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Background: Surgical stress provokes a cytokine storm and systemic inflammatory response syndrome, and can also affect redox balance during the postoperative course. However, whether inflammatory status, especially redox balance, during the perioperative period has effects on long-term outcome following surgery for lung cancer remains unclear. The aim of this study was to determine whether redox balance during the perioperative period is associated with long-term survival of patients after undergoing lung resection.Methods: Consecutive patients who underwent an anatomical lung resection greater than a segmentectomy for non-small cell lung cancer from January to June 2013 at our institution were investigated. The Ethical Committee of Dokkyo Medical University Hospital approved this study (#24043) and all participating patients provided informed consent. Serum was collected during the operation, and on post-operative day (POD) 3 and 7, and the levels of reactive oxygen metabolites (d-ROM) and biological antioxidant potential (BAP) were measured using FREE carpe diem (Wismerll). We analyzed overall survival, relapse, and cause of death.Results: Twenty-two patients (males 18, females; 69±7 years old) were enrolled, of whom 12 underwent open surgery and 6 VATS. Histology findings showed 12 adenocarcinomas, 6 squamous cell carcinomas, and 4 others. Comorbidities in the patients were chronic obstructive pulmonary disease in 8 and idiopathic pulmonary fibrosis in 5. d-ROM values on POD 3 and 7 were significantly increased as compared to those obtained during the operation (perioperative 288±65, POD 3 439±49, POD 7 479±49; p<0.001), whereas BAP did not change after surgery. Overall survival was 71.4% after 3 years. A receiver operating characteristic curve revealed a dROM cut-off value of 327 during the operation. Patients with a dROM value of 327 or less showed significantly superior 3-year survival as compared to those with a greater value (87.5% vs. 20.0%, p<0.001).Conclusion: Surgical stress caused an increase in dROM during the postoperative course. The dROM value obtained during the operation was correlated with longterm survival of patients after undergoing resection for lung cancer.

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Introduction: Screening for coronavirus disease 2019 (COVID-19) exposure, coupled with engaged decision making to prioritize cancer treatment in parallel with reducing risk of exposure and infection, is crucial in the management of COVID-19 during cancer treatment. After two reported case studies of imaging findings during daily computed tomography (CT)-based image-guided radiotherapy (RT) scans, a call for submission of anonymized case reports was published with the objective of rapidly determining if there was a correlation between the onset of new pulmonary infiltrates found during RT and COVID-19. We hereby report the results of the aggregate analysis.Methods: Data of deidentified case reports for patients who developed biochemically confirmed COVID-19 during RT were submitted through an online portal. Information requested included a patient's sex, age, cancer diagnosis and treatment, and COVID-19 diagnosis and outcome. Coplanar CT-based imaging was requested to reveal the presence or absence of ground-glass opacities or infiltrates.Results: A total of seven reports were submitted from Turkey, Spain, Belgium, Egypt, and the United States.Results and imaging from the patients reported by Suppli et al. and McGinnis et al. were included for a total of nine patients for analysis. All patients were confirmed COVID-19 positive using polymerase chain reaction-based methods or nasopharyngeal swabs. Of the nine patients analyzed, abnormalities consistent with ground-glass opacities or infiltrates were observed in eight patients.Conclusions: This is the largest case series revealing the potential use of CT-based image guidance during RT as a tool for identifying patients who need further workup for COVID-19. Considerations for reviewing image guidance for new pulmonary infiltrates and immediate COVID-19 testing