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

There is no universally-recognised method for staging malignant mesothelioma, although the use of computed tomograph (CT) scanning has improved the staging of non-invasive disease. The International Union against Cancer has recently proposed using the Tumour Node Metastases (TNM) staging system for mesothelioma, but in clinical practice it is difficult to assess tumour and nodal involvement due to the unique plate-like growth pattern of this tumour. In order to evaluate TNM staging we analysed pre-operative CT scans from 88 patients with histologically-confirmed malignant pleural mesothelioma, all from the same institution. The median age of the patients was 56 years (range 38-79). There were 70 men and 18 women, and 33 had tumours with epithelial histology. The median survival time was 10 months (range 0.2-110), from the date of histological confirmation of mesothelioma. The same radiologist analysed all the CT scans according to the TNM staging system. Actuarial survival curves were constructed by the Kaplan-Meier method. Survival curves for the different TNM categories were compared using the log-rank test. Node evaluation could not be completed in eight cases because the tumour had encompassed the hilum and mediastinum. In multivariate analysis, significant differences in prognosis correlated with the different T categories (P < 0.01), and the different TNM stages (P < 0.05), but not the N categories or the M categories. Larger studies are needed to assess the importance of TNM staging in the selection of treatment and as a prognostic factor for malignant mesothelioma.
Lung Cancer 1995 Mar
PMID:Evaluation of the clinical TNM staging system for malignant pleural mesothelioma: an assessment in 88 patients. 760 28

Nuclear DNA contents were measured using a flow cytometry technique in non-small cell lung carcinomas and differences in ploidy patterns were compared between primary lung carcinomas and metastatic lymph nodes. Negative node lung cancer revealed diploidy in 82.6% of the 224 non-small cell lung cancers, in contrast with 19.5% in positive node lung cancer. In multi-stemline cells, a high incidence of nodal involvement was seen when compared with single stemline cells. The more the DNA indices increased, the more the lymph nodes were seen to be extensively involved. Furthermore, intratumoral heterogeneity was evaluated in terms of n-categories. In conclusion, it is suggested that nodal metastasis may be caused by tumor cells with high DNA indices in lung carcinomas, in particular for multi-stemline cells.
Lung Cancer 1994 Sep
PMID:DNA stemline heterogeneity of non-small cell lung carcinomas and differences in DNA ploidy between carcinomas and metastatic nodes. 781 98

Atypical carcinoids are an intermediate form of tumor between low-grade malignant typical carcinoid and high-grade malignant small cell carcinoma, which represent the two ends of the spectrum of neuroendocrine bronchopulmonary tumors. Between 1983 and 1993, 27 patients with atypical carcinoids underwent surgical treatment. The histologic diagnosis of an atypical carcinoid was established if the criteria proposed by Arrigoni and associates were fulfilled. Seven pneumonectomies, 16 lobectomies, 2 segmentectomies, and 2 wedge resections were performed. Thirteen patients (48.1%) had regional nodal metastases and 6 patients (22%) had N2 disease at the time of surgical therapy. Distant metastases developed in 5 patients (18.5%) after initial treatment. The 10-year survival in patients with an atypical carcinoid was 49%, versus the 84% 10-year survival rate observed in patients with a typical carcinoid. We conclude that the aggressive behavior of atypical carcinoids precludes the use of limited surgical resection and requires a more aggressive approach, with lobectomy and mediastinal lymph node dissection constituting a minimal procedure. The same criteria used for well-differentiated lung carcinoma should apply to this form of neuroendocrine lung tumor. Adjuvant chemotherapy is recommended for patients with stage III or distant metastases.
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PMID:Carcinoid tumors of the lung: do atypical features require aggressive management? 781 64

Several analyses of the retinoblastoma (RB) gene in lung cancer at the DNA, mRNA and protein levels have recently been reported. In particular, small cell lung carcinoma shows a high incidence of RB gene abnormalities, suggesting that alterations of this gene may participate in tumor development. In the present study, we used an immunohistochemical technique with a monoclonal antibody raised against RB protein (PMG3-245) to detect its expression in representative paraffin sections of tissues obtained from 108 patients with various types of lung cancer treated by surgical resection of the primary tumor. While deletion of RB protein expression was observed in 7 (88%) of small cell lung carcinomas, only 17 (17%) of 100 non-small cell lung carcinomas showed decreased RB protein levels and 6 (6%) showed no RB protein expression. This low incidence of RB protein expression abnormalities in non-small cell lung carcinomas was significant (p < 0.0001). Thus, in contrast to small cell lung carcinoma, abnormalities in RB protein expression may be minor events in non-small cell lung carcinoma. In addition, no significant correlation was found between abnormalities in RB protein expression and clinical factors such as stage, tumor size, and nodal involvement in non-small cell lung carcinoma. However, abnormalities in RB protein expression in squamous cell carcinoma were observed only in the less differentiated types (p = 0.144), and there was a weak but not statistically significant association in non-small cell lung carcinoma between RB protein status and prognosis (p = 0.09). Therefore, in non-small cell lung carcinoma, although abnormalities in RB protein appear not to be closely associated with tumor development, further studies on a larger scale and with a longer-term follow-up are required to determine the clinicopathological significance of RB gene abnormalities, in particular the relationship between abnormalities of RB protein and differentiation or prognosis.
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PMID:Retinoblastoma protein expression in lung cancer: an immunohistochemical analysis. 797 May 1

The Lung Cancer Study Group (LCSG) randomized 141 patients with resected stage II and III adenocarcinoma and large cell undifferentiated carcinoma to receive postoperative combined chemotherapy with cyclophosphamide, doxorubicin, and cisplatin (CAP) chemotherapy or bacillus Calmette-Guerin (BCG) and levamisole immunotherapy. Careful intraoperative staging was performed on all patients. Before randomization, patients were stratified by stage, weight loss, cardiac arrhythmia, and institution. Prognostic variables such as stage, age, weight loss, and nodal involvement were equally distributed between the two groups. Disease-free survival was significantly prolonged in the group receiving chemotherapy. There was no evidence of a deleterious effect of the immunotherapy. This study indicates that postoperative CAP chemotherapy is effective in prolonging disease-free survival in these patients.
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PMID:Surgical adjuvant therapy for stage II and stage III adenocarcinoma and large cell undifferentiated carcinoma. 798 47

The purpose of this trial (Lung Cancer Study Group [LCSG] 853) was to perform a comparative study of immediate combination chemotherapy (cyclophosphamide, doxorubicin, cisplatin [CAP]) vs delayed combination chemotherapy (CAP) administered at the time of first systemic relapse in patients with completely resected stage II and stage III non-small cell cancer of the lung. We randomly assigned 188 patients with resected stage II or stage III non-small cell lung cancer of the lung (squamous, 53%; nonsquamous, 47%) to receive either immediate or delayed combination chemotherapy. Careful intraoperative staging was performed in all patients. Before randomization, patients were stratified according to stage--II (hilar nodes positive) vs III (mediastinal nodes positive or T3)--and histologic features (squamous vs nonsquamous). Ninety-four patients were randomized to receive immediate CAP vs 94 patients randomized to receive delayed CAP. Prognostic variables such as extent of disease, histologic features, sex, race, TN status, and Karnofsky performance status were equally distributed between randomized groups. The treatment groups differed with respect to greater than 10% weight loss. Forty-one percent of patients had stage II disease and 59% of patients had stage III disease. Median time to recurrence (19.5 months) and survival (32.7 months) did not differ between treatment groups. Immediate combination chemotherapy was associated with a 12% reduction in risk of recurrence and an 18% reduction in risk of death, although these rates were not statistically significant. Histologic features, sex, race, Karnofsky performance status, nodal status, and weight change were associated with higher risks of recurrence.
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PMID:A phase 3 randomized trial of immediate combination chemotherapy vs delayed combination chemotherapy in patients with completely resected stage II and III non-small cell carcinoma of the lung. 798 51

Lung Cancer Study Group (LCSG) Protocol 883, the comparative study of the results of magnetic resonance imaging (MRI) and computerized tomography (CT) for staging of tumor, nodal, and selected metastatic sights in patients with surgically staged lung cancer was activated in August 1988 but was not completed because of termination of LCSG funding. A literature review was therefore undertaken to determine the results of other studies that were performed to evaluate the relative efficacy of MRI and CT in the staging of patients with lung cancer. These studies determined that CT and MRI are approximately equal in the staging of N2 disease with a sensitivity of 70 to 90%, a specificity of 60 to 90%, and an accuracy of 66 to 90% depending on the criteria used for determining positive nodes and the compulsiveness of surgical staging. Magnetic resonance imaging is probably better in the assessment of superior sulcus tumors, tumors involving the aorta-pulmonary window, hilar nodes, in assessing chest wall or diaphragmatic invasion, and in evaluating patients whose CT findings are equivocal. Computed tomography and MRI reveal adrenal abnormalities in 10 to 20% of patients but only one third of these have metastases. Mediastinoscopy has a sensitivity of 85 to 90%, a specificity of 100%, and an accuracy of about 95% and is therefore the gold standard for N2 staging. If the CT examination reveals no N2 disease, one can proceed directly to thoracotomy with approximately a 15% chance of finding N2 disease. It was concluded that because CT is much cheaper, it should therefore be used for the noninvasive staging of patients with lung cancer unless the above-noted special circumstances are present that have been shown to favor MRI. Because of the limited accuracy of CT and MRI, however, positive findings must be confirmed by biopsy specimens and pathologic study.
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PMID:The role of CT and MRI in staging of the mediastinum. 798 71

To assess the interobserver variability of computed tomography in determining nodal status in non-small cell lung carcinoma, four experienced radiologists reviewed the computed tomographic scans of 147 patients. Interobserver variability was calculated using the kappa statistic. In addition, the accuracy of CT assessment of the nodal status by the four observers was measured by comparing their findings with thorough mediastinal exploration at both mediastinoscopy (n = 35) and thoracotomy (n = 112). Interobserver variability was large between the four radiologists regarding nodal status on a per-patient basis (kappa = 0.38). Sensitivity of computed tomography for the observers on a per-patient basis ranged from 40% to 69% with a 1.0-cm criterion and from 28% to 56% with a 1.5-cm criterion. From the large interobserver variability and the low sensitivities in this study it can be concluded that a negative result of computed tomography regarding mediastinal lymph nodes does not eliminate the need for mediastinoscopy or exploration of the mediastinum at the time of operation in patients with non-small cell lung cancer.
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PMID:Interobserver variability and accuracy of computed tomographic assessment of nodal status in lung cancer. 803 15

Atypical carcinoid is an intermediate form between low grade malignant typical carcinoid and high grade malignant small cell carcinoma which are the two ends of the spectrum of neuroendocrine bronchopulmonary tumors. Between 1983 and 1993, twenty-three atypical carcinoids underwent surgical treatment. Histologic diagnosis of atypical carcinoid was established if the criteria proposed by Arrigoni et al, were fulfilled. Diagnosis was most frequently based on screening chest roentgenogram (56%). CT-scan findings showed a nodular peripheral mass in 65% of patients and central mass or atelectasis in 35% of patients. Four pneumonectomies, 15 lobectomies, 2 segmentectomies and 2 wedge resections were performed. Nine patients (39%) had regional nodal metastases and 4 patients (17%) had mediastinal nodal metastases (N2 disease) at the time of surgery. There were 4 death related to recurrence of the disease with distant metastasis in 3 patients (14%). Ten-year survival in atypical form was 59% contrasting with the 90% ten-year survival rate in patient with typical form operated on the same period. Because of their aggressive behavior, atypical carcinoids were comparable to well differentiated carcinoma of the lung and require an aggressive approach with lobectomy and mediastinal lymph node dissection being a minimum procedure.
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PMID:[Heterogeneity of bronchial carcinoid tumors. Place of atypical forms]. 807 9

Using the pre-therapy CT scans of 266 node positive non-small cell lung cancer patients, we analysed the lymphatic pathways and the incidence of lymph node metastases in regional lymph nodes (as described by CT criteria corresponding to the modified mapping scheme of the American Thoracic Society), in order to develop the target volume for curative irradiation treatment. Among the 105 patients with node positive left sided primaries, the incidence of involvement of the ipsilateral supraclavicular lymph nodes was 9.5%, and the incidence of involvement of the contralateral lymph nodes was 3.8%. The incidence of involvement of the contralateral hilar lymph nodes was 4.8%. Among the 161 patients with nodal positive right sided primaries, the incidence of involvement of the ipsilateral supraclavicular lymph nodes was 8.7% and the incidence of involvement of the contralateral lymph nodes was 1.8%. For this group of patients, the incidence of involvement of the contralateral hilar lymph nodes was 3.7%. All patients with involvement of the contralateral hilar lymph nodes died within 2.5 years of diagnosis. In the cases where there was involvement of the supraclavicular lymph nodes, the patients died within 1.6 years. Involvement of the ipsilateral and/or contralateral supraclavicular lymph nodes, and/or the contralateral hilar lymph nodes, is defined as N3 disease, and is included in Stage IIIb. No curative surgery is indicated for these patients. Why therefore should this group of patients be treated with curative intent by irradiation of the primary, ipsilateral and contralateral hilar lymph nodes, as well as mediastinal, ipsilateral and contralateral supraclavicular lymph nodes? The curative radiation treatment volume for lung cancer has to include the primary tumor and the ipsilateral hilar, and the low and high mediastinal lymph nodes, as is indicated for Stage I, II and IIIa disease.
Lung Cancer 1994 Jul
PMID:The lymphatic pathways of non-small cell lung cancer and their implication in curative irradiation treatment. 808 6


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