Gefitinib failed to demonstrate superior OS compared with GP as first-line therapy for NSLAs.

No abstract

established the temporality of the disease events, which was otherwise lacking in the study. The overall burden of disease (number, duration and severity of TB relapse) and respiratory morbidity in childhood [2] are other potential confounding factors that were not considered in the study. Radiologically, healed pulmonary TB can present with cicatrisation, fibro-cavitory disease, end-stage lung destruction, pulmonary calcification, bronchiectasis, trachea-bronchial stenosis etc. [3]. With such diverse and mixed presentations, combined obstructive and restrictive defects seem highly probable, but were not observed in the study. In general, asymptomatic lung function defects in patients with past TB do not require any treatment. The study would have been clinically more relevant if the authors had given the percentage of previously treated TB patients with symptomatic lung function defects, particularly airway obstruction, who were likely to utilise medical resources in future. @ERSpublications Healed pulmonary TB often presents with residual lung function defects which may require further treatment We are grateful to Aggarwal and colleagues for their interest in our paper [1]. They are correct to point out the limitations of cross-sectional studies, particularly when they rely on recalled information, and we discussed these at some length in the paper. However, evidence needs to be evaluated in the round. Not all error is biased; the outcomes (lung function) that we used were measured objectively and, as the results were not shared with the participants at the time, are unlikely to have influenced their answers to questions about a past history of tuberculosis. We agree, of course, that objective measures of tuberculosis would have been preferable, but it seems more likely that these would have reduced random error and so strengthened the current findings. We hope to add these to future investigations in the Burden of Obstructive Lung Disease (BOLD) cohort. We also discussed at some length the problem of inferring causality from cross-sectional studies when the order of events is unclear. In this case, reverse causation (low lung function causing tuberculosis) seems unlikely, but finding that the tuberculosis preceded the lung function decline would have only slightly reduced, and not excluded, the possibility of both being explained by a third, unmeasured, variable. The argument against this rests largely on the strength of the association and the failure to account for it by adjustment for other known factors. Having raised a concern over recall errors, Aggarwal and colleagues suggest we should have used time to "lung defects" after the occurrence of tuberculosis and "total burden" of disease as exposure variables. In the BOLD study, we do not have this information but it would likely be even less reliable than the information on history of tuberculosis itself. We did have information on childhood hospitalisation for respiratory disease. We did not report this in the paper, largely because of the strong possibi...

Esophageal cancer is a leading cause of cancer mortality worldwide. Complete resection of esophageal cancer and adjacent malignant lymph nodes is the only potentially curative treatment. Accurate preoperative staging and assessment of therapeutic response after neoadjuvant therapy are crucial in determining the most suitable therapy and avoiding inappropriate attempts at curative surgery. Computed tomography (CT) is recommended for initial imaging following confirmation of malignancy at pathologic analysis, primarily to rule out unresectable or distant metastatic disease. With the advent of multidetector CT, use of thin sections and multiplanar reformation allows more accurate staging of esophageal cancer. Endoscopic ultrasonography (US) is the best modality for determining the depth of tumor invasion and presence of regional lymph node involvement. Combined use of fine-needle aspiration and endoscopic US can improve assessment of lymph node involvement. Positron emission tomography (PET) is useful for assessment of distant metastases but is not appropriate for detecting and staging primary tumors. PET may also be helpful in restaging after neoadjuvant therapy, since it allows identification of early response to treatment and detection of interval distant metastases. Each imaging modality has its advantages and disadvantages; therefore, CT, endoscopic US, and PET should be considered complementary modalities for preoperative staging and therapeutic monitoring of patients with esophageal cancer.

Mucoepidermoid carcinoma of the tracheobronchial tree, usually located in a segmental bronchus, appears at CT as a smoothly oval or lobulated airway mass. It adapts to the branching features of the airways.