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

Staging is the quantitative assessment of malignant disease and allows logical groupings of patients with a similar extent of disease for prognostic, therapeutic, and analytic purposes. In bronchogenic carcinoma a stage is assigned based on size, location, and the extent of invasion of the primary tumor, as well as the presence of any regional or metastatic disease. Selecting the most appropriate treatment for a patient with bronchogenic carcinoma depends on precise staging. The extent of local invasion and presence of metastatic disease will determine the likelihood of complete resection and possible cure. Careful assessment of the history, blood chemistry, radiographic studies, bronchoscopy, mediastinoscopy, and exploration (thoracotomy) are all important staging tools. Routine radionuclide scans have no useful role when there is no clinical or laboratory evidence of metastases. The T status of a tumor is best judged by bronchoscopy and at thoracotomy. Thoracic surgeons must be familiar with the techniques available to determine T status intraoperatively and use this information when planning resection. Computed tomography of the chest has fallen short in predicting direct invasion of the mediastinum and chest wall. Cervical and anterior mediastinoscopy remain important tools in determining operability. Intraoperative assessment of node involvement determines the extent of resection and likelihood of cure.
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PMID:Staging: the key to rational management of lung cancer. 172 32

Thyroid tumors were diagnosed in 26 dogs between 1977 and 1984. A total of 23 of the 26 tumors were carcinomas, and 3, detected as incidental findings at necropsy, were adenomas. The median patient age was 9.5 years. Dogs of the Beagle breed were affected most commonly (5 dogs). The most common physical abnormalities in carcinoma patients were cervical swelling, dyspnea, and coughing. A total of 25 of 26 dogs were clinically euthyroid. Aspiration cytology provided diagnostic information in 8 of 17 cases. In dogs with thyroid carcinoma, a cervical soft tissue lesion was identified consistently by use of radiography and scintigraphy with sodium pertechnetate. Pulmonary metastases were detected radiographically in 8 of 21 dogs with thyroid carcinoma. Thoracic nuclear imaging confirmed the radiographic findings in 11 of 14 dogs. Surgical excision of the thyroid mass was the primary treatment for 17 dogs with carcinoma. Eight dogs died within 2 years (median, 7 months) of surgery because of primary tumor regrowth or metastases. Four dogs were alive at a range of 3 to 48 months after surgery, and 4 dogs died from unrelated causes. Necropsy of 7 dogs with thyroid carcinoma revealed neoplastic infiltration of the cervical blood vessels and pulmonary metastases in each dog. The most common histologic patterns of thyroid carcinoma were solid or compact cellular (11 dogs) and mixed solid-follicular tumors (8 dogs). Dogs with a solid carcinoma had a median survival time of 10.5 months (6 dogs), and dogs with a mixed solid-follicular tumor had a median survival time of 8 months (3 dogs).
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PMID:Clinical and pathologic features of thyroid tumors in 26 dogs. 301 18

Between 1973 and 1985, 98 patients with primary tumor of the chest wall have been operated at the Clinic for Thoracic Medicine in Heidelberg Rohrbach. 71 tumors were benign, 27 malignant. Three objectives have priority in surgical therapy: 1) complete (wide) resection of tumor, 2) reconstruction of the chest wall to allow adequate spontaneous ventilation, and 3) cosmetically acceptable coverage with integument. Today almost any defect caused by resection can be repaired. Coverage of the defect with Marlex mesh is recommended. Long-time prognosis depends on the primary disease. Functional and cosmetic results are very satisfactory.
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PMID:[Surgical therapy of primary chest wall tumors--experiences with 98 patients]. 343 3

Previous reports have shown differences in the ability of CT to detect mediastinal lymph nodes, depending on the precise mediastinal location of the nodes. Poorest correlation between findings on CT and findings at autopsy has been described for left-sided lymph nodes, particularly those in the left peribronchial region (American Thoracic Society node station 10L), suggesting that cancers of the left lung might be less well staged by CT than cancers of the right lung. The relationship between the accuracy of mediastinal lymph node staging and the location of the primary lung cancer was examined in a retrospective study. In 103 patients with non-small-cell bronchogenic carcinoma who had preoperative CT evaluation of the mediastinum, the accuracy of preoperative staging was 81% for tumors of the right lung (70 patients) and 97% for tumors of the left lung (33 patients). The conclusion is that cancers of the left lung are staged at least as accurately as cancers of the right lung, despite the fact that left-sided mediastinal nodes are depicted more poorly on CT. Subcarinal and crossover (contralateral) nodal metastases and a low prevalence of metastasis involving only region 10L were the most important factors minimizing staging differences based on the site of the primary tumor.
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PMID:CT evaluation of mediastinal lymph nodes in lung cancer: influence of the lobar site of the primary neoplasm. 349 14

A 7-year-old German Shepherd Dog had a large cranial mediastinal mass that had resulted in chronic weight loss. A diagnosis of benign thymoma was made by transthoracic needle biopsy. The thymoma was removed surgically and the dog recovered without complications. At 4 months after surgery, the dog's activity was improved and it had gained weight. A 12-year-old mixed-breed dog was admitted for evaluation of dependent edema of the neck. Thoracic radiography revealed pleural effusion and lesions in the right lung and left scapula. Neoplastic epithelial cells were found in a needle aspiration specimen from the scapular lesion. The dog was euthanatized and necropsied. The primary tumor, a malignant thymoma, filled the cranial mediastinum and had invaded the cranial vena cava. Metastasis was confirmed in the right lung, liver, and left scapula. Eight cases of thymoma in the dog were retrieved from the Veterinary Medical Data Program. In 5 of the cases, the tumor was benign. The 3 dogs with malignant thymoma developed cranial vena caval syndrome, and they were euthanatized or died. Four of the dogs with benign thymoma were euthanatized for reasons unrelated to the tumor. One dog with benign thymoma was free of tumor when examined 5 years after surgical removal of the tumor.
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PMID:Thymoma in the dog: two case reports and review of 20 additional cases. 688 4

Combined modality therapy is of great importance in the management of small cell lung cancer. Randomized studies of the design chemotherapy with or without thoracic irradiation are required to demonstrate the impact of radiotherapy on rates of survival, local control and adverse effects. The method of meta-analysis allows one to analyse in a single study a set of different clinical trials of the same design. The first purpose of this paper is to briefly present the method, and the results of a meta-analysis on the role of thoracic irradiation combined with chemotherapy in the treatment of this disease. Thoracic irradiation added to chemotherapy results in a major decrease in local relapse (from 65% to 40% at 2 years), a modest increase in overall survival (from 16 to 22% at 2 years), and a small increase in lethal toxicity (from 1 to 2%). The second purpose is to discuss timing of thoracic irradiation with respect to the administration of chemotherapy using the results of a recently published trial. This Canadian study is based on the hypothesis that chemo resistant cells may develop as a result of spontaneous mutations during therapy. Limited disease patients all received the same chemotherapy (alternating 3-week cycles of CAV [cyclophosphamide, doxorubicin, vincristine] over EP [etoposide, cisplatinum] for a total of six cycles), after having been randomized to receive thoracic irradiation given either early (at 3 weeks following the beginning of treatment) or late (at 15 weeks). Of the 308 patients for analysis 155 were randomized to the "early radiotherapy" arm, and 157 to the "late radiotherapy". Prognostic factors were equally distributed between the two arms. The radiotherapy regiment consisted of a dose of 40 Gy in 15 fractions to a target volume including the primary tumor and mediastinum, and prophylactic brain irradiation (25 Gy in ten fractions in 2 weeks) to patients without progression of disease. The overall survival rate was better in the "early radiotherapy" arm, with a median survival of 21 months and on overall survival rate of 20% at 5 years, compared to a median of 16 months and a 5 years survival of 11% in the "late radiotherapy" arm. The survival curves are significantly different by the log rank (P = 0.008) and Wilcoxon (P = 0.005) tests, in favour of "early radiotherapy". After allowing for prognostic factors (sex, ECOG performance status) by the Cox model, the "early" arm retains a statistically significant advantage (P = 0.006).(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Small cell lung carcinoma: role of thoracic irradiation and its timing in relation to chemotherapy]. 789 17

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 radiographs of 25 cats with pulmonary metastatic disease and confirmed primary tumors were reviewed retrospectively. Pulmonary patterns of metastasis were divided into three categories, described as well-defined interstitial nodules, ill-defined interstitial nodules or a diffuse pulmonary pattern. The latter consisted of an alveolar pattern with or without ill-defined pulmonary nodules and/or pleural effusion. More cats presented with pulmonary metastatic disease in the category of either ill-defined nodules (n = 10) or a diffuse pattern (n = 7). Within this group, the most commonly represented primary tumor was mammary gland adenocarcinoma.
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PMID:Radiographic patterns of pulmonary metastasis in 25 cats. 949 10

Radiation therapy with concurrent chemotherapy is frequently used as definitive treatment for esophageal carcinoma. Although thoracic computed tomography (CT) is widely used in staging esophageal carcinoma, its application to radiation therapy planning has been regarded as optional rather than mandatory. Conventional radiation therapy planning is esophagogram-based rather than CT-based. The treatment port is generated by adding 5 cm to the proximal and distal margins of the tumor-involved segment as seen on esophagogram performed in the treatment position. Historically, a maximum port length of 15 cm was recommended to avoid excessive treatment morbidity. The authors examined the limitations of such a planning protocol by projecting conventional treatment ports onto the thoracic CT of 75 consecutive newly diagnosed cases of nondisseminated esophageal squamous cell carcinoma. The authors assessed the adequacy of coverage of the primary tumor and metastatic nodes, with respect to data from thoracic CT and neck ultrasonography. It was found that up to 38% of T2-T3 tumors and 30% of short-length (< or =5 cm) tumors had metastatic nodes outside the port. The addition of neck ultrasonography led to identification of an additional 5% of patients with nonpalpable nodes outside the port. It is concluded that the frequency of inadequate tumor coverage using an esophagogram-based planning protocol, with a maximum port length of 15 cm, is unacceptably high. Thoracic CT should be a mandatory rather than optional imaging investigation in guiding radiation therapy planning for esophageal cancer.
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PMID:Influence of staging thoracic computed tomography on radiation therapy planning for esophageal carcinoma. 1195 64

We present a 63-year-old man who was investigated for a lesion in the apex of the left lung and a coexisting osteolytic lesion in the right major trochanter. FNA of the thoracic mass was suggestive for malignancy yet not diagnostic regarding the tumor type and the site of the primary tumor. A diagnosis of a stage IV lung cancer was favored and he underwent a left exploratory thoracotomy in view to resect the primary tumor. An extrapulmonary mass localized to the pleura not involving the ipsilateral lung was disclosed. Multiple biopsies revealed metastatic clear cell RCC. A 5 x 7 cm left renal tumor was revealed in a postoperative abdominal CT scan. He was treated with combination of interferon A and vinblastin followed by radical nephrectomy. Twenty-four months after the diagnosis he is alive without evidence of local or distant recurrence. Pleural metastases from RCC are mainly presented as malignant pleural effusions. Thoracic metastatic lesions localized to the pleura, forming solitary or multiple mass(es) have been rarely reported. We review the literature regarding this rare clinical manifestation of the disease and we discuss diagnostic and therapeutic options.
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PMID:Metastatic renal clear cell carcinoma mimicking stage IV lung cancer. 1462 Feb 76


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