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Lee, H. Y., et al. (2021). "Clinical characteristics and survival of patients concurrently diagnosed with lung cancer and active pulmonary tuberculosis."https://assets.researchsquare.com/files/rs-279237/v1/5340f24a-94f7-4665-bde9-252c52595ba3.pdf?c=1631877735
Background: Active pulmonary tuberculosis (TB) occasionally coexists with lung cancer. However, the clinical and radiologic characteristics of this co-occurrence have not been fully evaluated.
Methods: Patients diagnosed with lung cancer and active pulmonary TB from January 2009 to December2017 in four hospitals of the Catholic University of Korea were retrospectively reviewed. The clinical characteristics, including the TB diagnosis methods, lung cancer pathology, staging, initial radiographic features, and survival were analyzed and compared to 575 lung cancer patients without active pulmonary TB from the same hospitals.
Results: Forty-eight (0.48%) of the 9,936 lung cancer patients had active pulmonary TB confirmed by positive culture results or polymerase chain reaction analysis for M. tuberculosis at the time of the initial cancer diagnosis. The majority of the patients (95.9%) had non-small cell lung cancer and 56.2% of the lung cancers were located in the both upper lobes. In the initial computed tomography, the most frequent
findings were a mass-like lesion (79.2%) and separate nodules (75%). When compared to lung cancer
patients without TB, the body mass index (BMI) was lower (21.4 vs. 23.1, P = 0.001) in patients with TB.
Moreover, the lung cancer patients with TB had advanced clinical stages compared to patients without
TB; T3-4 (70.9% vs. 50.6%, P = 0.002), N2-3 (85.2% vs. 55.6%, P < 0.001); M1 (65.9% vs. 44.5%, P = 0.007).
Patients' age, histology, location, and the presence of epidermal growth factor receptor mutations were
not statistically different between the two groups. Interestingly, lung cancer with TB was associated with
lower mortality (hazard ratio = 0.35, 95% CI: 0.2 1– 0.60).
Nakahama, K., et al. (2022). "Safe Concurrent Use of Anti-tuberculosis Drugs and Pembrolizumab in a Patient with Non-small-cell Lung Cancer Who Was Infected with Mycobacterium tuberculosis." Internal Medicine 61(7): 1039-1042 FULL TEXT @SWSLHD LIBRARIES
A 68-year-old Japanese man was diagnosed with lung adenocarcinoma stage IVB. We introduced a first-line chemotherapy of four cycles of carboplatin and pemetrexed and pembrolizumab, followed by pemetrexed and pembrolizumab maintenance therapy. Approximately four months after anticancer therapy, a small nodule appeared in the right peripheral S3 lesion. After five months, the nodule was confirmed as a Mycobacterium tuberculosis (TB) nodule. We initiated anti-TB therapy without stopping pembrolizumab, and the right S3 nodule shrank immediately. This report supports the concurrent use of anti-TB treatment with an immune checkpoint inhibitor when the TB infection area is limited.
Polistina, G., et al. (2020). "Pulmonary tuberculosis pre XDR and lung cancer: double trouble." Chest 157(6): A56 BANKSTOWN HOSPITAL PDF AT URL https://journal.chestnet.org/article/S0012-3692(20)30940-5/fulltext
Purpose: Evidence of pulmonary tuberculosis and lung cancer as a comorbidity has been widely reported in many studies. Lung cancer is known to occur on scars and post tuberculosis fibrotic areas. Literature on timing of treatment of both pathologies is contradictory. Our case report shows the possibility of simultaneously therapeutic scheme with both pathologies.
Methods: A 42 years old man. Ukrainian active smoker was admitted in emergency department for lumbar pain and paraplegia onset on wellness. History of multi drugs resistant (MDR) pulmonary tuberculosis in 2016. The CT scan showed: “right paratracheal lesion confluent invading the right conjugation foramina”. FNAB CT on right paravertebral lesion was performed.
Results: BAAR sputum research was negative on 3 samples. XpertMTB®/Ref. genotyping was positive 1 out of 3 samples. Culture resulted positive. Due the clinical conditions we decide to start specific anti-tuberculosis therapy. Histological results from FNAB CT showed neoplastic cell from SMALL CELL LUNG CARCINOMA. We decided with the oncology unit to add anti neoplastic therapy simultaneously. During therapy, culture became negative on two samples.
Conclusions: Several studies have shown that active tuberculosis is found in 2-5% of cases of lung cancer while lung cancer occurs in 1-2% of active tuberculosis due to the possible carcinogenic role played by chronic inflammation. We could not find in the Literature correct timing for therapeutic approach of the two simultaneous pathologies.
Clinical implications: This case report demonstrates that in case of MDR active tuberculosis infection and concomitant neoplastic pathology, it is possible to adopt a simultaneous therapeutic scheme as soon as possible.
Tang, W., et al. (2022). "Differences in CT imaging signs between patients with tuberculosis and those with tuberculosis and concurrent lung cancer." American Journal of Translational Research 14(9): 6234 PDF AT URL https://e-century.us/files/ajtr/14/9/ajtr0139046.pdf
Objective: The purpose of this study was to compare the differences in imaging features between patients with pulmonary tuberculosis (TB) alone and patients with TB complicated with lung cancer (LCA) as well as to investigate the diagnostic value of CT in these two groups. Methods: In this retrospective study, 110 patients with confirmed TB admitted to the Second Affiliated Hospital of Hainan Medical University from March 2020 to April 2021 were collected and divided into TB+LCA group (50 cases, diagnosed with TB complicated with lung cancer) and TB group (60 cases, diagnosed with TB alone) according to actual diagnosis. The CT results of both groups were analyzed by the same group of physicians in a double-blind manner. The diagnostic value of CT for TB alone and TB complicated with lung cancer was calculated. The differences in CT imaging characteristics between the two groups were investigated. The differences in the structural characteristics of para-cancerous tissue between the two groups were analyzed. Results: The diagnostic accuracy of CT was 91.67% in TB patients (55/60) and 92.00% in TB+LCA
patients (46/50) without significant difference (X2=0.004, P=0.949). The detection rate of spiculation, lobulation and cavitation in TB+LCA group was significantly higher than that in TB group (P<0.05), and the distribution, size and wall thickness of cavitation varied significantly between the two groups (P<0.05). Patients in TB group had higher percentage of mediastinal lymph node calcification, peripheral satellite lesion, and mediastinal lymph node enlargement around the TB lesions compared with those in TB+LCA group (P<0.05). Conclusion: CT has certain application value in differentiating TB alone from TB complicated with lung cancer, and there are many similarities in the imaging features of the two conditions. CT can be considered as a preliminary means of differential diagnosis of TB complicated with lung cancer, which is helpful to the primary screening diagnosis of lung cancer.
Ye, M.-F., et al. (2020). "Efficacy and safety of concurrent anti-tuberculosis treatment and chemotherapy in lung cancer patients with co-existent tuberculosis." Annals of Translational Medicine 8(18) FULL TEXT AT URL https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7576042/
Background: This retrospective study evaluated the safety and efficacy of concurrent anti-tuberculosis (TB) and chemotherapy treatment in patients with advanced lung cancer and active TB.
Methods: We retrospectively analyzed patients who were first diagnosed with advanced lung cancer and received first-line chemotherapy in Guangzhou Chest Hospital from 2015 to 2017. Patients were categorized into two groups (2:1): lung cancer patients without active TB (Group A), and lung cancer patients with active TB (Group B). Primary endpoints included adverse events (AEs), objective response rate (ORR), time to treatment failure, and overall survival (OS).
Results: A total of 99 patients were eligible (Group A, n=66; Group B, n=33). Grade ≥3 treatment-related AEs, primarily hematologic toxicity, occurred in 39.4% and 51.5% of patients in Groups A and B, respectively. The hypohepatia in both groups was generally at grade 1 or 2, with similar incidences (26% and 27%, respectively). After two cycles of chemotherapy, the ORR was 42.4% and 33.3% in Group A and B, respectively (P=0.383). The median time to treatment failure (TTF) was 7.0 and 5.6 months for Groups A and B, respectively (P=0.175). The median OS was 17.0 and 14.0 months for Groups A and B, respectively (P=0.312). After 3 months of anti-TB treatment, all patients achieved sputum acid-fast bacilli (AFB) smear conversion and absorption on imaging, and the end of follow-up observed no recurrence.
Conclusions: Concurrent anti-TB and chemotherapy treatment did not increase hematological toxicity or hypohepatia in lung cancer patients with pulmonary TB.
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