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Objective: To assess the predictive and prognostic value of progressive metabolic disease (PMD) by the use of early 18Fluorodeoxyglucose positron emission tomography (18FDG-PET) in patients with clinical stage IV non-small cell lung cancer (NSCLC) treated with first-line chemotherapy. Methods: An 18FDG-PET performed following the first cycle of chemotherapy (PET-1) was compared with a pretreatment 18FDG-PET (PET-0) and a computed tomography (CT) scan after the third cycle (CT-3). The primary endpoint was the positive predictive value (PPV) of PMD. Secondary endpoints included the prognostic value of PMD. Results: Eleven of 38 patients (29%) had a PMD by PET-1, and 15 (39%), including all patients with a PMD, experienced a progressive disease by CT-3. The PPV of PMD was 100% according to both the European Organization for Research and Treatment of Cancer (EORTC) criteria and the PET Response Criteria In Solid Tumors (PERCIST) (p value for both, <0.0001). Patients with a PMD by PET-1 had a median overall survival of 7.0 months versus 14.0 months for those without a PMD (p = 0.04, according to the EORTC criteria). Conclusions: Early 18FDG-PET assessment deserves further investigation for the identification of NSCLC patients who do not benefit from first-line chemotherapy. [ABSTRACT FROM AUTHOR]

Primary malignant neoplasms of trachea are extremely rare, accounting for 0.2% out of all malignancies and represent 0.12% of all death from trachea and lung cancer in UK. Furthermore, just a few reports featuring primary adenocarcinoma have been identified among large series of tracheal resections. Clinical presentation and histopathologic characteristics of a case of tracheal adenocarcinoma, treated at our Division, are described. A 60- year-old male, treated with bronchodilators and oral steroids for a presumed diagnosis of asthma during the previous three years, was admitted to our hospital with cough, dyspnea and wheezing. Computerized tomography showed a tracheal tumor. Bronchoscopy confirmed a wide-base polypoid tumor at the left wall of trachea, spot 4 cm above the carina and occluding >90% of lumen. A biopsy was taken and pathological examination reported a poorly differentiated adenocarcinoma (PDA). Through cervicosternotomy, a tracheal resection that contains two rings of trachea with malignant lesion was performed. No operative mortality and intraoperative or postoperative complications were observed. Nowadays, at the time of the article, the patient is alive and disease free 19 months after surgery. We conclude that primary malignant adenocarcinoma of trachea is an exceedingly rare neoplasm. Complete surgical resection remains the treatment of choice for improving the overall prognosis of tracheal tumors of this kind. To our knowledge this is the 10th case described in literature and we describe it for its rarety. [ABSTRACT FROM AUTHOR]