Session - Respiratory & Critical Care Medicine: no. G-RC-14published_or_final_versio

Chan, KN

Ho, JCM

Lam, WK

Ooi, CGC

Tsang, KWT

Yip, TC

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Title An assessment of tumour and nodal bulk volume for Chinesepatients with non small cell lung cancerAuthor(s) Yip, TC; Ooi, CGC; Lam, WK; Ho, JCM; Chan, KN; Tsang, KWTCitation The 5th Medical Research Conference, Hong Kong, China,January 2000, v. 22 n. Supp 2, p. 23Issued Date 2000URL http://hdl.handle.net/10722/45740Rights Creative Commons: Attribution 3.0 Hong Kong LicenseG-RC-14AN ASSESSMENT OF TUMOUR AND NODAL BULK VOLUME FOR CHINESE PATIENTS WITHNON SMALL CELL LUNG CANCERT.C. Yip, G.C. Ooi, *W.K. Lam, *J.C.M. Ho, #K.N. Chan, *K.W.T. Tsang Depts of Diagnostic Radiology, *Medicine& #Paediatrics, The University of Hong KongNon small cell lung cancer (NSCLC) is the commonest type of lung cancer in Hong Kong and patients frequentlypresent with metastatic disease to intra-thoracic lymph nodes and other organs. Little is known on the correlationbetween tumour volume (TV) and thoracic nodal volume (NV) in NSCLC. We have therefore prospectively performedtwo-dimensional computed tomography (2D-CT) volumetry to assess TV and NV in our patients. From July 1998to June 1999, 28 patients attending the Special Respiratory clinic, Queen Mary Hospital (QMH) with inoperableNSCLC were recruited. All patients underwent assessment with pre-treatment post-contrast (7mm and 5mm) CTscans of the thorax, TNM staging, and Karnofsky performance status (KPS). Tumour and nodal area at each CTsection were multiplied by slice thickness to yield the 2D-CT volume of each section. The sum of 2D-CT volumein all relevant sections approximated the overall 2D-CT TV and NV respectively. Correlations between TV and NVwith survival time, KPS, TNM staging, laboratory indices and site of metastases (M) were analysed. Of 28 patients,6 were excluded [drug allergy (n=3) and private CT (n=3)]. The data of 22 patients [ 15M, 7W; mean age 59.27±7.12yrs(48-70)] were analysed. Histological classification of the 22 tumours were adenocarcinoma (n=16), squamous cellcarcinoma (n=5), and NSCLC (n=l). 59.1 % and 40.9% patients had stage IIIB and stage IV disease respectively.All had baseline KPS equal or above 80. Overall mean TV and NV were 75382.02mm3 (645-547237.5) and23682.75mm3 (0-126480) respectively. Mean TV and NV for stage IIIB were 100364.1mm3 (645-547237.5) and12805.81mm3 (0-58507.5) respectively, while those for stage IV were 39296.78mm3 (2140-69200) and39393.89mm3 (0-126480) respectively. There was a correlation between TV and NV (r=0.71, p<0.01) in stageIIIB, but not in stage IV. This suggests that tumor spreads to other sites after NV reaches a "threshold volume".Median TV and NV of stage IIIB patients with haemoptysis were significantly larger than those without haemoptysis,but not in stage IV This suggests that haemoptysis is associated with tumor and nodal volumes in stage IIIB diseaseonly. Median NV of stage IIIB patients with baseline pleural metastasis was significantly smaller than those without.Median NV of stage IV patients with baseline lung metastasis was significantly smaller than those without, whichsuggests that tumor could spread outward to the lung and pleura earlier than LN initially in IIIB and IV diseases.Our results could re-conceptualize the current understanding in the biology of NSCLC.G-RC-15ASSESSMENT OF ASTHMA MANAGEMENT BEFORE AND AFTER THE INTRODUCTION OFGUIDELINES IN AN ACCIDENT AND EMERGENCY DEPARTMENT IN HONG KONGSik-hon TSUI. Arthur SHAM, Hon-kuan TONG, Moira CHAN-YEUNGObjectives: We investigated whether the introduction of guidelines for asthma management would improve themanagement of asthma in an A&E department in Hong Kong. Methods: An audit was carried out on records ofpatients with the diagnosis of asthma, older than 2 years of age, seen in the A&E department between August 18 toNovember 14, 1998 (88 days). The guidelines, similar to the one published by the British Thoracic Society butamended to fit in the department's system, were introduced and actively promoted on November 15,1998. Theaudit was repealed for patients seen between November 30 and February 10, 1999 (73 days). The following datawere collected: asthma history, investigations, treatment, outcome and medications given on discharge. Results:There were 233 and 337 asthma patients seen during the 2 periods respectively, with no differences in gender andage distribution. Their asthma severity was also not different as measured by pulse and respiratory rate, arterialoxygen saturation, peak flow rate before and after bronchodilator treatment. Peak flow rate was measured in 51.5%of patients before and 75% after the introduction of guidelines (p<0.01). Significant increases in the use of oxygen(82.8% vs 89%) and systemic steroids (6.4% vs 11.9%) were found. 35% and 37.7% of patients respectively wereadmitted into hospital before and after the introduction of the guidelines. For those who were discharged, a higherproportion were placed on a course of oral steroids (25.8% before and 52.7% after, p<0.005) after the introductionof the guidelines. Conclusion: We conclude that asthma management in the A&E department improved after theintroduction of guidelines but the improvement did not result in a reduction in the rate of hospital admission forasthma.- 23 -

An assessment of tumour and nodal bulk volume for Chinese patients with non small cell lung cancer

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An assessment of tumour and nodal bulk volume for Chinese patients with non small cell lung cancer

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