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

Since the introduction of bone scans in 1951, there have been many studies comparing biologic and physical characteristics of new bone-imaging agents and the results of scintigraphy and radiology in large numbers of patients. Relatively speaking, there have been fewer studies detailing the health benefits and financial cost associated with the use of skeletal scintigraphy. This review concerns these aspects in patients with malignancies of various sites and stages. About 2% of patients with stage I or II breast cancer have bone metastases at the time they first present, whereas nearly 28% of patients with stage III disease have bone metastases. A large percentage of patients with initially negative scans develop bone metastases during the first 3--4 yr; many of them develop them within the first 12--18 mo after initial diagnosis. For patients with lung cancer, the use of bone scans in staging their disease is somewhat controversial. Several studies indicate that the yield of positive bone scans may range from as low as 2% to as high as 35%. Data on the use of bone scans in staging prostatic cancer initially are similar to those in patients with breast cancer, that is, yields of 7% in patients with stage I or II disease and a yield of about 20% with stage III disease. Children with osteosarcoma or Ewing's sarcoma rarely have bone disease distant from the site of their primary bone lesion at presentation. However, a large percentage of them (30%--40% or so) develop bone metastases during the follow-up period. As in the case with patients with breast cancer, about half of these bone metastases are evident by 12--18 mo.
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PMID:Rationale for the use of bone scans in selected metastatic and primary bone tumors. 11 84

Skeletal scintigraphy, using phosphates or diphosphonates labeled with technetium 99m, is a sensitive method of detecting bone abnormalities. The most important and most frequent role of bone scanning is evaluating the skeletal areas in patients who have a primary cancer, especially a malignant condition that has a tendency to spread to bone areas. The bone scan is superior to bone radiographs in diagnosing these abnormalities; 15 percent to 25 percent of patients with breast, prostate or lung cancer, who have normal roentgenograms, also have abnormal scintigrams due to metastases. The majority of bone metastases appear as hot spots on the scan and are easily recognized. The incidence of abnormal bone scans in patients with early stages (I and II) of breast cancer varies from 6 percent to 26 percent, but almost invariably those patients with scan abnormalities have a poor prognosis and should be considered for additional therapies. Progression or regression of bony lesions can be defined through scanning, and abnormal areas can be identified for biopsy. The incidence of metastases in solitary scan lesions in patients with known primary tumors varies from 20 percent to 64 percent. Bone scintigraphy shows positive uptake in 95 percent of cases with acute osteomyelitis. Stress fractures and trauma suspected in battered babies can be diagnosed by scanning before there is radiological evidence. The procedure is free from acute or long-term side effects and, except in cases of very young patients, sedation is seldom necessary. Although the test is sensitive, it is not specific and therefore it is difficult to overemphasize the importance of clinical, radiographic, biochemical and scanning correlation in each patient.
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PMID:Skeletal scintigraphy. 39 Aug 86

Radiation pneumonitis usually occurs within 1-3 months after the completion of radiation therapy. A 63-year-old male with primary lung cancer treated by radiation therapy developed radiation pneumonitis 5 months after the completion of radiation therapy. He received 60 Gy to the lung tumor in a conventional fractionation schedule, and then two courses of intravenous chemotherapy using cis-diamine-dichloroplatinum (II) (110-140 mg) and etoposide (140-175 mg). Oral etoposide was initiated for bone metastases on the 104th day after the completion of radiation therapy at a daily dose of 20 mg, to a total dose of 1075 mg. He complained of fever and exertional dyspnea 5 months after the completion of radiation therapy. Chest radiography showed homogeneous infiltrates in the irradiated lung. These clinical signs and symptoms were refractory to antibiotic therapy, but steroid therapy resulted in marked improvement. The development of radiation pneumonitis was suspected to be induced by oral etoposide, which was given before the onset of radiation pneumonitis. These data suggest that etoposide induces a recall phenomenon, as has been demonstrated with such drugs as adriamycin and actinomycin-D.
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PMID:[A case with delayed-onset radiation pneumonitis suspected to be induced by oral etoposide]. 132 65

A questionnaire was sent to 488 radiation oncologists in the United States and 268 replied. Each was given a brief account of three hypothetical patients (one with brain metastases, one with locally advanced lung cancer and one with bone metastases) and asked how they would approach the problems posed. Younger radiation oncologists (less than 46 years) treated patients with brain metastases with a smaller number of fractions and were more likely to view the case of locally advanced lung cancer as palliative. The aim of the radiation oncologist was related to the treatment pattern chosen, with the aim to extend life frequently related to higher total dose and number of fractions. When the amount of private funding was compared with dose, number of treatments, and whether the case was called palliative or not, no relationship was found.
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PMID:Factors affecting treatment patterns of radiation oncologists in the United States in the palliative treatment of cancer. 137 Oct 69

Fifty consecutive patients who had a bone scan and a diagnosis of nonsmall-cell lung carcinoma were studied, retrospectively, to determine the usefulness of bone scans in the presurgical workup. Bone scans were interpreted as positive for bone metastases if the scanning abnormality could not be explained by other causes (e.g., trauma or arthritis) or by additional studies (e.g., radiography or CT scanning). Seventeen percent of the patients whose initial clinical and laboratory findings suggested only localized resectable tumor had positive bone scans, changing treatment from surgery to more conservative therapy. Thirty-six percent of patients with no evidence of lung cancer extending to the mediastinum or beyond by CT of the chest and upper abdomen had bone scans indicating bone metastases (positive bone scan). These results suggest that bone scan adds useful information to the presurgical evaluation of patients with nonsmall-cell lung cancer. Clinical findings and/or CT of the chest and upper abdomen are not sensitive or specific enough to exclude bone metastases. Bone scan is recommended before thoracotomy for patients considered for surgery for localized, potentially resectable nonsmall-cell lung cancer.
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PMID:A correlation study of bone scanning with clinical and laboratory findings in the staging of nonsmall-cell lung cancer. 184 93

In a consecutive series of 771 patients with pathologically verified squamous cell carcinoma of the head and neck, 28 patients (3.6%) had hypercalcemia (greater than 11.0 mg/dl) during the course of their disease. The buccal mucosa (16/205, 7.8%) and tongue (8/148, 5.4%) were the most frequent primary sites. Most of the patients were stage IV patients with recurrence and advanced disease. The prognosis was poor with a median survival of only 6 weeks. The possible etiology of their hypercalcemia included humoral factors, bone metastases and independent primary lung cancer. The treatment of hypercalcemia was evaluated in 22 patients. Success was noted in all patients initially receiving chemotherapy (10 cases) or radiotherapy (3 cases) with or without saline hydration plus furosemide diuretics. However, the response rate in patients (9 cases) initially receiving hydration plus furosemide diuretics alone was 22% (2/9), with 4 of 7 failure cases later responding to chemotherapy. It is suggested that hypercalcemia be treated with chemotherapy or radiotherapy quickly, along with hydration plus diuretics. Also, the serum calcium level must be checked in patients with advanced buccal or tongue cancer.
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PMID:Hypercalcemia in squamous cell carcinoma of the head and neck. 197 96

Hypercalcemia is the most frequent paraneoplastic syndrome observed in cancer patients. This morbidity can be divided into two categories: one is hypercalcemia induced by severe bone metastases; the other the elaboration of hypercalcemic factors by solid tumors, termed humoral hypercalcemia of malignancy (HHM). With regard to humoral factors responsible for HHM, a protein with parathyroid hormone (PTH)-like activity, designated PTH-related protein (PTHrP), was isolated from a cancer cell line established from a hypercalcemic patient's lung cancer tissue, and the structure of PTHrP mRNA was identified. Since the biological activity of PTHrP explained most of the clinical and laboratory findings of HHM patients and recent clinical studies indicated the very close relationship between the development of HHM and the production of PTHrP by tumor, PTHrP is now regarded to be the primary candidate for the actual factor responsible for HHM.
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PMID:[Malignancy-associated hypercalcemia]. 200 37

The scintigraphic "flare" phenomenon on bone imaging refers to an increase in intensity of tracer uptake in sites of bone metastases and/or the appearance of "new" lesions, which occur shortly after commencement of hormonal therapy or chemotherapy for breast, prostate, or lung cancer. In this study, we observed that scintigraphic flare can occur in patients with prostate cancer following treatment with the "hormone-like" luteinizing hormone releasing hormone analog, leuprolide acetate. Twenty-six patients with prostate cancer being treated with leuprolide acetate underwent serial bone scans at three-month intervals. Five (19.2%) of the 26 patients had findings consistent with a scintigraphic flare on bone scans obtained between three and six months after initiation of therapy. These scan findings should not be confused with progression of skeletal metastases.
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PMID:Leuprolide therapy for prostate cancer. An association with scintigraphic "flare" on bone scan. 211 49

To determine the role of lung cancer tumor imaging with monoclonal antibodies directed against high molecular weight human milk fat globule antigens, we administered i.v. 111In-KC-4G3 to 24 patients with advanced non-small cell lung cancer. One mg of 111In-KC-4G3 was mixed with 0, 9, 49, 99, or 499 mg of unlabeled KC-4G3 and infused i.v. over 1 to 5 h. The mean 111In-KC-4G3 radiochemical purity was greater than 97% and the resultant immunoreactivity averaged 62%. Successful imaging of cancer sites was accomplished in 92% of 24 patients, and 57% of 91 total lesions were visualized. Successful localization of tumor sites related to size (P less than 0.001), with 81% of lesions greater than 3.0 cm in diameter, 50% of lesions 1.5 to 3 cm, and 6% of lesions less than 1.5 cm successfully imaging, and to location (P less than 0.05), with 69% of pulmonary lesions, 80% of soft tissue lesions, and only 32% of bone metastases being visualized. Nonspecific reticulo-endothelial uptake of radioactivity was a major problem. Approximately 35% of 111In was chelated to serum transferrin by 24 and 48 h after infusion. The mean t 1/2 beta for plasma radioisotope and immunoreactive KC-4G3 was 29 and 27 h, respectively. There was no correlation between total infused antibody dose and imaging success or between total dose and effect on 111In and KC-4G3 kinetics. Circulating free KC-4 antigen was measurable in all but one patient before study. Tumor biopsy following infusion could demonstrate antibody presence but not saturable antigen binding. We conclude that (a) 111In-KC-4G3 demonstrates successful tumor localization in non-small cell lung cancers bearing generally high expression of its antigen and (b) further investigations to diminish nonspecific radioactivity for imaging and utilization of high dose radiolabeled antibody for therapeutic intent are warranted.
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PMID:Imaging of non-small cell lung cancers with a monoclonal antibody, KC-4G3, which recognizes a human milk fat globule antigen. 217 15

Four hundred and sixty-one doctors who treat lung cancer in Canada and the United States answered a questionnaire in which they were asked how they would wish to be managed if they developed non-small cell lung cancer (NSCLC). There was no evidence of a consensus as to preferred treatment in either of two clinical situations described. Personal treatment preferences were significantly influenced by specialist training and each discipline showed a preference for its own modality of treatment. The personal treatment preferences of American and Canadian doctors differed significantly. In the United States, the role of surgery in NSCLC with extensive mediastinal disease was controversial, whereas in Canada, the major controversy was whether any active treatment was desirable in this situation if symptoms were absent. The role of chemotherapy in the treatment of NSCLC with painful bone metastases was controversial in the United States, but the vast majority of Canadian doctors would not wish any form of chemotherapy in this situation. Respondents were also asked what treatment they usually recommended for patients with NSCLC in the two situations described. Almost all these doctors recommended for their patients exactly the same treatment which they would choose for themselves. It was concluded that the personal treatment preferences of doctors are an important factor in determining how patients with NSCLC are treated. Doctors were also asked (a) if they would be willing to participate as patient-subjects in a number of clinical trials for which they would be eligible if they developed NSCLC, and (b) if they would be willing to ask their patients to participate in the same trials. There were significant differences in the perceived acceptability of the trials studied, but in each case a higher proportion of doctors would be willing to ask their patients to participate than would be prepared to consent themselves.
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PMID:Controversies in the management of non-small cell lung cancer: the results of an expert surrogate study. 217 45


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