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Query: UMLS:C0242379 (lung cancer)
 71,905 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Since 1973, the Radiation Therapy Oncology Group (RTOG) has staged and stratified patients in non-small cell lung cancer (NSCLC) protocols according to the RTOG staging system. In 1985, the American Joint Committee on Cancer (AJCC) revised its lung cancer staging system, with the principle differences from the RTOG system being the staging of involvement of the chest wall and of contralateral mediastinal and hilar lymph nodes. To determine if the AJCC system discriminated outcome differently than the RTOG system in a nonoperative series, all 850 evaluable patients treated with hyperfractionated radiation therapy (RT) on the RTOG protocol 83-11 were restaged by the AJCC system. There was 67% agreement in patient distribution between the following comparable stages in each system: RTOG Stage II/AJCC Stage II; RTOG Stage III/AJCC Stage IIIA; and RTOG Stage IV/AJCC Stage IIIB. Both systems successfully predicted for survival (P less than 0.001), although the RTOG staging was more discriminating (relative risk ratios, 1.59 versus 1.38). Among the 507 favorable patients (those with less than or equal to 5% weight loss and Karnofsky performance status [KPS] of 70 to 100), the RTOG staging was also more predictive (P = 0.004 versus P = 0.01). When RTOG Stage III (462 patients) was divided into those without contralateral mediastinal or hilar adenopathy (AJCC Stage II/IIIA) and those with (AJCC Stage IIIB), a significant survival (P = 0.0001) was noted with 2-year survival rates of 26% versus 4%, respectively. When AJCC Stage IIIA (348 patients) was divided into the patients without chest wall invasion (RTOG Stage II/III) and those with (RTOG Stage IV), a difference in 2-year survival of 22% versus 10% was observed (P = 0.002). Although both staging systems independently predict for survival, a fusion of both staging systems is the most discriminating of outcome. Future nonoperative studies in locally advanced NSCLC should stratify for contralateral nodal involvement (per AJCC staging) and chest wall invasion (per RTOG staging).
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PMID:Comparison of the Radiation Therapy Oncology Group and American Joint Committee on Cancer staging systems among patients with non-small cell lung cancer receiving hyperfractionated radiation therapy. A report of the Radiation Therapy Oncology Group protocol 83-11. 164 32

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 I: Biology, diagnosis, and staging. 164 34

The presence of vital and sensitive organs such as the spinal cord, heart, and lungs makes curative radiotherapy of non-small cell lung cancer difficult to implement and necessitates use of oblique portals. Defining the target volumes in oblique portals is very difficult. We now show, for non-small cell lung cancer, how beam's eye view-based radiotherapy can be used for accurate delineation of treatment volumes and for avoidance of real or dosimetric geographic misses. Furthermore, the beam's eye view-based method enables one to project accurately a 2-dimensional image of 3-dimensional disease extension, especially in oblique fields, thus facilitating the design of accurate customized blocking and avoiding inadvertent blocking of the tumor or unnecessary irradiation of normal tissues. Beam's eye view volumetric analysis is helpful for devising a customized treatment plan for each patient. Such customization may minimize local failure, which is one cause of poor results of radiotherapy in this site. Beam's eye view-based radiotherapy has the potential of improving local control and hence may improve the survival of patients with non-small-cell lung cancer.
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PMID:Optimization of radical radiotherapy with beam's eye view techniques for non-small cell lung cancer. 165 9

The cigarette-smoking behavior of 840 patients with resected Stage I non-small cell lung cancer was analyzed prospectively for up to four years following diagnosis. Lung cancer patients were heavier smokers at diagnosis than other cancer patients and the general population. At one year, only 16.8 percent of the 317 current smokers at baseline, who were followed for two years or longer, continued to smoke, while 83.2 percent of patients either quit permanently (53.0 percent) or for some time period (30.2 percent). By two years, permanent cessation stabilized at over 40 percent; however, the prevalence of continuing smoking decreased through all periods of follow-up. Subjects who tried to quit or did quit permanently were more likely to be female and healthier than continuous smokers.
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PMID:Smoking behavior following diagnosis in patients with stage I non-small cell lung cancer. 165 77

We analyzed the 2,531-patient Southwest Oncology Group extensive-stage non-small-cell lung cancer (ENSCLC) data base from 1974 to 1988 to (1) assess the interactions of host- or tumor-related prognostic factors and therapy using Cox modeling and recursive partitioning and amalgamation (RPA) to determine whether each independently predicts outcome, and (2) use RPA to define prognostic subsets with different survival potentials. Good performance status (PS), female sex, and age greater than or equal to 70 years were significant independent predictors in a Cox model applied to the entire population. In a second Cox model for patients with good PS enrolled on recent studies, hemoglobin level greater than or equal to 11.0 g/dL, normal lactate dehydrogenase (LDH), normal calcium, and a single metastatic site were significant favorable factors. The use of cisplatin was an additional independent predictor of improved outcome in both Cox models after adjustments for year of accrual and all prognostic variables. The favorable effect of cisplatin was observed in each of six RPA-derived subgroups from the entire population. A second RPA of 904 patients from recent trials (nearly all received cisplatin-based therapy) resulted in three distinct prognostic subsets based on PS, age, hemoglobin, and LDH; greater than or equal to 1-year survivals were 27%, 16%, and 6% (P less than .0001). The best survival occurred for patients with a good PS who had a hemoglobin level greater than or equal to 11 g/dL and who were older than 47 years. This analysis suggests that although several factors were independent variables in the Cox models, three important prognostic subgroups were easily defined through RPA. Together with other analyses, our results suggest the need to modify the stage IV category in NSCLC.
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PMID:Survival determinants in extensive-stage non-small-cell lung cancer: the Southwest Oncology Group experience. 165 93

The present study examines the relationship between neuroendocrine (NE) differentiation and the clinical behaviour of non-small cell lung cancer (NSCLC). Retrospective (n = 315) and prospective (n = 44) cohorts of non-small cell tumours were obtained from surgically treated cases of lung cancer, comprising 218 squamous cell carcinomas, 65 adenocarcinomas, 51 adenosquamous carcinomas, and 25 large cell undifferentiated carcinomas. Paraffin wax embedded and fresh frozen tissue sections were stained for the NE markers neurone specific enolase, creatine kinase-BB, bombesin, neurotensin, chromogranin A, synaptophysin and UJ-13A. The expression of two or more markers was observed in 30% of cases, and was taken to identify NE-NSCLC. A statistically significant correlation between nodal status and NE differentiation (P = 0.05), and disease stage and NE differentiation (P = 0.04) was observed. However, there was no correlation between NE differentiation and survival. These findings suggest that NE-NSCLC, analogous to SCLC is more highly metastatic than non-NE-NSCLC.
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PMID:Neuroendocrine differentiation and clinical behaviour in non-small cell lung tumours. 165 75

Resting energy expenditure (REE) was determined in 30 patients with newly detected non-small cell lung cancer. Measured values were compared with the values predicted by the Harris-Benedict (HB) formula. Mean REE was 20% higher than predicted. Sixty percent of the patients (18 patients) had an elevated REE (greater than or equal to 115%) compared with this formula. The prevalence of hypermetabolism in a group of patients with gastric and colorectal cancer was only 13% (13 of 104 patients). When corrected for fat-free mass (FFM), REE was still significantly higher (P less than 0.001) in the lung cancer group compared with the gastric and colorectal cancer group. Whereas weight loss in healthy men leads to an adaptational decrease in energy expenditure (EE), weight loss in the patients with lung cancer was accompanied by an increase in REE. Tumor stage, tumor localization, pulmonary function, or smoking behavior could not explain the observed increase in REE in patients with lung cancer. Therefore, these metabolic alterations appear to be tumor mediated.
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PMID:Resting energy expenditure in patients with non-small cell lung cancer. 165 99

The capacity of alveolar macrophages and peripheral blood monocytes from patients with non-small cell lung cancer to develop tumoricidal function after in vitro stimulation with different macrophage activators was investigated. Alveolar macrophages were found to be impaired in their ability to develop cytotoxic activity compared with either the peripheral blood monocytes from the same patients or alveolar macrophages from patients with nonmalignant lung disorders. This result was observed consistently under diverse culture conditions and with different macrophage activators including gamma-interferon (gamma-IFN), granulocyte-macrophage colony-stimulating factor (GM-CSF), phorbol myristate acetate, or endotoxin. The impairment in tumoricidal function observed in alveolar macrophages was not associated with reduced target cell binding compared to peripheral blood monocytes. Alveolar macrophages from patients with lung cancer were found to secrete significantly greater amounts of tumor necrosis factor (TNF) and interleukin-1 (IL-1) than either peripheral blood monocytes from the same patients or alveolar macrophages from the patients with nonmalignant disorders. These results are consistent with either different regulatory pathways for cytotoxicity and cytokine secretion in the alveolar macrophages of patients with lung cancer or diversity in the subpopulations of cells responsible for these functions.
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PMID:Impaired tumoricidal function of alveolar macrophages from patients with non-small cell lung cancer. 165 12

The authors examined 72 fresh frozen sections of primary lung cancer using a monoclonal antibody for DNA polymerase-alpha (POL-alpha). The percentage of POL-alpha-positive cells was 17.3%. The tumors were divided into two groups. In one group, more than 5% of the POL-alpha-positive cells were designed POL-alpha-positive, and in the other group less than 5% were POL-alpha-negative. The incidence of POL-alpha-positive in men was statistically higher than that in women (P less than 0.05). The incidence correlated with the T (tumor) status, with a significance. Based on data on 43 patients with non-small cell lung cancer and who underwent a complete resection, the 3-year disease-free survival rates of POL-alpha-positive and POL-alpha-negative cells were 42% and 81%, respectively (P less than 0.05). When the patients were restricted to the class of N0 disease or Stage I, all the patients diagnosed as a cases of a relapse of lung cancer were POL-alpha positive. The 3-year disease-free survival rate of patients with POL-alpha negative was 100%. Our data suggest that in cases of non-small cell lung cancer, POL-alpha expression is associated with the extent of malignancy and a recurrence. Thus POL-alpha may prove to be a pertinent marker of an early relapse.
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PMID:DNA polymerase-alpha as a putative early relapse marker in non-small cell lung cancer. An immunohistochemical study. 165 17

The purpose of this study was to investigate whether the presence of a malignant tumor influences energy metabolism of the host. Resting energy expenditure (REE) was measured in 104 gastric and colorectal (GCR) cancer patients and in 47 non-small cell lung cancer patients and was compared with REE values in 40 healthy controls. REE expressed per kilogram of fat-free mass (FFM) in lung cancer patients was elevated, in comparison with healthy controls (33.6 +/- 4.6 and 29.6 +/- 2.9 kcal, respectively; P less than 0.001), in contrast to REE/FFM in GCR cancer patients, which showed no difference, compared with these controls (29.8 +/- 4.3 kcal). In 47 patients with GCR cancer and in 14 patients with lung cancer, REE was also determined after tumor resection. REE in GCR cancer patients measured 1.5 years after tumor resection showed a small but significant increase. No differences were observed between GCR cancer patients with or without signs of tumor recurrence. REE in lung cancer patients with no signs of tumor recurrence measured 1 year after tumor resection had a significant decrease in REE (REE/FFM, -6.8%; P less than 0.05), while patients who had evidence of tumor recurrence showed no change in REE or even an increase. After curative surgery REE returned to a normal level in the lung cancer patients. These results suggest that tumor type is a major determinant of an increased energy expenditure in cancer patients.
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PMID:Effect of different tumor types on resting energy expenditure. 165 79


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