Search

Introduction Les mutations activatrices du gene human epidermal growth factor receptor-2 (HER2) concerne 1,6 a 4,2 % des adenocarcinomes pulmonaires et sont majoritairement des insertions de l’exon 20. L’objectif de cette etude etait d’evaluer le microenvironnement immun et l’efficacite des anti-PD-1, mal connus dans ce sous-groupe moleculaire. Methodes Tous les cancers bronchiques non a petites cellules mutes HER2 (CBNPC HER2 +) diagnostiques par la plateforme de biologie moleculaire des Hospices Civils de Lyon (HCL) entre 2010 et 2019 ont ete inclus. Les donnees cliniques, histologiques, moleculaires et l’efficacite des anti-PD-1 ont ete collectees retrospectivement. Des immunomarquages PD-L1 ont ete realises sur les prelevements disponibles. Une cohorte controle de 225 patients CBNPC HER2 - traites par anti-PD-1 aux HCL de 2015 a 2019 apres echec d’une chimiotherapie a ete constituee. Les taux de reponses objectives aux anti-PD-1 selon RECIST 1.1 (test de Fisher), la survie sans progression (SSP) et globale (SG) (log rank) avec les anti-PD-1 etaient compares entre CBNPC HER2 + et − . Resultats Cinquante-trois CBNPC HER2 + etaient inclus : 55 % de femmes, 57 % de non-fumeurs, âge median 66 ans (45-88), 70 % de stade IV. Tous etaient des adenocarcinomes. Une expression de PD-L131 % des cellules tumorales etaient retrouvees dans 40 % des cas (16/40), 350 % dans 10 % (4/40). 11 CBNPC HER2 + ont recus un anti-PD-1 en deuxieme ligne et plus avec pour meilleure reponse une reponse partielle (RP) dans 9 % (1/11) des cas, une stabilite (ST) dans 46 % (5/11), une progression (PR) dans 45 % (5/11). La SSP mediane sous anti-PD-1 etait de 3,6 mois, la SG mediane de 5,8 mois. Dans la cohorte controle, la meilleure reponse aux anti-PD-1 etait une RP dans 7,5 % des cas, une ST dans 31 %, une PR dans 61 %, pour une SSP mediane de 2 mois et une SG mediane de 7,1 mois. Les taux de reponse (p = 0,22), la SSP (p = 0,59) et la SG (p = 0,66) n’etaient pas statistiquement differents entre les deux cohortes. Les taux de reponses, la SSP et la SG n’etaient pas statistiquement differents en comparant les CBNPC HER2 + et les CBNPC KRAS + ou pan-sauvage de la cohorte controle. 2 CBNPC HER2 + ont recu un anti-PD-1 en premiere ligne (PD-L1350 %) avec 2 RP, PFS a 7,75 mois et RP toujours en cours apres 9,5 mois de traitement, respectivement. Conclusion L’expression de PD-L1 est faible dans les CBNPC HER2+. Cependant, l’efficacite des anti-PD-1 semble comparable entre CBNPC HER2+ et CBNPC HER2−.

Thoracic radiotherapy is a usual treatment for lung cancer. Early-stages may be treated in stereotactic mode while locally advanced stages are usually treated with conventional radiotherapy mode. Pulmonary function tests show that thoracic irradiation has no impact on lung volume such as forced expiratory volume in one second (FEV1) or forced vital capacity (FCV). However, some studies found that CO (carbon monoxide) diffusing capacity (TLCO) may be altered under thoracic radiotherapy. DLCO alteration is usually symptomatic of either a lesion in the alveolar membrane or a pulmonary capillary alteration. Pulmonary diffusion may be also appreciated by the NO (azote monoxide) diffusion capacity. Moreover, using a double measurement of NO and CO diffusing capacities permit to assess which lung compartment (capillary or membrane) is affected. CONORT is an observational prospective monocentric study, aiming to assess the CO and NO diffusing capacity (as well as other pulmonary function tests) during thoracic radiotherapy. Inclusion criteria are patients with lung cancer, treated by thoracic radiotherapy (conformational or stereotactic), who signed consent. Pulmonary function tests are performed before, during, at the end and six weeks and six months after thoracic irradiation. To estimate a difference of 15% in diffusing capacity test, we have to include 112 patients with a 90% power and a 5% alpha risk. Four months after beginning, 36 patients were included. Preliminary data will be presented at the SFRO meeting.

Thoracic radiotherapy is a usual treatment for lung cancer. Early-stages may be treated in stereotactic mode while locally advanced stages are usually treated with conventional radiotherapy mode. Pulmonary function tests show that thoracic irradiation has no impact on lung volume such as forced expiratory volume in one second (FEV1) or forced vital capacity (FCV). However, some studies found that CO (carbon monoxide) diffusing capacity (TLCO) may be altered under thoracic radiotherapy. DLCO alteration is usually symptomatic of either a lesion in the alveolar membrane or a pulmonary capillary alteration. Pulmonary diffusion may be also appreciated by the NO (azote monoxide) diffusion capacity. Moreover, using a double measurement of NO and CO diffusing capacities permit to assess which lung compartment (capillary or membrane) is affected. CONORT is an observational prospective monocentric study, aiming to assess the CO and NO diffusing capacity (as well as other pulmonary function tests) during thoracic radiotherapy. Inclusion criteria are patients with lung cancer, treated by thoracic radiotherapy (conformational or stereotactic), who signed consent. Pulmonary function tests are performed before, during, at the end and six weeks and six months after thoracic irradiation. To estimate a difference of 15% in diffusing capacity test, we have to include 112 patients with a 90% power and a 5% alpha risk. Four months after beginning, 36 patients were included. Preliminary data will be presented at the SFRO meeting.

La radiotherapie est une des modalites de traitement du cancer bronchopulmonaire : soit pour les stades precoces en mode stereotaxique, soit en mode conformationnel pour les stades evolues. L’irradiation thoracique semble sans effet notable a long terme sur les volumes pulmonaires, evalues lors des explorations fonctionnelles respiratoires (EFR). Par contre, plusieurs etudes ont montre que la diffusion au monoxyde de carbone (DLCO) etait alteree par la radiotherapie thoracique. Une atteinte de la diffusion peut signer soit une atteinte de la membrane alveolo-capillaire, soit une atteinte du lit capillaire pulmonaire. La diffusion peut egalement etre appreciee a l’aide du monoxyde d’azote (DLNO). La double mesure de la diffusion par NO et CO permettrait de determiner le niveau precis de l’atteinte : membrane alveolaire ou lit capillaire. L’etude CONORT est une etude observationnelle prospective monocentrique, visant a evaluer les mesures de double diffusion au cours de la radiotherapie thoracique. Les patients inclus sont ceux atteints de cancer bronchique pour lesquels une indication de radiotherapie thoracique a ete retenue, et ayant donne leur accord. Chacun beneficiera d’une EFR avec double diffusion avant, au milieu, a la fin et 6 mois apres l’irradiation thoracique. Un total de 112 patients est necessaire pour mettre en evidence une difference de 15 % entre deux mesures de diffusion avec une puissance de 90 %. Les resultats a la fermeture des inclusions apres une periode de recrutement de 12 mois seront presentes lors du congres.

Distal metastases are classically situated below the knee or elbow. However, metastases of the extremities: wrist and hand, or ankle and foot, have etiological and histological characteristics. We report one case of bone metastasis and one case of soft tissue metastasis. The distal bone metastases are often solitary. Bronchial cancers represent the most frequent cause of distal metastases (20% of all cases). They are responsible for 50% of distal metastases of the upper limb and more often occurs as a squamous cancer. Their localization may sometimes reveal a bronchial cancer, and so allow curative surgery. The metastases of soft tissue are exceptional. In the literature, only 2 cases of soft tissue metastasis of bronchopulmonary cancer are described. Clinically, it is a painful swelling preserving the under lying bone. The prognosis is always one of bronchial metastasis cancer with an average survival of 3-6 months.

Bronchogenic cysts represent about 10 p. 100 of all surgical tumours of the mediastinum. They can never be diagnosed with absolute certainty prior to the operation, but when they arise in their typical sites, they can be suspected with a high probability. However, they can occur in very atypical sites, in which case the diagnosis remains very hypothetical until the operation. The authors report a case of a cyst which developed under the diaphragmatic pleura, in direct contact with the dome of the diaphragm and attached to the mediastinum by a fine vascular pedicle which inserted in the root of the triangular ligament.

A case of agenesis of the pericardium is reported. The condition is are; a search in the literature has yielded 364 cases. It always results from an abnormal embryonic development. The agenesis is more common on the left side (70%) than on the right side (4%) or the inferior side (17%). It is more often partial than total (9%) and may be associated with other malformations, particularly malformations of the heart. The diagnosis rests on radiography of the chest and, mainly, echocardiography. CT, MRI or surgical exploration (if needed for other reasons) confirm the anatomical defect. In patients with partial pericardial agenesis the risk of cardiac entrapment makes surgery mandatory.

Thirty-seven cases of pleural mesothelioma seen in our unit between 1974 and 1984 have been reviewed. In cases with limited lesions early thoracotomy with an attempt at pleurectomy/lung decortication seemed to be justified. Thereafter - or initially in patients with extensive lesions - we resort to radiotherapy and/or chemotherapy. Although the final result was mediocre, we found it difficult to abstain from any treatment. Owing to the lack of large series and to the heterogeneity of those that have been published, no fixed rule can be laid down for the treatment of mesothelioma. Nevertheless, it would appear that using multiple therapeutic methods results in a somewhat longer survival.

We report an observation of pneumopericardium occurring, without iatrogenic trauma in the preceding days, during the course of an epidermoid bronchial carcinoma, treated for a year by radio- and chemotherapy. The pneumopericardium produced a very attenuated clinical picture and was resorbed without incidence. But the patient died a few weeks after an overwhelming haemoptysis. The radiological picture is very characteristic. The differential diagnosis is above all that of a pneumo-mediastinum. But in the latter case, the clear zone exceeds the level of the great vessels and subcutaneous cervical emphysema in generally very clear both clinically and radiologically.

We studied the levels of carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9) in 90 patients with primary lung cancer. One or both markers were increased in 45 patients (50%): CEA only was increased in 13, CA 19-9 only was increased in 19, and both CEA and CA 19-9 were increased in 13. Increase of markers did not differ according to histologic subtype of cancer. Increase or decrease of the markers (mainly CA 19-9) usually parallelled evolution of the disease in our patients. Thus, measurement of both CEA and CA 19-9 levels are of diagnostic value in half the patients with primary lung cancer.