dose of vaccine against SARS-CoV-2 when vaccinated with two-dose regimens. Rapidly declining antibody titers six weeks after the first dose underline the need for a third dose three months later, in patients with lung cancer, and especially active smokers