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

Small cell lung cancer is generally staged as a localized or diffuse disease due to its great invasiveness and quick spread. The authors investigated the advantages of a more accurate staging by TNM system applied to small cell lung cancer. Sixteen patients (12 males and 4 females, mean age 54 years, max 66, min 48) were submitted to a treatment protocol consisting of 6 cycles of chemotherapy over an 18-month period. All patients underwent CT before and after the third and sixth cycles. Disease evolution was evaluated by means of the TNM system; relative to the N parameter, the American Thoracic Society criteria were followed. After completion of the third chemotherapy cycle, CT demonstrated reduction in T in 7/16 cases, while in the extant patients T was unchanged. N decreased too in 7 patients and remained unchanged in the others. CT examinations at the end of the whole treatment protocol demonstrated no changes in T. As for N, CT showed evolution from N0 to N2 in one case and from N3 to N0 in another one, while no changes were observed in the extant patients. The M parameter was constantly negative in all cases. Our results demonstrate that this approach to small cell lung cancer permits a more accurate characterization of the disease, thus making it easier to monitor the positive/negative response to treatment and allowing the latter to be personalized.
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PMID:[Small-cell lung tumors: is a more accurate staging possible and useful?]. 133 25

The authors present a series of twenty metachronous lung carcinomas operated upon in the Thoracic Surgery Unit of Nancy between 1975 and 1987. These lesions occur after a first lung tumor resected for stade 1 TNM in 19 cases, with a 59 month's mean free interval and they are surgically treated by 14 controlateral lobectomies and 6 completion pneumonectomies. In spite of 4 post-operative deaths, the survival rates reach 51% at 3 years and 32% at 5 years. This study with a review of the literature emphasize the relatively high incidence of metachronous lung carcinomas in the patient resected for a tumor of good pronostic factors, their occurrence after a prolonged interval, the difficulty to prove their primary nature and the justification of a surgical approach because the long-term results are comparable with that of patients operated upon for a single carcinoma.
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PMID:[Metachronous bronchial neoplasm. 20 cases surgically treated]. 270 Jan 58

The rapid and widespread development of imaging techniques during the last decade has markedly modified the previous algorithms used in the staging of pulmonary carcinoma, particularly M0/M1 in the TNM classification and the directives of the American Thoracic Society. Sensitivity and specificity of each method are reviewed according to the most frequent metastatic sites of bronchopulmonary carcinoma. Presently, CT is the most efficient technique for detection and display of metastases of the contralateral lung, brain, adrenal glands and retroperitoneal lymph nodes. Ultrasound is equal or even slightly superior to CT for the detection of liver metastases. The superiority of magnetic resonance imaging (MRI) over CT in the detection of brain metastases has already been demonstrated. The results of MRI using fast sequences have recently been demonstrated for imaging of thoracic, abdominal and bone metastases, but confirmation of these first results by prospective studies is needed. Skeletal survey is still obtained by radioisotope scanning.
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PMID:[Staging of pulmonary cancer, establishment of M1]. 367 84

A further comparison was made between the new international TNM staging system (1987) and the Chinese trial clinicopathological Staging system (1976) in 224 cases of intrathoracic esophageal carcinoma treated by surgical resection at the Department of Thoracic Surgery of Cancer Hospital, Chinese Academy of Medical Sciences between 1983.11-1986.5. Our results showed that the new international TNM staging classification is superior to that used in China with regard to the stratification of IIA, IIB and III stage grouping. The new stage grouping reflected fairly well the grade of disease extent. The new staging has greater predictive value for evaluating the incidence of possible Ro resections and especially permits a considerably improved prognostic assessment. Five-year survival rates of patients with radical resection were 80%, 47.3%, 22.2%, 16.1% and 0% in stages I, IIA, IIB, III and IV, respectively. It is suggested that the new TNM stage grouping should be adopted in our country. Some points were discussed in connection with the use of the new TNM stage grouping.
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PMID:[Evaluation of the new international TNM staging system for carcinoma of the esophagus as compared with the Chinese trial clinicopathological staging system--an analysis of 224 cases]. 817 81

The factors that influence decision making among surgeons are not well understood. We evaluated how tumor stage in patients subjected to potentially curative surgery for lung cancer affects the self-reported follow-up strategies employed by practicing surgeons. Hypothetical patient profiles and a detailed questionnaire based on these profiles were mailed to the 3,700 members of the Society of Thoracic Surgeons. The effect of TNM stage on the surveillance strategies chosen by the respondents was analyzed. All of the ten most commonly employed surveillance modalities were ordered significantly more frequently with increasing TNM stage, although the differences are small. Only 23% of respondents modified their strategies according to the patient's TNM stage. This effect persisted through 5 years of follow-up. We conclude that most surgeons performing surveillance after potentially curative surgery for otherwise healthy patients with lung cancer use the same follow-up strategy irrespective of TNM stage. These data should help in the design of prospective trials of this topic.
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PMID:How tumor stage affects surgeons' surveillance strategies after lung cancer surgery. 899 84

Two sets of patients with potentially curative resection of primary carcinomas operated in the Department of Thoracic Surgery, Thoraxklinik, Heidelberg during the period 1983-1984 (cohort I), and in 1994 (cohort II) were analyzed. The survival of patients, postsurgical TNM-stages, cell types, and exposure to potentially harmful substances were evaluated. In addition, cytometric and morphometric techniques, and various biotinylated markers have been applied to the tissue sections of the 1994 cohort. Cohort I comprised 282 patients (253 men and 29 women), cohort II all in all 171 patients (121 men and 49 women). In cohort I there were 262 heavy smokers, and 28 patients had a history of exposure to harmful environmental substances (asbestos, polycyclic aromates, etc.) compared to 145 smokers and 68 patients who inhaled potentially harmful substances in cohort II. Major changes were also seen in early lung cancer stages (pT1, pN0) which increased in cohort II, and in a decrease in the relative frequency of epidermoid carcinomas in both men and women with corresponding increase in the frequency of adenocarcinoma in both sexes. The median survival of patients operated with advanced tumor stages had remained unchanged, that of early stages (pT1, pN0, pN1) seems to have improved. Within the cytometric features syntactic structure analysis revealed that the current of structural entropy is closely associated with the survival of patients. Of prognostic significance are, in addition, the expression of binding capacities to histoblood group trisaccharides A and H, the presence and the binding of macrophage migration inhibitory factor, and the presence of ligands for the chicken liver galectin CL-16 and the LewisY antigen. Multivariant statistical analysis gave preferential prognostic importance to the glycohistochemical and morphometric parameters relative to the clinical pT and pN stages in survival analysis.
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PMID:Changes during the last decade in clinical parameters of operated lung carcinoma patients of a center for thoracic surgery and the prognostic significance of TNM, morphometric, cytometric, and glycohistochemical properties. 932 22

Survival of patients with lung cancer is poor in Denmark and worse than in the other Nordic countries. The study focuses on the treatment, the selection for operation, prognostic factors and the prognosis in lung cancer. During the years 1991-1993, 467 consecutive patients with pulmonary tumour suspicious lesions were prospectively followed at the Departments of Pulmonary Medicine and Thoracic Surgery, Bispebjerg Hospital, Copenhagen. Operation was performed in 83 (33%) of 252 patients with non-small-cell lung cancer. More than 70% of the 169 non-operated patients were judged inoperable on the basis of a clinical examination and a chest x-ray. The initial estimation of operability, done by the chest physician, was able to predict 91% of the inoperable patients. Therapeutic delay (diagnosis-operation) was on average 26 days and 95% were operated within 60 days. Three-year survival for all the operated patients was 36%, while 62% were alive when they were judged radically operated. For stage I tumours, 51% were alive after three years, while all with stage IV tumours were dead. In the operated patients, lung function was positively related to survival (p = 0.013). Females had a better survival than males (p = 0.01 for operated, p = 0.02 for non-operated). Among 43 with small-cell lung cancer, 32 were treated with chemotherapy, and half of these were alive after one year. Preoperative histology in peripheral lesions is of value in preventing unnecessary operations without significant losses. Mediastinoscopy should be performed before operation. Registration of TNM stage and lung function should become standard in order to make comparison from country to country more valid.
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PMID:[Therapeutic and prognostic course in patients with suspected lung cancer. Results of combined thoracic surgery-pulmonary medicine evaluation]. 945 3

The Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pneumology and Thoracic Surgery (GCCB-S) has been enrolled in a prospective data collection project from patients with bronchogenic carcinoma who underwent thoracotomy in 20 Spanish hospitals from October 1993 to September 1997. In this 4-year period, 2995 patients were registered and demographic, clinical, biological, diagnostic, surgical, pathological and follow-up information collected in a homogeneous way. The main objectives of the Group are to describe the population with lung cancer at the time of diagnosis in Spain; to analyse operative morbi-mortality; and to identify multiple prognostic factors. So far, some preliminary results have already been published concerning the description of the population, the methodology of the Group, the assessment of morbi-mortality, and the validation of the 1997 TNM classification.
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PMID:The Spanish data base for the staging of lung cancer. Experience of the Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pneumology and Thoracic Surgery (GCCB-S). 1080 71

In the carcinoid tumours of the bronchopulmonary tract surgical resection is still the primary goal. Many problems are, however, unclear: the extent of resection, formal lymph node dissection or not, the role of Video-Assisted Thoracic Surgery (VATS) and of the multidisciplinary approach. In the Department of Surgical Sciences and Applied Medical Technologies, "La Sapienza", Rome's University, from 1969 to 1994, we observed 18 patients with carcinoid tumours of the lung: 13 typical carcinoid (TC) and 5 atypical carcinoid (AC). In our series, the choice of therapeutic procedure was made on the basis of histological criteria and TNM classification. We performed 3 conservative and 10 extensive resections on typical carcinoid and 5 extensive resections on atypical carcinoid tumours. In our series VATS played a minor therapeutic role. Formal lymph node dissection was carried out on all our patients except in the cases of those with typical carcinoid tumours without enlarged hilar and mediastinal lymph nodes. The efficacy of adjuvant chemotherapy in carcinoid tumours treatment is controversial and will be confirmed by further trials. In bronchial carcinoid tumours the long-term prognosis is excellent. In our series the ten-year survival rate is 77 per cent in typical carcinoid and 40 per cent in atypical carcinoid cases.
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PMID:Therapeutic approach of carcinoid tumours of the lung. 1140 88

The aim of this retrospective study was to evaluate the prognostic role of gross tumor volume (GTV) on survival of locally advanced NSCLC patients, regardless of TNM stage, and to analyze whether GTV and other radiotherapy (RT) parameters were important for the development of lung toxicity. Thirty-two patients with locally advanced NSCLC (stage IIIA bulky/IIIB) treated with chemoradiotherapy were retrospectively analyzed. Patients received induction chemotherapy followed by combination treatment (27 patients) or induction chemotherapy followed by RT alone (5 patients). Thoracic RT consisted in 60 Gy, with standard fractionation and was the same for all 32 patients. Dose volume histograms were collected from the 3D treatment plans and GTV, planning target volume, mean lung dose, volume of lung receiving more than 20 Gy or more than 30 Gy were analyzed. Survival was significantly longer in patients with a GTV < 100 cm(3) compared with patients having GTV > 100 cm(3) (p = 0.03). In a multivariate analysis only N-status and GTV were predictors of survival with a risk ratio of 0.51 and 0.62, respectively. Ten patients (31%) developed radiation pneumonitis grade 2 or higher. None of the RT parameters examined correlated significantly with the development of lung toxicity. In locally advanced NSCLC, GTV and N-status play a prognostic role even in patients at the same clinical stage and receiving a combination of chemo- and radiotherapy. This could imply a reassessment of the current staging system in patients with non-resectable NSCLC to better identify those patients who would benefit more from the combined treatment, despite its higher toxicity.
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PMID:Role of gross tumor volume on outcome and of dose parameters on toxicity of patients undergoing chemoradiotherapy for locally advanced non-small cell lung cancer. 1626 Aug 55


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