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

Often it is very difficult to make decisions involving the termination of aggressive cancer care in the case of patients who are no longer benefiting. Among these patients, our ability to "do everything possible" to continue life is in conflict with "doing the right thing"; the greatest benefit to these patients derives from delivering excellent supportive care and assisting them in understanding and accepting end-of-life issues. Furthermore, in a cost-conscious environment with limited resources, all patients and, indeed, all of society, benefit when aggressive and often costly cancer care is limited to those patients who are likely to benefit. However, these issues are complex, blending treatment science and ethics, and thus, the physician frequently has no objective reference point on which to base the decisions. This paper integrates the principles of ethics (respect for autonomy, beneficence, nonmaleficence, and justice) and three difficult issues encountered by physicians in clinical decision-making in terminal cancer patients in the American healthcare system. These issues include: medical futility and appropriate care, applications of outcomes research in clinical decision-making, and impact of cost, particularly in a managed care environment, on treatment choice. These topics are illustrated with reference to patients presenting to our emergency center with stage IV lung cancer and dyspnea, and the application of an outcomes model under development to predict imminent death in these patients is discussed. Outcomes models may provide patients, their families, and their physicians with objective data on which to base end-of-life decision-making. Minimizing aggressive treatment of terminally ill patients may provide better life quality and will reduce costs during the patients' end of life. Ethics plays a crucial role in integrating medical science, patient choice, and cost in making appropriate decisions.
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PMID:Medical futility and appropriate medical care in patients whose death is thought to be imminent. 925 23

We retrospectively reviewed all of the patients who were treated for cardiac tamponade at Linkou Chang Gung Memorial Hospital between January 1991 and December 1995. There were a total of 112 patients (57 males, 55 females) with a mean age of 51 +/- 14 years (53 +/- 15, 49 +/- 13, respectively). Dyspnea was the most common complaint (85%). The mean blood pressure was 129 +/- 24/78 +/- 17 mmHg, and only 8% had a systolic blood pressure of less than 90 mmHg. Sinus tachycardia was the most frequent electrocardiographic finding (72%, 62/86). Diffuse low voltage was noted in 35% (30/86) of the patients and electrical alternans was seen in 17% (15/86). The mean volume of pericardial effusion was 610 +/- 263 ml. Sixty-five percent of the pericardial effusions were bloody, 31% were serosanguineous, 2% were purulent and 2% were chylous. Overall, 54.5% of the patients had malignant diseases. Of the 61 patients who died, 79% had malignancies. Thirty-five (57%) of these 48 patients had lung cancer. The mean survival time from emergent pericardiocentesis was 3.4 months. In conclusion, non-traumatic cardiac tamponade had a poor prognosis because most patients had malignant etiologies. There is still no definitive treatment for recurrent malignant pericardial effusion-induced cardiac tamponade. Percutaneous pericardiocentesis as clinically required may be the most appropriate treatment, since it is questionable whether such subjects should be subjected to the unnecessary pain and suffering associated with an operative procedure, considering their short mean survival time.
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PMID:Cardiac tamponade in Taiwan. 929 7

To evaluate the feasibility and pharmacology of intrapleural (IP(L)) administration of paclitaxel, 18 patients with malignant pleural effusions were entered onto a phase I clinical study, 13 were caused by lung cancer. Following an effusion drainage rate of less than 100 ml/24 h and full expansion of the lung, patients were treated with a single instillation of pacilitaxel administered IP(L) in 500 ml of normal saline and retained for a maximum of 96h when tolerated. No systemic chemotherapy or ipsilateral thoracic irradiation was given for 4 weeks before and after the IP(L) treatment. The starting dose was 82.5 mg/m2 with the dose escalation schedule of 125, 175, 225 and 300 mg/m2. There were minimal local or systemic toxicities, such as local chest pain or myelosuppression, even when the paclitaxel dose reached 225 mg/m2. The pharmacological advantages of the IP(L) administration of paclitaxel were demonstrated by the mean exposure of the pleural cavity (area under the concentration time curve) to paclitaxel after IP(L) delivery exceeding that of the plasma by approximately 370-fold (range 55-684) and by the extraordinarily slow IP(L) clearance of paclitaxel (mean +/- SE 0.49 +/- 0.07 l/m2/day; range 0.08-1.16 l/m2/day) with significant concentrations of paclitaxel persisting within the cavity for more than 48-96 h after a single IP(L) instillation. In patients with detectable plasma paclitaxel levels, the plasma levels achieved exceed the minimal concentrations that are required to induce cytotoxic effects in vitro. Four patients had progressive dyspnea during IP(L) retention of paclitaxel solution because of treatment failure and needed drainage of effusion. One of these patients who was at the dose level of 225 mg/m2 originally had severely chronic obstructive lung disease, developed acute respiratory failure, refused mechanical ventilation support and succumbed to respiratory failure. No further patients were included after this event. Antitumor effect was shown by four of the 15 evaluable patients having no recurrence of effusion on chest radiograph at 1 month. Most of these responders had a good performance status, normal pretreatment pleural pH and/or glucose compared with the non-responders. We conclude that paclitaxel at a dose level of 175 or 225 mg/m2 is feasible for use intrapleurally. It could be considered for incorporation into treatment programs for patients with less advanced thoracic tumors with carcinomatous pleuritis or with IP(L) tumors following surgical debulking.
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PMID:A phase I feasibility and pharmacokinetic study of intrapleural paclitaxel in patients with malignant pleural effusions. 930 May 70

Form March, 1991, to September, 1995, twenty-nine patients with endobronchial neoplastic stenosis were treated with high dose rate (HDR) brachytherapy at the Casa Sollievo della Sofferenza Hospital in San Giovanni Rotondo (Foggia, Italy). Fifteen patients had hemoptysis, 10 dyspnea, 6 constant cough and 6 lung atelectasis. The total dose, specified at 1 cm from the source, ranged 5 to 21 Gy and the fraction doses 5 to 15 Gy. Fourteen of 29 patients (48%) died. The mean survival is 7 months, with the follow-up ranging 1 to 22 months. Subjective responses were achieved in 78.4% of cases, with 67.6% complete and 10.8% partial remission rates. Complete remission of hemoptysis was observed in 100% of patients. Dyspnea improved in 70%, cough in 46.4% and atelectasis in 83.2%. Endoscopic findings, 1 month after the end of brachytherapy, showed a response in 79.4% of patients. The complication rate was 13.8% (1 tracheoesophageal fistula, 2 pulmonary hemorrhages and 1 cavitary necrosis). Even though the number of treated patients is small, our experience confirms the efficacy of HDR endobronchial brachytherapy in the palliation of lung cancer-related symptoms. Literature data show that brachytherapy improves the quality of life in the patients with poor prognosis who are otherwise untreatable. The HDR technique is more accurate than the LDR technique and therapy is better tolerated also because execution time is shorter. Prospective clinical trials are needed to investigate the most effective total doses and fractionations and to better define the role of brachytherapy in the curative treatment of lung cancer.
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PMID:[High-dose brachytherapy in endobronchial neoplastic stenoses]. 942 60

In this article is described problems of bronchioloalveolar carcinoma, with respect to increased incidence of adenocarcinoma and bronchioloalveolar carcinoma. It was observed that bronchioloalveolar carcinoma occurs more frequently in younger persons and in women. Etiology of bronchioloalveolar carcinoma is still unknown. There is not an obvious connection with smoking but connection with previous damage of lung parenchyma. Bronchioloalveolar carcinoma can be defined as neoplasm which is not of central origin , but is peripherally located; therefore the term "bronchiolo-" but not "broncho-alveolar" carcinoma. It grows along alveolar septa and lung parenchyma remains intact. There is three pathohistological subtypes of bronchioloalveolar carcinoma: mucinous, non-mucinous and sclerotic form and three radiological patterns: solitar, pneumonia-like and diffuse. Clinical features depend of the stage and patient are most frequently asymptomatic. They later present with chest pain, dyspnea, cough, hemoptysis and weight loss. Complications include bronchorrhoea and intrapulmonal shunts. These findings, together with laboratory analysis, radiological tests (including CT scans) and cytological or hystological proof of malignancy, make definite diagnosis. Therapy depends on the stage of disease and is identical with that of other subtypes of non-small-cell lung cancer.
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PMID:[Modern diagnostic and therapeutic methods in bronchiolo-alveolar carcinoma]. 948 May 71

Twenty-four cases of bronchopleural fistula were found by fiberoptic bronchoscopy performed in 526 consecutive patients undergoing surgery for diagnosis or treatment of lung cancer between February 1990 and January 1997 in Hospital General Universitario in Valencia (Spain). In 327 of the patients lung resection was performed. Clinical symptoms included fever, purulent or bloodstained expectoration, chest pain, dyspnea and general unfitness, with 83.33% of the patients having pleural empyema. Treatment was based on pleural drainage and broad-spectrum antibiotic therapy, along with planning of the appropriate surgery technique to each patient. Surgery consisted in re-thoracotomy and bronchial closure in early detection cases without evidence of infection (< 48 h); thoracostomy (Clagett) and second stage myoplasty if confirmed pleural infection; thoracoplasty in cases of incomplete fistulas that were unresolved by pleural drainage. Biological glues were delivered by fiberoptic bronchoscope in one patient. The incidence of bronchopleural fistula was studied, as were associated factors and the results obtained by various surgical techniques.
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PMID:[Approach to bronchopleural fistula in patients undergoing lung cancer surgery. A prospective study]. 952 16

The purpose of this study was to determine the benefit of high dose rate endobronchial brachytherapy in the treatment of obstructive lung cancer. Between September 1990 and March 1995, 189 patients with bronchogenic carcinoma were treated with high dose rate endobronchial brachytherapy. Most patients (69.3%) had received prior treatment and presented with symptomatic bronchial obstruction due to either recurrent or residual endobronchial disease. A small group (12%) was medically unfit for either surgical resection or thoracic radiotherapy and benefited from endobronchial brachytherapy alone for small endobronchial tumours. The remainder of the patients had not been treated previously and endobronchial brachytherapy was performed for life-threatening symptoms requiring emergency obstruction relief before other therapy. Treatment was performed weekly and consisted of three to four 8 to 10 Gy fractions at a radius of 10 mm from the centre of the source. Major symptomatic relief was obtained for haemoptysis (74%), dyspnoea (54%), and cough (54%). Complete endoscopic response was observed in 54% of cases. Median survival was 7 months for the entire group. For small, strictly endobronchial tumours, complete response rate was 96%, median survival 17 months, and 30 month survival 46%, with a plateau starting at 18 months. Grade 3 to 4 toxicities occurred at a rate of 17% and included massive haemoptysis (n=13), bronchial stenosis (n=12), soft tissue necrosis (n=8), and bronchial fistula (n=3). By univariate analysis, no factor was found to be predictive of late pulmonary toxicity. The present study confirms the usefulness of endobronchial brachytherapy in alleviating symptoms caused by endobronchial recurrence of bronchogenic carcinoma. In addition, this therapy can be tried with curative intent in patients who present with small endobronchial tumours and are not candidates for other forms of therapy.
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PMID:High dose rate endobronchial brachytherapy: results and complications in 189 patients. 954 87

Malignancy is one of the most common causes of exudative effusions and increases in incidence in the elderly. Lung cancer is the most common cause of malignant effusion caused by contiguous spread and its propensity to invade the pulmonary vasculature and embolize to the visceral pleura. Lung, breast, ovary, and gastric cancer and lymphomas account for about 80% of all malignant effusions. Dyspnea and cough are the most common symptoms at presentation. Thirty percent of patients have a low pleural fluid pH (> or = 7.30) and glucose (> 60 mg/dL) at presentation, which predicts a decreased survival, an increase yield on diagnostic studies, and a poor response to chemical pleurodesis. Talc by poudrage or slurry is the most successful pleurodesis agent. Pleural peritoneal shunt is an option for patients with an intractable, symptomatic malignant effusion who cannot undergo or who have failed pleurodesis.
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PMID:Malignancy metastatic to the pleura. 964 86

MVP chemotherapy (mitomycin C 8 mg m(-2), courses 1, 2, 4 and 6, vinblastine 6 mg m(-2), cisplatin 50 mg m(-2)) is an active low-toxicity regimen in non-small-cell lung cancer (NSCLC). Based on the single-agent activity of these agents in SCLC, we have conducted a phase II trial of MVP in SCLC. Fifty chemo-naive patients with SCLC were entered in this trial. There were 33 men and 17 women with median age 66 years (range 46-83 years); 18 patients had limited disease (LD) and 32 extensive disease (ED). WHO performance status (PS) was: three patients PS 0, 33 patients PS 1, ten patients PS 2, four patients PS 3. A maximum of six cycles was given in responding patients. On completion of chemotherapy, patients with LD obtaining complete response (CR)/good partial response (PR) received thoracic irradiation and those obtaining CR were offered entry into the ongoing MRC Prophylactic Cranial Irradiation Trial. The overall response was 79% with 17% CR and 62% PR. For LD patients, 38% obtained CR but for ED only one patient achieved CR. Median response duration for LD patients was 8 months and for ED patients 5 months. Median survival was 10 months for LD patients and 6 months for ED patients. There was complete resolution of symptoms in 24%, partial improvement in 68%, no change in 2% and progressive symptoms in 6%. As regards toxicity, 24% developed WHO grade 3/4 neutropenia, 16% grade 3/4 thrombocytopenia and 6% significant hair loss. Two patients died during the first week of treatment with neutropenic infection. Quality of life using the EORTC questionnaire (QLC-C30) with lung cancer module demonstrated significant improvements from baseline levels in emotional and cognitive functioning, global QOL, of pain, dyspnoea and cough. MVP, an effective palliative regimen for NSCLC, is also active against SCLC with low toxicity and merits comparison with more toxic conventional schedules.
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PMID:A pilot study of MVP (mitomycin-C, vinblastine and cisplatin) chemotherapy in small-cell lung cancer. 966 76

The present retrospective study was undertaken to study the clinical profile of primary bronchogenic carcinoma seen during last eight years in a teaching hospital. Out of a total of 279 diagnosed cases, 86% were males with an average age of 57 years, smoking was the risk factor in 81.6%. Forty percent of female patients were smoker with a significant overlap in use of smoking objects. Twenty four (8.8%) patients were less than 40 years of age at the time of diagnosis. Average duration of illness was 4.5 months. Weight loss (77%) and fever (34%) were the commonest general symptoms. Other chest symptoms include cough (68%), dyspnoea (59%), chest pain (22%), hemoptysis (20%) and dysphagia (6%). Fiberoptic bronchoscopy (FOB) (75%) and fine needle aspiration cytology (FNAC) (74.8%) were found to be the most efficient diagnostic procedures. Histologically, squamous cell carcinoma, adenocarcinoma, large cell carcinoma and small cell carcinoma were seen in 42%, 20%, 18% and 14% cases, respectively. Six percent patients showed malignant cells only and marked as unclassified. Radiologically, obstructive pneumonitis was the commonest presentation (59.5%) followed by mass lesion (31.8%) and rib destruction (5.1%). Inspite of its limitation, this study for the first time reports lung cancer pattern from mid-west Rajasthan.
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PMID:Primary bronchogenic carcinoma: clinical profile of 279 cases from mid-west Rajasthan. 977 68


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