Measurement of exhaled alveolar nitrogen oxide in patients with lung cancer: a friend from the past still precious today

Anastasios Kallianos,1 Sotirios Tsimpoukis,2 Paul Zarogoulidis,3 Kaid Darwiche,4 Andriani Charpidou,2 Ilias Tsioulis,3 Georgia Trakada,5 Konstantinos Porpodis,3 Dionysios Spyratos,3 Athanasios Panoutspoulos,5 Lemonia Veletza,5 Konstantinos Kostopoulos,5 Charalampos Kostopoulos,4 Ilias Karapantzos,6 Kosmas Tsakiridis,7 Wolfgang Hohenforst-Schmidt,8 Konstantinos Zarogoulidis,3 Aggeliki Rapti,1 Konstantinos Syrigos21Second Pulmonary Clinic, Sotiria Hospital, 2Oncology Unit, Sotiria Hospital, Athens, Greece; 3Oncology Unit, G Papanikolaou General Hospital, Thessaloniki, Greece; 4Interventional Unit, Ruhrland Clinic, Essen, Germany; 5Pulmonary Laboratory, Alexandra Hospital, Athens, Greece; 6Ear, Nose, and Throat Department, Saint Luke Private Hospital, 7Cardiothoracic Department, Saint Luke Private Hospital, Thessaloniki, Greece; 8II Medical Clinic, Hospital of Coburg, Coburg, GermanyAbstract: Nitric oxide (NO) is a marker of airway inflammation and indirectly a general indicator of inflammation and oxidative stress. NO is a contributing factor in lung cancer at an early stage and also after chemotherapy treatment of lung cancer. We studied whether exhaled NO levels were altered by three cycles of chemotherapy at diagnosis and after chemotherapy, and whether, directly or indirectly, these changes were related to the course of disease. Also, a correlation of NO levels with other markers of inflammation was performed. We studied 42 patients diagnosed early: 26 men and 16 women with lung cancer. We analyzed blood tests for control of inflammatory markers, functional pulmonary tests, and alveolar exhaled NO. We recorded a decrease in exhaled NO after three cycles of chemotherapy in all patients, regardless of histological type and stage: there were 42 patients with mean 9.8 NO after three cycles (average 7.7). Also, a strong correlation appeared between NO measurements before and after chemotherapy and C-reactive protein (P < 0.05, r = 0.42, before) and (P < 0.045, r = 0.64, after). NO alveolar measurement as an indicator of airway inflammation indicates response to chemotherapy in lung cancer. Also, the inflammatory process in lung cancer was confirmed and indicated response to chemotherapy through an index that is sensitive to inflammatory disease of the airways.Keywords: nitric oxide, lung cancer, inflammation