Virtual Library
Start Your Search
R.M. Terra
Author of
-
+
P1.11 - Poster Session/ Palliative and Supportive Care (ID 229)
- Event: WCLC 2015
- Type: Poster
- Track: Palliative and Supportive Care
- Presentations: 2
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
-
+
P1.11-008 - What Happens to the Pleural Space Affected by Malignant Effusion after Bedside Pleurodesis? (ID 439)
09:30 - 09:30 | Author(s): R.M. Terra
- Abstract
Background:
The treatment of recurrent malignant pleural effusion (RMPE) has a palliative purpose. Pleurodesis is the most used method. However, not all the procedures are effective, in part because of the lung entrapment by the visceral pleura, preventing the contact between the pleural surfaces. The behavior of the pleural cavities submitted to pleurodesis has not been studied more objectively to date. Moreover, how evolve cases with good initial lung expansion and those with poor expansion?
Methods:
Prospective study including 131 patients with recurrent malignant pleural effusion candidates for treatment with bedside pleurodesis with silver nitrate or mineral talc. Each patient underwent two chest CT scans, one right after the drainage (CT1) and another 30 days after pleurodesis (CT30). A thoracic radiologist has calculated pleural volume using the software Aquarius Intuition Viewer® (Terarecon). The evaluation of lung expansion was based on residual pleural volume on CT1 and the radiological evolution on the difference between the pleural volumes on CT30 and CT1 (Delta volume). The pleural volumes on CT1 were arbitrarily classified into small cavity after the drainage (volume <500mL) and large cavity after the drainage (volume ≥500 mL). After that, the Delta volume was classified in unchanged (≥-268.77 and ≤254,49 mL), negative (<-268.77 mL) and positive (> 254.49 mL). For such we used the average of the numerical variable and half of the standard deviation upwards and downwards. The clinical effectiveness was evaluated as the need for additional procedures to control symptoms.
Results:
We evaluated 87 patients of a total of 131 recruited. The median pleural volume on CT1 was 377 (IR: 171-722) mL and 386 (IR: 164-726) mL on CT30, and has no significant difference between them (p= 0.753). The clinical effectiveness was observed in 86.2% of patients. We found 54 patients (62.06%) in the small cavity after the drainage group and 33 (37.93%) in the large cavity group. Clinical effectiveness was 92.6% and 75.8% respectively. There was significant difference (p= 0.051), with an odds ratio of 4.00 (CI: 1.098 to 14.570) in favor of the small cavity. Among patients with small pleural cavity, 27.77% progress with a significant accumulation of fluid, 66.66% did not show significant changes and 5.55% have decreased pleural volume. Clinical effectiveness was 86.7%, 94.4% and 100% respectively with no significant difference (p= 0.552). Among patients with large pleural cavity, 21.21% progress with an even greater volume of pleural cavity, 27.27% did not show significant changes and the majority (51.51%) evolves with a decrease in the pleural volume. Clinical effectiveness was 57.1%, 77.8% and 82.4% respectively with no significant difference (p= 0.418).
Conclusion:
Almost two third of the patients with RMPE treated with pleurodesis had good lung expansion, while just over one-third had a bad one. Those with good expansion had 4 times higher chances of clinical success. Among poor lung expansion patients, more than half had significant reduction of pleural volume in 30 days, while a fifth had a significant accumulation.
-
+
P1.11-009 - Predictors of Hospital Discharge in Cancer Patients with Pericardial Effusion Who Undergo Surgical Pericardial Drainage (ID 2500)
09:30 - 09:30 | Author(s): R.M. Terra
- Abstract
Background:
Pericardial effusion (PE) is a complication of late-stage cancer and operative pericardial drainage is its standard treatment. However, in many patients PE is an end-of-life event and some never leave the hospital despite the procedure. The main objective of this study was to identify predictors of hospital discharge in patients with cancer who coursed pericardial effusion and underwent operative pericardial drainage. We also looked at predictors of ICU discharge and overall survival and also factors that might be associated with paradoxical hemodynamic instability (PHI).
Methods:
Retrospective study carried out in a tertiary cancer center. We included all patients with known malignancy who coursed with PE and underwent surgical pericardial drainage from 2011 to 2014. Patients who underwent previous pericardial drainage or only needle pericardiocentesis were excluded from the study.
Results:
Out of the 90 patients included in this study, fifty one were discharged from hospital (56%). Renal failure and pulmonary embolism negatively influenced the chances of hospital discharge [OR 0,247; p=0,039 and OR 0,293; p=0.089, respectively]. On the other hand, patients who received recent chemotherapy were more likely to leave the hospital (OR 3,9; p=0,009). 55 patients (61%) were discharged from ICU. Renal failure was the main determinant of that (OR 0,284 (p=0,047)). Mean survival was 138.2 days (95% CI 84,48-189,90), influenced only by ECOG status (OR 1,258; p=0,047). PHI occurred in 6 patients and all of them died within 30 days after surgery. In our series, we could not identify predictors for PHI.
Conclusion:
In this study we demonstrated that almost half of cancer patients admitted with PE requiring drainage never leave the hospital. Renal failure and pulmonary embolism are strong predictors of in-hospital death. PHI remains a serious condition with causes unknown.
-
+
P2.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 210)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
-
+
P2.02-009 - Expected Variability of C-Reactive Protein after Pulmonary Resections: Which Factors Are Associated with Their Normal Variation? (ID 2513)
09:30 - 09:30 | Author(s): R.M. Terra
- Abstract
Background:
In patients undergoing lung resection, infectious complications are diagnosed when clinical and radiological evidences are observed. Therefore, early detection of complications may benefit patients and could lead cost reduction. C-reactive protein (CRP) measurements persistently high may indicate complications after surgical resection. Our aim is to define the expected variability of CRP after pulmonary resections which have not progressed to clinical or surgical complications.
Methods:
Retrospective Cohort of patients with neoplastic lung disease treated by anatomic pulmonary resection, between January-2010 and June-2014, which had not developed postoperative complications. A CRP curve was built with data until the fifth postoperative day (POD). Surgical and clinical data was collected to look for predictors of CRP values. Statistical analysis was made with median and confidence interval, T-test for median comparison and logistic regression for predictors.
Results:
We analyzed 220 medical records, 100 patients were excluded because lack of data and 50 due to complication development. Seventy patients were included. The median age was 65 years (from 14 to 89). Forty-one were male (58%). Ten patients (14,8%) had Diabetes, 1 (1,42%) hepatopathy and 1 (1,42%) renal failure. Sixty-one patients (87,14%) underwent lobectomy, 8 (11,42%) pneumonectomy and 1 (1,42%) segmentectomy. There were 48 (68,57%) open thoracotomy and 22 (31,42%) video assisted thoracotomy. The histologic type of tumor was 33 (47,14%) adenocarcinoma, 14 (20%) spinocellular carcinoma, 3 (4,28%) benign diseases and 20 (28,57%) others. The median CRP were 12,85 mg/dl (CI-5,44) preoperative; 76,82 mg/dl (CI-8,49) first day, 156,36 mg/dl (CI-17,91) second , 132,35 mg/dl (CI-17,62) third, 103,24 mg/dl (CI-16,29) forth and 94,11 mg/dl (CI-14,32) fifth. Logistic regression pointed that patients operated by videothoracoscopy (VATS) approach are associated with are associated with lower increase of CRP levels (p=0,002). Other studied factors as age, sex, type of surgery, comorbidities and histology fail to predict CRP level.
Conclusion:
It was observed that CRP peak occurs in the second POD. From the third to the fifth POD, there was a drop of CRP levels, however, it does not returne to the preoperative baseline. The VATS approach induces smaller increases in CRP
-
+
P3.08 - Poster Session/ Thymoma, Mesothelioma and Other Thoracic Malignancies (ID 226)
- Event: WCLC 2015
- Type: Poster
- Track: Thymoma, Mesothelioma and Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
-
+
P3.08-017 - Quality of Life Impact and Adverse Events after Pleurodesis in Patients with Recurrent Malignant Pleural Effusion (ID 2510)
09:30 - 09:30 | Author(s): R.M. Terra
- Abstract
Background:
Even though pleurodesis is the gold-standard procedure to manage recurrent malignant pleural effusion (RMPE), little is known of its impact on the quality of life (QOL), adverse events, and systemic inflammatory consequences. Our main objective was to evaluate the impact of pleurodesis on the QOL of patients with RMPE and the adverse events related to the procedure. The secondary objectives were to evaluate systemic consequences of pleurodesis and to identify predictors of QOL improvement after pleurodesis.
Methods:
Retrospective study including data from patients who underwent pleurodesis from 2005 to 2014 at our Institution. QOL was measured through WHOQoL-Bref instrument, pain visual analog scale, and British Medical Research Council dyspnea scale. Adverse events were systematically registered and classified according to the NCI–CTCAEV.4.0. Blood tests were collected before, 2, 5, and 10 days after the pleurodesis. To compare continuous variables we used paired-T test or Wilcoxon test. To find predictors we built linear regression models. We considered as significant tests which p<0.05.
Results:
257 patients (77% female) with mean age of 69 years-old(± 13.01) were included. The most frequent primary malignancies were breast cancer (56%) and lung cancer (25%). The sclerosing agents used were talc (38%), silver nitrate (36%), and iodopovidone (25%). Clinical recurrence was observed in 8% of the patients and mean survival was 8 months. The physical domain of QOL as well as pain and dyspnea scores were the most abnormal results at baseline and were also the variables which improved the most 30 days after the procedure (p<0.001 for all 3 parameters). Female gender, low pleural fluid lymphocytes count, and the use of silver nitrate were associated with QOL improvement. Adverse events occurred in 43% of the patients, and in 16.3% we observed severe events (Grade 3 or higher). Hypoxia, renal failure, and pain were the most frequent. We observed significant variation in the following blood tests: C-Reactive Protein (rise), hemoglobin (decrease), platelets (rise), alkaline phosphatase (rise).
Conclusion:
Pleurodesis is associated with improvement of the QOL of patients with RMPE; nevertheless, it is also associated with high number of adverse events and systemic metabolic effects.
-
+
P3.11 - Poster Session/ Palliative and Supportive Care (ID 231)
- Event: WCLC 2015
- Type: Poster
- Track: Palliative and Supportive Care
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
-
+
P3.11-002 - Survival and Predictors of Mortality in Patients Submitted to Endoscopic Treatment of Malignant Airway Obstruction (ID 2528)
09:30 - 09:30 | Author(s): R.M. Terra
- Abstract
Background:
Neoplastic obstruction of the airways occurs in about 30% of lung neoplasms, and is often associated woth end-stage, or advanced disease. Nonetheless, endoscopic treatment of the obstruction may improve quality of life and survival in selected patients. The primary objective is to evaluate the median survival and the predictors of mortality in patients undergoing endoscopic treatment of neoplastic airway obstruction. The secondary objective is to evaluate the morbidity of the procedure.
Methods:
Retrospective study, from January 2010 to December 2014. All data was collected until February 2015. We included patients with neoplastic obstruction of the trachea and bronchi, that underwent endoscopic treatment. Procedures were performed in the operating room under general anesthesia, through rigid bronchoscopy or suspension laryngoscopy.Age, sex, neoadjuant chemo-radiotherapy, adjuvant chemo-radiotherapy, ECOG status, ASA status, urgent procedures, need for mechanical ventilation, reintervention procedures, site of obstruction, type of stent and tumor histology were considered predictors for mortality.The median survival was analyzed by Kaplan-Meier curve. Prognostic factors of mortality were analyzed by Cox regression.
Results:
We included 42 patients (25M / 17F) with a mean age of 54 + 11 years, that underwent 68 endoscopic procedures. The most common histologic types were lung cancer (n = 15; 36%), esophagus (n = 11; 26%) and cystic adenoid carcinoma (n = 8; 19%). Twenty-five stents were placed. The silicone Y stent was the most common (n=14;56%). Eleven percent of patients required a tracheostomy. Complications occurred in 37.5% of cases; pneumonia (n = 10; 15%) and stent obstruction (n = 6; 9%) were the most frequent.The median survival was 221 days. The 30-day mortality was 14%, and overall mortality 40%. The predictors of mortality by Cox regression were re-intervention procedures (HR 5.9; p <0.001; 95% CI 2:25 to 15:45), mechanical ventilation before the procedure (HR 7:38; p = 0.015; 95% CI: 1.46- 37) and tumor hystology (HR: .23; p <0.001; 95% CI: .11 - .47). Individuals with esophageal cancer had a significant lower median survival, when compared with lung cancer and cystic adenoid carcinoma (94 vs 166 vs 346 days; p=0.002).
Conclusion:
The morbidity and mortality of patients submitted to endoscopic treatment of neoplastic airway obstruction is not negligible. Reintervention procedures, mechanical ventilation prior to treatment and tumor histology were significant predictors of mortality.
