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Abramson Cancer Center
NCI CANCERLIT® Search: Radiation, Surgery for Non-small Cell Lung Cancer - July 2002
National Cancer Institute®
Last Modified: July 1, 2002
- Morbidity after induction therapy and surgery in non small cell lung cancer (NSCLC). Focus on pulmonary function.
- [Surgical treatment for metastatic renal cell tumors of the lung]
- Disparities in surgical resection of early-stage non-small cell lung cancer.
- Prognostic impact of micrometastatic tumor cells in the lymph nodes and bone marrow of patients with completely resected stage I non-small-cell
- Locally advanced non-small cell lung cancer.
- Superior sulcus tumors.
- Limited stage small cell lung cancer.
- Follow-up of local (stage I and stage II) non-small-cell lung cancer after surgical resection.
- Inoperable localized stage I and stage II non-small-cell lung cancer.
- [Morphologic changes of bronchial epithelium after intraoperative radiotherapy of lung cancer]
- [Exploratory thoracotomy: causes of inoperability of non-small-cell lung cancer]
- Role of adjuvant therapy in resected stage II/IIIA non-small-cell lung cancer.
- Re: Effects of N-(4-hydroxy-phenyl)retinamide on hTERT expression in the bronchial epithelium of cigarette smokers.
- Indicators of free radical activity in patients developing radiation pneumonitis.
- Randomized phase II chemotherapy and radiotherapy trial for patients with locally advanced inoperable non-small-cell lung cancer: long-term
- Twice daily irradiation increases locoregional control in patients with medically inoperable or surgically unresectable stage II-IIIB
- Gemcitabine induction chemotherapy in non-small cell lung cancer.
- [Prognostic influence of neoplastic involvement of bronchial stump after anatomical lung resection for NSCLC]
- Surgery as part of combined modality treatment in stage IIIB non-small cell lung cancer.
- Serum carcinoembryonic antigen level in surgically resected clinical stage I patients with non-small cell lung cancer.
Table of Contents
1
UI - 11955660
AU - Granone P; Cesario A; Margaritora S; Galetta D; Valente S; Corbo GM;
TI -
Fumagalli G; Trodella L; D'Angelillo RM
Morbidity after induction therapy and surgery in non small cell lung
cancer (NSCLC). Focus on pulmonary function.
SO - Lung Cancer 2002 May;36(2):219-20
2
UI - 12049011
AU - Csekeo A; Fawzi Sel-T
TI -
[Surgical treatment for metastatic renal cell tumors of the lung]
SO - Magy Seb 2002 Apr;55(2):73-6
AD - Orszagos Koranyi Tbc es Pulmonologiai Intezet Mellkassebeszeti Osztaly,
1529 Budapest. csekeo@koranyi.hu
Number of resection for lung metastasis in Hungary is low, however
surgery provides benefit for patients using an integrated oncological
therapeutical protocol. The authors give a retrospective analysis of 57
patients operated on for metastatic renal cell tumor to the lung.
Metastases were discovered most frequently by x-ray picture of an
accidental investigation or screening at symptom-free patients and in 32
cases solitary and in 25 cases multiple deposits were proved. After
selection's protocol 20 patients underwent lobectomy and 32 ones wedge
resection while in 5 cases only biopsy was done. Out of 52 cases 33
complete resections were performed and in 9 cases incomplete resection
was carried out. The cumulative five-year survival time was 35%,
following complete resection 45%. If DFI was longer than 12 months,
survival was observed 38% at five year. SUMMARY: On basis of our
experience after surgery of metastatic renal cell tumors to the lung
might expect favourable survival which is significantly better after
complete resection of lung metastasis and after longer than 12 months
DFI.
3
UI - 12063465
AU - Jazieh AR; Kyasa MJ; Sethuraman G; Howington J
TI -
Disparities in surgical resection of early-stage non-small cell lung
cancer.
SO - J Thorac Cardiovasc Surg 2002 Jun;123(6):1173-6
AD - Barrett Center for Cancer, University of Cincinnati, Cincinnati, Ohio
45267-0501, USA. jazierhar@uc.edu
OBJECTIVES: The aim of our study was to identify the factors that
determined whether a patient underwent surgery and its impact on patient
outcome. METHODS: A retrospective evaluation of the records of all
patients diagnosed with resectable stages I and II non-small cell lung
cancer between 1990 and 1998 at the University of Arkansas and Veterans
Administration Hospitals were included in the study. Demographic,
clinical, pathologic, and outcome data were captured. Analysis was
conducted to identify prognostic factors as well as factors leading to
surgical treatment disparities. RESULTS: A total of 551 patients were
included; 490 (89%) were men, 480 (87%) were white, and 315 (57%) were
aged >65 years. Median follow-up of these patients was 24 months (1-109
months). Surgery was performed on 455 patients (82.6%); 26 patients
received nonsurgical treatment including chemotherapy, radiation
therapy, or both, and 70 patients did not receive any type of treatment.
A univariate analysis revealed that age, race, sex, and forced
expiratory volume in the first second were significantly different
between the surgery and no surgery groups. However, a multivariate
analysis showed that age, forced expiratory volume in 1 second, and
hemoglobin were significantly different between both groups. The median
overall survival was 45.5 months (1-109 months) for the surgically
treated patients compared with 12.0 months (1-86 months) for those who
did not undergo surgery (P <.0001). CONCLUSION: Elderly patients with
early-stage non-small cell lung cancer are less likely to undergo a
potentially curative surgical resection. Racial and sex disparities may
be due to other comorbidities.
4
UI - 12089221
AU - Osaki T; Oyama T; Gu CD; Yamashita T; So T; Takenoyama M; Sugio K;
TI -
Yasumoto K
Prognostic impact of micrometastatic tumor cells in the lymph nodes and
bone marrow of patients with completely resected stage I non-small-cell
lung cancer.
SO - J Clin Oncol 2002 Jul 1;20(13):2930-6
AD - Department of Surgery II, School of Medicine, University of Occupational
and Environmental Health, Kitakyushu, Japan. t-osaki@med.uoeh-u.ac.jp
PURPOSE: This study was designed to substantiate the prognostic impact
of occult micrometastatic tumor cells in the lymph nodes (LNs) and bone
marrow (BM) in stage I non-small-cell lung cancer (NSCLC) patients using
cytokeratin (CK) as a micrometastatic marker and the relationship
between the micrometastases in the LNs and BM. PATIENTS AND METHODS: A
total of 2,432 hilar and mediastinal LNs were removed during surgery
from 115 patients with completely resected stage I NSCLC. The LNs were
analyzed for micrometastasis using immunohistochemistry with the
biclonal anti-CK antibody AE1/AE3. BM aspirates from 115 patients were
immunocytochemically stained with the monoclonal anti-CK antibody CK2.
RESULTS: CK-positive (CK+) cells were detected in 42 (1.7%) of 2,432
LNs, in 32 (27.8%) of 115 patients, and in 32 (27.8%) of 115 BM
aspirates. There was no relationship between the frequencies of CK+
cells in the LNs and in the BM. The patients with CK+ cells in the LNs
had a poor prognosis by both univariate (P =.008) and multivariate
analyses (P =.01), whereas the presence of CK+ cells in the BM did not
allow prediction of survival (P =.32). The prognostic impact of LNs
micrometastasis was independent even after adjusting for the status of
BM micrometastasis. CONCLUSION: The detection of lymph nodal
micrometastatic tumor cells provides an accurate assessment of tumor
staging and has powerful prognostic implications for completely resected
stage I NSCLC patients.
5
UI - 12057138
AU - Cohen EE; Vokes EE
TI -
Locally advanced non-small cell lung cancer.
SO - Curr Treat Options Oncol 2001 Feb;2(1):27-42
AD - Section of Hematology and Oncology, Department of Medicine, The
University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA.
Locally advanced non-small cell lung cancer remains a paradoxical entity
to manage. Although this type of cancer is confined to the thorax and is
ostensibly curable, most patients presenting at this stage of disease
eventually succumb to it. The accepted therapy presently includes
chemotherapy and radiation. The exact agents, schedules, and
combinations need to be defined further, although cisplatin has become
the widely viewed standard cytotoxic drug in this setting.
Notwithstanding, newer chemotherapeutic and biologic agents are being
extensively tested to find less toxic options with greater efficacy.
Drugs that are gaining widespread approval include carboplatin,
paclitaxel, gemcitabine, and vinorelbine. At the same time, advances in
radiation therapy are triggering a revolution in dose intensity and
scheduling that will one day offer superlative local control.
6
UI - 12057139
AU - Wright CD; Mathisen DJ
TI -
Superior sulcus tumors.
SO - Curr Treat Options Oncol 2001 Feb;2(1):43-9
AD - General Thoracic Surgical Unit, Massachusetts General Hospital, 55 Fruit
Street, Boston, MA 02114, USA.
Superior sulcus tumors (also known as Pancoast's tumors) are an unusual
presentation of non-small cell lung cancer (NSCLC) that are often
initially misdiagnosed. Accurate and thorough staging is necessary prior
to treatment and typically includes magnetic resonance imaging if a
surgical approach is being considered. Standard therapy has been
induction radiation therapy followed by resection, which results in a
5-year survival of about 30%. Complete resection remains the key to
long-term survival in localized NSCLC but is difficult to achieve with
superior sulcus tumors due to early invasion of bone and to vascular and
nervous structures at the apex of the chest. Complete resection has been
enhanced by using an anterior trans-cervicomediastinal approach that
facilitates resection of anterior-based tumors that invade the
subclavian vessels. Recently, induction chemoradiotherapy has been
reported to enhance complete resection rates and improve survival
compared with historical controls and is likely to become the new
standard treatment for localized superior sulcus tumors.
7
UI - 12057141
AU - Murray N; Sheehan F
TI -
Limited stage small cell lung cancer.
SO - Curr Treat Options Oncol 2001 Feb;2(1):63-70
AD - British Columbia Cancer Agency, 600 West 10th Avenue, Vancouver, British
Columbia, Canada V5Z 4E6.
The management of limited stage small cell lung cancer begins with a
firm pathologic diagnosis and careful staging. Patients with adequate
pulmonary function, ambulatory performance status, and no evidence of
metastatic disease outside a "tolerable" local radiotherapy volume
should have consultation from both medical and radiation oncology
disciplines for planning of integrated therapy. The chemotherapy
prescription recommended is cisplatin plus etoposide at standard doses
for four chemotherapy cycles. Thoracic irradiation should be
administered concurrently with the first or second cycle of cisplatin
and etoposide. Patients with complete response and excellent partial
response should receive prophylactic cranial irradiation after
completion of all chemotherapy.
8
UI - 12057089
AU - Edelman MJ; Schuetz J
TI -
Follow-up of local (stage I and stage II) non-small-cell lung cancer
after surgical resection.
SO - Curr Treat Options Oncol 2002 Feb;3(1):67-73
AD - Division of Hematology and Oncology, University of Maryland Greenebaum
Cancer Center, 22 South Greene Street, Baltimore, MD 21201, USA.
medelman@umm.edu
Non-small-cell lung cancer (NSCLC) is responsible for more deaths each
year in the United States than is any other malignancy. Early stage
disease can be cured with surgical resection. Postoperative surveillance
for recurrent disease and the development of second malignancies are
important parts of the overall treatment plan. Follow-up strategies have
been analyzed and guidelines (most notably those of the National
Comprehensive Cancer Network ) have been published. However, common
practice often does not comply with these rationally developed
guidelines. Understanding the general principles of effective
surveillance may improve compliance with the guidelines and may lead to
more cost-effective management. New methods of surveillance,
postoperative risk stratification, and emerging therapies may alter
these recommendations for postoperative surveillance of patients with
early stage NSCLC in the future.
9
UI - 12057090
AU - Gressen EL; Curran WJ Jr
TI -
Inoperable localized stage I and stage II non-small-cell lung cancer.
SO - Curr Treat Options Oncol 2002 Feb;3(1):75-83
AD - Department of Radiation Oncology, Frankford Hospital Torresdale
Division, Knights and Red Lion Roads, Philadelphia, PA 19114, USA.
eric.gressen@mail.tju.edu
Early stage, medically inoperable non-small-cell lung cancer is a
treatable disease. A thorough clinical work-up is necessary to optimize
management for this group of patients. Thoracic radiation therapy has
been used for such patients with achievement of durable local control
and prolonged survival. To improve upon the results of standard
fractionation radiation therapy, novel approaches are needed. Dose
escalation may further enhance local tumor control and survival rates.
Efforts to minimize irradiation to normal lung parenchyma are necessary.
Multiple strategies to optimize the therapeutic ratio are being
investigated. Elimination of elective nodal irradiation may reduce late
toxicity of treatment but may compromise locoregional control. Other
strategies, such as intensity-modulated radiation therapy with dose
volume histograms will help minimize lung parenchyma irradiation, which
will reduce the probability of radiation pneumonitis. Chemotherapy
appears to play a minimal role in the treatment of inoperable limited
disease, but researchers continue to conduct investigational trials with
active chemotherapeutic agents in the hopes of reducing local and
distant tumor failures.
10
UI - 12101570
AU - Zyrianov BN; Kritskaia NG; Zav'ialov AA; Ialova MF; Cheremisina OV;
TI -
Miller SV
[Morphologic changes of bronchial epithelium after intraoperative
radiotherapy of lung cancer]
SO - Vopr Onkol 2002;48(1):63-7
AD - Research Institute of Oncology, Research Center, Siberian Branch,
Russian Academy of Medical Sciences, Tomsk.
Integration of intraoperative radiotherapy (IORT) with combined
treatment of non-small cell carcinoma of the lung seems to be promising.
Of particular interest are studies of morphological changes in the
bronchial epithelium under the influence of large single dose of
radiation (15 Gy). Our clinical investigation included patients with
non-small cell carcinoma stage III who had received different schedules
of treatment at the Center's clinics. Examination was carried out of
biopsy material sampled from the bronchus stump as well as from the
contralateral segment of the bronchial tree following combined therapy.
Exacerbation of the chronic process in the bronchus stump after IORT was
reported. One month after bronchial resection, 80% of patients suffered
from catarrhal sclerosing bronchitis. Its progression triggered on
bronchial sclerosis in 20%. Catarrhal sclerosing bronchitis in the
contralateral segment of the bronchial tree occurred in 60%; there was
no significant correlation between catarrhal sclerosis, on the one hand,
and the initial condition of the bronchus, on the other. In the control
group, there were also signs of chronic bronchitis exacerbation on the
site of operation. On the whole, the distribution of patients by
bronchitis patterns remained unchanged.
11
UI - 12101574
AU - Akonov AL; Levashev IuN
TI -
[Exploratory thoracotomy: causes of inoperability of non-small-cell lung
cancer]
SO - Vopr Onkol 2002;48(1):78-82
The investigation is concerned with evaluation of different procedures
of preoperative examination as well as reasons for carrying out
explorative thoracotomy for lung cancer. The data on examination and
surgical treatment of 81 patients who underwent explorative thoracotomy
for primary non-small cell cancer of the lung were analyzed. The
procedure was performed in 9.3% of surgical patients. Assessment of
preoperative clinical and macro- and microscopic findings as well as
resected material was carried out for each patient. The X-ray,
bronchological, functional, angiographic and computed tomography
evidence identified involvement of the mediastinal systems (pulmonary
artery, vena cava superior, myocardium, aorta and trachea) and
dissemination of tumor to the pleura as the most common cause of
inoperability. Radical surgery was contraindicated in 65% because of the
involvement of several organs and tissues. In certain situations,
explorative thoracotomy should be resorted to as the last method of
diagnosis of primary lung cancer.
12
UI - 11831614
AU - Movsas B
TI -
Role of adjuvant therapy in resected stage II/IIIA non-small-cell lung
cancer.
SO - Oncology (Huntingt) 2002 Jan;16(1):90-5, 100; discussion 100-2, 105-6
AD - Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia,
Pennsylvania 19111, USA. B_Movsas@FCCC.edu
The role of adjuvant therapy following complete resection of
node-positive (stage II/IIIA) non-small-cell lung cancer remains
controversial. Five-year survival rates in pathologic stage II disease
range from 30% to 50% and in resected stage IIIA disease from 10% to
30%. The majority of recurrences following surgery are distant
issue, analyzes the role of adjuvant therapy in this setting, using an
evidence-based approach and focusing primarily on randomized trials and
meta-analyses. The key variables in evaluating these studies are
elucidated, ranging from the extent of mediastinal, systemic, and
"molecular" staging to the quality of the adjuvant treatments
administered. Some of the potential flaws inherent in meta-analyses are
reviewed. To date, there is no convincing evidence that any therapy
consistently improves survival in the adjuvant setting. Postoperative
radiotherapy has been associated with a significant improvement in local
control, particularly in patients with pathologic N2 disease.
Chemotherapy should be offered to patients on appropriate clinical
trials, and active phase III trials are reviewed. Future strategies
include novel chemotherapy, methods to reduce toxicity, the emerging
role of neoadjuvant therapy, and the promise of new biologic agents.
13
UI - 12072549
AU - Bowman R; Clarke B; Duhig E; Larsen J; Fong K
TI -
Re: Effects of N-(4-hydroxy-phenyl)retinamide on hTERT expression in the
bronchial epithelium of cigarette smokers.
SO - J Natl Cancer Inst 2002 Jun 19;94(12):949-50; discussion 950-1
14
UI - 12118544
AU - Jack CI; Cottier B; Jackson MJ; Cassapi L; Fraser WD; Hind CR
TI -
Indicators of free radical activity in patients developing radiation
pneumonitis.
SO - Int J Radiat Oncol Biol Phys 1996 Jan 1;34(1):149-54
AD - Department of Geriatric Medicine, University of Liverpool, UK.
ddevine@liverpool.ac.uk
PURPOSE: Radiation pneumonitis is thought to occur as the result of
excess free radical generation following radiotherapy. Various in vitro
studies have shown that large doses of irradiation can cause membrane
lipid peroxidation and the oxidation of protein sulphuryl groups. We,
therefore, studied two circulating markers of lipid peroxidation and an
indicator of "catalytic iron" (potentially available iron to catalyze
the generation of free radicals) in patients undergoing radiotherapy.
METHODS AND MATERIALS: The 9,11 diene conjugate of 9,12 linoleic acid,
expressed as their molar ratio (percentage molar ratio (MR)) and
thiobarbituric acid reactive acid-substances (TBARS), as well as levels
of circulating desferrioxamine-chelatable iron assay, were assayed.
Serial blood samples were taken over a 3-month period in 25 patients
with inoperable nonsmall cell lung cancer. RESULTS: Ten patients
developed radiation pneumonitis. The patients who developed pneumonitis
showed a tendency for the serum percentage molar ratio to increase after
a week. The change in the percentage molar ratio between Time 0 and 1
week of radiotherapy was significantly higher in the group that
subsequently developed pneumonitis compared to the group that did not (p
= 0.002). The initial serum TBARS levels in patients were not
significantly elevated compared to controls and there was no difference
in the serum TBARS levels in the pneumonitis and nonpneumonitis groups
throughout the study period. After 1 week of radiotherapy the group that
subsequently developed pneumonitis had a significantly higher level of
desferrioxamine-chelatable iron (DFx-iron) compared with the
nonpneumonitis group (p = 0.05). CONCLUSION: These data suggest that
both the percentage MR and DFx-iron appear to reflect an increased
susceptibility to develop radiation pneumonitis and after 1 week of
radiotherapy they indicate patients who are likely to subsequently
develop pneumonitis. Hence, these indicators could indicate the group of
patients that could benefit from intervention therapies with
antioxidants.
15
UI - 12062596
AU - Komaki R; Seiferheld W; Ettinger D; Lee JS; Movsas B; Sause W
TI -
Randomized phase II chemotherapy and radiotherapy trial for patients
with locally advanced inoperable non-small-cell lung cancer: long-term
follow-up of RTOG 92-04.
SO - Int J Radiat Oncol Biol Phys 2002 Jul 1;53(3):548-57
AD - The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe
Boulevard, Box 97, Houston, TX 77030, USA. rkomaki@mdanderson.org
PURPOSE: The standard treatment for patients with locally advanced
inoperable non-small-cell lung cancer and good prognostic factors has
become combined chemotherapy (ChT) and radiotherapy (RT). However, the
sequencing of the two modalities, as well as fractionation of RT, has
been controversial. The Radiation Therapy Oncology Group (RTOG) Study
92-04 was a randomized Phase II study designed to evaluate further the
toxicity and efficacy of 2 different strategies of chemoradiation
evaluated in 2 prior RTOG Phase II studies. METHODS: Patients with Stage
II or III medically inoperable or unresectable non-small-cell lung
cancer, good performance status, and minimal weight loss were enrolled
into a prospective randomized Phase II RTOG study. Arm 1 consisted of
induction ChT (vinblastine 5 mg/m(2) i.v. bolus weekly for the first 5
weeks, and cisplatin, 100 mg/m(2) i.v. on Days 1 and 29) followed by
concurrent ChT/RT (cisplatin 75 mg/m(2) i.v. on Days 50, 71, and 92)
during thoracic radiotherapy (63 Gy in 34 fractions during 7 weeks
starting on Day 50). Arm 2 was concurrent ChT and hyperfractionated RT
starting on Day 1 with a total dose of 69.6 Gy in 58 fractions during 6
weeks, 1.2 Gy/fraction b.i.d. ChT consisted of cisplatin, 50 mg/m(2)
i.v. on Days 1 and 8, and oral VP-16, 50 mg b.i.d. for 10 days only on
the days of thoracic radiotherapy repeated on Day 29. RESULTS: A total
of 168 patients were entered between 1992 and 1994, and 163 patients
were eligible for analysis. Eighty-one patients were treated in Arm 1
and 82 patients in Arm 2. Pretreatment characteristics, including age,
gender, Karnofsky performance status, histologic features, and stage,
were similar. The incidence of acute esophagitis was significantly
higher among patients treated in Arm 2 than among those treated in Arm 1
(p <0.0001). The incidence of acute hematologic toxicity was
significantly higher among patients treated in Arm 1 (p = 0.01 for
anemia and p = 0.03 for other hematologic toxicities) than among those
treated in Arm 2. Analysis of late toxicity showed that chronic
esophageal toxicity was significantly more frequent in Arm 2 than in Arm
1 (p = 0.003). The time to in-field progression was significantly
different (p = 0.009), favoring Arm 2 compared with Arm 1 (26% vs. 45%
with failure in 2 years and 30% vs. 49% with failure in 4 years,
respectively). The median 2-year and overall 5-year survival rates were
similar between the two arms. CONCLUSION: Concurrent ChT and
hyperfractionated RT resulted in a significant prolongation of the time
to in-field progression, but with higher acute and chronic esophagitis.
No other significant differences were observed between the two groups.
Investigation with a chemoradio-protector is under way.
16
UI - 12062597
AU - Liao Z; Komaki R; Stevens C; Kelly J; Fossella F; Lee JS; Allen P; Cox
TI -
JD
Twice daily irradiation increases locoregional control in patients with
medically inoperable or surgically unresectable stage II-IIIB
non-small-cell lung cancer.
SO - Int J Radiat Oncol Biol Phys 2002 Jul 1;53(3):558-65
AD - Division of Radiation Oncology, The University of Texas M. D. Anderson
Cancer Center, 1515 Holcombe Boulevard, Box 97, Houston, TX 77030, USA.
zliao@mdanderson.org
PURPOSE: To evaluate the effect of q.d. or b.i.d. radiotherapy (RT) on
the outcome of patients with locally advanced non-small-cell lung
cancer. METHODS AND MATERIALS: We retrospectively reviewed the outcome
of 261 patients with medically inoperable or surgically unresectable
Stage II-IIIB non-small-cell lung cancer, who were treated with combined
modality cisplatin-based chemotherapy and RT. Chemotherapy was
administered either sequentially or concurrently with thoracic RT. The
median follow-up was 18 months (range 2-92). Treatment groups included
sequential chemotherapy and q.d. RT (n = 109), concurrent chemotherapy
and q.d. RT (n = 48), and concurrent chemotherapy and b.i.d. RT (n =
104). Of the 261 patients, 97% had a Karnofsky performance score > or
=80, and 86.2% had < or =5% weight loss in the 3 months before
diagnosis; 66.7% had nonsquamous cell histologic features. All but 8
patients had Stage IIIA-B disease. RESULTS: The 2- and 5-year
locoregional control rate was 42.4% and 25.7% for the q.d. group and
70.6% and 45.8% for the b.i.d. group, respectively (p = 0.0001). The 2-
and 5-year disease-free survival rate was 26.7% and 6.5% for the q.d.
group and 39.6% and 27.3% for the b.i.d. group, respectively (p =
0.0114). The corresponding overall survival rates were 35.9% and 9.4%
for the q.d. group and 38.7% and 26.1% for the b.i.d. group. No
difference was found in the rate of distant metastasis between the 2
groups. Multivariate analysis indicated that b.i.d. RT was a favorable
prognostic factor for locoregional control and disease-free survival.
CONCLUSION: RT b.i.d. significantly improved locoregional control and
disease-free survival compared with RT q.d. in patients with Stage
IIIA-B non-small-cell lung cancer.
17
UI - 12094341
AU - Depierre A; Westeel V; Jacoulet P
TI -
Gemcitabine induction chemotherapy in non-small cell lung cancer.
SO - Semin Oncol 2002 Jun;29(3 Suppl 9):55-60
AD - Service de Pneumologie, Centre Hospitalier Universitaire, Besancon,
France.
Surgery has long been considered standard treatment in early stage
non-small cell lung cancer. Preoperative chemotherapy is a real
challenge in the treatment of these stages. Some conclusions can be
drawn from the first phase II studies in stage IIIA tumors. Response
rates were higher than those observed in stage IV tumors, reaching
approximately 70%. Although toxicity seemed acceptable, increased
morbidity and mortality have to be taken into account for the choice of
preoperative regimens. Two randomized studies that included only a few
patients were conducted in stage IIIA disease and showed highly positive
survival results. The French randomized study argued in favor of
preoperative chemotherapy with an absolute difference in survival rates
that remains constant beyond the third year. New studies are ongoing to
evaluate the role of the gemcitabine/cisplatin combination. Several
phase II studies of this regimen in the preoperative setting or in
combination with radiotherapy have been presented at the most recent
meetings of the American Society of Clinical Oncology. These studies
confirmed both its efficacy and good tolerability. In several ongoing
randomized studies, this combination has been chosen to test the concept
of preoperative chemotherapy. One such study, which compares two
different strategies of preoperative chemotherapy, is by the Intergroupe
Francophone de Cancerologie Thoracique. Copyright 2002, Elsevier Science
(USA). All rights reserved.
18
UI - 11721203
AU - Mezzetti M; Panigalli T; Scarlata P
TI -
[Prognostic influence of neoplastic involvement of bronchial stump after
anatomical lung resection for NSCLC]
SO - Minerva Chir 2001 Dec;56(6):593-8
AD - Clinica Chirurgica, Ospedale S. Paolo, Universita degli Studi, Milan,
Italy.
BACKGROUND: The problem of unexpected neoplastic residual at the
bronchial stump after surgery is discussed. Even if the prognostic
impact of a macroscopic neoplastic residual at the bronchial stump is
well known, the microscopic residual is still uncertain as well as the
better therapeutic strategy to face this problem. METHODS: 43 out of
2350 patients operated on for lung cancer in our Institute from 1976 to
1998 had a neoplastic residual bronchial stump; 16 patients underwent a
second surgery and are no more included in this study. 27 patients with
a mean follow-up of three years were treated without another operation.
Radiotherapy was proposed to all these patients and performed only in
20, while 4 patients were treated with polychemotherapy alone.
Postoperative stage was IIIa in 17 patients, IIb in 8 and IIa in 2.
RESULTS: The three year survival rate is 29% (8 patients still alive, 7
of which disease free); 7 received radiotherapy (35% of the whole
patients treated with radiotherapy), only 5 complicated by radiation
pneumonia without stopping the treatment, and one only chemotherapy. The
survival rate after therapy is the same of patients operated on in the
same stage without neoplastic bronchial residual. CONCLUSIONS: The
authors are favorable to perform a second look surgery to enlarge
bronchial resection in the initial stages and to perform in all cases
adjuvant therapy. Attention is given to the meaning of mucosal or
extramucosal involvement, to the effectiveness of frozen section
examination and the authors' therapeutic suggestions in relationship to
stage and histotype are discussed.
19
UI - 12118751
AU - Pitz CC; Maas KW; Van Swieten HA; de la Riviere AB; Hofman P; Schramel
TI -
FM
Surgery as part of combined modality treatment in stage IIIB non-small
cell lung cancer.
SO - Ann Thorac Surg 2002 Jul;74(1):164-9
AD - Department of Pulmonology and Thoracic Surgery, St Antonius Hospital
Neiuwegein, The Netherlands.
BACKGROUND: The role of surgery after neoadjuvant chemotherapy in
patients with stage IIIB non-small cell lung cancer (NSCLC) remains
unclear. METHODS: A prospective multicenter trial of neoadjuvant
chemotherapy followed by surgery or radiotherapy or both was conducted
with 41 patients with stage IIIB NSCLC. End points were toxicity,
response, downstaging, complete resectability, and survival. The
diagnostic value of repeat mediastinoscopy after neoadjuvant
chemotherapy (three courses of gemcitabine/cisplatin) was also studied.
RESULTS: Response rate after neoadjuvant chemotherapy was 66% (27 of
41). Fifteen patients underwent repeat mediastinoscopy, which proved to
be inadequate in 6 patients. Two repeat mediastinoscopies were false
negative. Resection was performed in 18 patients, of which 10 proved to
be radical. Hospital mortality was 2.4% (n = 1). Major complications
occurred in 6 patients (fistula, empyema, hemorrhage).
Histopathologically proven downstaging was seen in 16 patients (39%).
Twenty-five patients underwent radiotherapy of whom 14 were diagnosed
with stable/progressive disease and 9 with partial/complete response.
Median survival for all patients was 15.1 months, for nonresponders 8.4
months and for responders 16.8 months (p = 0.11). Patients with
partial/complete response had a mean survival of 21.5 months after
resection and 13.0 months after radiotherapy (p = 0.0003). CONCLUSIONS:
Radical surgery can be performed in 37% (10 of 27) of the responders
resulting in a prolonged survival. Surgery as part of combined modality
treatment is feasible in stage IIIB NSCLC. Results of a repeat
mediastinoscopy are disappointing and proved to be a not-so-effective
restaging tool because of the high number of incomplete procedures and
because it yields false negative results.
20
UI - 12118753
AU - Sawabata N; Ohta M; Takeda S; Hirano H; Okumura Y; Asada H; Maeda H
TI -
Serum carcinoembryonic antigen level in surgically resected clinical
stage I patients with non-small cell lung cancer.
SO - Ann Thorac Surg 2002 Jul;74(1):174-9
AD - Division of Surgery, Toneyama National Hospital, Toyonaka, Osaka, Japan.
nori@toneyama.hosp.go.jp
BACKGROUND: There is little general agreement concerning the
effectiveness of serum carcinoembryonic antigen (CEA) as a prognostic
indicator for non-small cell lung cancer (NSCLC) in clinical stage I
patients. We conducted a retrospective study to investigate the
relationship between serum CEA level and survival. METHODS: We assessed
297 consecutive patients with clinical stage I NSCLC who underwent
surgical resection at Toneyama National Hospital from 1985 to 1998.
Serum CEA levels were measured with an enzyme-linked immunosorbent assay
kit with the upper limit of normal defined as 7.0 ng/mL based on the 95%
specificity level for benign lung disease, in our hospital. RESULTS:
There were 56 (19%) patients with serum CEA greater than 7.0 ng/mL. The
high CEA group had a median survival time of 50 months and a 5-year
survival rate of 49% compared with a 5-year survival rate of 72% (p <
0.0001) for the normal CEA group (n = 241). Patients with
postoperatively high CEA levels (n = 15) had the worse prognosis (median
survival time 35 months, and 5-year survival 18%) compared with patients
whose levels returned to normal (n = 41, median survival time 8.8
months, and 5-year survival 68%; p = 0.01). These differences were also
observed in patients with pathologic stage I or II tumors but not in
those with pathologic stage III or IV tumors. CONCLUSIONS: Serum CEA
level is a useful predictor of survival for patients with clinical stage
I NSCLC, and a persistently high CEA level after surgery is an
especially strong indicator of a very poor prognosis.
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