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NCI CANCERLIT® Search: Radiation, Surgery for Non-small Cell Lung Cancer - March 2002
National Cancer Institute®
Ultima Vez Modificado: 1 de marzo del 2002
Table of Contents
1
UI - 11821819
AU - Yoshino I; Baba H; Fukuyama S; Kameyama T; Shikada Y; Tomiyasu M;
TI -
Suemitsu R
A time trend of profile and surgical results in 1123 patients with
non-small cell lung cancer.
SO - Surgery 2002 Jan;131(1 Suppl):S242-8
AD - Department of Surgery and Science, Graduate School of Medical Sciences,
Kyushu University, Fukuoka, Japan.
BACKGROUND: A time trend for characteristics and prognoses of patients
with non-small cell lung cancer (NSCLC) who underwent surgical resection
was investigated. METHODS: A series of 1123 consecutive patients with
NSCLC who underwent surgical resection from 1975 to 1998 was reviewed
with respect to changes in patient profile and surgical outcome among
subgroups classified by clinicopathologic factors. RESULTS: With time,
the proportion of female, elderly (> or =70 years), pathologic stage IA,
nonsmoking, and adenocarcinoma patients increased significantly whereas
pneumonectomy, incomplete resection, and pathologic stage IIIA patients
decreased significantly. Overall survival showed an upward trend with
5-year survival rates of 30.0% in the 1970s, 41.6% in the 1980s, and
50.1% in the 1990s (P <.0001). This tendency was similar in every
pathologic stage that was observed. The proportion of female patients
with adenocarcinoma that exhibited the most favorable prognosis among
subpopulations classified by gender and cell types was significantly
higher in the 1990s (28.0%) than in the 1970s (14.0%). Multivariate
analysis revealed that female gender, adenocarcinoma, complete
resection, and early pathologic stage were independently favorable
factors whereas advanced age was an unfavorable factor. CONCLUSIONS: The
improved survival following surgical resection for NSCLC during the
study period was associated with an increasing population of female
patients with adenocarcinoma, more detection of early disease, and
effective elimination of unresectable cases.
2
UI - 11845848
AU - Kernstine KH; Mclaughlin KA; Menda Y; Rossi NP; Kahn DJ; Bushnell DL;
TI -
Graham MM; Brown CK; Madsen MT
Can FDG-PET reduce the need for mediastinoscopy in potentially
resectable nonsmall cell lung cancer?
SO - Ann Thorac Surg 2002 Feb;73(2):394-401; discussion 401-2
AD - Department of Biostatistics, College of Public Health, University of
Iowa, and Iowa City Veterans Administration Medical Center, USA.
kemp-kernstine@uiowa.edu
BACKGROUND: Few fluoro-deoxy-glucose (FDG)-positron emission tomography
(PET) nonsmall cell lung cancer (NSCLC) trials have had sufficient
patients to adequately evaluate PET for mediastinal staging. We question
whether once PET is performed, is mediastinoscopy necessary? METHODS: We
performed a 5-year retrospective analysis of operable patients with
known or suspicious NSCLC. Standard PET techniques were used. Inclusion
criteria were (1) surgical mediastinal nodal sampling by mediastinoscopy
within 31 days of the PET and (2) definitive diagnosis. RESULTS: There
were 237 patients who met the evaluation criteria; ninety-nine patients
with NSCLC and 138 with suspicious lesions (137 men and 100 women; aged
20 to 88 years). The PETs were performed from 0 to 29 days before
mediastinoscopy (median, 7 days). The standardized uptake value for the
primary lesion was 0 to 24.6 (7.9+/-5.0). Nine primary lesions had no
FDG uptake (1 benign, 8 NSCLCs). Seventy-one patients (31%) had
mediastinal PET positive disease, and 44 patients (19%) had histologic
positive mediastinal disease; N2 41 patients (17%) and N3 9 patients
(4%). In 6 patients (3%), the initial frozen sections were negative, but
PET positivity encouraged further biopsies that were positive for
cancer. The PET sensitivity was 82%, specificity 82%, accuracy 82%,
negative predictive value 95%, and positive predictive value was 51%.
All primary lesions with a standardized uptake value less than 2.5 and a
negative mediastinal PET were negative histologically (n = 29). Logistic
regression analysis resulted in 100% specificity for PET in this group.
CONCLUSIONS: In NSCLC PET may reduce the necessity for mediastinoscopy
when the primary lesion standardized uptake value is less than 2.5 and
the mediastinum is PET negative. Accepting this approach in our patient
population, the need for mediastinoscopy would have been reduced by 12%.
3
UI - 11845850
AU - Patelli M; Agli LL; Poletti V; Trisolini R; Cancellieri A; Lacava N;
TI -
Falcone F; Boaron M
Role of fiberscopic transbronchial needle aspiration in the staging of
N2 disease due to non-small cell lung cancer.
SO - Ann Thorac Surg 2002 Feb;73(2):407-11
AD - Department of Thoracic Diseases, Maggiore/Bellaria Hospitals, Bologna,
Italy. marco.patelli@ausl.bologna.it
BACKGROUND: Transbronchoscopic needle aspiration (TBNA) can offer a
unique opportunity to identify surgically unresectable lung cancer and
to avoid surgical mediastinal exploration in many patients with
mediastinal lymph node extension of the tumor. The aim of this study was
to assess the yield of TBNA performed with either histology or cytology
needles in mediastinal staging of N2 disease due to non-small cell lung
cancer (NSCLC). METHODS: Retrospective chart review was carried out on
a single institution. Inclusion criteria were pathologic evidence of
NSCLC; contrast enhancement computed tomography scan of the chest
suggesting N2 disease; and negative bronchoscopic examination for
possible neoplastic lesions at the site of RESULTS: Overall sensitivity
and diagnostic accuracy were 71% and 73%, respectively, with no
significant differences between 19-gauge and 22-gauge cytology needles.
Procedures performed for right paratracheal and subcarinal lymph node
stations had a significantly higher yield than those for the left
paratracheal station. CONCLUSIONS: TBNA mediastinal staging, performed
during the initial diagnostic evaluation of NSCLC, can spare costs and
risks of more invasive procedures in patients with inoperable tumors, in
patients who are not candidates for operation because of coexistent
significant comorbidities, and in patients with N2 disease.
4
UI - 11845851
AU - Sawabata N; Matsumura A; Motohiro A; Osaka Y; Gennga K; Fukai S; Mori T;
TI -
The Japanese National Chest Hospital Study group for Lung Cancer
Malignant minor pleural effusion detected on thoracotomy for patients
with non-small cell lung cancer: is tumor resection beneficial for
prognosis?
SO - Ann Thorac Surg 2002 Feb;73(2):412-5
AD - Division of Surgery, Toneyama National Hospital, Toyonaka, Osaka, Japan.
nori@toneyama.hosp.go.jp
BACKGROUND: This study attempts to clarify the benefit of surgery for
non-small cell lung cancer (NSCLC) with malignant minor pleural effusion
that is detected at thoracotomy. METHODS: Records of surgical patients
with NSCLC were reviewed, with a definition of minor pleural effusion as
less than 300 mL. The patients were divided into three groups as
follows: (1) group C consisted of patients who underwent grossly
complete resection; group I, patients with incomplete tumor resection;
and group E, patients who underwent exploratory thoracotomy only.
RESULTS: There were 196 patients who had minor pleural effusion; of
these, 96 (46%) underwent an examination to define the malignancy status
of pleural effusion after surgery. In 43 patients (45%), the effusion
was found to be malignant. The median survival time and 5-year survival
rate, respectively, were 13 months and 9% for group C (n = 11); 34
months and 10% for group I (n = 14; p = 0.3); and 17 months and 0% for
group E (n = 18; p = 0.8). CONCLUSIONS: Tumor resection is not
beneficial for the survival of patients with NSCLC who have a minor
malignant pleural effusion.
5
UI - 11823702
AU - Chen M; Jiang GL; Fu XL; Wang LJ; Qian H; Zhao S; Liu TF
TI -
Prognostic factors for local control in non-small-cell lung cancer
treated with definitive radiation therapy.
SO - Am J Clin Oncol 2002 Feb;25(1):76-80
AD - Department of Radiation Oncology, Cancer Center, Sun Yat-sen University
of Medical Sciences, 651 Dong-Feng Road, Guangzhou 510060, China.
Radiotherapy plays an important role as a treatment for locally advanced
non-small-cell lung cancer (NSCLC), but local failure still occurs in
70% to 80% of the patients. A retrospective analysis was carried out to
analysis. All patients received definitive radiotherapy. The
significance of prognostic variables on local control was evaluated
using univariate analysis and Cox stepwise regression model. The
prognostic index was calculated according to the value of each
prognostic factor on local control. Median local progression-free
survival time of the whole group was 9.7 months, and 1-, 3-, and 5-year
actuarial local progression-free survival were 54%, 24%, and 19%,
respectively. Univariate and multivariate analyses showed patients with
smaller tumor volume, earlier clinical staging, and treated with higher
total dose in shortened overall treatment time had better local control.
Tumor volume, clinical staging, and radiotherapy methods were
independent prognostic factors on local control. The prognostic index
model could predict the local control condition of NSCLC treated with
radiation therapy more effectively than a single variable such as TNM
staging.
6
UI - 11857309
AU - Hommura F; Furuuchi K; Yamazaki K; Ogura S; Kinoshita I; Shimizu M;
TI -
Moriuchi T; Katoh H; Nishimura M; Dosaka-Akita H
Increased expression of beta-catenin predicts better prognosis in
nonsmall cell lung carcinomas.
SO - Cancer 2002 Feb 1;94(3):752-8
AD - First Department of Medicine, Hokkaido University School of Medicine,
Sapporo, Japan.
BACKGROUND: beta-Catenin has been shown to function as a Wnt signaling
molecule to stimulate cyclin D1 expression and cell growth in several
kinds of tumors. METHODS: The authors immunohistochemically examined
specimens of 217 surgically resected primary nonsmall cell lung
carcinomas (NSCLCs) for beta-catenin expression and classified them
semiquantitatively into three categories, including those with high,
moderate, and low scores of expression. RESULTS: High, moderate, and low
scores of expression were found in 37 (17.1%), 145 (66.8%), and 35
(16.1%) tumors, respectively. beta-Catenin expression was not correlated
with cyclin D1 expression, but was positively correlated with the Ki-67
cell growth fraction (P = 0.04). The direct sequencing analysis for the
beta-catenin gene mutation of 13 specimens of 217 tumors for the current
study revealed no mutations. The relation between survival and
beta-catenin expression was evaluated in 148 potentially curatively
resected tumors with pathologic Stages I-IIIA. A trend toward better
survival was found in patients with tumors having higher scores. In
multivariate analysis, high beta-catenin expression was a significant
and independent favorable prognostic factor (hazards ratio, 0.31; P =
0.007) as was pathologic stage. Analyzed by cell type, in nonsquamous
cell carcinomas, patients with tumors having high scores survived a
significantly longer time than those with tumors having moderate or low
scores (5-year survival rates, 84%, 55%, and 32%, respectively; P =
0.02), and high beta-catenin expression tended to be a favorable
prognostic factor (hazards ratio, 0.32; P = 0.052). CONCLUSIONS: These
results indicate that, in NSCLCs, increased expression of beta-catenin
can predict favorable prognosis of patients with resected tumors,
suggesting that accumulation of beta-catenin has no or little oncogenic
effect via activation of the Wnt pathway, unlike in colon carcinomas or
hepatomas. Copyright 2002 American Cancer Society. DOI
10.1002/cncr.10213ROUND: N2b Catenin has been
7
UI - 11770423
AU - Chen Q; Zhou J; Wu Y
TI -
[Quantitative studies on expression of peripheral blood CD44 and CD54 in
non-small cell lung carcinoma]
SO - Zhonghua Jie He He Hu Xi Za Zhi 2001 Oct;24(10):605-7
AD - Department of Biomedical Engineering, Zhejiang University, Hangzhou
310012, China.
OBJECTIVE: To assess the relationship between expression of peripheral
blood CD44 and CD54 in lymphocyte with non-small cell lung cancer and
clinicopathological features. METHODS: Peripheral blood CD44 contents in
50 patients with lung cancer were detected by flow-cytometry, 30 normal
donors and 25 patients with benign lesions served as controls. RESULTS:
Peripheral blood CD44 and CD54 in lymphocyte with lung cancer were
significantly higher than those in benign lesions and normal controls (P
< 0.01). There is no distinct difference between CD44 and CD54 in benign
lesions and normal controls (P > 0.05). Lung cancer with lymph node
metastasis showed higher expression of CD44 and CD54 than lung cancer
without lymph node metastasis (P < 0.01). Distinctly statistic
difference was showed between CD44 in stage III, IV and stage I, II (P <
0.01). CD54 content in stage IV was higher than that in stage I, II and
III, respectively. Histopathological grade was significantly associated
with the expression of CD44 and CD54. Peripheral blood CD44 and CD54
contents were not related with squamous cell carcinoma and
adenocarcinoma. CONCLUSION: Detection of CD44 and CD54 levels by flow
cytometry might be used as a marker to evaluate prognosis and metastasis
in patients with non-small cell lung cancer.
8
UI - 11872280
AU - Mac Manus MP; Wong K; Hicks RJ; Matthews JP; Wirth A; Ball DL
TI -
Early mortality after radical radiotherapy for non-small-cell lung
cancer: comparison of PET-staged and conventionally staged cohorts
treated at a large tertiary referral center.
SO - Int J Radiat Oncol Biol Phys 2002 Feb 1;52(2):351-61
AD - Department of Radiation Oncology, Peter MacCallum Cancer Institute,
Melbourne, Victoria, Australia. mmanus@petermac.unimelb.edu.au
PURPOSE: At our center, approximately 30% of radical radiotherapy (RRT)
candidates become ineligible for RRT for non-small-cell lung cancer
(NSCLC) after positron emission tomography (PET). We hypothesized that
early cancer death rates would be lower in patients receiving RRT after
PET staging compared with conventionally staged patients. METHODS AND
MATERIALS: Two prospective cohorts were compared. Cohort 1 consisted of
all participants in an Australian randomized trial from our center given
60 Gy conventionally fractionated RRT with or without concurrent
carboplatin from 1989 to 1995. Eligible patients had Stage I--III,
Eastern Cooperative Oncology Group status 0 or 1, <10% weight loss, and
had not undergone PET. Cohort 2 included all RRT candidates between
fulfilled the above criteria for stage, Eastern Cooperative Oncology
Group status, and weight loss. RESULTS: Eighty and 77 eligible patients
comprised the PET and non-PET groups, respectively. The PET-selected
patients had significantly less weight loss; 73% and 49% of the PET and
non-PET patients, respectively, received chemotherapy. The median
survival was 31 months for PET patients and 16 months for non-PET
patients. Mortality from NSCLC and other causes in the first year was
17% and 8% for PET patients and 32% and 4% for non-PET patients,
respectively. The hazard ratio for NSCLC mortality for PET vs. non-PET
patients was 0.49 (p = 0.0016) on unifactorial analysis and was 0.55 (p
= 0.0075) after adjusting for chemotherapy, which significantly improved
survival. CONCLUSION: Patients selected for RRT after PET have lower
early cancer mortality than those selected using conventional imaging.
9
UI - 11872281
AU - Lee JS; Scott CB; Komaki R; Ettinger DS; Sause WT
TI -
Impact of institutional experience on survival outcome of patients
undergoing combined chemoradiation therapy for inoperable non-small-cell
lung cancer.
SO - Int J Radiat Oncol Biol Phys 2002 Feb 1;52(2):362-70
AD - University of Texas M. D. Anderson Cancer Center, Houston, TX 77030,
USA. jslee@ncc.re.kr
PURPOSE: Clinical experience of both physicians and institutions has
been shown to significantly influence the outcome of patients. We
conducted this retrospective cohort study to examine its impact on the
outcome of patients undergoing combined chemoradiation therapy for the
treatment of locally advanced inoperable non-small-cell lung cancer.
METHODS AND MATERIALS: We compared the clinical data from 239 patients
who were enrolled in two consecutive Radiation Therapy Oncology Group
(RTOG) trials (RTOG 91-06, RTOG 92-04) according to the number of
patients enrolled from each institution in either trial alone or the two
trials combined. RESULTS: Overall, patients treated at the institutions
that enrolled > or = 5 patients survived longer than those treated at
the institutions that enrolled <5 patients (median survival 20.5 vs.
13.4 months, p = 0.0006) with a more than doubling of the 2- and 3-year
survival rates (45% and 31% vs. 20% and 13%, respectively). Multivariate
analyses confirmed that the number of patients enrolled from each
institution was an important prognostic factor for the entire group (p =
0.001) and also for RTOG 91-06 (p = 0.05) and RTOG 92-04 (p = 0.004)
when the data were analyzed separately. CONCLUSION: Institutional
experience has a significant impact on the survival outcome of patients
undergoing combined chemoradiation therapy for inoperable non-small cell
lung cancer.
10
UI - 11872282
AU - Sloan JA; Bonner JA; Hillman SL; Allmer C; Shanahan TG; Brooks BJ; Marks
TI -
RS; Vargas-Chanes D; Jett JR
A quality-adjusted reanalysis of a Phase III trial comparing once-daily
thoracic radiation vs. twice-daily thoracic radiation in patients with
limited-stage small-cell lung cancer(1).
SO - Int J Radiat Oncol Biol Phys 2002 Feb 1;52(2):371-81
AD - Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
jsloan@mayo.edu
PURPOSE: We undertook an analysis of quality-adjusted survival using the
Q-TWiST (Quality Time Without Symptoms or Toxicity) methodology and
developed a new graphic representation called a quality-adjusted
life-years plot, which presents a complete and concise Q-TWiST analysis
on a single plot. METHODS AND MATERIALS: The Q-TWiST plot incorporates
the time without symptoms or toxicity and several combinations of
utility coefficients for toxicity and relapse days into the same plot.
In addition, the plot includes threshold lines, to judge whether a
particular combination of utility coefficients reaches a significance
level. RESULTS: The differential in toxicity incidence and severity
between the two thoracic radiation treatment arms was inconsequential.
Sensitivity analyses were run using Q-TWiST plots. For all combinations
of the various toxicity definitions and utility coefficients, the median
Q-TWiST was greater for the once-daily thoracic radiation treatment arm
than for the twice-daily treatment arm, without achieved significance.
CONCLUSION: This work refines the results previously reported for this
Phase III clinical trial in patients with limited-stage small-cell
cancer, and there was no significant difference in survival after
adjusting for toxicity and progression. Furthermore, the new methods
developed for this trial allow for a more detailed and parsimonious
presentation of survival and toxicity data for all oncology clinical
trials.
11
UI - 11872283
AU - Willner J; Baier K; Caragiani E; Tschammler A; Flentje M
TI -
Dose, volume, and tumor control prediction in primary radiotherapy of
non-small-cell lung cancer.
SO - Int J Radiat Oncol Biol Phys 2002 Feb 1;52(2):382-9
AD - Department of Radiation Oncology, University of Wurzburg, Wurzburg,
Germany. willner@strahlentherapie.uni-wuerzburg.de
BACKGROUND: To evaluate the influence of total dose and tumor volume on
local control and survival in primary radiotherapy of non-small-cell
lung cancer (NSCLC). METHODS AND MATERIALS: We retrospectively analyzed
the clinical course and CT-derived pre- and post-therapeutic tumor
volume data of 135 patients with NSCLC undergoing primary radiotherapy
at our department between 1989 and 1996. Among these, a total of 192
spatially separated tumor volumes (135 primary tumors, 1 additional
intrapulmonary tumor, and 56 involved lymph nodes) were available for
analysis. In all patients, treatment was planned using CT-based
three-dimensional treatment planning. The dose to each tumor volume was
derived from the individual dose plans. Mean total dose was 59.9 Gy
(range: 30-80 Gy). All but 3 patients were followed until death. For
local control analysis, each tumor was analyzed separately, and its
remission status was determined in serial follow-up CT scans. A total of
784 CT scans were analyzed. Actuarial local control analysis was
performed for the 192 separated tumor volumes, and survival analysis was
performed for the 135 patients. Tumor control probability was calculated
using a Poisson statistical model. RESULTS: Overall 1- and 2-year local
control rate was 50% and 37%, respectively. The 2-year local control
rate for tumors <50 ccm, 50-200 ccm, and >200 ccm was 51%, 22%, and 10%,
respectively (p = 0.02). The 2-year local control rate for dose levels <
or = 60 Gy and >60 Gy was 28% and 43% (p < 0.001). For the subgroup of
147 tumors smaller than 100 ccm, the local control rate increased up to
70% (1 year) and 51% (2 years) with doses of more than 60 Gy. For tumors
larger than 100 ccm, no dose effect was seen. Only 2 of 45 tumors >100
ccm were controlled more than 2 years. Multivariate analysis revealed
tumor volume, total dose, histopathologic type, and grading as
significant and independent prognostic factors for local control. The
number of delay days by split course (if used) and application of
chemotherapy was not found to influence local control. Overall 1- and
2-year survival rate was 42% and 13%. Total radiation dose,
chemotherapy, and T and N stage---but not tumor volume---were found to
be independent and significant prognostic factors for survival in
multivariate analysis. CONCLUSION: Tumor volume is an important
predictor of local control in NSCLC. We found a clear dose effect for
local control and survival in NSCLC. Long-term local control for a
significant proportion of patients seems possible for small tumors only
(<100 ccm, i.e., maximum diameter 6 cm) with doses of 70 Gy and more.
Tumors of > or = 100 ccm are unlikely to be controlled long term by
conventional doses up to 70 Gy. These results support dose escalation in
patients with NSCLC.
12
UI - 11872284
AU - Okamoto Y; Murakami M; Yoden E; Sasaki R; Okuno Y; Nakajima T; Kuroda Y
TI -
Reirradiation for locally recurrent lung cancer previously treated with
radiation therapy.
SO - Int J Radiat Oncol Biol Phys 2002 Feb 1;52(2):390-6
AD - Department of Radiology, Tenri Hospital, Nara, Japan.
yoshirt@olive.plala.or.jp
PURPOSE: Local recurrence of lung cancer after previous external beam
irradiation poses some problems for subsequent management. We
retrospectively reviewed our series of patients with local recurrence of
lung cancer to evaluate the efficacy and safety of reirradiation.
PATIENTS AND METHODS: Between 1979 and 2000, 34 patients with local
recurrence of lung cancer were retreated with external radiation. There
were 29 males and 5 females ranging in age from 38 to 85 years (median:
69 years). At the time of reirradiation, the clinical stage was I or II
in 2 patients, IIIa in 5 patients, IIIb in 14 patients, and IV in 13
patients. Reirradiation was performed in 18 patients with the aim of
achieving a cure or prolongation of survival (radical treatment), while
16 patients were treated for improvement of their symptoms (symptomatic
treatment). RESULTS: The median interval between the initial radiation
therapy and reirradiation was 23 months, with a range of 5 to 87 months.
The dose of initial irradiation delivered to the tumor ranged from 30 to
80 Gy (median: 60 Gy) in 1.5--2.0-Gy fractions per day. During
reirradiation, it ranged from 10 to 70 Gy (median: 50 Gy) in 1.8--3.0-Gy
fractions per day. The cumulative dose delivered to the tumor by
treatments of both initial and second irradiation ranged from 56.5 to
150 Gy (median: 110 Gy). A response was observed in 14 out of 18
patients given radical treatment (complete response, 6; partial
response, 8). Twelve of the 16 patients (75%) given symptomatic
treatment also showed a symptomatic benefit. The overall survival rate
after reirradiation was 43% at 1 year and 27% at 2 years, with a median
survival time of 8 months. The median survival time after radical
treatment was 15 months, with a range of 3 to 58 months, whereas that
after symptomatic treatment was 3 months, with a range of 1 to 14
months. Six long-term survivors lived for more than 20 months.
Reirradiation-induced toxicity included symptomatic radiation
pneumonitis in 19 patients and symptomatic radiation esophagitis in 6
patients. These toxicities were not fatal, and radiation myelopathy was
not caused by reirradiation. CONCLUSION: Based on this study, external
beam reirradiation can achieve satisfactory results for local recurrence
of lung cancer provided that attention is paid to the possible hazards.
13
UI - 11810779
AU - Ye M; Wang L; Fu X
TI -
[Accelerated hyperfractionation radiation therapy combined with
chemotherapy for non-small cell lung cancer complicated with superior
vena cava syndrome]
SO - Zhonghua Zhong Liu Za Zhi 2001 Sep;23(5):426-7
AD - Department of Radiation Oncology, Cancer Hospital, Shanghai Medical
University, Shanghai 200032, China.
OBJECTIVE: This retrospective study was done to evaluate the patient's
tolerance and effect of accelerated hyperfractionation radiation therapy
in the treatment of superior vena cava syndrome (SVCS) caused by
non-small cell lung cancer (NSCLC). METHODS: Thirty-four NSCLC patients
1996. Their ages ranged from 36-78 years (median 57). There were 30
(88.2%) male and 4(11.8%) female patients. Dyspnea (67.6%) and facial
swelling (52.9%) were the two most common symptoms. Engorgement of neck
veins (38.2%) and dilated chest wall veins (28.5%) were the most common
physical findings. According to their pathological diagnosis, there were
17(50%) squamous cell carcinomas, 14(41.2%) adenocarcinomas, 2(5.9%)
mixed squamous and adenocarcinomas and 1(2.96%) poorly differentiated
carcinomas. By thoracic CT scans, a mass was most commonly found in the
right upper lobe and the upper mediastinum. For these patients,
chemotherapy IEP or IAP (IFO 2.0 g d1-4, DDP 40 mg d1-3, Vp-16 0.1 g
d1-3 or ADM 50 mg d1) was given first. Twenty-four to 72 hours after
chemotherapy, accelerated hyperfractionation radiation therapy was
started to deliver to the primary tumor and the metastatic mediastinal
lymph nodes, a tumor dose of 30 Gy/20 fx/2 wk followed by a boost to
36-40.8 Gy/30-34 fx/3-3.5 wk. Diuretics, steroids and dehydrating agents
were concomittantly prescribed during the radiation therapy. RESULTS:
Relief of SVCS to various degrees was noted in all patients. CR, PR and
MR rates were 20.6% (7/34), 50% (17/34) and 29.4% (10/34), respectively.
The median survival was 12 months (4-26 months). The 1-2 year actuarial
survival rates were 58.1% and 18.2% Except radio-esophagitis in
different degrees, no other severe complications were observed.
CONCLUSION: The fraction and total dose of radiotherapy are tolerable in
this accelerated hyperfractionation trial. Radiation therapy combined
with chemotherapy gives similar results as non-surgery for stage III
NSCLC. No significant difference in the survival rates of the various
histological types is observed.
14
UI - 11810780
AU - Wang Y; Wang L; Zhang D
TI -
[Diagnosis and surgical treatment of double primary lung cancer]
SO - Zhonghua Zhong Liu Za Zhi 2001 Sep;23(5):428-30
AD - Department of Thoracic Surgery, Cancer Institute (Hospital), Chinese
Academy of Medical Sciences, Peking Union Medical College, Beijing
100021, China.
OBJECTIVE: To arrive at a rational diagnosis and effective surgical
treatment of double primary lung cancer. METHODS: Thirty-four patients
with double primary lung cancers were operated in our department from
1977 to 1999. RESULTS: Twenty-two lesions were metachronous and 12
synchronous. Among the patients with metachronous second primary lung
cancer, 10 were treated by lobectomy, 11 by partial resection and one
was explored only. The morbidity, mortality and 5-year survival rates
were 13.6%, 4.6% and 25.0%, respectively. Among the synchronous double
primary lung cancer patients, 2 were treated by lobectomy and 2 by
pneumonectomy and the others by partial resection at least for one
tumor. There was no morbidity or mortality, and the 5-year survival rate
was 14.3%. CONCLUSION: Because of the low detection rate of double
primary lung cancer, preoperative diagnosis, differential diagnosis and
postoperative follow up must be paid with due attention. Conservative
operation and incomplete lymph node dissection, being the chief reasons
of poor outcome, should be stressed.
15
UI - 11828286
AU - Grunenwald DH; Mazel C; Girard P; Veronesi G; Spaggiari L; Gossot D;
TI -
Debrosse D; Caliandro R; Le Guillou JL; Le Chevalier T
Radical en bloc resection for lung cancer invading the spine.
SO - J Thorac Cardiovasc Surg 2002 Feb;123(2):271-9
AD - Thoracic Department, Institut Mutualiste Montsouris, Paris, France.
thorax@imm.fr
OBJECTIVE: We reviewed our 8-year experience with en bloc partial and
total vertebrectomy for lung cancer invading the spine and report
outcome and survival. METHODS: Nineteen patients with lung cancers
involving the spine underwent en bloc resection. Eleven received
induction treatment (chemotherapy, n = 5; chemoradiotherapy, n = 4; and
radiation, n = 2). Pneumonectomy was performed in 3 patients, lobectomy
in 13 patients, and wedge resection in 3 patients. Hemivertebrectomy was
performed in 15 patients, and total vertebrectomy was performed in 4
patients. The median number of resected vertebral bodies was 3 (range,
1-4). Tumor stage was IIIB in 14 patients, IIIA in 1 patient, and IIB in
4 patients (hemivertebrectomy is performed in the case of T3 disease to
obtain free margins). Surgical nodal status was N0 in 13 patients, N1 in
3 patients, N2 in 1 patient, and N3 (supraclavicular) in 2 patients.
Complete macroscopic and microscopic resection was achieved in 15 (79%)
patients. RESULTS: There was no immediate postoperative mortality.
Morbidity was observed in 10 patients, including 4 (21%) complications
related to the spinal surgery. The median hospital stay was 30 days.
Seven patients were alive after a mean follow-up of 26 months (range,
7-74 months). The 1- and 5-year predicted survivals (updated) are 59%
and 14%, respectively. Nine local recurrences were observed.
CONCLUSIONS: En bloc resection of chest tumors with vertebrectomy is
technically demanding, and postoperative morbidity should be critically
addressed with this aggressive surgical intervention. However, an
encouraging long-term survival observed in this series suggests that en
bloc resection could be a valid option in selected patients with
vertebral involvement of chest tumors.
16
UI - 11828287
AU - Battafarano RJ; Piccirillo JF; Meyers BF; Hsu HS; Guthrie TJ; Cooper JD;
TI -
Patterson GA
Impact of comorbidity on survival after surgical resection in patients
with stage I non-small cell lung cancer.
SO - J Thorac Cardiovasc Surg 2002 Feb;123(2):280-7
AD - Department of Surgery, Division of Cardiothoracic Surgery, Washington
University School of Medicine, St Louis, MO 63110-1013, USA.
battafarano@msnotes.wustl.edu
OBJECTIVE: As the mean age in patients with non-small cell lung cancer
increases, the proportion of patients with serious comorbidity who are
considered for surgical resection also increases. Patients with
non-small cell lung cancer have been shown to have a higher burden of
comorbidity than do patients with tumors of other sites, such as breast,
prostate, colon, and head and neck. The goal of this review was to
determine the impact of comorbidity on postoperative and long-term
survival after surgical resection in patients with stage I non-small
cell lung cancer. METHODS: A database analysis of our hospital's tumor
registry included 451 patients who underwent surgical resection for
pathologic stage I non-small cell lung cancer between January 1, 1994,
and December 31, 1999. Comorbidity severity was prospectively determined
with the Kaplan-Feinstein Index. Survival data were collected for each
patient from the date of operation, with a mean duration of follow-up of
35.7 months. Bivariate statistics and Cox proportional hazards model
analyses were used. RESULTS: The mean age was 64.4 years, and 249 (55%)
patients were male. The distribution of overall comorbidity severity was
none, 142 (31.5%); mild, 150 (33.3%); moderate, 115 (25.5%); and severe,
44 (9.8%). The overall in-hospital mortality was 2.2% (n = 10/451).
There was a nonsignificant trend toward higher hospital mortality with
greater comorbidity: none, 0.7% (n = 1/142); mild, 3.3% (n = 5/150);
moderate, 0.9% (n = 1/115); and severe, 6.8% (n = 3/44, P =.055).
Kaplan-Meier estimated survivals at 3 years for each level of
comorbidity were as follows: none, 85.6%; mild, 74.8%; moderate, 68.8%;
and severe, 70.0% (P <.002). After adjustment for age, sex, T status,
and tumor histologic type, the relative risks of death as a function of
comorbidity were mild, 1.44 (95% confidence interval 0.89-2.34);
moderate, 2.28 (95% confidence interval 1.43-3.65); and severe; 1.94
(95% confidence interval 1.023-3.70). CONCLUSIONS: Comorbidity has a
significant impact on survival after surgical resection of patients with
stage I non-small cell lung cancer. These data may help to explain the
lower than expected survival results for patients after surgical
resection for stage I non-small cell lung cancer.
17
UI - 11856695
AU - Wu MT; Pan HB; Chiang AA; Hsu HK; Chang HC; Peng NJ; Lai PH; Liang HL;
TI -
Yang CF
Prediction of postoperative lung function in patients with lung cancer:
comparison of quantitative CT with perfusion scintigraphy.
SO - AJR Am J Roentgenol 2002 Mar;178(3):667-72
AD - Department of Radiology, Kaohsiung Veterans General Hospital, 386
Ta-chung 1st Rd., Kaohsiung, 813, Taiwan.
OBJECTIVE: Prediction of postoperative lung function is important in
preoperative evaluation of patients with lung cancer. Perfusion
scintigraphy is the current method to assess the fractional contribution
of lung function of the remaining lung. We developed a quantitative CT
method and compared it with perfusion scintigraphy for predictions of
postoperative forced expiratory volume in 1 sec (FEV1) in patients with
lung cancer. SUBJECTS AND METHODS: Forty-four patients with lung cancer
undergoing lung resection with preoperative CT and perfusion
scintigraphy were enrolled. Quantitative CT used a dual threshold (-500
and -910 H) on standard preoperative CT to semiautomatically extract
lung volume without emphysema or tumor and atelectasis, which we defined
as "functional lung volume." Prediction was calculated from preoperative
FEV1 multiplied by the fractional contribution of functional lung volume
of the remaining lung by quantitative CT. Perfusion scintigraphy was the
standard method. Predictions were correlated with postoperatively
measured FEV1. RESULTS: Both quantitative CT and perfusion scintigraphy
predicted postoperative FEV1 well in patients who underwent
pneumonectomy (n = 28, r = 0.88 vs r = 0.86) and in lobectomy (n = 16, r
= 0.90 vs r = 0.80) (both, p < 0.001). There was good agreement between
the two methods by the Bland-Altman method. In the four patients with
low measured postoperative FEV1 (<40% predicted normal), quantitative CT
had true-positive prediction in four and perfusion scintigraphy, in only
two. CONCLUSION: Given its simplicity, we proposed that quantitative CT
be widely used in predicting postoperative FEV1.
18
UI - 11870504
AU - Yang CH; Tsai CM; Wang LS; Lee YC; Chang CJ; Lui LT; Yen SH; Hsu C;
TI -
Cheng AL; Liu MY; Chiang SC; Chen YM; Luh KT; Huang MH; Yang PC; Perng
RP
Gemcitabine and cisplatin in a multimodality treatment for locally
advanced non-small cell lung cancer.
SO - Br J Cancer 2002 Jan 21;86(2):190-5
AD - Department of Oncology and Cancer Research Center, National Taiwan
University Hospital, College of Medicine, National Taiwan University, 7,
Chung-Shan South Road, Taipei, 10016, Taiwan.
The role of new cytotoxic agents like gemcitabine has not yet been
proven in the neoadjuvant settings. We designed a phase II study to test
the feasibility of using gemcitabine and cisplatin before local
treatment for stage III non-small cell lung cancer patients. Patients
received three cycles of induction chemotherapy of gemcitabine (1000 mg
m(-2), days 1, 8, 15) and cisplatin (90 mg m(-2), day 15) every 4 weeks
before evaluation for operability. Operable patients underwent radical
resection. Inoperable patients and patients who had incomplete resection
received concurrent chemoradiotherapy with daily low dose cisplatin. All
patients who did not progress after local treatment received three more
cycles of adjuvant chemotherapy of gemcitabine and cisplatin. Fifty-two
patients received induction treatment. Two patients had complete
response and 31 patients had partial response (response rate 63.5%)
after induction chemotherapy. Thirty-six patients (69%) were operable.
Eighteen patients (35%) had their tumours completely resected. Two
patients had pathological complete response. Median overall survival was
19.1 months, projected 1-year survival was 66% and 2-year survival was
34%. Three cycles of gemcitabine and cisplatin is effective and can be
used as induction treatment before surgery for locally advanced
non-small cell lung cancer patients. Copyright 2002 The Cancer Research
Campaign
19
UI - 11717013
AU - Barlesi F; Doddoli C; Thomas P; Kleisbauer JP; Giudicelli R; Fuentes P
TI -
Bilateral bronchioloalveolar lung carcinoma: is there a place for
palliative pneumonectomy?
SO - Eur J Cardiothorac Surg 2001 Dec;20(6):1113-6
AD - Department of Thoracic Oncology, Sainte-Marguerite Hospital, Marseille,
France. fbarlesi@mail.ap-hm.fr
OBJECTIVE: Bronchioloalveolar lung carcinoma (BAC) is characterized by
bronchial and lymphatic dissemination explaining multifocal and
bilateral spreading. Bilateral BAC is usually considered as a
contraindication to surgery. Regarding poor efficacy of symptomatic and
oncological treatments, we hypothesized that surgery might play a role
to palliate hypoxemia associated with serious intrapulmonary shunting,
as well as continuous bronchorrhea. METHODS: We retrospectively studied
here four consecutive patients, who underwent palliative pneumonectomy.
RESULTS: The shunt was confirmed again at the time of the surgery by a
pulmonary artery occlusion demonstrating immediate improvement in
arterial oxygen saturation from 89% at baseline to 98% after occlusion.
Lung resections consisted of a left pneumonectomy in three cases and a
right pneumonectomy in one. PaO(2) levels under 5l/min oxygen therapy
improved dramatically when comparing preoperative data (mean 50.5 mmHg)
to post-operative results (mean 150 mmHg). One patient died
postoperatively. Three patients, who experienced an uneventful immediate
post-operative course, received chemotherapy after surgery. Improvement
of quality of life is testified by the absence of both symptoms and any
need for oxygen therapy for few months. Disabling symptoms reappeared at
1, 8 and 10 months. Survival of these patients was 3, 12 and 18 months.
CONCLUSIONS: These results support the interest of consideration of a
surgical resection for highly selected patients presenting with
bilateral BAC and severe intrapulmonary shunting.
20
UI - 10917968
AU - Riquet M; Porte H; Chapelier A; Brichon PY; Bernard A; Dujon A; Dahan M;
TI -
Bonette P; Guidicelli R; Jancovici R; Monteau M; Moreau JL; Moreau JM;
Peillon C; Bellenot F; Faillon JM; Mouroux J
Resection of lung cancer invading the diaphragm.
SO - J Thorac Cardiovasc Surg 2000 Aug;120(2):417-8
AD - Departments of Thoracic Surgery, Hopital Laennec, Paris; Hopital
Calmette, Lille, France. marc.riquet@lnc.ap-hop-paris.fr
21
UI - 11892374
AU - Anonymous
TI -
Chemotherapy and non-small-cell lung cancer.
SO - Drug Ther Bull 2002 Feb;40(2):9-11
Around 34,000 people in the UK die from lung cancer each year. Over 75%
of patients with the disease have non-small-cell lung cancer (NSCLC).
Here, we discuss the role of chemotherapy in the management of NSCLC, a
treatment that some medical oncologists estimate would benefit 50% of
patients with NSCLC, but which is given to fewer than 10%.
22
UI - 11824322
AU - Fisseler-Eckhoff A
TI -
[Malignant lung tumors--histomorphological classification,
immunohistological techniques and prognostic factors]
SO - Kongressbd Dtsch Ges Chir Kongr 2001;118():590-5
AD - Institut fur Pathologie, Zentralklinik Emil-von-Behring, Gimpelsteig
3-9, 14165 Berlin.
Histological typing of lung tumors is based on the new WHO-IASLC
classification of lung and pleural tumors published in 1999. Based on
histological growth pattern, the major light microscopic categories of
lung carcinomas are squamous cell carcinoma, small cell carcinoma,
adenocarcinoma and large cell carcinoma. The further subclassification
within the main categories resembles the high degree of lung tumor
heterogeneity. Immunohistochemistry may detect differentiation that
cannot be seen by routine light microscopy on small bioptically obtained
specimens. Evaluation of the proliferation index of tumor cells,
hormonal receptors, oncogenes and tumor-suppressor genes is possible.
Oncogenes, tumor-suppressor genes, angiogenetical factors as well as
single cell dissemination of tumor cells in lymph nodes are discussed as
possible prognostic factors.
23
UI - 11824324
AU - Hillejan L; Muller MR; Eberhardt W; Stuben G; Stamatis G
TI -
[Neoadjuvant chemotherapy and chemoradiotherapy in surgically treated
non-small-cell stage III bronchial carcinoma]
SO - Kongressbd Dtsch Ges Chir Kongr 2001;118():601-5
AD - Ruhrlandklinik Essen, Tuschenerweg 40, 45239 Essen.
Patients with unfavorable stages of lung cancer are rarely cured with
local treatment modalities alone. Aim of our phase II trial was to
investigate the effectivity of a multimodality treatment. Ninety-four
patients with NSCLC (stage IIIA/IIIB) were treated preoperatively with
chemoradiotherapy (cisplatin and etoposide, 45 Gy hyperfractionated
accelerated radiotherapy). After repeat mediastinoscopy patients
underwent surgery. Complete resection (R0) was achieved in 53% of all
patients with NSCLC. Two patients died of sepsis preoperatively and four
postoperatively (90-days lethality: 6.4%). The median survival time was
20 months for IIIA and 18 months for IIIB. Calculated survival rates at
6 years were 34% for IIIA and 17% for IIIB. This multimodality treatment
demonstrates high efficacy in prognostically unfavorable NSCLC compared
with historical controls.
24
UI - 11824325
AU - Serke M; Allica E; Wolf M; Schonfeld N; Kaiser D; Loddenkemper R
TI -
[Non-small-cell bronchial carcinoma with pathological N2 involvement:
adjuvant radiotherapy versus adjuvant chemo-radiotherapy]
SO - Kongressbd Dtsch Ges Chir Kongr 2001;118():606-10
AD - Abteilung fur Pneumologie, Zentralklinik Emil von Behring, Dept.
Lungenklinik Heckeshorn, Zum Heckeshorn 33, 14109 Berlin.
Fifty-eight patients, 28 of them included in a German multicenter study,
were treated either with radiotherapy (5 x 2 Gy/50 Gy) or combined
radio-chemotherapy (cisplatin 75 mg/m2 d1 in cases with pneumonectomy
etoposide 120 mg/m2 d1-3) and Ifosfamid 1.5 mg/m2 d1-4, 3 cycles)
following surgery in pN2-NSCLC. Metastatic disease or local failure was
seen in 24 patients (43%), in the majority with distant metastasis (n =
21), in 4 patients combined local and distant failure. Time to
progression (TTP) was 27 to 1172 days, median 244 days. Median survival
of the whole group was 873 days (= 29 months), the 3-year survival 49%.
Comparing the two groups there was an advantage (not significant) in
favor of the combined treated group with a median survival of 1449 days
versus 765 days (p = 0.22).
25
UI - 11783103
AU - Wang S; Wu Y; Ou W
TI -
[Skip metastasis to the mediastinal lymph nodes in non-small cell lung
cancer]
SO - Zhonghua Zhong Liu Za Zhi 2001 May;23(3):259-61
AD - Cancer Center, Sun Yet-sen University of Medical Sciences, Guangzhou
510060, China.
OBJECTIVE: To ascertain if any difference exists in clinical
characteristics between resected non-small cell lung cancer (NSCLC) with
either skip or ordinary mediastinal lymph node metastases. METHODS:
Among 176 patients with stage IIIAN2 disease between 1982-1994 treated
in our hospital, 53 had no metastasis at the hilar lymph nodes [skip(+)
group] while 123 had [skip(-) group]. To investigate the extent of nodal
involvement, the mediastinal lymph nodes were divided into three
regions. RESULTS: In the skip(+) group, mediastinal node metastasis was
found in only one region in 49 of the 53 patients(92.4%), whereas 45 of
the 123 patients(36.6%) from the skip (-) group revealed medinastinal
metastasis at two or three regions The overall survival rate at 5 years
after operation was 29.3% in the skip(+) group and 12.2% in the skip (-)
group (P = 0.038). Furthermore, regarding patients with mediactint node
metantion in one region, the skip(+) group had a better prognosis than
the skip (-) group (32.1% vs 15.3%, P = 0.042). CONCLUSION: These
results suggest that patients with skip mediastinal lymph node
metastases represent a unique subgroup of N2 disease.
26
UI - 11762351
AU - Virgolini I; Patri P; Novotny C; Traub T; Leimer M; Fuger B; Li SR;
TI -
Angelberger P; Raderer M; Wogritsch S; Kurtaran A; Kletter K; Dudczak R
Comparative somatostatin receptor scintigraphy using
in-111-DOTA-lanreotide and in-111-DOTA-Tyr3-octreotide versus
F-18-FDG-PET for evaluation of somatostatin receptor-mediated
radionuclide therapy.
SO - Ann Oncol 2001;12 Suppl 2():S41-5
AD - Department of Nuclear Medicine, University of Vienna, Austria.
irene.virgolini@akh-wien.ac.at
BACKGROUND: Based on the high number of somatostatin (SST) receptors
expressed by neuroendocrine tumors, long-acting SST analogs have been
successfully used for tumor detection. New developments point to the
potential use of these types of radioligands for tumor-specific
radionuclide therapy. PATIENTS AND METHODS: We have comparatively
investigated the diagnostic capacity of the SST analog.
111In-DOTA-lanreotide (LAN), as opposed to
111ln-DOTA-DPhe1-Tyr3-octreotide (TOCT) in tumor patients. This article
gives an overview of recent scintigraphic results compared to CT/MRI,
18F-FDG-PET, endoscopy and/or surgery in a threshold of 218 tumor
patients. RESULTS: As opposed to radiology, previously unknown tumor
lesions were demonstrable by either SST radioligand in about one third
of patients. In carcinoid patients, the SST scan sensitivity was 64% for
LAN (18 of 28) and 87% (34 of 39) for TOCT, whereas the sensitivity was
100% in patients with (radioiodine-negative) thyroid cancer (17 of 17)
for LAN and 95% for TOCT (20 of 21). Discordant scintigraphic results
between LAN and TOCT (higher tumor uptake and/or visualisation of
different lesions in the same patient) were also seen in patients with
lymphoma, lung cancer and intestinal adenocarcinoma. In a direct
comparison of both SST tracers in 38 tumor patients, LAN gave positive
results in 35 of 38, TOCT in 36 of 38 and 18F-FDG-PET in 14 of 22 of the
same patients. SST scan results obtained by both tracers were equivocal
in 23 of 38 patients, but were better in 10 patients withTOCTand in 5
patients with LAN. CONCLUSIONS: We conclude that both SST radioligands
are suitable tracers for tumor imaging, but may give significantly
different uptake results for different tumor types. Since the uptake is
most important for tumor therapy, using either longacting SSTanalogs,
and/or 90Y-labeled analogs, careful evaluation should be made prior to
therapy.
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