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

In order to achieve mediastinal lymph node staging in bronchial cancer, axial mediastinoscopy (combined with left anterior mediastinoscopy for cancers of the left upper lobe) is by far the most efficient and the most reliable technique. Since mediastinoscopy has been part of the investigations that can be made before thoracotomy, the number of exploratory thoracotomies has considerably decreased in all teams, thus reducing at the same time intraoperative mortality. Thoracic CT, which arrived in the diagnostic weaponry for lung cancer a long time after mediastinoscopy, has a major asset in that it allows selecting the patients for whom mediastinoscopy seems to be useful, on the basis of criteria related to the size of mediastinal lymph nodes (10 mm generally being the threshold chosen to perform mediastinoscopy or not). For almost all authors, systematic mediastinoscopy is no longer useful. Similarly, a positive mediastinoscopy must not lead to systematically refuse patients, as the invasion or absence of invasion of a mediastinal lymph node is neither necessary nor sufficient to discuss a surgical indication. While some still automatically refuse all patients with positive mediastinoscopy, most authors still remain very interventionistic for N2 patients selected on very accurate criteria that are analyzed above. Surgery can then be performed at once or, for some authors, after a "neo-adjunctive" therapy, the long-term efficacy of which has unfortunately not been rigorously demonstrated as yet.
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PMID:[How can intrathoracic lymphatic involvement be assessed using mediastinoscopy in primary bronchial cancer?]. 133 70

In order to achieve mediastinal lymph node staging in bronchial cancer, axial mediastinoscopy (combined with left anterior mediastinoscopy for cancers of the left upper lobe) is by far the most efficient and the most reliable technique. Since mediastinoscopy has been part of the investigations that can be made before thoracotomy, the number of exploratory thoracotomies has considerably decreased in all teams, thus reducing intraoperative mortality at the same time. Thoracic CT, which arrived in the diagnostic weaponry against lung cancer a long time after mediastinoscopy, has a major asset in that it allows selecting the patients for whom mediastinoscopy seems to be useful, on the basis of criteria related to the size of mediastinal lymph nodes (10 mm generally being the threshold chosen to perform mediastinoscopy or not). For almost all authors, systematic mediastinoscopy is no longer useful at present. Similarly, positive mediastinoscopic findings must not lead to systematically refuse patients, as the invasion or absence of invasion of a mediastinal lymph node is neither necessary nor sufficient to discuss a surgical indication. While some still automatically refuse all patients with positive mediastinoscopy, most authors still remain very interventionistic for N2 patients selected on the basis of very accurate criteria that are analyzed above, and surgery can then be performed at once or, for some authors, after a "neo-adjunctive" therapy, the long-term efficacy of which has unfortunately not been rigorously demonstrated as yet.
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PMID:[Mediastinoscopy in the evaluation of the extension of primary bronchial cancer. Techniques, indications and therapeutic deductions]. 133 23

Ultrasonography is useful in the detection of mass lesions in the collapsed lung, using the collapsed lungs as a "sonic window". Twenty-four patients suspected of having a tumor causing lung collapse, as shown on their chest radiographs, were examined by ultrasonography. Eighteen out of 24 patients were found to have mass lesions in their collapsed lungs. Thoracic computed tomography (CT) was also performed in 12 of these 18 patients; of those, 11 showed compatibility with sonographic findings in the detection of mass lesions in their collapsed lungs. The remaining six of these 24 patients with no mass lesions detected by ultrasonography were proven to have collapsed lung due to sputum impaction (n = 2) and lung cancer (n = 4). The fact that four patients had lung cancer that was not detectable by ultrasonography, might have been due to relatively small mass lesions at deep locations (main or intermediate bronchus) and narrowing of the "sonic window" (partial lung collapse). Though it has some limitations, ultrasonography is helpful in detecting mass lesions in collapsed lungs. Sono-guided fine needle aspiration biopsy (SGFNAB) can also be performed simultaneously, smoothly and without any major complications. In our series, SGFNAB was performed in eight out of 18 patients to make a cytopathologic diagnosis. We recommend this safe, convenient, and noninvasive method to screen for lesions in the collapsed lung, especially when bronchoscopic examination is impossible.
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PMID:Detection of mass lesions in the collapsed lung by ultrasonography. 135 36

Thoracic failure is a significant obstacle to the cure of limited stage small-cell lung cancer (LSCLC) patients treated with combined modality therapy. In 1985 we initiated a prospective trial to evaluate the impact of twice daily thoracic irradiation without concomitant chemotherapy on control of intrathoracic tumor in LSCLC. Twenty-nine patients treated in this fashion were compared with 36 patients treated from 1979-1982 with once daily thoracic irradiation and concomitant chemotherapy. Both groups received the same induction chemotherapy; cyclophosphamide, Adriamycin, and vincristine (CAV) alternating with cisplatin and etoposide. For consolidation, the twice daily patients received thoracic irradiation, 45 Gy in 1.5 Gy fractions given twice daily, and the once daily patients received thoracic irradiation, 45 Gy in 2.5 Gy fractions given once daily with concomitant cyclophosphamide and vincristine. After completion of radiotherapy both groups received maintenance chemotherapy. The complete response (CR) rate after thoracic irradiation was higher for twice daily patients (86% (25/29) compared to the once daily patients [61% (22/36), p = 0.02]. However, this advantage was offset by the shorter duration of thoracic control among CR patients treated with twice daily thoracic irradiation compared to once daily thoracic irradiation (32% vs 67% at 2 years, p less than 0.05). In view of the enhanced initial response of LSCLC to twice daily thoracic irradiation, this basic radiotherapeutic approach seems appropriate, but new strategies using higher doses of twice daily thoracic irradiation or concomitant chemotherapy appear to be necessary to enhance long-term thoracic control.
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PMID:Twice daily thoracic irradiation for limited small cell lung cancer. 165 42

The first description of multiple primary tumors of the lung was reported by Billroth in 1889. In a series of 448 thoracotomies for lung cancer in the Department of Thoracic Surgery of the Geneva Cantonal University Hospital, 11 were performed in 9 men and 2 women for double metachronous lung tumors. The tumor-free time interval between the operations ranged from 9 months to 15 years, with a mean of 61 months. The tumor was in the contralateral lung in 4 patients and in the ipsilateral one in 7 cases. Pathological examination demonstrated a different histology in 4 patients (36%). Eight of the 11 patients had resectable disease. Twenty-five percent of the patients survived without recurrence for 5 years. Four patients (36%) died within one year of diagnosis of the second tumor; three of these patients did not have a resectable second tumor. The risk of development of a second primary lung carcinoma is low, less than 1-2.1% in some series, 2.7% in our series. The survival is fairly similar to that of primary lung carcinomas in general. Surgery offers the best treatment for these tumors, which is why resection of lung carcinomas should be as limited as possible. Long-term follow-up for more than 5 years and suppression of carcinogenic factors are therefore justified.
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PMID:[Multiple metachronous lung tumors. Metastases or second primary tumor]. 201 38

Usual interstitial pneumonitis (UIP) is a chronic pulmonary process with a characteristic peripheral fibrotic pattern on gross pathologic lung sections and CT scans. This condition is often idiopathic, but asbestosis, rheumatoid arthritis, and scleroderma may cause the same peripheral fibrosis in the lungs. UIP is associated with an increased incidence of pulmonary neoplasms. The purpose of this study was to evaluate the size of mediastinal lymph nodes in patients with UIP in whom no evidence was seen of malignancy or current active infection. CT scans of 14 patients (12 with idiopathic pulmonary fibrosis and two with collagen vascular disorders) were assessed for lymph node location (American Thoracic Society mediastinal map) and size. In 13 of 14 patients, nodes measured greater than threshold size values. Nodes as large as 20 x 30 mm were identified in three patients. Nodal sites 10R, 4R, 2R, 5, and 6 were most commonly abnormal. We conclude that increase in the size of mediastinal lymph nodes as shown on chest CT scans is common in patients with UIP, occurs without superimposed infectious or malignant complications, and is thus presumably part of the chronic inflammatory process. Consequently, lymphadenopathy in these patients does not suggest that they have lung cancer also.
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PMID:Mediastinal lymph node enlargement on CT scans in patients with usual interstitial pneumonitis. 210 8

The survey conducted by the French Language Society of Thoracic and Cardiovascular Surgery collected a total of 2,962 exploratory thoracotomies for lung cancer performed over a period of 10 years. Over the same period, 25,291 operations were performed for lung resection, so that the mean rate of exploratory thoracotomy was therefore 11.7%. The rate of exploratory thoracotomy varied from one unit to another (2.7% to 45.8%) and appeared to be virtually independent of the operative activity. It has continued to decrease over time, which is even more significant in view of the fact that the operative activity has increased in all of the units. The local and regional spread of the tumour represents the principal reason for non-resection (79% of cases); it was less common in units with a high operative activity (72%) than in other units (84%) especially when the mediastinal lymph nodes were involved. The major thoracic surgery units also appear to be distinguished by a greater audacity, as well as an increased failure rate in the case of tumour spread to the trachea. The risk of exploratory thoracotomy is considerable as it was responsible for death in 3% of cases. A better radiological and clinical assessment, rather than the use of mediastinoscopy should avoid 2% of these useless explorations. The subsequent course of these patients barely concerns the surgeon: it is rapidly unfavourable and the rare long-term survivals (2% at five years) are not sufficient to justify operation at any cost.
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PMID:[Exploratory thoracotomy of necessity in surgery of bronchial cancer]. 218 34

The purpose of this inquiry is to try to attain a common opinion between European Thoracic Surgeons and Chest Physicians about the examinations which are mandatory or not mandatory but useful before to put the indication to lung cancer resection. The examinations proposed are divided from functional point of view and from oncological as well as technical point of view. A questionnaire specially conceived was sent to 78 Thoracic Surgeons and Chest Physicians in Europe. Answers obtained by 52 institutions are analysed.
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PMID:Inquiry between European thoracic surgeons and chest physicians about the mandatory examinations before operating a lung cancer. 250 82

Twenty-nine patients with small-cell lung cancer undergoing surgery during a 5-year period at the Department of Thoracic Surgery, School of Medicine, University of Zagreb were reviewed. The radical surgical procedure was performed in 22 patients (73.9%). The median survival of these patients was 26.5 months. Two-year survival was 36.4% (eight of 22 patients) and in patients after radical surgery, the four-year survival rate was 18.2% (four of 22 patients). Three patients were alive at the time when this paper was written (60, 59, and 57 months after the initial diagnosis). It is concluded that the surgical therapy is an important part in the multi-disciplinary approach to the treatment of small-cell lung cancer with limited stage.
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PMID:[The role of the surgical approach in the treatment of microcellular carcinoma of the lung]. 255 80

Seventy patients with limited-stage small-cell lung cancer (SCLC) were given six courses of chemotherapy alternating two drug combinations: a combination of cyclophosphamide, doxorubicin (Adriamycin [Adria Laboratories, Columbus OH]) and vincristine (CAV) was alternated with cisplatin and etoposide at 3-week intervals. Thoracic radiotherapy was administered concurrently with the first cisplatin-etoposide chemotherapy. Prophylactic cranial irradiation (PCI) was administered after the completion of all chemotherapy. No maintenance treatment was used. Seventy-six percent of patients achieved a complete clinical response. The median survival was 78 weeks and the 2-year survival rate was 32% with an average follow-up of 3 1/2 years. Seventeen percent are currently alive and disease free. Cisplatin and etoposide can be administered concurrently with thoracic irradiation with acceptable toxicity. Our results justify further clinical research using alternating chemotherapy and concurrent thoracic irradiation and cisplatin-etoposide chemotherapy.
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PMID:Alternating chemotherapy and thoracic radiotherapy with concurrent cisplatin-etoposide for limited-stage small-cell carcinoma of the lung. 302 Jun 95


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