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Abramson Cancer CenterNCI CANCERLIT® Search: Radiation, Surgery for Non-small Cell Lung Cancer - February 2002
National Cancer Institute®
Last Modified: February 1, 2002
Table of Contents
1
UI - 11778566
AU - Cao K; Huang H; Tu M
TI -
[Clinical study of prophylactic cranial irradiation for small-cell lung
cancer]
SO - Zhonghua Zhong Liu Za Zhi 2000 Jul;22(4):336-8
AD - Radiotherapy Department, Cancer Center, Sun Yat-sen University of
Medical Sciences, Guangzhou 510060, China.
OBJECTIVE: To study the influence of prophylactic cranial irradiation
(PCI) on survival and brain metastases in patients with limited
small-cell lung cancer (SCLC). METHODS: Fiftyone patients with limited
SCLC under complete remission after chemoradiotherapy were randomly
divided into prophylactic cranial irradiation (PCI) group (n = 26) and
control group (n = 25). Patients in PCI group received irradiation at a
dose of 25.2-30.6 Gy. Survival rates were analyzed and compared by life
table and Long-Rank, incidence of cranial metastases by chi 2 test.
RESULTS: The clinical features of patients such as age, sex, effect of
treatment before PCI were similar between the two groups. The incidence
of cranial metastases was 3.8% in PCI group in contrast to 28% in the
control group (P < 0.05). The 1, 2, 3-year survival rate was 84.6%,
73.1%, 42.3% respectively in PCI group and 72%, 40%, 32% respectively in
the control group. The differences between the two groups of petients
were statistically insignificant. No serious sequela was observed in
patients receiving PCI. CONCLUSION: PCI decreases the incidence of
cranial metastases for patients with limited SCLC following complete
response to chemoradiotherapy, but it does not improve survival.
2
UI - 11720753
AU - Van Schil PE
TI -
Surgery for non-small cell lung cancer.
SO - Lung Cancer 2001 Dec;34 Suppl 2():S127-32
AD - Department of Thoracic and Vascular Surgery, University Hospital of
Antwerp, Wilrijkstraat 10, B-2650, Edegem, Belgium.
paul.van.schil@uza.be
Although never proven to be superior in a randomized trial, surgical
resection remains the treatment of choice for early stage non-small cell
lung cancer (NSCLC). In stages IA, IB, IIA, IIB and selected stages IIIA
surgical treatment offers the best long-term prognosis when a complete
resection can be performed. Standard operations include lobectomy,
bilobectomy and pneumonectomy. Whenever possible, lobectomy is the
procedure of choice. Lesser resections like segmentectomy or wedge
excision are not indicated in primary NSCLC due to a higher local
recurrence rate and poorer long-term survival. Specific lung parenchyma
saving operations include tracheo- and bronchoplastic procedures which
are indicated in selected cases of centrally located NSCLC. Extended
resections include removal of lung together with another organ or
structure as thoracic wall, pericardium, diaphragm or superior sulcus.
En bloc excision of the involved structure is advised. Technically more
demanding is lung resection after induction therapy, especially after
combined chemoradiotherapy. A dense fibrotic reaction may render
operative staging and dissection difficult. The precise, necessary
extent of resection after induction therapy has not been determined yet.
Although combined modality treatment has an overall increased morbidity
and mortality rate, it may improve survival in selected cases of locally
advanced NSCLC. Its precise role, however, still remains to be defined
in large randomized trials.
3
UI - 11720754
AU - Waller DA
TI -
Surgery for non-small cell lung cancer--new trends.
SO - Lung Cancer 2001 Dec;34 Suppl 2():S133-6
AD - Department of Thoracic Surgery, Glenfield Hospital, Groby Road, LE3 9QP,
Leicester, UK. debra.grew@uhl-tr.nhs.uk
New trends in lung cancer surgery focus on new approaches to the
management of the primary tumour, combined modality approaches to both
local and distant control of the tumour, new approaches to ensure
resectability by staging and techniques to expand the limits of
operability. With new screening methods for NSCLC there is a trend
toward sublobar, segmental resections of smaller tumours including an
expanding use of video assisted thoracoscopy. Improvements in surgical
and anaesthetic procedures have stimulated a renewed interest in the
resection of locally advanced tumours. The understanding that local
control alone may not give the best chance of long term survival has
stimulated new trends in the use of neoadjuvant and adjuvant
chemotherapy. There is a trend towards more detailed preoperative and
intraoperative nodal staging in NSCLC, including video assisted
techniques, and the identification of sentinel lymph node involvement to
direct lymph node dissection. Increased understanding of the
physiological benefits of surgery in emphysema have resulted in a
re-evaluation of the selection of patients for lung cancer surgery. This
together with a greater application of bronchoplastic and angioplastic
techniques is leading to greater resection rates.
4
UI - 11720755
AU - Orlowski TM; Szczesny TJ
TI -
Surgical treatment of stage III non-small cell lung cancer.
SO - Lung Cancer 2001 Dec;34 Suppl 2():S137-43
AD - Department of Surgery, Institute of Lung Diseases and Tuberculosis,
Ptocka St. 26, 01-138, Warsaw, Poland. t.orlowski@igichp.edu.pl
The resectability of NSCLC is determined by its stage. The surgical
treatment in stage I and II NSCLC remains a golden standard. Stage IIIA
NSCLC constitutes a non-homogenous group, and many patients are
potentially non-resectable. The patients in stage IIIA NSCLC also
constitute a non-homogenous group. The patients in stage T3N1 usually
undergo surgical resection, but many patients with N2 disease are
disqualified from surgical treatment due to the negative prognostic
factors. The negative prognostic factors comprise: (1) metastases to
upper paratracheal (no 2), anterior paratracheal (no 3), and subcarinal
(no 7) lymph nodes; (2) metastases to multiple mediastinal lymph nodes;
(3) occurrence of the so called 'bulky disease'; (4) capsular lymph node
invasion. The occurrence of one of these negative prognostic factors
disqualifies the patient with N2 disease from radical surgical
treatment. In more advanced cases, i.e. stage IIIB, and stage IV NSCLC,
patients are rarely operated. It regards the patients in stage T4 N1,
and in M1 disease with a single metastasis (mainly to CNS) accompanied
by the stage I, or II, of the primary focus. In these cases N2 disease
always constitutes the contraindication to the surgical treatment.
Multidisciplinary approach in the treatment of NSCLC is supposed to
improve the results of the treatment of NSCLC.
5
UI - 11720756
AU - van Zandwijk N
TI -
Neoadjuvant strategies for non-small cell lung cancer.
SO - Lung Cancer 2001 Dec;34 Suppl 2():S145-50
AD - Department of Thoracic Oncology, The Netherlands Cancer Institute,
Plesmanlann 121, 1066 CX, Amsterdam, The Netherlands. zandwijk@nki.nl
During the last 15-20 years, several phase II trials have investigated
the use of chemotherapy and chemoradiation prior to surgery in the
management of stage IIIA non-small cell lung cancer (NSCLC). The results
of these studies, in contrast to insignificant outcomes of comparative
studies with chemotherapy in the postoperative setting, have been
encouraging. Moreover, phase III trials comparing surgery alone with
chemotherapy plus surgery have confirmed the efficacy of this
multimodality approach. In recent years, newer and more effective
chemotherapy combinations have become available and are now being used
prior to surgery. One focus of ongoing research is to confirm that
preoperative chemotherapy followed by complete resection is a better
treatment approach than surgery alone, even for patients with
early-stage NSCLC. Recent data suggest that induction chemotherapy in
this category of patients yields high response rates and does not
compromise the outcome of surgery. Given the systemic nature of lung
cancer it is estimated that systemic therapy before local treatment will
play an increasingly important role for patients with early-stage NSCLC.
6
UI - 11720757
AU - Jablonka S; Furmanik F; Jablonka A; Paprota K; Karczmarek-Borowska B;
TI -
Kukielka-Budny B; Korobowicz E; Zdunek M; Sagan D
Principles of induction chemotherapy for non-small cell lung cancer.
SO - Lung Cancer 2001 Dec;34 Suppl 2():S151-3
AD - Department of Thoracic Surgery, University School of Medicine,
Jaczewskiego 8, 20-954, Lublin, Poland.
The results of lung cancer treatment have not significantly improved for
many years. About 35% of patients with non-small cell lung cancer
(NSCLC) are in clinical stage IIIA. Clinically asymptomatic distant
metastases occur in the majority of these patients. In such cases only
combined treatment offers a chance of cure. In the Chest Surgery Center
in Lublin a clinical trial was carried out aimed to assess late results
of combined treatment in patients with IIIA NSCLC. Over 700 patients
were enrolled in the study. The results of the trial disclosed, that
neoadjuvant chemotherapy prolonged life of the operated patients and
improved their life quality. However, a question of qualification for
this complex treatment and complexity of assessment criteria, still
remain to be answered.
7
UI - 11720759
AU - Krzakowski M
TI -
New agents within the preoperative chemotherapy of non-small cell lung
cancer.
SO - Lung Cancer 2001 Dec;34 Suppl 2():S159-63
AD - Lung and Thoracic Tumors Department, The M. Sklodowska-Curie Cancer
Center and Institute of Oncology, 5 K.W. Roentgen St., 02-781, Warsaw,
Poland. maciekk@coi.waw.pl
Surgery alone fails to cure the majority of resected non-small cell lung
cancer (NSCLC) patients. Only about half of stage I and II patients
remain free of the disease for 5 and more years. The vast majority of
stage IIIA patients resected for cure relapse (most of them develop
distant spread). A combined modality approach (preoperative
cisplatin-based chemotherapy, surgery and radiotherapy) has been shown
to increase cure rates in stage IIIA NSCLC from 10-15% to 25-40%. Future
improvements, currently under investigation, are expected with the use
of chemotherapy prior to surgery in resectable patients with stage IB
and II disease. The advent of newer agents, such as paclitaxel,
docetaxel, vinorelbine, and gemcitabine have led to the design of
potentially more effective preoperative regimens with the ability to
advance the cure rate even further. The superiority of new cytotoxic
agents incorporated into the preoperative systemic therapy has not been
definitely confirmed. This overview presents the current experience with
the use of new agents in preoperative chemotherapy for NSCLC.
8
UI - 11720762
AU - Jassem J
TI -
Radiotherapy for non-small cell lung cancer.
SO - Lung Cancer 2001 Dec;34 Suppl 2():S177-80
AD - Department of Oncology and Radiotherapy, Medical University of Gdansk, 7
Debinki St, 80-211, Gdansk, Poland. jjassem@amg.gda.pl
This article shortly reviews the role of external-beam radiotherapy in
the management of NSCLC with the focus on novel therapeutic approaches.
The following applications of radiotherapy are addressed: definitive
treatment in localized inoperable disease, radiotherapy as an adjunct to
surgery (preoperative and postoperative), and palliative chest
irradiation.
9
UI - 11720763
AU - Jassem J
TI -
Combined modality treatment with chemotherapy and radiation in locally
advanced non-small cell lung cancer.
SO - Lung Cancer 2001 Dec;34 Suppl 2():S181-3
AD - Department of Oncology and Radiotherapy, Medical University of Gdansk, 7
Debinki St., 80-211, Gdansk, Poland. jjassem@amg.gda.pl
This article reviews combined chemotherapy and radiation in locally
advanced inoperable non-small cell lung cancer. Presented are rationale
for the use of this strategy, methods of combining drugs and radiation
and results of major phase III trials.
10
UI - 11720747
AU - O'Byrne KJ; Cox G; Swinson D; Richardson D; Edwards JG; Lolljee J; Andi
TI -
A; Koukourakis MI; Giatromanolaki A; Gatter K; Harris AL; Waller D;
Jones JL
Towards a biological staging model for operable non-small cell lung
cancer.
SO - Lung Cancer 2001 Dec;34 Suppl 2():S83-9
AD - Thoracic Oncology Research Group, Institute of Cancer Studies and
Institute of Lung Health, Leicester, UK. ken.obyrne@uhl.trent.nhs.uk
Non-small cell lung cancer is the most common cause of cancer-related
death in North America and Europe. Despite improvements in the diagnosis
and treatment of the disease the prognosis remains poor, the overall
5-year survival being 4-14%. An increased understanding of the molecular
biology of the disease may identify novel targets for drug development.
We evaluated epidermal growth factor receptor (EGFR), HER-2/neu, matrix
metalloproteinase (MMP)-2, MMP-9, p53 and bcl-2 expression and
microvessel density (MVD) in patients who underwent surgery with
curative intent in our department between 1991 and 1996. Co-expression
of EGFR/MMP-9, MVD and bcl-2 were found to be independent prognostic
variables, which allowed prediction of patient outcome independent of
surgical stage. Other prognostic factors identified in our series were
gender, surgical stage, platelet count, extent of necrosis, the hypoxia
marker carbonic anhydrase-9 and beta-catenin. In collaboration with
groups in Oxford and Greece, we were also able to establish the
angiogenic growth factors vascular endothelial growth factor and
platelet-derived endothelial growth factor as prognostic variables. The
inter-relationships between these factors are currently being examined
in an expanded patient series. Through this work we hope to be able to
construct an integrated biological prognostic model which can be tested
in prospective studies. This work has identified several potential
targets for novel therapeutic agents currently in development.
11
UI - 11732293
AU - Szczesny TJ; Szczesna A
TI -
[Surgical treatment of limited small cell lung cancer]
SO - Pneumonol Alergol Pol 2001;69(5-6):300-10
AD - Klinika Chirurgii Instytutu Gruzlicy i Chorob Pluc w Warszawie.
12
UI - 11802049
AU - Kuriakose MA; Loree TR; Rubenfeld A; Anderson TM; Datta RV; Hill H;
TI -
Rigual NR; Orner J; Singh A; Hicks WL Jr
Simultaneously presenting head and neck and lung cancer: a diagnostic
and treatment dilemma.
SO - Laryngoscope 2002 Jan;112(1):120-3
AD - Department of Head and Neck Surgery, Roswell Park Cancer Institute, Elm
and Carlton Streets, Buffalo, NY 14263, U.S.A.
OBJECTIVES/HYPOTHESIS: Synchronous tumors are defined as malignancies
presenting within 6 months of the index tumors. A significant subset of
patients present at initial evaluation with malignant tumors of both the
head and neck (head and neck squamous cell carcinoma) and the lung,
which are termed simultaneous primaries. The management and treatment
outcomes in this cohort of patients have not been clearly defined and
are the subject of the present review. STUDY DESIGN: Retrospective chart
squamous cell carcinoma of the head and neck. Forty-two patients
fulfilled the criteria for synchronous head and neck and lung
malignancy. Of these, 27 patients had simultaneous tumors of the head
and neck and the lung. This cohort of patients (n = 27) was stratified
into three treatment groups. Patients in group A (n = 10) had resectable
head and neck and lung primaries treated with curative intent. Group B
(n = 8) was composed of patients who could have been treated with
curative intent but declined and were given only palliative therapy.
Patients in group C (n = 9) were candidates for only palliative
treatment. RESULTS: The estimated 5-year disease-specific survival in
group A was 47%, whereas patients in group B had a 5-year
disease-specific survival of only 13% (P =.05). There were no survivors
beyond 1 year in group C. The presence of mediastinal adenopathy in
patients in group A portended poor clinical outcome. There was an
estimated 5-year disease-specific survival of 51% in patients with no
preoperative evidence of mediastinal adenopathy (n = 7), whereas 67% of
patients with radiological evidence of mediastinal adenopathy died (two
of three patients). CONCLUSION: The presence of simultaneous head and
neck squamous cell carcinoma and pulmonary malignancies should not be a
deterrent to aggressive surgical therapy because a potentially
satisfactory outcome can be expected in these patients.
13
UI - 11803634
AU - Wu Y
TI -
[Differentiated carcinoma of the thyroid in children and adolescents]
SO - Ann Chir 2001 Dec;126(10):977-80
AD - Service de chirurgie cervicofaciale, centre anticancereux de Shanghai,
Republique populaire de Chine.
AIM OF THE STUDY: Evaluation of resection "a la demande" for
differentiated thyroid carcinoma in young patients. PATIENTS AND
METHODS: From 1963 to 1996, 70 differentiated thyroid carcinomas were
observed in young patients (mean age: 16 years, range: 9-19 years).
Three had pulmonary metastases. Resections were 39 extra-capsular
lobo-isthmectomies (56%), 11 total lobo-isthmectomies with contra
lateral subtotal lobectomies (16%), and 20 total thyroidectomies "de
necessite" (28%). Lymph node resection was unilateral in 41 cases (58%),
bilateral in 23 (33%), and more extended in 5 (7%). In tracheal (n = 8),
esophageal (n = 4) or bilateral inferior laryngeal nerve involvement (n
= 6), the visceral extension was preserved and surgery completed with
postoperative external radiotherapy. In patients with pulmonary
metastases surgery was completed with I131. Two patients were lost of
follow-up. The others were evaluated from 5 years to 28 years later.
RESULTS: There were no postoperative deaths, no laryngeal palsy except
those existing before surgery. In 6 patients, resection was complicated
by permanent hypoparathyroidism. In the follow-up, the death of two
patients was not correlated with the thyroid carcinoma. Five patients
who had a recurrence were reoperated and were alive without any sign of
recurrence. All the patients were alive. CONCLUSION: These results
suggest that in children and adolescent patients, without previous
irradiation, a surgical procedure "a la demande" is justified.
Preservation of tracheal, esophageal or laryngeal involvement, followed
by postoperative radiotherapy was associated with good results.
14
UI - 11809983
AU - Herder GJ; Verboom P; Smit EF; van Velthoven PC; van den Bergh JH;
TI -
Colder CD; van Mansom I; van Mourik JC; Postmus PE; Teule GJ; Hoekstra
OS
Practice, efficacy and cost of staging suspected non-small cell lung
cancer: a retrospective study in two Dutch hospitals.
SO - Thorax 2002 Jan;57(1):11-4
AD - Department of Pulmonary Medicine, VU University Medical Center,
Amsterdam, The Netherlands.
BACKGROUND: A study was undertaken to investigate the clinical practice,
yield, and costs of preoperative staging in patients with suspected
NSCLC and to obtain baseline data for prospective studies on the cost
effectiveness of (18)F-fluorodeoxyglucose positron emission tomography
in the management of these patients. METHODS: A retrospective study of
the medical records of all patients with suspected NSCLC was performed
during a 2 year interval (1993-4) in an academic and a large community
hospital. RESULTS: Three hundred and ninety five patients with suspected
NSCLC were identified; 58 were deemed to be medically inoperable and 337
patients proceeded to the staging process. Staging required a mean (SD)
of 5.1 (1.5) diagnostic tests per patient (excluding thoracotomy)
carried out over a median period of 20 days (IQR 10-31). Many of the
tests (including both invasive and non-invasive) were done because
previous imaging tests had suggested metastases, and in most cases the
results of initial tests proved to be false positives. After clinical
staging, 168 patients were considered to be resectable (stage I/II) and
144 patients underwent surgery with curative intent. At surgery 33
patients (23% of those who underwent surgery) were found to have
irresectable lesions and 19 (13%) had a benign lesion. Surgery was also
considered to be futile in 22 patients (15%) who developed metastases or
local recurrence within 12 months following radical surgery. Hospital
admission was responsible for most of the costs. CONCLUSION: In many
patients staging involved considerable effort in terms of the number of
diagnostic tests, the duration of the staging period and the cost, with
limited success in preventing futile surgery. Failures relate to the
quality of diagnostic preparation at every level of the TNM staging
system.
15
UI - 11809979
AU - Treasure T
TI -
Whose lung is it anyway?
SO - Thorax 2002 Jan;57(1):3-4
16
UI - 11809982
AU - Dowie J; Wildman M
TI -
Choosing the surgical mortality threshold for high risk patients with
stage Ia non-small cell lung cancer: insights from decision analysis.
SO - Thorax 2002 Jan;57(1):7-10
AD - Public Health and Policy Department, London School of Hygiene and
Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
jack.dowie@lshtm.ac.uk
The recent British Thoracic Society guidelines recommend that surgical
mortality should not be greater than 8% for pneumonectomy and 4% for
lobectomy. These cut offs are advanced as guidelines to inform decision
making as to whether or not patients with operable lung cancer should be
offered surgery. They have been developed from a notion of what
acceptable surgical mortality should be. The planning of care for
patients with lung cancer involves making choices between different
treatments with different outcomes. While it is accepted that the
probability of these outcomes is likely to differ among patients,
individual patient preferences for them are also likely to vary. Fixed
cut offs for surgical mortality mean ignoring this variation. Decision
analysis can be used to assist in the complex task of integrating
clinical characteristics and varying patient preferences. By considering
high risk patients with potentially curable stage Ia non-small cell lung
cancer, it is shown that decision analysis has the potential to
illuminate decision making and guideline development within the field of
cancer care.
17
UI - 11815997
AU - Ng CS; Zhang J; Wan S; Lee TW; Arifi AA; Mok T; Lo DY; Yim AP
TI -
Tumor p16M is a possible marker of advanced stage in non-small cell lung
cancer.
SO - J Surg Oncol 2002 Feb;79(2):101-6
AD - Department of Surgery, The Chinese University of Hong Kong, Prince of
Wales Hospital, Shantin, NT, Hong Kong.
BACKGROUND AND OBJECTIVES: The inactivation of the tumor suppressor gene
p16 by methylation (p16M) has been recognized recently as an important
process in the oncogenesis for a variety of carcinomas. There have been
few reports of its use in lung cancer. We investigate p16M in patients
with non-small cell lung cancer (NSCLC). METHODS: p16M in tumor, plasma,
and pleural lavage fluid from patients with resectable NSCLC were
investigated by using methylation-specific polymerase chain reaction.
RESULTS: Of the 33 patients studied, 14 (42%) had p16M tumors. There was
a significant association between p16M tumors and advanced TNM staging
(stage III or IV, P=0.047, Fisher exact test). Circulating p16M was
identified in 2 of the 14 patients with p16M tumor and was also
associated with advanced TNM staging (P=0.049). The presence of plasma
p16M in NSCLC patients and in p16M tumor patients was associated with
poor survival and shorter disease-free survival (P=0.0028, P=0.0039,
Kaplan-Meier log rank). In addition, p16M was present in three
preresectional and four postresectional lavage samples. Preresectional
p16M was associated with poor survival and shorter disease-free survival
(P=0.0085). p16M tumor involving the visceral pleura was significantly
associated with positive p16M postresectional lavage. CONCLUSIONS:
Positive tumor and plasma p16M indicate advanced staging in NSCLC.
Patients with plasma and preresection pleural lavage p16M have shorter
survival. Further research in this direction is warranted. Copyright
2002 Wileyb Liss, Inc.
18
UI - 11694803
AU - Sanderson DR
TI -
Lung-sparing cancer surgery.
SO - Respiration 2001;68(5):449
19
UI - 11782773
AU - Yokoi K; Matsuguma H; Anraku M
TI -
Extrapleural pneumonectomy for lung cancer with carcinomatous pleuritis.
SO - J Thorac Cardiovasc Surg 2002 Jan;123(1):184-5
AD - Division of Thoracic Surgery, Tochigi Cancer Center, Utsunomiya,
Tochigi, Japan. kyokoi@tcc.pref.tochigi.jp
20
UI - 11788261
AU - Lardinois D; Horsch A; Krueger T; Dusmet M; Ris HB
TI -
Mediastinal reinforcement after induction therapy and pneumonectomy:
comparison of intercostal muscle versus diaphragm flaps.
SO - Eur J Cardiothorac Surg 2002 Jan;21(1):74-8
AD - Division of Thoracic Surgery, University Hospital, Bern, Switzerland.
didier.lardinois@chi.usz.ch
OBJECTIVE: Prospective non-randomised comparison of full-thickness
pedicled diaphragm flap with intercostal muscle flap in terms of
morbidity and efficiency for bronchial stump coverage after induction
therapy followed by pneumonectomy for non-small cell lung cancer
(NSCLC). METHODS: Between 1996 and 1998, a consecutive series of 26
patients underwent pneumonectomy following induction therapy. Half of
the patients underwent mediastinal reinforcement by use of a pedicled
intercostal muscle flap (IF) and half of the patients by use of a
pedicled full-thickness diaphragm muscle flap (DF). Patients in both
groups were matched according to age, gender, side of pneumonectomy and
stage of NSCLC. Postoperative morbidity and mortality were recorded. Six
months follow-up including physical examination and pulmonary function
testing was performed to examine the incidence of bronchial stump
fistulae, gastro-esophageal disorders or chest wall complaints. RESULTS:
There was no 30-day mortality in both groups. Complications were
observed in one of 13 patients after IF and five of 13 after DF
including pneumonia in two (one IF and one DF), visceral herniations in
three (DF) and bronchopleural fistula in one patient (DF). There were no
symptoms of gastro-esophageal reflux disease (GERD). Postoperative
pulmonary function testing revealed no significant differences between
the two groups. CONCLUSIONS: Pedicled intercostal and diaphragmatic
muscle flaps are both valuable and effective tools for prophylactic
mediastinal reinforcement following induction therapy and pneumonectomy.
In our series of patients, IF seemed to be associated with a smaller
operation-related morbidity than DF, although the difference was not
significant. Pedicled full-thickness diaphragmatic flaps may be
indicated after induction therapy and extended pneumonectomy with
pericardial resection in order to cover the stump and close the
pericardial defect since they do not adversely influence pulmonary
function.
21
UI - 11788269
AU - Foroulis C; Kotoulas C; Konstantinou M; Lioulias A
TI -
The use of pedicled pleural flaps for the repair of pericardial defects,
resulting after intrapericardial pneumonectomy.
SO - Eur J Cardiothorac Surg 2002 Jan;21(1):92-3
AD - 2nd Department of Thoracic Surgery, Chest Diseases Hospital Sotiria,
Messogion Avenue, 11527 Athens, Greece. foroulis@internet.gr
We report our technique for the repair of large pericardial defects
resulting after intrapericardial pneumonectomy for locally advanced
non-small cell lung carcinoma, using pedicled pleural flaps. Creation of
a pedicled pleural flap, large enough to cover the pericardial defect,
performing blunt dissection of parietal pleura from the inferior edge of
the thoracotomy incision and suturing it in the defect margins, is an
easy, safe and effective technique for the prevention of cardiac
herniation. Pedicled pleural flaps are an excellent material, not very
popular nowadays, for the repair of pericardial defects resulting after
intrapericardial pneumonectomy, when it is possible to create a pleural
flap.
22
UI - 11776031
AU - Xu G; Rong T; Lin P
TI -
Adjuvant chemotherapy following radical surgery for non-small-cell lung
cancer: a randomized study on 70 patients.
SO - Chin Med J (Engl) 2000 Jul;113(7):617-20
AD - Tumor Hospital, Sun Yat-Sen University of Medical Sciences, Guangzhou
510060, China. nkzl@gzsums.edu.cn
OBJECTIVE: To evaluate the efficacy of adjuvant chemotherapy after
radical surgery for non-small-cell lung cancer (NSCLC). METHODS: Seventy
patients with NSCLC (stages I-III) undergoing radical surgery were
randomized into two groups. Group 1 (n = 35): combination group, which
received adjuvant chemotherapy with cyclophosphamide 300 mg/m2,
vincristine 1.4 mg/m2, adriamycin 50 mg/m2, and lomustine 50 mg/m2 on
day 1, and cisplatin 20 mg/m2 on days 1-5. The treatment was repeated
every 4-6 weeks for 4 cycles, followed by oral administration of
ftorafur (FT-207) 600-900 mg/d for 1 year. Group 2 (n = 35): surgery
group, which received surgical treatment only. RESULTS: The overall
5-year survival rate was 48.6% in the combination group versus 31.4% in
the surgery group, and difference between the two groups was not
statistically significant (chi 2 = 3.09, P > 0.05). The 5-year survival
rate for patients with stage III disease was 44% and 20.8% in the
combination and surgery groups, respectively, showing a statistically
significant difference (chi 2 = 5.28, P < 0.025). The 5-year survival
rates of patients in stages I-II in the two groups were 60.0% and 54.5%,
respectively, and were not significantly different (chi 2 = 0.03, P >
0.75). CONCLUSION: Postoperative adjuvant chemotherapy provides
statistically significant improvement in the 5-year survival rate only
in patients with stage III NSCLC.
23
UI - 11783068
AU - Wu Y; Wang S; Huang Z
TI -
[Extent of lymphadenectomy in stage I-IIIA non-small cell lung cancer: a
randomized clinical trial]
SO - Zhonghua Zhong Liu Za Zhi 2001 Jan;23(1):43-5
AD - Lung Cancer Research Center, Sun Yat-sen University of Medical Sciences,
Guangzhou 510630, China.
OBJECTIVE: To study the role of radical systematic mediastinal
lymphadenectomy for non-small cell lung cancer (NSCLC). METHODS: All 504
operable eligible cases with NSCLC were randomly divided to a radical
lymphadenectomy (RL) group and a conventional lymph node dissection
group (control) treated between Aug. 1989 and Dec. 1995. For patients
postoperatively eligible, thirteen parameters (operation type,
pathological type and grade, tumor size, total number of dissected lymph
nodes, number of metastatic lymph nodes, metastasis ratio of lymph
nodes, postoperative TNM staging, adjuvant therapy, recurrence or
metastasis, morbidity, survival and life quality) were evaluated. The
end point of follow-up was Dec. 31, 1998. Lost follow-up rate was 1.9%.
The results were analyzed with soft were SPSS7.5. The cumulative
survival was calculated by the Kaplan-Meier method and compared by the
log rank test. The prognostic factors were analyzed by the Cox model.
RESULTS: There were 320 cases, 160 cases in each group, who entered the
study. The mean numbers of dissected lymph nodes was 9.49 in the RL
group and 3.63 in the control group. For stage I NSCLC patients, the
1,3,5,9-year survival rate was 91.8%, 86.9%, 81.4%, 74.2% respectively
in the RL group and 88.7%, 72.5%, 58.5%, 52.1% respectively in the
control group (P < 0.014). However, no statistically significant
difference in survival rates between RL and control groups of patients
with stage II and IIIA NSCLC. The postoperative TNM staging, metastasis
ratio of lymph nodes, extent of lymphadenectomy were the factors
influencing long term survival upon multivariable analysis. CONCLUSION:
Classical lobectomy or pneumonectomy with radical systematic mediastinal
lymphadenectomy is the surgical treatment of choice for NSCLC.
24
UI - 11783078
AU - Wu X; Li X; Liu Z
TI -
[Experience and evaluation of extended resection and lymph nodes
dissection in stage T3-4N2M0 lung cancer]
SO - Zhonghua Zhong Liu Za Zhi 2001 Jan;23(1):76-8
AD - Southeast University Affiliated Zhong Da Hospital, Nanjing 210009,
China.
OBJECTIVE: To report our experience of surgical treatment for stage
T3-4N2M0 lung cancer. METHODS: One hundred thirty one patients with lung
cancer in stage T3-4N2M0 were surgically treated by extended tumor
resection, lymph nodes dissection and resection of ipsilateral
mediastinal pleura and fatty tissue. RESULTS: The 3-year survival rate
of patients in stage T3N2M0 with squamous-cell carcinoma and
adenocarcinoma was 34% and 18%, respectively. That for stage T4N2M0
patients was only 13% and 5%, respectively. The survival rate was not
improved in patients who received combination treatment in addition to
surgery. CONCLUSION: The indication of extended resection with lymph
node dissection in the treatment of T3-4N2M0 lung cancer is limited.
25
UI - 11834017
AU - Watanabe S; Ladas G; Goldstraw P
TI -
Inter-observer variability in systematic nodal dissection: comparison of
European and Japanese nodal designation.
SO - Ann Thorac Surg 2002 Jan;73(1):245-8; discussion 248-9
AD - Department of Thoracic Surgery, Royal Brompton Hospital, London,
England. shunuk@aol.com
BACKGROUND: Systematic nodal dissection is accepted as an important
component of the intrathoracic staging of patients undergoing
thoracotomy for lung cancer. Several lymph node maps have been proposed
in an attempt to ensure uniformity in designating lymph node stations.
The Japan Lung Cancer Society has published detailed definitions for
each nodal station adopting the Naruke map. However, since these
definitions had not been interpreted into other languages, they have not
been universally accepted. The objective of this study was to assess the
inter-observer variability in the interpretation of lymph node stations.
METHODS: A total of 424 lymph node stations were removed from 41
patients undergoing thoracotomy for non-small cell lung cancer. All
nodal stations were labeled using the Naruke map. As each station was
excised, it was designated in a blind fashion by one of two surgeons
trained in the UK and one surgeon trained in Japan. The designation
accorded to each nodal station was analyzed. RESULTS: The total
concordance was 68.5% (right side 67.0%, left side 69.9%). The
concordance rate for individual nodal stations varied from 0% to 100%.
Considerable discordance existed between the Japanese and European
surgeons in the designation of nodal stations 2, 4, 8 and N1 station 12.
In 14 (34.1%) patients, discordance in the labeling of lymph nodes led
to disease being categorized as N1 by one observer, whereas the other
considered the same nodes to be N2. CONCLUSIONS: Considerable
discordance in the designation of nodal station has been demonstrated.
We would expect similar inter-observer variability elsewhere between
surgeons, institutions, or countries. More detailed nodal charts and
precise, easily understood definitions of nodal stations are needed for
intrathoracic staging. The first English version of the Japan Lung
Cancer Society staging manual goes some way to address this.
26
UI - 11834019
AU - Riquet M; Lang-Lazdunski L; Le PB; Dujon A; Souilamas R; Danel C;
TI -
Manac'h D
Characteristics and prognosis of resected T3 non-small cell lung cancer.
SO - Ann Thorac Surg 2002 Jan;73(1):253-8
AD - Department of Thoracic Surgery and Pathology, Hjpital Europeen Georges
Pompidou, Paris, France. marc.riquet@hop.egp.ap-hop-paria.fr
BACKGROUND: T3 tumors can be divided into several subgroups depending on
the type of anatomical structure invaded: chest wall, mediastinal
pleura, or main bronchus. The aim of this study was to analyze the
characteristics and prognosis of each subgroup of T3 tumors. METHODS:
The results of surgical treatment were retrospectively analyzed for 261
patients with T3 non-small cell lung cancer invading either the
mediastinal pleura or parietal pericardium by direct extension
(mediastinal pT3, n = 68), or main bronchus (bronchial pT3, n = 68), or
chest wall (chest wall pT3, n = 125) that were operated on between 1984
and 1996. Complete resection including radical mediastinal lymph node
dissection was intended in all patients. One patient had segmentectomy,
91 had lobectomy (34.9%), and 169 had pneumonectomy (64.8%). One hundred
and fifty-eight patients received adjuvant radiation therapy and 7
patients received both adjuvant chemotherapy and radiation therapy.
Actuarial survival curves were drawn using the Kaplan-Meier method and
risk factors for late death were identified. RESULTS: In-hospital
mortality was 6.1%. Follow-up was 98% complete. Global 5-year survival
was 28%, with survival being not significantly different among the three
subgroups: 34.9%, 30.6%, and 22.5% (p = 0.19) in the bronchial pT3,
mediastinal pT3, and chest wall pT3 subgroups, respectively. Resection
margins were microscopically invaded in 33 patients (12.6%).
Seventy-four patients had N1 involvement (28.4%) and 78 patients had N2
involvement (29.8%). N0 involvement was more prevalent in the chest wall
pT3 subgroup, whereas N1 involvement was more prevalent in the bronchial
pT3 subgroup and N2 involvement was more prevalent among patients with
mediastinal invasion. Pathologic factors influencing the 5-year survival
were tumor size (p = 0.03) and N involvement (p = 0.003). Histology,
type of surgical resection (lobectomy versus pneumonectomy), and use of
adjuvant therapy did not influence survival significantly. CONCLUSIONS:
Five-year survival was not significantly different among the three
subgroups of pT3 non-small cell lung cancer, although bronchial pT3
tumors tended to have a better prognosis and chest wall pT3 tumors
tended to have a worse prognosis. The pathologic characteristics of each
pT3 subgroup seems different. Further research is warranted to explore
the pathologic and biological factors influencing prognosis for each pT3
subgroup.
27
UI - 11837246
AU - Moghissi K; Thorpe JA; Dixon K
TI -
Postoperative fluorescence bronchoscopic surveillance: a worthwhile
procedure in a subset of patients.
SO - Ann Thorac Surg 2002 Jan;73(1):348
28
UI - 11834059
AU - Demos NJ
TI -
Durability of the intercostal muscle pedicle.
SO - Ann Thorac Surg 2002 Jan;73(1):349
29
UI - 11697833
AU - Skarlos DV; Samantas E; Briassoulis E; Panoussaki E; Pavlidis N;
TI -
Kalofonos HP; Kardamakis D; Tsiakopoulos E; Kosmidis P; Tsavdaridis D;
Tzitzikas J; Tsekeris P; Kouvatseas G; Zamboglou N; Fountzilas G
Randomized comparison of early versus late hyperfractionated thoracic
irradiation concurrently with chemotherapy in limited disease small-cell
lung cancer: a randomized phase II study of the Hellenic Cooperative
Oncology Group (HeCOG).
SO - Ann Oncol 2001 Sep;12(9):1231-8
AD - Athens Medical Center, Greece. hecogoff@otenet.gr
BACKGROUND: Concurrent platinum etoposide chemotherapy given in
combination with hyperfractionated thoracic radiation therapy (HTRT) in
limited disease (LD) small cell lung cancer (SCLC) is associated with a
high response rate and significant prolongation of survival. Given these
results, the Hellenic Cooperative Oncology Group (HeCOG) performed a
multicenter randomized phase II study in patients with LD SCLC to
evaluate the timing of HTRT (early vs. late) when given concurrently
with chemotherapy. PATIENTS AND METHODS: To be eligible for the study,
patients were required to have histologically or cytologically proven LD
SCLC, confined to one hemithorax and/or ipsilateral mediastinal or
supraclavicular lymphnodes and absence of pleural effusion or
controlateral supraclavicular lymphnode involvement. Moreover, patients
had to have a good performance status and adequate haematological, liver
and renal function. Patients with LD SCLC were randomized to receive
HTRT either concurrently with the first (Group A) or with the fourth
(Group B) cycle of chemotherapy. Chemotherapy consisted of carboplatin
administered at an AUC of six given as an i.v. 1-hour-infusion
immediately followed by etoposide at a dose of 100 mg/m2 i.v. as a
two-hour infusion for three consecutive days every three weeks up to a
total of six cycles. Prophylactic cranial irradiation was also given to
patients achieving a complete response. RESULTS: 42 and 39 patients,
were eligible for efficacy evaluation in group A and B respectively. The
overall response rate was 76% in group A and 92.5% in group B (P = 0.07)
with a complete response rate of 40.5% and 56.5%, respectively. After a
median follow-up of 35 months, time to progression was 9.5 months in
group A and 10.5 in group B (NS) while overall median survival was 17.5
and 17 months respectively (NS). The 2-year survival was 36% in group A
and 29% in group B (NS) and the 3-year survival 22% and 13%,
respectively (NS). The distant relapse rate was 38% in group A and 61%
in group B (P = 0.046). Severe grade 3 4 anemia was recorded in 19% of
group A and 12.5% of group B (NS), while severe leucopenia was recorded
in 35.5% and 20.5% (P = 0.09) and neutropenic fever in 5% and 2.5% (NS),
respectively. Severe thrombocytopenia did not differ significantly
between the two treatment groups being 21.5% and 23%, respectively.
Severe grade 2-3 esophageal toxicity was 19% in group A and 23% in group
B (NS), while grade 3 lung toxicity was 5% and 7.5% (NS), respectively.
No toxicity-related deaths were recorded. CONCLUSION: Concurrent
administration of HTRT with carboplatin etoposide is associated with a
high response and survival rate. Although a trend for higher response
rate was recorded in the group of patients who received late HTRT, the
overall median, 2-year and 3-year survival rates did not differ
significantly between the two treatment groups. The toxicity of this
promising therapeutic approach was acceptable. Comparative phase III
studies with an adequate number of patients are recommended in order to
answer this question.
30
UI - 11801701
AU - Higashi K; Ueda Y; Arisaka Y; Sakuma T; Nambu Y; Oguchi M; Seki H; Taki
TI -
S; Tonami H; Yamamoto I
18F-FDG uptake as a biologic prognostic factor for recurrence in
patients with surgically resected non-small cell lung cancer.
SO - J Nucl Med 2002 Jan;43(1):39-45
AD - Department of Radiology, Kanazawa Medical University, Ishikawa, Japan.
h550208@kanazawa-med.ac.jp
Among patients with resected non-small cell lung cancer (NSCLC),
approximately 50% present with a recurrent tumor. The clinical or
pathologic TNM staging does not always provide a satisfactory
explanation for differences in relapse and survival. Thus, it is of
major importance to be able to predict these relapses and to prevent
them with an active chemotherapy or radiotherapy program (or both).
18F-FDG uptake on PET could be of prognostic significance in patients
with resected NSCLC. The goal of this study was to determine whether the
level of metabolic activity observed with 18F-FDG uptake correlates with
the probability of postoperative recurrence in patients with NSCLC.
METHODS: Fifty-seven patients with NSCLC were examined with 18F-FDG PET.
For semiquantitative analysis, standardized uptake values (SUVs) were
calculated. Patients were classified into high-SUV (> 5.0) and low-SUV
(< or = 5.0) groups. All patients underwent thoracotomy within 4 wk
after the 18F-FDG PET study. Tumor 18F-FDG uptake (SUV), pathologic
stage, and lesion size were analyzed for their possible association with
disease-free survival. RESULTS: Forty-six patients had pathologic stage
I NSCLC and 11 had pathologic stage II or stage III NSCLC. In a
univariate analysis, patients with an SUV of < or = 5 had a much better
disease-free survival than did patients with an SUV of > 5 (P < 0.0001).
In patients with pathologic stage I and stage IA NSCLC, the SUV was also
correlated with disease-free survival (P < 0.0001 and P = 0.0012,
respectively). Patients with pathologic stage I disease had an expected
5-y disease-free survival rate of 88% if the SUV was < or = 5 and a
survival rate of < or = 17% if the SUV was > 5. A multivariate Cox
analysis identified the SUV as the most significant independent factor
for disease-free survival. CONCLUSION: We conclude that the 18F-FDG
uptake in primary NSCLC determined by PET has a significant independent
postoperative prognostic value for recurrence, especially in patients
with pathologic stage I NSCLC. 18F-FDG uptake was superior to pathologic
stage in predicting relapse of patients with NSCLC.
31
UI - 11842546
AU - Fukino S; Fukata T; Hayashi E; Okada K; Metsugi H; Miwa K; Morio S
TI -
[Cases of death after surgery for pathologic stage I non-small cell lung
cancer]
SO - Kyobu Geka 2002 Feb;55(2):110-5
AD - Department of Surgery, Tottori Prefectural Kousei Hospital, Kurayoshi,
Japan.
We clinically examined cases of death from pathologic stage I non-small
cell lung cancer with the aim of improving the 5-year survival rate
after surgery for this condition. The subjects were 70 patients with
p-stage IA (20 cases of death) and 59 patients with p-stage IB (26 cases
of death) from among those who underwent surgery for p-stage I non-small
cell lung cancer between 1986 and 2000. 1) Of 30 patients who died from
p-stage I lung cancer, 20 had distant metastases and 10 had recurrence
in the thoracic cavity. Of 16 patients who died from other diseases, 5
had respiratory organ disease, 5 had cancers of other organs and 6 had
circulatory organ disease. 2) Of 30 patients who died from p-stage I
lung cancer, 20 (66.7%) had distant metastases, with lung metastasis
occurring most frequently, in 10 of them (33.3%). The most common cause
of death of patients with p-stage IB lung cancer was recurrence in the
thoracic cavity. 3) The mean durations of survival (mean +/- standard
deviation) after surgery for lung cancer of the patients who died from
p-stage I lung cancer (30 patients) were 36.3 +/- 22.2 months for the 20
patients with distant metastases and 26.2 +/- 14.3 months for the 10
patients with recurrence in the thoracic cavity, the difference between
groups was 10 months, but was not significant. 4) The 5-year survival
rate in 45 patients who underwent p-stage IA mediastinal lymph node
dissection was 83.1% whereas that in 25 patients without p-stage IB
mediastinal lymph node dissection was 50.9% showing a significant
difference of 32.2% (p < 0.01). 5) The patients in p-stage IA who died
from other diseases were all men (10 patients). The mean durations of
survival after surgery for lung cancer in the patients who died from
other diseases were 35.2 +/- 19.0 months in the patients with
respiratory organ disease, 37.0 +/- 23.9 months in those with cancers of
other organs and 60 +/- 19.1 months in those with circulatory organ
disease. 6) The 5-year survival rate after surgery in all cases of death
was 76% in the patients in p-stage IA and 61.4% in those in p-stage IB.
The 5-year survival rates in the patients excluding those who died from
other diseases were 85% in the patients in p-stage IA (60 patients) and
60.3% in those in p-stage IB (53 patients) (p < 0.01). 7) To improve the
5-year survival rate in the patients with p-stage IA lung cancer, it is
necessary to prevent death from other diseases in men. It is still
possible
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