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

The authors describe their experience with the surgical treatment of metachronous homolateral lung cancer by completion pneumonectomy. In the Department of Thoracic Surgery of the National Cancer Institute of Milan, over a period ranging from 1982 to 1996, 30 completion pneumonectomies were performed for local relapses or second primary tumors. The patients submitted to this intervention had a lobectomy as their first operation in 23 cases (77%), a bilobectomy in 4 (13%) and a typical segmentectomy in 3 (10%). Associated with these interventions we performed 2 en bloc chest wall resections and a contralateral wedge resection. Two subjects received neoadjuvant chemo-therapy. Histology revealed squamous carcinoma in 14 cases (47%) and adenocarcinoma in 16 (53%). Seventeen patients (57%) were classified as stage I, 8 as stage II (26%), 4 as stage III (13%) and 1 as stage IV (4%). Four patients received adjuvant chemotherapy and/or radiotherapy. Lung cancer relapse occurred as a single lesion in 27 cases (90%) and as multiple lesions in 3 (10%). We performed 18 right (60%) and 12 left (40%) completion pneumonectomies. In 1 case (4%) a sleeve pneumonectomy was necessary. Associated with these interventions we performed 5 en bloc chest wall resections. The perioperative mortality was 10% and the postoperative morbidity 40%. Histological tests showed 12 squamous carcinomas (40%) and 18 adenocarcinomas (60%). Two patients (7%) had a different histology. Disease was classified as stage I in 13 cases (44%), as stage II in 9 (30%) and as stage III in 8 (26%). Four patients received adjuvant chemotherapy and/or radiotherapy. Two subjects developed a metachronous contralateral tumor (7%). The disease-free interval was 22.70 +/- 14.69 months, with a median value of 17 months (range: 7-53 months). Mean survival after completion pneumonectomy was 49.77 +/- 49.29 months, with a median value of 26.5 months (range: 4-190 months). The 5-year actuarial survival rate, calculated using the Kaplan-Meier method, was 30%. Completion pneumonectomy is a technically very demanding intervention carrying a high risk of morbidity. On the basis of the analysis of our data, we can affirm that mean postoperative survival seems to be satisfactory and to justify this aggressive attitude towards recurrent tumor. We should stress the importance of careful evaluation of indications and precise selection of patients.
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PMID:[Surgery in the treatment of metachronous homolateral non-small cell lung cancer]. 1119 May 46

The authors describe the usefulness of video-assisted thoracoscopic surgery (VATS) in the staging and diagnosis of primary lung cancer. In the Oncological Thoracic Surgery Department of Milan's National Cancer Institute, over the period from January 1995 to January 2000, 46 patients, suspected of having mediastinal lymphadenopathies in the presence of lung cancer, were proposed for a VATS biopsy. Forty-four patients underwent a thoracoscopic lymph node biopsy (95%), while in 2 subjects, in whom pleural metastases were found, the histological diagnosis was established by pleural metastatic nodule thoracoscopic biopsy (5%). A VATS lymph node biopsy was performed in 16 cases at level 5 (35%), in 13 at level 6 (28%), in 9 at level 7 (19%) and in 6 at level 8 (13%). Lymph node biopsies were ipsilateral in 37 patients (80%) and contralateral in 7 (15%). No postoperative complications were observed. Histological examination revealed adenocarcinoma in 23 cases (50%), epidermoid carcinoma in 12 (26%), microcytoma in 8 (17%) and giant-cell lung carcinoma in 3 (7%). Two patients were classified as stage IV (5%), 7 as stage III B (15%) and 21 as stage III A (45%). The subsequent treatment was neoadjuvant chemotherapy for stage III A patients and chemotherapy in association with radiotherapy for stage III B subjects. The patients with microcytoma underwent integrated radiotherapy and chemotherapy and pan-encephalic radiotherapy. Sixteen patients, with negative frozen-section histological findings for mediastinal lymph node neoplastic disease, underwent pulmonary resection after thoracotomy in the same operating session (35%) and were subsequently classified as stages I and II. In conclusion, VATS proved extremely useful in the diagnosis and staging of patients affected by lung cancer with synchronous lymph node enlargement. This procedure allowed the diagnosis of suspect involved mediastinal lymph nodes in all cases thus affected and the exclusion of lymph node disease in patients subsequently treated by lung resection in a single session. The precise staging obtained then made it possible to direct the patients towards the most appropriate form of treatment.
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PMID:[Significance of video-assisted thoracoscopic surgery in the diagnosis and staging of primary pulmonary neoplasms]. 1145 13

Bronchial resection and anastomosis represents an alternative to the pneumonectomy in patients with severe impairment of pulmonary function and/or other diseases which make such radical surgery too risky. The authors present two clinical cases of right upper lobe lung cancer (a squamous-cell carcinoma and an adenocarcinoma) admitted in the Thoracic Surgery Department of the National Institute of Pulmonology "Marius Nasta" from Jan-March 2001, in which they could not perform pneumonectomy because of unacceptable high risks. In both patients a right upper lobectomy with "sleeve" resection was done, with the anastomosis of right main bronchus to the intermediary one. The clinical, bronchoscopic and functional results were excellent. The literature review also shows very good results of this technique in the surgical treatment of lung cancer. For these reasons, the authors recommend this procedure in all the cases in which it can be technically applied; more than that, the survival rate is similar with other more radical techniques, but without any complications.
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PMID:[The indications of bronchial resection and anastomosis in lung cancer]. 1158 70

The recent British Thoracic Society guidelines recommend that surgical mortality should not be greater than 8% for pneumonectomy and 4% for lobectomy. These cut offs are advanced as guidelines to inform decision making as to whether or not patients with operable lung cancer should be offered surgery. They have been developed from a notion of what acceptable surgical mortality should be. The planning of care for patients with lung cancer involves making choices between different treatments with different outcomes. While it is accepted that the probability of these outcomes is likely to differ among patients, individual patient preferences for them are also likely to vary. Fixed cut offs for surgical mortality mean ignoring this variation. Decision analysis can be used to assist in the complex task of integrating clinical characteristics and varying patient preferences. By considering high risk patients with potentially curable stage Ia non-small cell lung cancer, it is shown that decision analysis has the potential to illuminate decision making and guideline development within the field of cancer care.
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PMID:Choosing the surgical mortality threshold for high risk patients with stage Ia non-small cell lung cancer: insights from decision analysis. 1232 84

The objective of the study was to find out whether the delay in time from when bronchogenic carcinoma is diagnosed until a therapeutic thoracotomy is performed affects patient survival. The population analysed comprised 1082 patients with clinical stage I and II, non-small cell lung cancer (NSCLC), who had been operated on between October 1993 and September 1997, and were registered in the Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pneumology and Thoracic Surgery (GCCB-S). In this series, the median therapeutic delay was 35 days (1-154), with a median survival rate of 52 months (45.6-58.3). A statistical study was developed that, in addition to the delay, included the variables of age, histology, clinical stage, and pathological stage of the disease. Therapeutic delay was included in the multivariable analysis as a quantitative and qualitative variable and a comparison among the different intervals of delay in days (1-20 vs. 21-40 vs. 41-60 vs. > 60) was performed in order to ascertain its influence on survival. Univariate and multivariate Cox's regression analyses showed that age (> 70 years), clinical stage (I vs. II), and pathological stage influence survival. As for the histology and the delay, no significant differences were observed in the survival of any of the intervals even when compared against the intervals at the extremes (1-20 vs. > 60). In conclusion we found no influence of delay upon the survival.
Lung Cancer 2002 Apr
PMID:Influence of delays on survival in the surgical treatment of bronchogenic carcinoma. 1189 Oct 34

The purpose of this study was to investigate the utility of 18fluorodeoxyglucose (FDG) coincidence detection position emission tomography (CDET) in the evaluation of metastatic mediastinal lymph nodes in patients with potentially operable non-small-cell lung cancer (NSCLC). A prospective study was performed in thirty patients with newly suspected NSCLC. Thoracic computed tomography (CT), FDG CDET, and invasive surgical staging were performed in patients. Blinded prospective interpretation was performed for each test and compared to pathological staging obtained by mediastinoscopy and/or by thoracotomy. Patients were followed for six months to detect occult metastases. The sensitivity and specificity of CDET for the detection of mediaStinal lymph nodes were 75% and 94.4% respectively. The corresponding value for CT were 50% and 80.9%. Three patients with N1 disease were classified as N0 by CDET. With regard to definitive surgical node staging, CDET could identify nodal disease in 26 patients and CT only in 18 patients (n = 30). FDG full-ring positron emission tomography (PET) is the most accurate non-invasive method for the detection and staging of lung cancer. In addition, FDG CDET shows high accuracy for the detectability of pulmonary lesions with a diameter at least 2 cm and the evaluation of lymph node in NSCLC.
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PMID:[Value of 18FDG-CDET in the evaluation of operable bronchial cancer]. 1192 80

The aim of this report was to evaluate the effectiveness of video-assisted thoracoscopic surgery (VATS) in staging, diagnosis, and treatment of lung cancer. Fifty-two patients were scheduled for mediastinal lymph node VATS biopsy at the Oncologic Thoracic Surgery Department of the National Cancer Institute in Milan. Fifty patients underwent lymph nodal thoracoscopic biopsy (96%), whereas for the other 2 patients, histologic diagnosis was done by pleural metastatic nodule thoracoscopic biopsy (4%). We performed 17 lymph nodal biopsies in level 5 (33%), 14 in level 6 (27%), 12 in level 7 (23%), and 7 in level 8 (13%). No postoperative complications were observed, and 19 subjects (36%) underwent open lung resection. The histologic diagnosis was adenocarcinoma in 25 cases (48%), epidermoid carcinoma in 14 (27%), microcytoma in 9 (17%), and giant-cell lung carcinoma in 4 (8%); 10 patients were at stage I (19%), 9 at stage II (17%), 31 at stage III (60%), and 2 at stage IV (4%). The use of VATS allowed diagnosis of the suspected involved mediastinal lymph nodes in lung cancer patients and obviated the need for painful thoracotomy, enabling accurate staging and thus selection of the optimal treatment.
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PMID:Video-assisted thoracoscopic surgery for diagnosis, staging, and management of lung cancer with suspected mediastinal lymphadenopathy. 1194 96

Pronostic of lung carcinoma is very poor but, every year in Europe and North America, thousands of patients are offered a chance of cure. However only a long period of time without relapse allows to state the reality of cure. Sequelae generated by cancer treatments are potentially increased by the use of treatments combinations. In operated patients, chronic respiratory insufficiency is the most common late complication often interfering with professionnal activity especially for manual workers. Late toxicity after radiotherapy for lung cancer has been little studied. Thoracic irradiation especially affects lung and cardiac functions. Late toxicity of chemotherapy may be more frequent with the increasing use of neoadjuvant chemotherapy before surgery or radiotherapy in patients potentially cure.
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PMID:[To be cured of lung cancer]. 1201 35

Sixteen patients with untreated locally advanced (n = 15) or recurrent (n = 1) non-small-cell lung cancer (NSCLC) were enrolled in this study between July 1996 and March 1999. Eight patients had stage IIIA NSCLC, seven had stage IIIB disease, and one had recurrent disease after prior resection of stage I disease. Patients were treated with paclitaxel 30 mg/m2/d for 4 days by continuous intravenous infusion followed by cisplatin 80 mg/m2 on day 5. Therapy was administered every 3 weeks until disease progression or a maximum of four cycles. Thoracic radiation was started within 3 to 4 weeks of day 1 of the last cycle of paclitaxel and cisplatin. Fourteen patients (87.5%) received all four cycles of chemotherapy and subsequent radiation therapy. Forty-four percent of patients achieved a partial response, and 1 patient complete response (overall response rate, 50%). The median progression-free survival was 8.8 months. At a median potential follow-up of 3.7 years, the median survival for all 16 enrolled patients was 13.2 months, and the actuarial 1-, 2-, and 3-year survivals were 62.5%, 43.8%, and 21.9%. In contrast to predictions from in vitro cytotoxicity models, the sequential use of prolonged infusional paclitaxel and bolus cisplatin followed by thoracic radiation does not appear to have a greater impact over shorter chemotherapy
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PMID:Phase II neoadjuvant trial of paclitaxel by 96-hour continuous infusion (CIVI) in combination with cisplatin followed by chest radiotherapy for patients with stage III non-small-cell lung cancer. 1204 Feb 86

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.
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PMID:Inoperable localized stage I and stage II non-small-cell lung cancer. 1205 90


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