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Query: UMLS:C0729233 (Thoracic)
 6,478 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Depending on the local extension of primary non-small cell lung cancer (NSCLC) and invaded T4 structure(s), 49 patients underwent complete (CR, n = 14) or palliative (PR, n = 13) resection of exploratory thoracotomy (ET, n = 22) between January 1982 and June 1988. Thoracic radiotherapy (TR) was given to all patients receiving PR (median dose, 43 Gy) and ET (median dose, 53 Gy). With a median follow-up of 44 months, overall 2- and 5-year survival was 25 and 5%, respectively. Patients undergoing ET plus TR had a significantly worse survival than those treated by CR (P = 0.041) and PR plus TR (P = 0.046). Only completely resected patients became long-term survivors (5-year survival, 29%) and significant predictors of their survival were previous weight loss, hemoglobin, and creatinine level, in univariate analysis, and previous weight loss in multivariate analysis. The site of initial treatment failure was mainly local for PR plus TR (85%) and systemic for CR (71%) and ET plus TR (86%). Presented results suggest that surgery might play a role for selected patients with T4 NSCLC, but advances in systemic and local therapy are necessary.
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PMID:Results of treatment and lessons learned from pathologically staged T4 non-small cell lung cancer. 171 30

Computed tomography was used to evaluate mediastinal lymph nodes in 97 patients with nonsmall cell lung cancer. All patients had thorough surgical-pathological determination of mediastinal node status. Twenty-three patients were found to have metastatic lymph nodes. The usual lymphatic pathways of tumor spread into the mediastinum were defined using the node mapping scheme suggested by the American Thoracic Society. We considered mediastinal nodes abnormal when the short axis of the largest mediastinal node in the lymphatic drainage territory of the cancer was greater than or equal to 10 mm and the difference between this node and the largest node in the other territories is greater than 5 mm. The sensitivity was 78%, the specificity 99%, the positive predictive value 95%, the negative predictive value 94%, and the accuracy 94%. Comparing our method to those that used the size criterion alone, the number of false positives was reduced.
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PMID:Computed tomography of mediastinal lymph nodes in nonsmall cell lung cancer. A new approach based on the lymphatic pathway of tumor spread. 283 59

Nonsurgical combined approaches of non-small cell lung cancer represent a concept that has only been investigated so far with chemotherapy and radiation therapy. Thoracic irradiation of locoregional disease is associated with a high rate of local control and a 5-10% long-term (5-year) survival; however, distant metastases remain the main cause of failure. This observation suggests that the tumor is often microscopically disseminated at the time of diagnosis. Systemic therapy therefore must be associated to radiation therapy to try to control both the undetectable metastases and the local disease. However, the results reported so far have been disappointing, probably because of the modest activity of the available chemotherapy. Further progress with the combined approach requires new developments in the chemotherapy of non-small cell lung cancer, particularly the introduction of new active drugs.
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PMID:Nonsurgical combined modality therapies in non-small cell lung cancer. 351 76

Computed tomography was used to evaluate the mediastinum preoperatively in 60 patients with non-small cell lung cancer; 49 of these patients had thorough surgical-pathologic determination of mediastinal node status. Mediastinal lymph nodes were located by CT using the node-mapping scheme suggested by the American Thoracic Society and were considered abnormal when larger than 100 mm2 in cross-sectional area. The sensitivity of CT was 95% in detecting malignant mediastinal adenopathy; however, specificity was only 64%. Receiver operating characteristic (ROC) curve analysis showed that the optimal size criterion for diagnosing malignant mediastinal adenopathy is 1.0-1.5 cm when the short axis of a node is measured. CT staging of the mediastinum in patients with non-small cell lung cancer is clinically useful; negative mediastinal CT makes mediastinoscopy unnecessary, whereas positive CT should lead to biopsy of the enlarged node.
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PMID:The mediastinum in non-small cell lung cancer: CT-surgical correlation. 660 89

From July 1989 to July 1991, 73 previously untreated patients with histologically proven stage III inoperable non-small cell lung cancer have been treated with standard fractionation radiation therapy and concomitant cisplatin by continuous infusion. Thoracic irradiation was delivered at a dose of 40 grays in 20 fractions over 4 weeks to the entire mediastinum, ans was followed after a two-week rest by a boost of 30 grays in 15 fractions over 3 weeks with oblique fields sparing the spinal cord. Continuous infusion cisplatin was given during the second week or each radiation therapy sequence at a dose of 20 mg/sqm/24 hours during five days (120 hours) with usual hyperhydratation and antiemetic measures. Toxicity was essentially hematologic and gastro-intestinal but there was only 4.1% grade 3 or grade 4 complications. Radical surgery became feasible after the first cycle of treatment in 10 patients (13.7%). Complete response rate as determined by CT-scan and fiberoptic bronchoscopy was 61.6%. At a median follow-up of 26 months, actuarial overall survival at 1, 2 and 3 years was 46.6%, 27.7% and 24.5%, respectively. There were no local recurrence or distant relapses after 3 years, which will hopefully result in long-term survival in one quarter of these patients. These results compare favorably with other studies combining radiation therapy and concomitant cisplatin with different dosage and schedule. Local control appears substantially improved by this combined modality treatment over radiation therapy alone. However, the incidence of distant metastasis remains significant, especially during the first year of follow-up. Further improvement of early and long-term survival could possibly result from the incorporation in this protocol of a second drug active against subclinical dissemination.
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PMID:[Radiotherapy and concomitant cisplatin in stage III non-small cell bronchial cancer: results of a pilot study]. 765 47

The adenosquamous carcinoma is a rare combined tumour of non-small cell lung cancer (NSCLC). The survival prognosis of surgically treated patients with adenosquamous carcinoma and patients with squamous cell carcinoma, large cell carcinoma or adenocarcinoma were compared during a study. Two hundred and seventyfive patients who had been treated surgically because of primary lung cancer in the Department of Thoracic-Surgery at the Martin-Luther-University Halle-Wittenberg between 1980 and 1989 were evaluated. The five year survival study of 172 patients who underwent resection because of squamous cell carcinoma was 45%, the one of patients with adenocarcinoma (n = 84) was 27%. 26% was the five year survival rate of the patients (n = 9) with large cell carcinoma. Of 13 patients (4%) with adenosquamous carcinoma none survived five years after surgical treatment. The two year survival rate was 28%. The presented results demonstrate the poor survival prognosis of patients suffering from adenosquamous carcinoma and ask for an adjuvant therapy.
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PMID:The adenosquamous lung carcinoma: clinical and pathological characteristics. 769 72

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.
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PMID:The lymphatic pathways of non-small cell lung cancer and their implication in curative irradiation treatment. 808 6

Thoracic radiotherapy is widely used in patients with non-small cell lung cancer. Its role as adjuvant treatment before or after surgery has not been established clearly. In patients with locally advanced disease, the main cause of failure is the absence of local control. Recently, three treatment approaches have shown a beneficial effect on overall survival in randomized trials conducted in this group of patients: sequential combination of thoracic radiotherapy and cisplatin-based chemotherapy, concomitant use of radiation and daily low-dose cisplatin therapy, and hyperfractionated accelerated radiotherapy. Another area that merits further investigation is the role of adjuvant surgery.
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PMID:Current strategies for radiation therapy in non-small cell lung cancer. 933 91

The role of multimodality management in locally advanced non-small cell lung cancer (NSCLC) continues to evolve and is a subject of ongoing clinical research. Induction chemotherapy followed by surgical resection with or without thoracic radiotherapy has proved superior to surgical resection alone in patients with ipsilateral mediastinal (N2) disease. Whether surgery alone still plays a role in these patients is the subject of an ongoing intergroup study. As no definitive, optimal effective chemotherapy regimen currently exists for NSCLC, future studies will attempt to incorporate novel and active agents like the taxanes, irinotecan, vinorelbine, and gemcitabine into combined-modality therapy for locally advanced NSCLC. Thoracic radiation therapy by itself provides local control and effective palliation of tumor-related symptoms but has minimal impact on the survival of patients with locally advanced disease. Novel schemes such as hyperfractionated radiotherapy and continuous hyperfractionated accelerated radiotherapy are currently being investigated and appear promising but need to be tested in combination with chemotherapeutic agents. Randomized studies have demonstrated the benefit of concurrent or sequential chemoradiation in selected patients with a good performance status and minimal weight loss. The exact sequence of combined-modality therapy has yet to be determined. The combination of paclitaxel and platinum compounds has shown impressive activity in advanced NSCLC in both phase II and III randomized studies. We have incorporated weekly low-dose paclitaxel and carboplatin with concurrent thoracic radiation in treating patients with locally advanced, inoperable NSCLC, and long-term follow-up has shown remarkable survival rates. Confirmation of these phase II combined-modality studies is needed. Combination sequential chemotherapy followed by concurrent chemoradiation in patients with advanced NSCLC has the potential to improve overall survival by increasing both local and distant control.
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PMID:Combined-modality treatment of locally advanced non-small cell lung cancer: incorporation of novel chemotherapeutic agents. 943 91

During the last 50 years, the 5-year survival of lung cancer patients has been unchanged at 5%. As the prognosis for patients with operable nonsmall cell lung cancer (NSCLC) is much better, the diagnostic examination of tumour suspicious lesions with secondary judgement of operability in NSCLC is an important subject. This study focuses on the diagnostic process. During the years 1991-1993, 467 consecutive patients with pulmonary tumour suspicious lesions were prospectively followed at the Department of Pulmonary Medicine and the Department of Thoracic Surgery, Bispebjerg Hospital. In 40% of the patients, the diagnostic delay was longer than 30 days. Fiberbronchoscopy and fine needle biopsy were the most important diagnostic tests with an accuracy of approx. 90% for both central and peripheral lesions. Benign lesions comprised 19% of all, while the prevalence of squamous cell carcinoma, adenocarcinoma, small-cell carcinoma and large-cell carcinoma was respectively 21%, 26%, 15% and 18% of the malignant infiltrates. Histological diagnosis was not achieved in 104 patients. Histological diagnosis was achieved in most patients, but the diagnostic process was slow. A faster diagnostic process is to be aimed for and can, hopefully, be achieved by accomplishing diagnostic standards as just proposed by the Danish Lung Cancer Group.
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PMID:[Diagnostic procedure in patients with suspected lung cancer. Results of combined evaluation by thoracic surgery and pulmonary medicine specialists]. 945 2


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