Table of Contents
1
UI - 10944131
AU - Andre F; Grunenwald D; Pignon JP; Dujon A; Pujol JL; Brichon PY;
TI -
Brouchet L; Quoix E; Westeel V; Le Chevalier T
Survival of patients with resected N2 non-small-cell lung cancer:
evidence for a subclassification and implications.
SO - J Clin Oncol 2000 Aug;18(16):2981-9
AD - Departments of Medicine and Biostatistics, Institut Gustave Roussy,
Villejuif, France. UIMMUNOC@igr.fr
PURPOSE: Patients who suffer from non-small-cell lung cancer (NSCLC)
with ipsilateral mediastinal lymph node involvement (N2) belong to a
heterogeneous subgroup of patients. We analyzed the prognosis of
patients with resected N2 NSCLC to propose homogeneous patient
subgroups. PATIENTS AND METHODS: The present study comprised 702
consecutive patients from six French centers who underwent surgical
resection of N2 NSCLC. Initially, two groups of patients were defined:
patients with clinical N2 (cN2) and those with minimal N2 (mN2) disease
were patients in whom N2 disease was and was not detected preoperatively
at computed tomographic scan, respectively. RESULTS: The median duration
of follow-up was 52 months (range, 18 to 120 months). A multivariate
analysis using Cox regression identified four negative prognostic
factors, namely, cN2 status (P <. 0001), involvement of multiple lymph
node levels (L2+; P <.0001), pT3 to T4 stage (P <.0001), and no
preoperative chemotherapy (P <. 01). For patients treated with primary
surgery, 5-year survival rates were as follows: mN2, one level involved
(mN2L1, n = 244): 34%; mN2, multiple level involvement (mN2L2+, n = 78):
11%; cN2L1 (n = 118): 8%; and cN2L2+ (n = 122): 3%. When only patients
with mN2L1 disease were considered, the site of lymph node involvement
according to the American Thoracic Society numbering system had no
prognostic significance (P =.14). Preoperative chemotherapy was
associated with a better prognosis for those with cN2 (P <.0001).
Five-year survival rates were 18% and 5% for cN2 patients treated with
and without preoperative chemotherapy, respectively. CONCLUSION: This
study has identified homogeneous N2 NSCLC prognostic subgroups and
suggests different therapeutic approaches according to the subgroup
profile.
2
UI - 11181689
AU - Grannis FW Jr
TI -
Subclassification of N2 non-small-cell lung cancer.
SO - J Clin Oncol 2001 Feb 15;19(4):1228
3
UI - 11370493
AU - Sause WT
TI -
Nonsurgical management of non-small-cell lung cancer.
SO - Hematol Oncol Clin North Am 2001 Apr;15(2):277-89
AD - Department of Radiation Oncology, LDS Hospital, Salt Lake City, Utah,
USA.
Aggressively applied radiotherapy can cure approximately 15% to 20% of
medically inoperable patients. It is hoped that with more sophisticated
treatment planning and more dose-intensive radiation, the results in
these tumors can be improved. No good clinical evidence to date suggests
that including areas of subclinical involvement will result in higher
cure rates. In patients who have regionally advanced disease,
combination therapy consisting of concurrent chemotherapy and
irradiation seems to have yielded an improvement in short-term and
median survival. Patients selected for this type of aggressive treatment
must have a good performance status and should be less than 70 years of
age. Refinements in chemotherapeutic agents, in the delivery of
radiotherapy, and in the interdigitation of these modalities are areas
of intense clinical research.
4
UI - 11394503
AU - Sakamoto J; Teramukai S; Watanabe Y; Hayata Y; Okayasu T; Nakazato H;
TI -
Ohashi Y; The Japanese Meta-Analysis Group in Cancer; in: Japanese
Society of Strategies for Cancer Research and Therapy
Meta-analysis of adjuvant immunochemotherapy using OK-432 in patients
with resected non-small-cell lung cancer.
SO - J Immunother 2001 May-Jun;24(3):250-6
AD - Department of Surgery and Laboratory of Clinical Oncology, Aichi
Prefectural Hospital, Okazaki, Japan.
The benefits of immunochemotherapy with a penicillin-treated,
lyophilized preparation of Streptococcus pyogenes, OK-432 (Picibanil),
were reassessed in patients with resected non-small-cell lung cancer
through a meta-analysis based on data from 1,520 patients enrolled in 11
randomized clinical trials. All 11 trials were started before 1991, and
the subjects had been followed up for at least 5 years after surgery and
randomization. In these trials, standard chemotherapy was compared with
the same therapy plus OK-432. The endpoint of interest was overall
survival, and analysis was based on intent-to-treat population without
patient exclusion. Data were analyzed using the Mantel-Haenszel method.
The 5-year survival rate for all eligible patients in the 11 trials was
51.2% in the immunochemotherapy group versus 43.7% in the chemotherapy
group. The odds ratio (OR) for overall survival was 0.70 (95% CI =
0.56-0.87, p = 0.0010). Analysis of four trials in which central
randomization was performed also reconfirmed a significantly longer
survival time for the immunochemotherapy group (OR = 0.66, 95% CI =
0.44-1.00, p = 0.049). Based on these results of meta-analysis, it is
postulated that postoperative adjuvant immunochemotherapy using OK-432
might improve the survival of patients after resection of non-small-cell
lung cancer.
5
UI - 11401061
AU - Laudanski J; Niklinska W; Burzykowski T; Chyczewski L; Niklinski J
TI -
Prognostic significance of p53 and bcl-2 abnormalities in operable
nonsmall cell lung cancer.
SO - Eur Respir J 2001 Apr;17(4):660-6
AD - Dept of Thoracic Surgery, Medical Academy of Bialystok, Poland.
The association of p53 abnormalities and bcl-2 protein expression with
clinical data and prognosis in 102 patients with resected nonsmall cell
lung cancer (NSCLC) was investigated. Deoxyribonucleic acid analysis of
exons 5-8 of the p53 gene showed mutations (p53-M) in 47% of resected
NSCLC, serum p53 antibodies (p53-Abs) were detected in 25%, p53 protein
overexpression (p53-PE) in 54%, and bcl-2 protein overexpression
(bcl-2-PE) in 48%. A statistically significant association was found
between p53-PE, serum p53-Abs and the presence of a p53 gene alteration.
No significant associations were found between results of the p53-M,
p53-Abs, bcl-2-PE tests and clinicopathological parameters. In the case
of the p53-PE test there were significantly fewer positive results for
adenocarcinoma than for squamous cell carcinoma and large cell
carcinoma. Survival analysis showed that both p53 abnormalities and
negative staining for bcl-2, when analysed separately, were associated
with poor overall survival. In a multivariate analysis, only the
positive result of the p53-M test remained an independent, statistically
significant, unfavourable prognostic factor for survival. When the p53
mutation test was removed from the model, positive results of the p53-PE
test and the p53-Abs test became statistically significant, unfavourable
prognostic factors. To conclude, among p53 and bcl-2 abnormalities, only
p53 gene mutations seem to have a strong and independent effect on
prognosis. When deoxyribonucleic acid sequence information is not
available, p53 protein expression and the presence of p53 antibodies in
serum may be used to obtain important prognostic information.
6
UI - 11571539
AU - Huang M; Batra RK; Kogai T; Lin YQ; Hershman JM; Lichtenstein A; Sharma
TI -
S; Zhu LX; Brent GA; Dubinett SM
Ectopic expression of the thyroperoxidase gene augments radioiodide
uptake and retention mediated by the sodium iodide symporter in
non-small cell lung cancer.
SO - Cancer Gene Ther 2001 Aug;8(8):612-8
AD - Pulmonary Immunology and Gene Medicine Laboratory, Division of Pulmonary
and Critical Care Medicine, Department of Medicine, UCLA and VA Greater
Heathcare System, Los Angeles, California 90073, USA. minhuang@ucla.edu
Radioiodide is an effective therapy for thyroid cancer. This treatment
modality exploits the thyroid-specific expression of the sodium iodide
symporter (NIS) gene, which allows rapid internalization of iodide into
thyroid cells. To test whether a similar treatment strategy could be
exploited in nonthyroid malignancies, we transfected non-small cell lung
cancer (NSCLC) cell lines with the NIS gene. Although the expression of
NIS allowed significant radioiodide uptake in the transfected NSCLC cell
lines, rapid radioiodide efflux limited tumor cell killing. Because
thyroperoxidase (TPO) catalyzes iodination of proteins and subsequently
causes iodide retention within thyroid cells, we hypothesized that
coexpression of both NIS and TPO genes would overcome this deficiency.
Our results show that transfection of NSCLC cells with both human NIS
and TPO genes resulted in an increase in radioiodide uptake and
retention and enhanced tumor cell apoptosis. These findings suggest that
single gene therapy with only the NIS gene may have limited efficacy
because of rapid efflux of radioiodide. In contrast, the combination of
NIS and TPO gene transfer, with resulting TPO-mediated organification
and intracellular retention of radioiodide, may lead to more effective
tumor cell death. Thus, TPO could be used as a therapeutic strategy to
enhance the NIS-based radioiodide concentrator gene therapy for locally
advanced lung cancer.
7
UI - 11557110
AU - Ichinose Y; Kato H; Koike T; Tsuchiya R; Fujisawa T; Shimizu N; Watanabe
TI -
Y; Mitsudomi T; Yoshimura M; The Japan Clinical Oncology Group
Overall survival and local recurrence of 406 completely resected stage
IIIa-N2 non-small cell lung cancer patients: questionnaire survey of the
Japan Clinical Oncology Group to plan for clinical trials.
SO - Lung Cancer 2001 Oct;34(1):29-36
AD - National Kyushu Cancer Center, Fukuoka, Japan
BACKGROUND: the group of completely resected stage IIIA-N2 non-small
cell lung cancer patients (NSCLC) is considered to be heterogeneous in
various aspects including survival and the recurrent pattern. In the
present study, we attempted to clarify the factors which separate these
patients into high and low risk groups based on the survival and local
recurrence. METHODS: a questionnaire survey on the survival and local
recurrence of non-small cell lung cancer patients with pathological
stage IIIA-N2 disease who underwent a complete resection from January
that of local recurrence in 332 of them was available. RESULTS: the
5-year survival of the 406 patients was 31.0%. In a univariate analysis,
the age, clinical and pathological T status, number of N2 stations,
pathological N1 disease, operative modality and postoperative
radiotherapy were all found to be important prognostic factors. Clinical
N2 disease marginally influenced the survival (P=0.07). In a
multivariate analysis of these variables including clinical N2 disease,
the survival was significantly worse in the case of multiple N2 stations
(hazard ratio=1.741), the presence of pathological N1 disease (1.403),
pathological T2 or 3 disease (1.399) and an age older than 65 (1.327).
The rate of freedom from any local recurrence at the bronchial stump, or
in the hilar, mediastinal or supraclavicular lymph nodes at 5 years was
64%. In a univariate analysis of the freedom from local recurrence, the
clinical N status, pathological T status, pathological N1 disease and
number of N2 stations were all found to be important prognostic factors.
A multivariate analysis revealed the freedom from local recurrence to be
adversely influenced by multiple N2 stations (hazard ratio=2.05), and
the presence of either clinical N1 or 2 (1.733) disease. The 5-year
survival and the rate of freedom from local recurrence at 5 years were
43 and 75% in patients with a single N2 station and 17 and 48% in those
with multiple N2 stations, respectively. CONCLUSIONS: the number of N2
stations (single vs. multiple N2 stations) was found to be a useful
prognostic factor, which can separate completely resected stage IIIA-N2
patients into high and low risk groups regarding both the overall
survival and local recurrence.
8
UI - 11557112
AU - Sasaki H; Chen LB; Auclair D; Moriyama S; Kaji M; Fukai I; Kiriyama M;
TI -
Yamakawa Y; Fujii Y
Overexpression of Hrad17 gene in non-small cell lung cancers correlated
with lymph node metastasis.
SO - Lung Cancer 2001 Oct;34(1):47-52
AD - Department of Surgery II, Nagoya City University Medical School, 1
Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
hisasaki@med.nagoya-u.ac.jp
We used palindromic PCR-driven cDNA differential display technique to
identify and isolate a gene, human homologue of the Schizosaccharomyces
pombe checkpoint gene rad17, from colon cancer tissues. The loss of
checkpoint control in mammalian cells results in genomic instability,
leading to the amplification, rearrangement, or loss of chromosomes,
events associated with tumor progression. We hypothesized that the
Hrad17 may be expressed in non-small cell lung cancer (NSCLC). We
attempted to determine the influence of Hrad17 expression on
clinicopathological features for patients with NSCLC who had undergone
surgery. Expression of Hrad17 messenger RNA was evaluated by reverse
transcription-polymerase chain reaction (RT-PCR) in 102 non-small cell
lung carcinomas and adjacent histologically normal lung samples from
patients for whom follow up data were available. Hrad17 transcripts were
detected in 26 (25.5%) of the tumor samples, although some of the paired
normal lung samples showed weak expression. There was no relationship
between Hrad17 gene expression and age, gender or T-status. About 13 of
31 (41.9%) NSCLC patients with Hrad17 overexpressions were node
positive, on the other hand, 13 of 76 (18.3%) cases without Hrad17
overexpressions were node positive. Thus the expression of Hrad17 mRNA
correlated with lymph node metastasis (P=0.0231) from NSCLC. Hrad17
protein was highly expressed at the advancing margin of the tumor of
lung cancer tissue but not within the normal lung tissue by
immunohistochemistry. Thus the expression of Hrad17 might correlate with
more advanced NSCLC.
9
UI - 11557116
AU - Fukuse T; Hirata T; Tanaka F; Wada H
TI -
The prognostic significance of malignant pleural effusion at the time of
thoracotomy in patients with non-small cell lung cancer.
SO - Lung Cancer 2001 Oct;34(1):75-81
AD - Department of Thoracic Surgery, Otsu Red-Cross Hospital, 1-1-35 Nagara,
Otsu-City 520-8511, Japan. fukuse@kuhp.kyoto-u.ac.jp
Surgery is usually not indicated for malignant pleural effusion (PE) due
to its poor prognosis. However, PE is first detected at thoracotomy, and
it is difficult to judge an appropriate mode of resection. Forty-nine
patients with lung cancer were first diagnosed as PE and/or pleural
dissemination (PD) at thoracotomy. The histological types were 36
adenocarcinoma, ten squamous cell carcinoma and three large cell
carcinoma. Sixteen patients had only PE, 17 had only PD, and 16 had both
PE and PD. Ten patients underwent only exploratory thoracotomy, seven
partial resection, 27 lobectomy and five panpleuropneumonectomy. The
overall survival rate was 26.7% at 3 years. The patients with PE and/or
PD seemed to have a poorer survival compared to our previous study. The
patients with only PE showed a significantly better prognosis than the
patients with only PD (P=0.0001) or with PD+PE (P=0.019). The patients
who underwent exploratory thoracotomy showed poor survival. There were
significant differences in the survival in relation to the extent of the
primary tumor. In conclusion, the patients with T1-2 of primary tumor
and only a small amount of PE without PD can be expected to show
long-term survival after tumor resection.
10
UI - 11570051
AU - Osaki T; Oyama T; Takenoyama M; So T; Yamashita T; Aikawa M; Ono K;
TI -
Yasumoto K
[Results of surgical treatment for primary lung cancer; time trends of
survival and clinicopathologic features]
SO - J UOEH 2001 Sep 1;23(3):277-83
AD - Department of Surgery II, School of Medicine, University of Occupational
and Environmental Health, Japan. Yahatanishi-ku, Kitakyushu 807-8555,
Japan.
To assess whether the survival of patients who underwent surgical
resections for non-small cell lung cancer (NSCLC) improved, we examined
the time trends for survival after operation. A total of 851 consecutive
patients with NSCLC who underwent surgical resections between 1979 and
2000 were retrospectively reviewed by 3 groups according to year of the
operation: the early period (from 1979 to 1986, n = 138), the middle
period (from 1987 to 1993, n = 288), and the late period (from 1994 to
2000, n = 425). There were 606 men and 245 women with a mean age of 65.4
years. The histologic type included 453 adenocarcinoma, 282 squamous
cell carcinoma, and 63 large cell carcinoma. The pathologic stage
included 203 stage I A, 171 stage I B, 21 stage II A, 117 stage II B,
180 stage III A, 123 stage III B, and 36 stage IV diseases. The mean age
at the middle and late periods showed a significant increase compared
with the early period. There were no significant histologic differences
among the three periods. The ratio of patients with stage I A disease
increased significantly at the middle and late periods compared with the
early period. The 5-year survival rate of the 851 patients was 43.7%,
and the median survival was 44.8 months. The 5-year survival rates at
the early, the middle, and the late periods were 33.3%, 44.2%, and
45.8%, respectively, with significant improvement at the middle and late
periods compared with the early period. The overall 30-day operative
mortality was 2.2% (19/851): 8.7% (12/138) at the early period, 1.4%
(4/288) at the middle period, and 0.7% (3/425) at the late period,
showing significant decrease during the middle and late periods compared
with the early period. The postoperative prognosis of patients with
resected NSCLC during the later periods had a better survival, which was
caused by an increase in the ratio of patients with stage I A disease,
and a decrease in the rates of operative mortality.
11
UI - 11574760
AU - Plataniotis GA; Theofanopoulou MA
TI -
Treatment of inoperable stage III and IV non-small-cell lung cancer: the
'average' radiotherapist's point of view.
SO - Onkologie 2001 Aug;24(4):333-9
AD - Department of Radiation Oncology, Aristotelian University of
Thessaloniki, AHEPA General Hospital, Thessaloniki, Greece.
gplatan@auth.gr
Stage III non-small-cell lung cancer (NSCLC) presents a major
therapeutic problem for the radiation oncologist who treats patients
outside of clinical trials. It is a heterogeneous disease with great
variation of the clinical extent, and the optimal therapeutic decision
must be based on various parameters: the most important unfavorable
characteristics are represented by a low Karnofsky performance status,
weight loss > 5%, locally too advanced disease (e.g. T4, positive
pleural effusion), intensive symptomatology, and distant metastases. The
presence of these factors advocates the use of short hypofractionated
radiotherapy (RT) schemes of one or two fractions (e.g., 1 x 10 Gy, 2 x
8.5 Gy), which results in fast and effective palliation. Radical
treatment must be given to patients without the above-mentioned
unfavorable characteristics. Results from randomized clinical trials
support the use of high RT doses, preferably hyperfractionated/
accelerated. The CHART schedule could be used in case of squamous-cell
histology. Elderly patients could be treated by the standard scheme of
30 x 2 Gy (or equivalent). Chemotherapy reduces the risk of (other than
brain) distant metastases and improves the median survival time,
especially for patients with non-squamous-cell NSCLC. Platinum-based
chemotherapy is usually administered in conjunction with RT as inductive
and/or concurrent. Patients of stage IV are probably candidates for
chemotherapy in case of good performance status and for a short-term
radiotherapy if local symptoms are predominant. Copyright 2001 S. Karger
GmbH, Freiburg
12
UI - 11574207
AU - Kotoulas C; Lazopoulos G; Foroulis C; Konstantinou M; Tomos P; Lioulias
TI -
A
Wedge resection of the bronchus: an alternative bronchoplastic technique
for preservation of lung tissue.
SO - Eur J Cardiothorac Surg 2001 Oct;20(4):679-83
AD - Second Department of General Thoracic Surgery, Chest Diseases Hospital,
Athens, Greece. chrkotoulas@hol.gr
OBJECTIVES: We present a modified wedge resection of the bronchus, as an
alternative bronchoplastic technique for lung resection, in cases of
patients with or without adequate pulmonary reserve to undergo a
pneumonectomy, in order to preserve lung tissue. METHODS: Seventeen
patients underwent a major lung resection with wedge resection of the
bronchus for non-small cell lung cancer (NSCLC) in our department, from
males, with a mean age 62.5+/-6.6 (range 51-72) years. Further workup
was free of metastatic disease. All patients underwent a right
posterolateral thoracotomy, under general anesthesia with a double lumen
endotracheal tube. Twelve right upper lobectomies, four right upper and
middle lobectomies and one carinal resection were performed. The wedge
resection of the bronchus carried out longitudinally, along the
bronchial tree, and the bronchial defect was reapproximated
transversely, in a single-layer, with interrupted non-absorbable suture.
The frozen section of the distal margin of the resected bronchus was
negative for malignancy in all patients. Extended mediastinal lymph node
dissection followed each lung resection. RESULTS: The pathology report
showed 12 squamous-cell carcinomas, three adenocarcinomas, one
adenosquamous carcinoma and one neuroendocrine carcinoma. The
differentiation of the carcinomas was well in two cases, moderate in ten
and poor in five. The pTNM stage was IB in four patients (23.5%), IIA in
one (5.9%), IIB in eight (47.1%) and IIIA in four (23.5%). The median
disease-free distal margin of the bronchus was 5 mm (range 2-15 mm). The
average postoperative hospital stay was 15 days (range 12-28 days). The
morbidity and mortality rate was 11.8 and 5.9%, respectively.
Postoperative follow-up was every 6 months. The average survival is
20.0+/-15.2 months (range 1-54 months). There are 12 patients alive, and
their follow-up is negative for locoregional recurrence or distant
metastasis. The survival study showed no significantly statistic
relation to the histologic type, cancer differentiation, pTNM stage, and
disease-free distal margin of resection larger or less than 0.5 cm
(Kaplan-Meier study log rank method). CONCLUSIONS: The wedge resection
of the bronchus as a bronchoplastic procedure is an easy, fast and safe
technique of reparation of the bronchial tree. It presents not only a
low rate of morbidity and mortality, but also a satisfactory survival.
13
UI - 11574208
AU - Santambrogio L; Nosotti M; Baisi A; Ronzoni G; Bellaviti N; Rosso L
TI -
Pulmonary lobectomy for lung cancer: a prospective study to compare
patients with forced expiratory volume in 1 s more or less than 80% of
predicted.
SO - Eur J Cardiothorac Surg 2001 Oct;20(4):684-7
AD - Thoracic Surgery Unit, I.R.C.C.S. Ospedale Maggiore Policlinico, Via F.
Sforza, 35, 20122 Milan, Italy.
OBJECTIVE: To compare post-operative course, lung function and survival
of lung cancer patients with a forced expiratory volume in 1 s (FEV1)
more or less than 80% of predicted submitted to lobectomy. METHODS: The
data of patients undergoing lobectomy for non small cell carcinoma at
the Thoracic Surgery Unit of the Ospedale Maggiore Policlinico of Milan,
Italy, were prospectively collected. Inclusion criteria were a radical
resectable tumor with size less than 2.5 cm, negative mediastinal nodes,
capability to complete pulmonary function tests, Exclusion criteria were
FEV1 <40% of predicted, pre- or post-operative chemo or radiotherapy,
lobe to be resected receiving more than 30% of the perfusion, incapacity
to quit smoking. RESULTS: Eighty-eight patients entered the study and
were divided into two groups according to their FEV1%: 45 patients were
included in control group (mean FEV1: 92.2%) and 42 in chronic
obstructive pulmonary disease group (mean FEV1: 64.2%). Post-operative
complications, operative mortality and actuarial survival were the same
in the 2 groups. Six months after lobectomy, the mean changes in FEV1
were -14.9% for first group and -3.2% for second group (P<0.001).
CONCLUSION: Lobectomy for cancer can be performed successfully also in
selected patients with chronic obstructive pulmonary disease.
Post-operative course and survival of these patients is not different
from that of patients with normal FEV1, on the contrary, patients with
low FEV1 may lose less pulmonary function or even mend it.
14
UI - 11574210
AU - Myrdal G; Gustafsson G; Lambe M; Horte LG; Stahle E
TI -
Outcome after lung cancer surgery. Factors predicting early mortality
and major morbidity.
SO - Eur J Cardiothorac Surg 2001 Oct;20(4):694-9
AD - Department of Thoracic and Cardiovascular Surgery, Uppsala University
Hospital, SE-751 85 Uppsala, Sweden. gunnar.myrdal@thorax.uas.lul.se
OBJECTIVE: This study was undertaken to assess mortality, complications
and major morbidity during the first 30 days after lung cancer surgery
and to estimate the significance of presurgical risk factors. METHODS:
The study was based on all patients referred for surgery for primary
616 patients with primary lung cancer. Three-hundred and ninety-four
were men and 222 women. Postoperative events studied were divided into
major and minor complications or death during the first 30 days after
surgery. The significance of risk factors for an adverse outcome
(defined as death or major complication in the first 30 days
postoperatively) was assessed by uni- and multivariate logistic
regression analyses. RESULTS: During the study period an increasing
number of women and of patients older than 70 years underwent surgery.
Overall 30-day mortality was 2.9, 0.6% after single lobectomy and 5.7%
after pneumonectomy. Major complications occurred in 54 patients (8.8%).
Fifty-eight patients (9.5%) had an adverse outcome during the first 30
days. Male gender, smoker, FEV(1)< or =70% of expected value, squamous
cell carcinoma and pneumonectomy were risk factors predicting adverse
outcome in the univariate model. Pneumonectomy and FEV(1)< or =70%, were
the only independently significant factors for adverse outcome. Only
pneumonectomy was independently associated with an increased risk for
early death. CONCLUSION: Our results show low mortality and morbidity
after lung cancer surgery. However, patients with reduced lung capacity
and those undergoing pneumonectomy should be treated with great care, as
they run a considerable risk of major complications or death during the
first 30 days postoperatively. Older age (>70 years) does not appear to
be a contraindication to lung cancer surgery, but patients in this group
should undergo careful preoperative evaluation.
15
UI - 11574211
AU - Novoa N; Varela G; Jimenez MF
TI -
Morbidity after surgery for non-small cell lung carcinoma is not related
to neoadjuvant chemotherapy.
SO - Eur J Cardiothorac Surg 2001 Oct;20(4):700-4
AD - Section of Thoracic Surgery, Salamanca University Hospital, Paseo San
Vicente 58, 37007 Salamanca, Spain. ctorax@usal.es
OBJECTIVES: To compare postoperative morbidity and mortality rates in
two groups of operated non-small cell lung carcinoma patients (NSCLC)
with or without induction chemotherapy. METHODS: This is a case-control
study on 42 cases and 42 controls. Cases (Group A) underwent induction
chemotherapy. Chemotherapy indications and regimens were variable.
Control cases (Group B) were randomly selected among 494 NSCLC
comparable patients operated on in the same period of time. The
selection criteria for operation were the same in both groups. Dependent
outcomes were operative death and complications. Independent selected
variables were: age, co-morbidity, predicted postoperative FEV1% (1 s
forced expiratory volume in percentage), type of surgery and clinical
and pathological staging. All postoperative events and independent
variables were prospectively registered. Chi-square and risk
calculations on contingence tables and one-way ANOVA have been tested.
RESULTS: Both series are comparable in demographics, preoperative
variables and type of surgery. No mortality has been registered. In
Group A, the overall morbidity was 26.2% (11 out of 42 cases), and in
Group B, this was 42.9% (18 out of 42 cases; P=0.084). Morbidity was not
related to the type of surgery (pneumonectomy vs. other; P=0.205 in
Group A and P=0.08 in Group B). Pathological staging did not influence
the postoperative outcome, either in Group A (P=0.72; odds ratio, 1.515;
95% confidence interval (CI), 0.375-6.122) or Group B (P=0.299; odds
ratio, 0.4; 95% CI, 0.089-1.797). CONCLUSIONS: Induction chemotherapy in
NSCLC has no influence on postoperative morbidity.
16
UI - 11547240
AU - Rixe O
TI -
[Concomitant radiochemotherapy for non-small-cell lung cancer: towards
an ideal strategy]
SO - Rev Mal Respir 2001 Sep;18(4 Pt 1):365-6
17
UI - 11547248
AU - Lebeau B; Urban T; Baud M; Collon T; Le Guen Y; Febvre M; Touboul E
TI -
[Chemoradiotherapy-chemotherapy for grade III inoperable non-small-cell
lung cancer]
SO - Rev Mal Respir 2001 Sep;18(4 Pt 1):405-9
AD - Service de Pneumologie, Hopital Saint Antoine, Assistance
Publique-Hopitaux de Paris, Universite Paris VI, 75012 Paris, France.
PURPOSE: The purpose of this work was to assess results obtained with
the MIP (mitomycin 6 mg/m(2) day 1, ifosfamide 1500 mg/m(2) days 1,2, 3,
cisplatin 30 mg/m(2) days 1,2, 3) chemotherapy protocol combined with
cisplatin-sensitized chest radiotherapy as developed in the French
multicentric trial on perioperative chemotherapy.PATIENTS AND METHODS:
Thirty-five patients with grade III non-small-cell lung cancer (NSCLC)
were given two or three starter MIP cycles every 4 weeks then underwent
radiation therapy for six weeks for a total dose of 60 Gy with injection
of 8 mg/m(2) cisplatin every day for the first two weeks and the last
two weeks of treatment. In case of objective response (OR) to MIP before
radiotherapy, the MIP protocol was repeated for one to four
supplementary cycles according to tolerance.RESULTS: The rate of OR
after MIP was 51% and after chemoradiotherapy it was 69%. Toxic effects
were limited to one death due to aplasia and 18 cases of grade 3-4
toxicity, mainly due to hematology disorders. Moderate esophagitis was
observed in ten cases. Median survival was 13.5 months. Survival rates
were 57% and 29% at one and two years.DISCUSSION: This novel scheme,
which can be improved, has demonstrated its efficacy. Tolerance is
satisfactory and the cost is low compared with associations using "new"
drugs.
18
UI - 11576719
AU - Dunst J
TI -
Role of radiotherapy in small cell lung cancer.
SO - Lung Cancer 2001 Sep;33 Suppl 1():S137-41
AD - Department of Radiotherapy, Martin-Luther-University Halle-Wittenberg,
Dryanderstrasse 4, D-06097, Halle, Germany.
juergen.dunst@medizin.uni-halle.de
Traditionally, small cell lung cancer has been considered as a disease
with early onset of distant metastases. Therefore, the role of
locoregional therapy (radiotherapy or surgery) was thought to be very
limited. This was supported by the first trials investigating the role
of radiotherapy since there was no improvement of median survival.
Recently, two meta-analyses changed this point of view: radiotherapy is
essential to achieve long term survival. The possible biological
explanation may be that uncontrolled distant metastases may cause the
death of patients during the first months of their disease. The longer
patients survive the more important local therapy becomes. Today, there
is growing acceptance that adequate systemic and local therapy
contributes to better treatment results of limited small cell lung
cancer.
19
UI - 11576720
AU - Wendt TG
TI -
Thoracic radiotherapy in the treatment of limited disease of small-cell
cancer: sequence and fractionation.
SO - Lung Cancer 2001 Sep;33 Suppl 1():S143-6
AD - Department of Radiation Oncology, Friedrich-Schiller-University,
Bachstrasse 18, D-07743, Jena, Germany. thomas.wendt@med.uni-jena.de
Since two meta-analyses showed improved survival rates at 3 years of
approximately 5%, thoracic radiotherapy is accepted as an essential
component of optimal management of limited-disease. However, optimal
sequencing, timing, fractionation, dose, and field size still remain a
matter of controversy. The issue has changed since the traditional
doxorubicin-based chemotherapy has been substituted by cisplatin based
regimens which clearly produce less acute toxicity and allow concomitant
chemoradiation protocols. Up-front radiotherapy seems to improve 5-years
survival rates compared to the traditional sequential modality.
Different fractionation schedules and escalated total doses are tested
prospectively in order to reduce the intrathoracic relapse rate.
Increased intensity of intrathoracic radiotherapy seems to augment long
term survival rates.
20
UI - 11576721
AU - Passlick B
TI -
Can surgery improve local control in small cell lung cancer?
SO - Lung Cancer 2001 Sep;33 Suppl 1():S147-51
AD - Department of Thoracic Surgery, Asklepios-Fachkliniken Munchen-Gauting,
Klinik fur Thoraxchirurgie, Robert-Koch-Allee 2, D-82131, Gauting,
Germany. passlick@lrz.uni-muenchen.de
Current therapy for small cell lung cancer (SCLC) consists of
chemotherapy with or without radiotherapy. Radiotherapy is generally
accepted as an essential treatment component of limited stage disease.
However, the local failure rate after chemo- and radiotherapy is still
high and ranges from 30 to 70%. Furthermore, despite having obtained a
complete radiographic response, up to 75% of these patients will have
residual disease in the tumor specimen, if resection is performed.
Therefore, more effective means are needed to eradicate the primary
tumor and to obtain an improved local disease control. Recent phase two
trials of multimodal regimens for stage I-IIIA SCLC demonstrate that in
selected patients with early stage SCLC the combination of surgery and
chemotherapy with or without radiotherapy is feasible with low morbidity
and mortality rates. The combination therapy results in satisfying long
term outcome depending on the pathological tumor stage and a local
disease control is achieved in almost all patients. It is remarkable
that the pneumonectomy rate has decreased over the past decades from
almost 100 to 27-39%. In order to confirm these promising results, a
German multicenter prospective randomized phase III trial has been
designed for patients with stage I-IIIA SCLC consisting of induction
chemotherapy, followed by surgery, adjuvant thoracic radiotherapy and
prophylactic cranial radiation compared to thoracic radiotherapy and
prophylactic cranial radiation.
21
UI - 11576722
AU - Pottgen C; Stuschke M
TI -
The role of prophylactic cranial irradiation in the treatment of lung
cancer.
SO - Lung Cancer 2001 Sep;33 Suppl 1():S153-8
AD - Department of Radiotherapy, University of Essen Medical School,
Hufelandstrasse 55, D-45122, Essen, Germany.
Patients with lung cancer face concurrent risks of their disease by
local, regional as well as distant failure. The brain is one of the
major sites of distant relapse and the prevention of cerebral metastasis
has therefore gained rising interest. A recent meta-analysis has
confirmed the benefit of prophylactic cranial irradiation in patients
with limited disease small-cell lung cancer in complete remission
following induction therapy. In non-small-cell lung cancer, aggressive
multimodality therapy regimens including surgery have achieved
locoregional control rates of 50% and higher. In these patient groups
the relatively high incidence of brain relapses as a site of first
failure causes substantial morbidity and worsens the prognosis. Given
the proven efficacy of prophylactic cranial irradiation (PCI) to prevent
metastases to the brain, the introduction of PCI into the treatment of
non-small cell lung cancer in the curative setting seems promising.
22
UI - 11576705
AU - Rube C; Phu Nguyen T; Fleckenstein J; Niewald M
TI -
Postoperative radiotherapy in localized non-small cell lung cancer.
SO - Lung Cancer 2001 Sep;33 Suppl 1():S29-33
AD - Department of Radiotherapy, Saarland University Hospital, Building 49,
D-66421, Homburg/Saar, Germany. ruebe@med-rz.uni-saarland.de
Surgery alone can cure 40-85% of patients with localized non-small cell
lung cancer, depending on tumor stage and metastatic lymph-node
involvement. As local failure rates occur in up to 50% of the cases,
postoperative radiotherapy as an adjuvant treatment option has been
evaluated in several trials. This review briefly summarizes the
published data mainly from randomized trials. While most of the studies
showed a decrease in local recurrence rate, especially in stage-III/N2
tumors after postoperative radiotherapy, no impact could be shown on
overall survival. In early stages a detrimental effect of postoperative
radiotherapy has been postulated, but those findings have to be
interpreted with caution as radiation techniques used were suboptimal
and probably not today's state of the art. A carefully designed
randomized trial using modern radiotherapy techniques is warranted to
define the impact of irradiation on completely resected NSCLC.
23
UI - 11576701
AU - Dienemann H
TI -
Principles of surgical treatment in localized non-small cell lung
cancer.
SO - Lung Cancer 2001 Sep;33 Suppl 1():S3-8
AD - Chirurgische Abteilung, Thoraxklinik Heidelberg gGmbH, Amalienstrasse 5,
D-69126, Heidelberg, Germany. hdienemann@aol.com
Non-small cell cancer has become the leading cause of cancer-related
deaths in women and men in the western hemisphere. Surgical resection
remains the mainstay of therapy in stage I and II disease. Surgical
therapy has an acceptable morbidity and mortality rate. Analysis of
5-year survival shows 70-75% in experienced centers for stage I and 40%
for stage II, including tumors extending to the chest wall. Local and
distant recurrence account for the disappointing survival rates after
complete resection. In the future, appropriate selection of surgical
procedures and effective use of systemic therapies might depend upon the
elucidation of prognostic factors that predict recurrence and poor
outcome. Thus, parameters need to be identified that characterize those
patients preoperatively.
24
UI - 11576706
AU - Baumann M; Appold S; Petersen C; Zips D; Herrmann T
TI -
Dose and fractionation concepts in the primary radiotherapy of non-small
cell lung cancer.
SO - Lung Cancer 2001 Sep;33 Suppl 1():S35-45
AD - Department of Radiotherapy and Radiation Oncology, Medical Faculty Carl
Gustav Carus, University of Dresden, Fetscherstrasse 74, D-01309,
Dresden, Germany. michael.baumann@mailbox.tu-dresden.de
At present, radiotherapy alone or in combination with chemotherapy
offers the only chance of cure of medically inoperable or locally
advanced unresectable non-small cell lung cancer. The radiobiological
basis and clinical results of current dose and fractionation concepts in
the primary radiotherapy of NSCLC are briefly reviewed. Whenever
possible, focus is given to the results of randomized phase III trials.
With the exception of early disease treated to doses higher than 60 Gy,
the prognosis of inoperable localized NSCLC is very poor. Local
recurrence is the major cause of failure after radiation therapy calling
for intensified local treatment. Dose-escalation using conventional
fractionation or moderate hypofractionation is promising but randomized
trials are presently not available. Dose-escalated hyperfractionation
theoretically offers advantages, however, there appears currently no
strong evidence from randomized trials supporting this approach in
NSCLC. The highly accelerated CHART regimen significantly improved
survival by 9% compared to standard radiotherapy. Nevertheless, even
when treated with CHART, about 80% of all patients will eventually
develop local recurrence and 60% distant metastases. Many trials on
combined radiochemotherapy have used radiotherapy regimens that are not
optimal from a current perspective. Because of the high rate of both,
local recurrence and distant metastases, future research should be
directed to further intensify radiotherapy as well as to integrate such
protocols with systemic treatment in carefully selected patients. Since
toxicity is expected to increase, state-of-the-art 3D conformal
radiation techniques need to be part of clinical trials testing such
strategies.
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