National Cancer Institute®
Last Modified: July 1, 2002
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
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. firstname.lastname@example.org
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.
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. email@example.com
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.
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. firstname.lastname@example.org
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.
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.
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.
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.
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. email@example.com
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.
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. firstname.lastname@example.org
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.
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.
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.
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.
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
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. email@example.com
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.
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. firstname.lastname@example.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.
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. email@example.com
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.
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.
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.
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.
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. firstname.lastname@example.org
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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