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

Treatment of inoperable, regionally advanced non-small-cell lung cancer has been problematic, given the poor long-term results and toxicity of current treatment measures and the extensive comorbid disease commonly found in these predominantly elderly patients. The generally acknowledged standard of care has been administration of radiotherapy to the involved sites and nodal drainage sites. This may improve survival in patients with good prognostic factors. No modality, however, has demonstrated a clear benefit over the others in this setting. Of 13 randomized trials comparing radiotherapy with or without chemotherapy, 5 using non-cisplatin-containing regimens showed no benefit. However, 4 of 6 trials with cisplatin-containing regimens have shown modest benefit. Cisplatin given concurrently with radiotherapy on a daily basis was significantly better than radiotherapy alone and was associated with improved locoregional control, suggesting that the radiation sensitization properties of the drug and consequent local control may be important for enhanced survival. Determining relapse patterns of patients according to these and other treatment approaches may help guide future development of therapeutic options. Improvements in both local and systemic control will be required before a curative approach to treatment can be considered. In this regard, hyperfractionated radiotherapy or radiation sensitizers to enhance locoregional control may complement enhancement of systemic control with chemotherapy, especially if a balance can be struck between the efficacy and toxicity of these modalities.
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PMID:Chemotherapy and radiotherapy for regionally advanced non-small-cell lung cancer. 838 71

To clarify the significance of factors of coagulation and fibrinolysis in tumor progression, we measured levels of D-Dimer, Thrombin-Anti-Thrombin III complex (TAT), and Plasmin-alpha 2-Anti-Plasmin complex (PAP) in 55 patients with primary lung cancer, and studied the relationship between these parameters and clinical TNM stage. D-Dimer, TAT and PAP increased in parallel with progression of primary tumor and distant metastasis, whereas there was no significant relationship between the progression of nodal involvement and these factors. In 19 patients, we investigated changes of D-Dimer, PAP and TAT during chemotherapy. These parameters decreased in the partial response group and minor response group, whereas they increased in the progressive disease group. These data suggest that D-Dimer, PAP and TAT determination is useful for evaluation of disorders of coagulation and fibrinolysis related to tumor progression or remission in patients with lung cancer.
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PMID:[Significance of factors of coagulation and fibrinolysis in progression of lung cancer]. 839 May 88

To assess the effect of neoadjuvant platinum-based chemotherapy on resectability, stage of disease at resection, and patterns of recurrence and survival in patients with IIIA, N2 non-small-cell lung cancer, we examined the first 60 patients treated with neoadjuvant chemotherapy followed by attempted resection in our institution. Of 67 patients identified, 7 patients were ineligible because of comorbidities, 3 patients refused chemotherapy, and 1 consented but died before treatment. Fifty-six received neoadjuvant chemotherapy. Complications of chemotherapy were minor, with no deaths. Fifty-four patients had thoracotomy; 75% (n = 42) had complete resection and 25% (n = 14) had unresectable lesions. One postoperative death occurred (2%). Pathologic review of specimens and nodal groups revealed that 41% (n = 23) were downstaged, 39% (n = 22) remained stage IIIA, and 19% (n = 11) progressed. Squamous histologic type was predictive of resectability, 18 of 20 patients having resectable squamous cell tumors (p < 0.05). Actuarial survivals at 1 and 2 years were 74% and 52%, respectively. In patients with resectable tumors survivals at 1 and 2 years were 85% and 67%, respectively. For those with unresectable lesions, survivals were 43% and 14%. Relapse-free survivals at 1 and 2 years for patients with resectable lesions were 70% and 42%, respectively. Relapses were local in 25% (n = 4), at a distant site only in 50% (n = 8), combined local and distant in 25% (n = 4). Distant relapse occurred in the central nervous system only in 7 of 8 patients (88%). Complete resectability was highly predictive of improved survival (p < 0.0002). Weight loss did not affect resectability but was associated with decreased survival (p < 0.003). Neoadjuvant chemotherapy appears to improve resectability and to pathologically downstage N2 non-small-cell lung cancer from stage IIIA. Multiinstitutional randomized trials are needed to further demonstrate the efficacy of this approach.
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PMID:Multimodality therapy of patients with stage IIIA, N2 non-small-cell lung cancer. Impact of preoperative chemotherapy on resectability and downstaging. 841 65

Two hundred nine patients with completely resected stage III non-small-cell lung cancer were randomized to receive postoperative cisplatin and vindesine chemotherapy or no further treatment. Before randomization, patients were stratified by the histologic characteristics of their tumors (squamous versus nonsquamous cell carcinoma). Prognostic variables such as histology, performance status, extent of operation, and tumor and nodal status of the eligible patients in chemotherapy (n = 90) and control groups (n = 91) were equally distributed. There was no statistically significant difference in disease-free and overall survival between the two groups. The 3-year disease-free survivals of the chemotherapy and control groups were 37% and 42%, respectively. The median survival times (5-year survival) were 31 months (35%) in the chemotherapy group and 37 months (41%) in the control group. These was no different pattern in the first site of recurrence (local versus systemic) between the two groups. This study failed to demonstrate the therapeutic benefits of postoperative cisplatin and vindesine chemotherapy.
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PMID:Adjuvant chemotherapy for completely resected stage III non-small-cell lung cancer. Results of a randomized prospective study. The Japan Clinical Oncology Group. 841 66

To determine the prevalence of mediastinal lymph node metastases in T1 non-small cell lung cancer and assess the sensitivity and specificity of computed tomography (CT) in detection of such metastases, the CT scans and surgical findings in 104 patients with T1 lesions were reviewed. Nodes longer than 10 mm on the short or long axis were considered abnormal. All patients underwent thorough mediastinal lymph node dissection at mediastinoscopy or thoracotomy. A total of 362 lymph nodes were sampled. Nodal metastases were present in 22 patients (21%). The sensitivity of CT for metastases to individual nodal stations was 41% for nodes measured on the short axis and 55% for those measured on the long axis. The specificity was 93% and 86%, respectively. When the adjacent nodal stations were included in the analysis, the sensitivity of CT was 59% for nodes measured on the short axis and 77% for those measured on the long axis; the specificity was 91% and 73%, respectively. T1 lung cancer has a higher prevalence of lymph node metastasis than previously reported, and CT is recommended in the preoperative staging of this disease.
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PMID:T1 lung cancer: prevalence of mediastinal nodal metastases and diagnostic accuracy of CT. 841 52

Glycolysis is increased in tumor tissues. [18F]fluoro-2-deoxy-D-glucose (FDG) is a glucose analogue radiopharmaceutical used in positron emission tomography (PET) to trace glucose metabolism. We investigated the sensitivity and specificity of FDG-PET imaging in the diagnosis and staging of lung cancer. One hundred and seven patients who had abnormal chest roentgenograms underwent whole-body PET imaging using FDG. PET scan results were classified as positive or negative based on the presence or absence of increased FDG uptake in the lung and/or in the mediastinum. All 82 patients with lung cancer had increased FDG uptake in the lungs, whereas only 12 of 25 patients with nonmalignant diseases had increased FDG uptake. Sixteen lung cancer patients with mediastinal metastases had increased FDG uptake in the mediastinum, of whom three had no lymphadenopathy on computed tomography of the chest. Sixteen lung cancer patients without mediastinal nodal involvement had no FDG uptake in the mediastinum. Seven of these patients had lymphadenopathy on computed tomography. FDG-PET imaging is 100% accurate in predicting mediastinal involvement in patients with lung cancer. It is 100% sensitive and 52% specific in predicting the malignant nature of a chest radiographic abnormality.
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PMID:Fluorodeoxyglucose-positron emission tomography in the detection and staging of lung cancer. 854 52

Presentation of endogenous antigenic peptides to cytotoxic T lymphocytes is mediated by the major histocompatibility complex (MHC) class I molecules. For the stable assembly of MHC class I complex it is necessary that the antigenic peptide is transported by the MHC-encoded transporters TAP-1 and TAP-2 into a pre-Golgi region. T-cell-mediated host-vs-tumour response might therefore depend on the presence of these molecules on tumour cells. The presence of MHC class I antigens and TAP-1 was studied in a series of 93 resection specimens of non-small-cell lung carcinomas (NSCLCs) by immunohistochemical methods using antibodies against the assembled class I molecule, beta 2-microglobulin (beta 2-m), heavy-chain A locus, A2 allele and TAP-1 protein. Eighty-six patients were included in the survival analysis. Total loss of class I molecule was observed in 38% of the cases and was usually accompanied by loss of beta 2-m and of heavy chain A locus. Selective loss of A locus was seen in 8.3% and of A2 allele in 27% of the cases. TAP-1 loss was always combined with beta 2-m and/or heavy chain A locus loss. No correlation was found between the expressional status of any of the above molecules, including the selective A2 allelic loss and histological type, degree of differentiation, tumoral stage, nodal stage and survival. Our findings suggest that loss of antigen-presenting molecules (including both MHC class I alleles and TAP-1) is a frequent event in lung cancer. However, the immunophenotypic profile of MHC class I and TAP-1 seems to be unrelated in vivo to the phenotype, growth or survival of NSCLC.
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PMID:Loss of antigen-presenting molecules (MHC class I and TAP-1) in lung cancer. 854 99

Adenosquamous carcinoma of the lung is an uncommon form of the lung cancer. Owing to the infrequent occurrence of this disease, no series reported to date (and to our knowledge) has been of adequate size for definitive statistical analysis. In this study, survival curves and background factors affecting prognosis in those with resected adenosquamous carcinoma of the lung were reviewed. In the period from 1973 to 1994, a total of 1,284 patients with primary lung cancer, including 44 cases (3.4%) of adenosquamous carcinoma, were surgically treated in our department. The cumulative 5-year postoperative survival rate, for all cases of adenosquamous carcinoma of the lung was 18.5%. When the survival rates were compared by histologic type, the outcomes of patients with adenosquamous carcinoma were statistically worse than for patients with squamous cell carcinoma and adenocarcinoma, owing to the highly aggressive pathologic stage of adenosquamous carcinoma. The background factors most closely associated with the survival rate in those with adenosquamous carcinoma, using Cox's proportional hazard model, were gender and the degree of nodal involvement. Five-year survival was obtained in seven patients as follows: T1N0M0 in one patient, T2N0M0 in three, T2N1M0 in two, and T3N0M0 in one. Of these seven patients, all had received complete resections, and five were N0 cases. Although our series is small, this study suggest that adenosquamous carcinoma of the lung is an aggressive tumor that grows rapidly.
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PMID:A clinicopathologic study of resected cases of adenosquamous carcinoma of the lung. 863 82

Many factors have been individually related to outcome in populations of non-small-cell lung cancer (NSCLC) patients. Factors responsible for the outcome of an individual after surgical resection are poorly understood. We have examined the importance of 'tumour volume' in determining prognosis of patients following resection of NSCLC in a multivariate model. Cox's proportional hazard analysis was used to determine the relative prognostic significance of stage, patient age, gender, tumour cell-type, nodal score and estimated 'tumour volume' in 669 cases with NSCLC treated with surgical resection, of which 280 had died. All factors (except tumour cell-type, P = 0.33) were individually related to survival (P < 0.05). When examined together, survival time was significantly and independently related to 'tumour volume' and stage (P < 0.001), and other factors ceased to be significant. In cases with stage I or II tumours, risk of death was found to increase significantly with increasing estimated 'tumour volume' (23.8% relative increase in hazard to death per doubling of 'tumour volume', 95% confidence interval 13.2-35.2%, P < 0.001 stage I; P < 0.006 stage II). In cases with stage IIIa tumours this factor alone was the significant prognostic variable. In conclusion, an estimate of 'tumour volume' significantly improves prediction of prognosis for individual NSCLC patients with UICC stage I or II tumours.
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PMID:'Tumour volume' as a predictor of survival after resection of non-small-cell lung cancer (NSCLC) 902 Apr 99

Current methods for evaluating the mediastinum include chest radiography, computed tomography (CT) or magnetic resonance (MR) imaging and mediastinoscopy. Despite advances in morphologic imaging, some lung cancer patients are found to have unresectable disease at surgery. In contrast to CT scan or MR imaging, which depend primarily on anatomic and morphological criteria, positron emission tomography (PET) with 18fluorodeoxyglucose (FDG) depends mainly of the metabolic characteristics of a tissue for the diagnosis of disease. We perform a prospective study to compare FDG-PET and CT of the thorax in the presurgical assessment of the mediastinum in patients with newly diagnosed non-small cell lung cancer. Thirty patients have been included. CT and PET-scans were interpreted separately and results were compared to surgical staging during thoracotomy. In assessing mediastinal involvement, CT scan had a sensitivity of 56% and a specificity of 64%. For diagnosis mediastinal nodal disease, FDG-PET was 87% sensitive and 78% specific. Its positive predictive value was 82%, and the negative value was 83%. In conclusion, our preliminary results show that FDG-PET appears more accurate than CT in staging of mediastinal non-small cell lung cancer.
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PMID:[Positron emission tomography in the evaluation of intrathoracic lymphatic extension of non-small cell bronchial cancer. A preliminary study of 30 patients]. 876 21


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