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Query: UMLS:C0027651 (tumor)
 685,946 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The new international staging system remains a source of some controversial issues as the survival of 716 non-small cell lung cancer patients in our series (286 in stage I, 63 in stage II, 225 in stage IIIA, 81 in stage IIIB and 61 in stage IV) is analyzed with regard to the T, N and M categories. The problems are aired and some proposals made for revising the staging system. Multivariate analysis of significant factors contributing to the prognoses of stage I patients made it clear that the most important factor was the size of the primary tumor. A significant difference in survival was found between T1N0M0 and T2N0M0 disease. Furthermore, patients having tumors larger than 5 cm in diameter showed a significantly worse prognosis than those having tumors less than 5 cm. Accordingly, stage I should be divided into stage IA (T1N0M0, tumors less than 3 cm) and stage IB (T2aN0M0, tumors less than 5 cm). Tumors greater than 5 cm should be categorized as T2b, and T2bN0M0 disease should be classified as stage II. Patients having N2 disease involving the pretracheal (#3) node had a significantly worse survival rate than those with other ipsilateral nodal involvement, so #3 nodal involvement should be categorized as N3 disease. Patients having ipsilateral intrapulmonary satellite nodules, most of which were verified by microscopic examination of the resected specimens, had a significantly better survival rate than stage IIIB patients and showed no significant difference from stage IIIA disease. Accordingly, ipsilateral intrapulmonary satellite lesions should be categorized as T3 disease.
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PMID:Proposals regarding some deficiencies in the new international staging system for non-small cell lung cancer. 165 12

Twelve inoperable lung cancer patients were treated with a combination chemotherapy of cisplatinum (CDDP) and etoposide (VP16), as a continuous infusion for 5 days, every 21 days, and with a daily oral administration of GaCl3. Dosages of CDDP and VP16 were adapted in order to obtain an area under the curve (AUC) of 80,000 micrograms l-1.h for plasma total platinum and of 200 mumol.l-1 h for plasma VP16 during each 120 h infusion. GaCl3 was given at the dosage of 400 mg/24h from the time of diagnosis at least until the evaluation after 3 courses of chemotherapy. An objective response was observed in 5 non small cell (NSCLC) lung cancer patients (group 1) and 3 small cell (SCLC) lung cancer patients (group 2). In the other 4 patients with a NSCLC no partial response was noted (group 3). No significant difference in area under the curve (AUC) was noted between the 3 groups, either for plasma total platinum (group 1 = 89,598 +/- 20,843 micrograms l-1.h; group 2 = 88,081 +/- 15,431 micrograms l-1.h; group 3 = 83,820 +/- 13,455 micrograms l-1.h), or for VP16 (group 1 = 227 +/- 41 mumol.l-1 h; group 2 = 217 +/- 29 mumol.l-1.h and group 3 = 211 +/- 30 mumol.l-1.h). The maximal plasma Ga concentrations were 244 +/- 34 micrograms/l in group 1, 112 +/- 57 micrograms/l in group 3 (p less than 0.005) and 243 +/- 132 micrograms/l in group 2. It was then decided to increase the dose of GaCl3 in the further non-responding patients. In 6 responders, 3 additional courses of this combination chemotherapy could have been given without major toxicity, allowing a much more important decrease in the tumor volume in 4 of them. This schedule of treatment should permit the chemotherapy to continue for longer than 6 courses, in order to improve the survival time.
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PMID:Combination chemotherapy with cisplatin, etoposide and gallium chloride for lung cancer: individual adaptation of doses. 166 Jun 90

Present treatment options for non-small cell lung cancer in the adjuvant and neoadjuvant settings are far from ideal. The bottom line of improvement in overall survival by any treatment modality used has yet to be achieved. For this to happen, better drug therapy will be required. Future trials should be carefully designed with intraoperative staging and stratification of patients by histology, stage, and potentially immunologic markers, ploidy, and molecular biologic markers such as growth factors and their receptors. Combination of individual therapies to maximal toxicity in an attempt to overcome inherent tumor resistance will be key. The use of colony-stimulating factors, with high-dose chemotherapy integrated with hyperfractionated radiotherapy, may be seen in future studies. Combining standard chemotherapy and radiotherapy with cytokines or immunotherapy using interleukin-1 and -2, or tumor necrosis factor or monoclonal antibodies to growth factors may be seen in innovative trials. By such meticulously and intelligently designed trials, progress in adjuvant and neoadjuvant treatment of the important group of patients with locally advanced non-small cell lung cancer will occur.
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PMID:Neoadjuvant and adjuvant therapy of non-small cell lung cancer. 166 61

A total of 14 patients with locally advanced and unresectable head and neck (SCCHN) or non small cell lung cancer were treated with a definitive course of radiation therapy with conventional fractionation and 30 mg/m2 carboplatin (CBDCA) given daily as an i.v. infusion during the 1st, 3rd, 5th and 7th weeks of the combined treatment. The planned tumor dose of at least 7000 cGy was reached in all SCCHN patients except 1 (6600 cGy). The 2 NSCLC patients received 6320 and 5980 cGy, respectively. The planned total CBDCA-dose of 600 mg/m2 was administered in all patients. No treatment delays were required in 10 patients. Interruptions for severe mucositis or myelosuppression occurred in 4 patients (28.6%), but in no case did the delay exceed 1 week. Complete response was obtained in 8 patients (57.1%); 7 of the 12 with SCCHN and 1 of the 2 with NSCLC. The other 6 patients achieved a partial response. Granulocytopenia of WHO grade 3 occurred in 1 patient; apart from vomiting and mucositis, toxicities above grade 2 were not observed.
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PMID:Daily low-dose carboplatin and standard radiotherapy in unresectable head and neck and lung cancers: a pilot study. 166 54

The relative usefulness of a combination of some tumor markers, such as CEA, AFP, ferritin and NSE for the diagnosis of lung cancer was assessed by multiple logistic analysis. Serum concentration of these markers was determined in 68 patients with lung cancer (50 with NSCLC and 18 with SCLC, in 68 patients with benign lung disease and 75 normal control subjects. Ferritin proved to be the most useful in diagnosing both NSCLC and SCLC, while NSE was found to be of some help in diagnosing SCLC only. The multiple marker panel proved to be more sensitive and specific than any single marker in discriminating lung cancer from normal control tissue, but it was of limited value in discriminating malignant from benign lung disease. The results of the present study would suggest that the panel of investigated tumor markers is not of great help for the early diagnosis of lung cancer.
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PMID:Clinical significance of a multiple biomarker assay in patients with lung cancer. A study with logistic regression analysis. 168 30

Resulting from the declared palliative aim and from time economic and tumor affecting high dosed single fraction meanwhile a hypofractionated irradiation rhythm was applied to more than 500 patients with lung carcinoma and 5 x 5 Gy were given in daily succession if possible. A hospitalization was necessary in a third of the patients. In spite of histology (NSCLC: 46%, SCLC: 35%) a mean survival of 12 months was attained, in which the fate is determined for 75% of the patients within the first year after therapy. Detrimental effects were not provoked by the applied irradiation mode.
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PMID:[The results of hypofractionated irradiation in patients with bronchogenic carcinoma]. 170 57

The article describes a retrospective study of the prognosis for 450 patients with inoperable non-small cell lung cancer discharged during the period 1970 to 1979. 81% of the patients were males. The predominant cell type was squamous cell carcinoma. One out of seven patients was inoperable because of poor cardiorespiratory function, six out of ten because of mediastinal metastases. Median survival was six months and was related both to staging of the tumor and to cell type. The prognosis was worst for patients with adenocarcinoma. Only 8% of the 450 patients were alive after two years. Specific and palliative therapy had a minor effect on median survival. Controlled clinical trials can probably settle whether an extension of the criteria for surgical treatment can improve the prognosis of this large group of patients.
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PMID:[Prognosis of inoperable non-small cell bronchial cancer]. 170 68

Based on our review of 35 cases and the literature, we found the spectrum of pulmonary neuroendocrine (NE) tumors to be too broad to fit into the traditional three-category classification scheme of typical carcinoid (TC), atypical carcinoid (AC), and small-cell lung carcinoma (SCLC). We found that a spectrum of high- and low-grade tumors exist between TC and SCLC and that in the past many of these tumors have been called AC. We chose to adhere to Arrigoni's definition of AC, as his original criteria characterized a low-grade tumor. For the higher grade non-small-cell tumors (NSCLC), we propose a fourth category of large-cell neuroendocrine carcinoma (LCNEC), which is characterized by: (a) light microscopic NE appearance; (b) cells of large size, polygonal shape, low nuclear-cytoplasmic ratio (N:C), coarse nuclear chromatin, and frequent nucleoli; (c) high mitotic rate [greater than 10/10 high-power fields (HPF)] and frequent necrosis; and (d) NE features by immunohistochemistry (IHC) or electron microscopy (EM). Thus, after deciding that a pulmonary NE tumor is high grade, the major diagnostic issue is separation of LCNEC from SCLC. This distinction is based not only on cell size, but on a variety of morphologic features. We studied 20 TC, six AC, five LCNEC, and four SCLC and characterized the clinical, light microscopic, EM, IHC, and flow cytometric features of each type of tumor. We did not find any advantage to IHC, EM, or flow cytometry over light microscopy in the subclassification or prediction of prognosis; however, these methods were useful in characterizing these four types of pulmonary NE tumors and in demonstrating their NE properties. LCNEC must be distinguished from a fifth category pulmonary NE tumor: NSCLC with NE features in which NE differentiation is not evident by light microscopy and must be demonstrated by EM or IHC. Although the prognosis of LCNEC appears to be intermediate between AC and SCLC, larger numbers of patients will be needed to demonstrate significant differences in survival.
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PMID:Neuroendocrine tumors of the lung with proposed criteria for large-cell neuroendocrine carcinoma. An ultrastructural, immunohistochemical, and flow cytometric study of 35 cases. 170 58

When the number of silver-stained nucleolar organizer regions (Ag-NORs) was counted in 274 patients with non-small cell lung cancer, the mean number per nucleus in patients overall was 5.07 +/- 1.92 (SD). With the use of the tumor (T)-nodes (N)-metastasis (M) classification, the mean Ag-NOR count for patients with T1 and T2 disease was statistically lower than that for those with T3 and T4 disease (P less than 0.01). The mean Ag-NOR counts were lower in patients with N0 disease than in those with N1 and N2 disease (P less than 0.01); lower in patients with stage I disease than in those with stage II, IIIA, IIIB, or IV disease (P less than 0.01); and lower in patients with adenocarcinoma than in those with squamous cell carcinoma (P less than 0.01) or large-cell carcinoma (P less than 0.05). In 131 patients with stage I disease, the mean Ag-NOR count was 3.80 +/- 1.32, and the 5-year survival rates of patients with Ag-NOR counts of less than 3.80 and greater than or equal to 3.80 were 78 and 44%, respectively, including 78% and 25% for adenocarcinoma, respectively (P less than 0.01). However, there was no statistically significant difference for those in stage II, IIIA, IIIB, or IV, and in stage I (without an adenocarcinoma). Because patients with stage I non-small cell lung cancer and a high number of Ag-NORs had a poor prognosis, Ag-NORs can serve as a pertinent marker of an early recurrence.
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PMID:Nucleolar organizer regions as a prognostic indicator for stage I non-small cell lung cancer. 171 25

Squamous, large cell, and adenocarcinoma, collectively termed non-small cell lung cancer (NSCLC), are diagnosed in approximately 75% of patients with lung cancer in the United States. The treatment of these three tumor cell types is approached in virtually identical fashion because, in contrast to small cell carcinoma of the lung, NSCLC more frequently presents with localized disease at the time of diagnosis and is thus more often amenable to surgical resection but less frequently responds to chemotherapy and irradiation. Cigarette smoking is etiologically related to the development of NSCLC in the great majority of cases. Genetic mutations in dominant oncogenes such as K-ras, loss of genetic material on chromosomes 3p, 11p, and 17p, and deletions or mutations in tumor suppressor genes such as rb and p53 have been documented in NSCLC tumors and tumor cell lines. NSCLC is diagnosed because of symptoms related to the primary tumor or regional or distant metastases, as an incidental finding on chest radiograph, or rarely because of a paraneoplastic syndrome such as hypercalcemia or hypertrophic pulmonary osteoarthropathy. Screening smokers with periodic chest radiographs and sputum cytologic examination has not been shown to reduce mortality. The diagnosis of NSCLC is usually established by fiberoptic bronchoscopy or percutaneous fine-needle aspiration, by biopsy of a regional or distant metastatic site, or at the time of thoracotomy. Pathologically, NSCLC arises in a setting of bronchial mucosal metaplasia and dysplasia that progressively increase over time. Squamous carcinoma more often presents as a central endobronchial lesion, while large cell and adenocarcinoma have a tendency to arise in the lung periphery and invade the pleura. Once the diagnosis is made, the extent of tumor dissemination is determined. Since most NSCLC patients who survive 5 years or longer have undergone surgical resection of their cancers, the focus of the staging process is to determine whether the patient is a candidate for thoracotomy with curative intent. The dominant prognostic factors in NSCLC are extent of tumor dissemination, ambulatory or performance status, and degree of weight loss. Stages I and II NSCLC, which are confined within the pleural reflection, are managed by surgical resection whenever possible, with approximate 5-year survival of 45% and 25%, respectively. Patients with stage IIIa cancers, in which the primary tumor has extended through the pleura or metastasized to ipsilateral or subcarinal lymph nodes, can occasionally be surgically resected but are often managed with definitive thoracic irradiation and have 5-year survival of approximately 15%.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Non-small cell lung cancer. Part II: Treatment. 171 39


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