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Query: UMLS:C0684249 (lung carcinoma)
 23,830 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To better define the prognostic factors influencing the response to therapy and survival in small cell carcinoma of the lung (SCCL), an expanded "TNM" type staging system was developed and investigated in a series of 73 protocol treated patients. Because serum LDH levels at disease presentation have been correlated to disease extent, response to therapy, and treatment outcome in a number of malignancies, including SCCL, these interrelationships were also analyzed in the protocol patients. The TNM system was found to be a more descriptive and specific "shorthand" for denoting sites of involvement and for indicating the body burden of tumor than the traditional limited-extensive disease (LD-ED) system. A clear statistical advantage could not be shown over the LD-ED system for predicting chemotherapy response or survival, although there were trends suggesting the TNM system could divide patients into three prognostic subgroups. Serum LDH proved to be a useful index of disease extent and therapy outcome. LDH levels at presentation were proportionately higher with more extensive tumor, measured by either the LD-ED or TNM staging. High LDH predicted poorer responses to chemotherapy and lower survival within similar stage subgroups compared to patients with normal LDH levels. The negative effect of elevated LDH was independent of hepatic involvement and did not predict subsequent hepatic failure in any consistent way. The SCCL TNM staging system proposed needs further refinement and should be tested with larger patient numbers. LDH, along with other tumor markers recently identified, need to be integrated into the staging system to form an overall prognostic index.
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PMID:Prognostic influence of TNM staging and LDH levels in small cell carcinoma of the lung (SCCL). 301 12

In a retrospective study of long term survival in patients with small cell carcinoma of the lung who had been treated purely by surgery, 1820 patients with lung cancer seen during the 15 years 1962-77 were reviewed and reclassified histologically and according to the TNM system. Of these patients, 924 had had resections and 284 exploratory thoracotomies. Cancer chemotherapy was not used in this period and radiotherapy was given only occasionally as palliative treatment. Seventy seven of the patients having pulmonary resections had small cell carcinoma (8.4%), and there were six survivors among the 71 with T1-2, N0-1, M0 tumours. The five and 10 year survival rates were both 12%. The histological specimens from these six patients with a small cell carcinoma who survived more than 10 years were re-evaluated and confirmed as small cell by an independent group of pathologists. It seems justified to conclude that a selected group of patients with small cell carcinoma should be treated by surgery alone without adjuvant chemotherapy, which might reduce the long term survival.
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PMID:Survival in small cell lung carcinoma after surgery. 302 49

The pattern of failure was studied in 1012 patients with resected Stage I or II non-small-cell carcinoma of the lung. Initial intrathoracic failure (41%) was more common than initial extrathoracic failure (34%) even though a complete resection was the intent in all patients. The most frequent sites of initial failure were the bronchial resection line (16%) and the central nervous system (CNS) (15%). The site distribution of initial failure does not appear to depend on TNM stage or pattern of nodal involvement. Patients with poorly differentiated disease had a greater rate of initial extrathoracic failure (p less than 0.01), predominantly bone or CNS. Implications for therapy and future research are discussed.
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PMID:Patterns of failure in patients with resected stage I and II non-small-cell carcinoma of the lung. The Ludwig Lung Cancer Study Group. 302 60

This paper compares two staging regimes for the inoperable small-cell carcinoma of the lung. It reveals that at present the differentiation in two classes of the Veterans Administration Lung Cancer Study Group (VALCSG) is preferred to the TNM-classification of the World Health Organization (WHO), as it includes an orientation of prognosis and enables consequences of therapy relevant to practice. If studies of therapy of the small-cell carcinoma of the lung are compared, the uniform application of the classification should be considered.
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PMID:[Staging of inoperable small cell bronchial cancer]. 303 20

The staging and histologic cell type of patients in the Lung Cancer Study Group (LCSG) clinical trials program are reviewed and confirmed or resolved at the reference center for anatomic and pathologic classification of lung cancer. A high level of consistency in classification has been achieved through the use of criteria that minimize intraobserver variability. The data obtained from the review project have been used to characterize the relationship of disease extent and cell type to survival in the clinical trials population. Survival characteristics were generated for 1,121 patients who underwent apparent complete resection of nonsmall cell lung cancer and were subsequently entered into various protocols to receive either adjuvant treatment or no further therapy. The end results study provides some insight regarding the biological behavior of squamous cell carcinoma and adenocarcinoma of the lung in terms of the anatomic extent of disease at the time of apparent complete resection. Patients with squamous cell carcinoma had an outcome superior to that of patients with adenocarcinoma in every TNM subset. The differences in survival according to these major cell types were significant overall and in the T1 N0, T1 N1, and T2 N1 subsets but not in the TNM subsets in stage III disease. Histologic cell type and extent of disease are important factors in survival expectations; thus the accuracy and reproducibility of these classifications plays a significant role in the evaluation of differing modalities of treatment.
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PMID:Lung cancer classification: the relationship of disease extent and cell type to survival in a clinical trials population. 303 95

TNM stage, immunostaining with various monoclonal and polyclonal antibodies, analysis of distance of neighboring cells, remission rates, and survival were analyzed in 60 patients suffering from small cell anaplastic carcinoma of the lung. The majority of patients showed advanced tumors at the time of admission to hospital (T2, T3 stage). Distant metastases prior to chemotherapy were detected in 34 patients. Partial remissions lasting 2-4 months were observed in 38 patients, and complete remission was documented in 7 patients. The remission rate was independent of cell type but dependent on the stage of the tumor. Some 30 patients showed positive staining with an antibody recognizing epitopes detectable on carcinoembryonic antigen, whereas 60% of the tumors were positive to a polyclonal neuron-specific enolase antibody. Tissue polypeptide antigen was found to stain positively in 5 cases only. Some 14 patients with negative staining against the monoclonal antibody BMA 406/14 showed prolonged survival compared to patients with positive staining (P less than 0.05). Patients suffering from tumors with smaller distances between neighboring cells had worse prognoses compared to patients with larger distances (P less than 0.01). Survival of patients was found to be indistinguishable if cohorts were grouped according to T stage, N stage, or existence of distant metastases. Ten patients who underwent surgical treatment of tumors did not show prolonged survival compared to 50 patients treated by combined chemotherapy only.
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PMID:TNM stage, immunohistology, syntactic structure analysis and survival in patients with small cell anaplastic carcinoma of the lung. 304 Jul 67

The International Staging System for Lung Cancer provides for classification of six levels of disease extent in five stage groups that relate to patient management and prognosis. Stage 0 is reserved for patients with carcinoma in situ. The Stage I and II definitions provide for classification of two levels of disease extent completely contained within the lung that have different prognostic and therapeutic implications. Definitive resection is the first choice of therapy for patients with non-small cell lung cancer in these stage groups. The Stage II category takes into account the erosion of survival expectations in the optimum group of T1 and T2 patients as a consequence of intrapulmonary lymph node involvement. Although small cell carcinoma is infrequently encountered as Stage I and Stage II disease, these classifications may be useful in the structure of investigational programs involving adjuvant surgery. The exclusion of distant metastases and the division of Stage III into two levels of extrapulmonary disease allow for selection of patients for specific treatment plans. Patients with non-small cell tumors with Stage IIIa disease usually are candidates for definitive surgical treatment. The specificity of the T and N definitions in the Stage IIIa and IIIb categories identifies patients for whom particular radiotherapy treatment plans are structured and protocol assignments are made. It is consistent with patient management concepts that all those with distant metastases are classified as having Stage IV disease. Implications of the system for selection of surgical, radiotherapeutic, and chemotherapeutic regimens are rational for all cell types. The classification meets the requirement for simplicity and can be readily applied in a broad spectrum of clinical and teaching environments. It is, however, sufficiently specific to be useful for reporting results of investigational therapies. Prospective use of the classification should encourage precision in clinical evaluations that exploit full use of refinements in imaging technologies. The cooperative efforts of the Task Force on Lung of the AJCC and the TNM Committees of the UICC to bring this classification system to fruition and international acceptance have been described. It has been adopted by these groups and others, including the International Association for the Study of Lung Cancer, the Japanese Cancer Committee, and the Spanish Society of Respiratory Disease, as their official recommendation for staging lung cancer.
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PMID:The new International Staging System for Lung Cancer. 362 29

The records of 168 patients treated by definitive radiation therapy for non-oat-cell-carcinoma of the lung in the Radiotherapy Department of the "Ospedale Regionale Multizonale" of Varese, Italy, from may 1979 to december 1984, were analyzed. Cumulative probability of survival from the beginning of radiotherapy were 48 +/- 4% at 12 months and 8 +/- 3% at 60 months. It appears to be no significant difference in survival according to TNM classes, UICC stages, histology and grading. Significant differences in survival were found grouping patients by performance status (I.K. less than 70 v.s. greater than or equal to 70), total absorbed dose (dose less than 56 Gy v.s. greater than or equal to 56 Gy), total isoeffect levels (CRE less than 17 reu v.s. greater than or equal to 17 reu), and response to treatment. The latter could be the most important prognostic factor. Median survival for CR, PR and NC categories were 48.5, 12 and 10 months respectively. We suggest that RT may be of value in improving quality of life and survival of patients affected by non operable non-oat-cell-carcinoma of the lung.
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PMID:[Radiotherapy as a single local regional treatment of non-oat cell carcinoma of the lung]. 371 80

We reviewed survival of patients with clinically localized small cell carcinoma of the lung treated by surgical resection, combination chemotherapy, and prophylactic cranial irradiation. Long-term survival was defined as continuing complete remission 30 months after the start of treatment. Initial TNM staging determined the course of treatment. Ten patients with disease in Stages I and II were treated over 30 months ago by initial resection followed by the full course of chemotherapy. Only one has had a relapse, whereas 80% remained disease-free at 30 months. Five of these patients have passed 5 years. Four patients with T3 N1 disease were treated by two cycles of chemotherapy, surgical resection, and cranial irradiation plus resumption of chemotherapy thereafter; two remained in remission at 30 months. Sixteen patients initially with N2 disease were treated according to the same schedule; 10 of the 16 underwent successful resection. All 16 patients have had a relapse, but the relapse occurred very late in three--at 27, 30, and 37 months. The reasons for the apparently poor prognosis of N2 disease are not clear. Considerations of tumor response kinetics and somatic mutation suggest that these biologic factors are fundamentally responsible. Other studies may find disease control achieved in a very few patients with N2 disease.
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PMID:Adverse prognostic effect of N2 disease in treated small cell carcinoma of the lung. 609 Aug 17

The long-term fate of patients treated surgically for carcinoma of the lung is not well known. In a careful review of the literature the authors found only nine papers with a postoperative followup of at least 10 years; the mean survival was 16,3% of patients so treated. Factors making for a good long-term prognosis include small initial tumor size, absence of mediastinal lymph node invasion, a favorable histologica type, and the type of surgery performed (partial exeresis). Translated into TNM code, this means that the best candidates for prolonged survival are patients with lung carcinoma of the squamous cell type, stage I, treated by limited lung exeresis.
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PMID:[Long-term survival of patients operated on for carcinoma of the lung (author's transl)]. 616 Sep 18


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