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463 Retrospective analysis of 200 lung cancer patients
Therapy - Combined Modality 11-111stages (Tl-3NO-ZMO) have been radically operated. 73 of them have lived more than 5 years without any features of the process progressing. 85 LCP died because of relapses and generalization of cancer during the first 5 years after radical operation. Explorative and palliative surgical treatment was performed for 72 LCP having the IV stage (Tl-3NO-2Ml) of the decease. The developed technology of prognosis was verified on another group of 222 operated LCP with the I-IV stages (Tl-3NO-2MO-1) having been monitored in postponed period. It is revealed that the prognosis of LC strictly depends on phase transition of early LC into invasive LC. It is proved that the 5-year survival rate of radically operated LCP is regulated significantly both by homeostasis parameters of the concrete patient and tumor’s characteristics. It is also found that the behavior and aggressiveness of LC and the postponed decease prognosis are strongly determined by the ratio of malignant cell population’s quantity to the factors of cell homeostasis in the integral human organism. It is proved that between the life duration of radically operated LCP with the ll-lll stages the whole number of hematological and biochemical homeostasis data and tumor’s characteristics there is a net of complex, specific quantitative, nominal and logical dependencies. It is discovered that the life duration of radically operated LCP with the ll-lll stages having the unfavorable decease outcome and patients with the IV stage of LC is regulated by the same factors of homeostasis and the quantity of tumor cell population in the whole patients organism. The complex dependencies of survival for LCP with unfavorable decease prognosis are calculated and identified.
463
Retrospective
analysis of 200 lung cancer patients
El K. Dural ’ , I. Olcay s, 0. Okcu ’ , F. Kocabeyoglu *, ij. Sakinci ’ ’ Department of Thoracic Surgery, Numune Hospital, Ankara; 2Department of Respiratory Medicine, Numune Hospital, Ankara,
Turkey
In this study, 200 patients with lung cancer admitted to our hospital in 1996 were retrospectively evaluated (mean age 54 year, 179 men, 21 women). Pretreatment staging procedures included bronchoscopy with bronchial biopsy, abdominal ultrasound, thorax and brain computed tomography, radionuclide bone scan. Duration of symptoms was approximately 4 months. The percentage of smokers was 91% (n: 182). 168 patients (84%) were operated and performed operations were; pneumonectomy 40% (n: 68), lobectomy 35% (n: 59) bilobectomy 14% (n: 23) thoracic wall resection 4% (n: 6) segmentectomy 1% (n: 2) wedge resection 1% (n: 2). 8 patients (5%) were evaluated as inoperable and resectic I couldn’t be performed. Postoperative lung cancer cell types were as follows: squamous cell carcinoma 69% (n: 116) adenocarcinoma 22% (n: 37) large cell carcinoma 5% (n: 9), small cell carcinomas 4% (n: 6). Postoperative classification was; Stage I 28% (n: 45). stage II 30% (n: 48) stage Ill a 38% (n: 61) stage III b 4% (n: 8) limited disease 100% (n: 6). Operation complications were as follows: atelectasis 2% (n: 4), empyema 0.5% (n: 1), infection 3% (n: 5), exitus 3.5% (n: 6) total 9% (n: 16). Finally, the preoperative staging methods were failed in 8 cases (5%).
I 464
Operative experiment of extended resection and comment of the treatment result in stage TwNsMc lung cancer
Wu Xi, Gu Yongping. F’R China
Nanjing
railway
Medical
College,
Nanjing 210009,
In recent 15 years extended resection and scavenging lymph nodes were performed on 102 cases with pathological stage TsNzMc lung cancer in our hospital. Sleeve pneumonectomy, lobectomy, total pneumonectomy resection and reconstruction of carina were achieved. At the same time, combined resection of the lung cancer and a single additional organ was performed in those patients, which includes total pleura, partial pericardium, left atrium, superior vena cava, diaphragm, esophagus, and adventitia of the aorta, according to two maximum degree principle. One of principle is to resect tumor in the maximum degree: the other principle is to remain normal tissue in the maximum degree. Four patients occurred in ARDS of infection within 7 days after operation. The overall operative mortality was 0% in this study. 9 cases with left atrium combined resected still alive 2.5 years without any recurrence or metastasis. The serious symptoms affecting patients life may be relieved and life quality may be improved. These operative methods could increase resection rate, and decrease exploratory thoracotomy rate. However, 49 patients incomplete resection
Therapy
119
were performed, during recent same 15 years, and no patients survived more than 2 years (P < 0.01). Specifically 3 years surviving rate with squamous cell carcinoma is 17%, and with adenocarcinoma is 11% after operation. The former much higher than the later (P < 0.05). And 5 years surviving rate is 5% in our group. The most significant prognostic factor was the Ns factor. Not significant difference in surviving rate was seen between TsNs and T4Ne in this study. Intervention radiology method could not prolong surviving time. Extended resection plus chemotherapy or/and radiotherapy in TwNzMc could not see beneficial prognosis. Although 102 cases underwent combined resection, the result of comprehensive treatments is very poor, because this group not belongs to early stage. Extended operations for TwNsMo lung cancer should be restricted for selected patients.
465 L-L
Outcome of surgery for non small cell lung cancer, without preoperative mediastinoscopy
P.H. Cole. The Prince
Char/es
Hospital
Brisbane,
Australia
This study is a review of 212 sequential patients undergoing surgery for NSCLC from July “87 to Dee ‘91 The commonest presentations were: no symptoms 70 pts, haemoptysis 59 pts and cough 44 pts. The diagnosis was predominantly made by Fine Needle Biopsy (FNA) in 113 pts, or bronchial biopsy 59 pts with the most frequent cell type being Squamous cell 96 pts, then Adenocarcinoma 69 pts. Preoperative respiratory function showed FEVI 77.7% predicted for pneumonectomy and 84% predicted for lobectomy, overall. Mediastinoscopy was used to assess resectability in 13 cases. 7 pts had open/shut thoracotomies. All types of resections were performed, including Pancoast 5 pts and incontinuity chest wall resections (20 pts). Post operative thoracic epidural for pain relief was used in 184 pts, using continuous Fentanyl and Marcaine. Digoxin was required in 22 pts, 16 pts were transfused in the first 48 hrs. Pathology of the cancer and mediastinal node mapping revealed: Stage l-118 pts, Stage 2-31 pts, Stage 3a 53 pts, Stage 3b 3 pts. Post operatively 6 required ventilation, 6 others died, with overall mortality of 3% (Pneumonectomy 6%, Lobectomy 2%)
w Fergus
Evidence-based guidelines for lung cancer management: How much evidence is there? Macbeth.
Scottish
Cancer
Therapy
Network,
Edinburgh,
UK
In December 1995 the Lung Cancer Focus Group of the Scottish Cancer Therapy Network (SCTN) started work on producing evidence-based guidelines for the management of lung cancer, to be validated by the Scottish Intercollegiate Guidelines Network (SIGN). Standard SIGN methodology was used to set up the multiprofessional group, formulate recommendations, collect and review the published evidence, and grade the recommendations on the basis of the evidence (Grade A: randomised controlled trial or metanalysis; Grade 6: well conducted clinical studies; Grade C: expert opinion, no evidence). The draft guidelines were presented to an open meeting in October 1996. Of 66 recommendations 10 (15%) were Grade A; 17 (26%) were Grade B and 39 (59%) were Grade C. Of the 39 Grade C recommendations, only 11 were about clinical management and 28 were about efficiency and professional standards. So, of the clinical recommendations 26% were Grade A, 45% Grade Band 29% Grade C. One clinical recommendation (that chemotherapy for advanced non-small cell lung cancer should not be standard but only as part of clinical trials) was Grade C despite Grade A evidence of effectiveness. This reflects the prevailing national consensus, as well as economic and practical considerations. Conclusions: 1. Research evidence alone is not sufficient to produce comprehensive and practical guidelines for lung cancer management. Both expert and consensus opinion must be considered. 2. initiatives of this type should guide clinical research to areas of insufficient evidence.
463
Retrospective
analysis of 200 lung cancer patients
El K. Dural ’ , I. Olcay s, 0. Okcu ’ , F. Kocabeyoglu *, ij. Sakinci ’ ’ Department of Thoracic Surgery, Numune Hospital, Ankara; 2Department of Respiratory Medicine, Numune Hospital, Ankara,
Turkey
In this study, 200 patients with lung cancer admitted to our hospital in 1996 were retrospectively evaluated (mean age 54 year, 179 men, 21 women). Pretreatment staging procedures included bronchoscopy with bronchial biopsy, abdominal ultrasound, thorax and brain computed tomography, radionuclide bone scan. Duration of symptoms was approximately 4 months. The percentage of smokers was 91% (n: 182). 168 patients (84%) were operated and performed operations were; pneumonectomy 40% (n: 68), lobectomy 35% (n: 59) bilobectomy 14% (n: 23) thoracic wall resection 4% (n: 6) segmentectomy 1% (n: 2) wedge resection 1% (n: 2). 8 patients (5%) were evaluated as inoperable and resectic I couldn’t be performed. Postoperative lung cancer cell types were as follows: squamous cell carcinoma 69% (n: 116) adenocarcinoma 22% (n: 37) large cell carcinoma 5% (n: 9), small cell carcinomas 4% (n: 6). Postoperative classification was; Stage I 28% (n: 45). stage II 30% (n: 48) stage Ill a 38% (n: 61) stage III b 4% (n: 8) limited disease 100% (n: 6). Operation complications were as follows: atelectasis 2% (n: 4), empyema 0.5% (n: 1), infection 3% (n: 5), exitus 3.5% (n: 6) total 9% (n: 16). Finally, the preoperative staging methods were failed in 8 cases (5%).
I 464
Operative experiment of extended resection and comment of the treatment result in stage TwNsMc lung cancer
Wu Xi, Gu Yongping. F’R China
Nanjing
railway
Medical
College,
Nanjing 210009,
In recent 15 years extended resection and scavenging lymph nodes were performed on 102 cases with pathological stage TsNzMc lung cancer in our hospital. Sleeve pneumonectomy, lobectomy, total pneumonectomy resection and reconstruction of carina were achieved. At the same time, combined resection of the lung cancer and a single additional organ was performed in those patients, which includes total pleura, partial pericardium, left atrium, superior vena cava, diaphragm, esophagus, and adventitia of the aorta, according to two maximum degree principle. One of principle is to resect tumor in the maximum degree: the other principle is to remain normal tissue in the maximum degree. Four patients occurred in ARDS of infection within 7 days after operation. The overall operative mortality was 0% in this study. 9 cases with left atrium combined resected still alive 2.5 years without any recurrence or metastasis. The serious symptoms affecting patients life may be relieved and life quality may be improved. These operative methods could increase resection rate, and decrease exploratory thoracotomy rate. However, 49 patients incomplete resection
Therapy
119
were performed, during recent same 15 years, and no patients survived more than 2 years (P < 0.01). Specifically 3 years surviving rate with squamous cell carcinoma is 17%, and with adenocarcinoma is 11% after operation. The former much higher than the later (P < 0.05). And 5 years surviving rate is 5% in our group. The most significant prognostic factor was the Ns factor. Not significant difference in surviving rate was seen between TsNs and T4Ne in this study. Intervention radiology method could not prolong surviving time. Extended resection plus chemotherapy or/and radiotherapy in TwNzMc could not see beneficial prognosis. Although 102 cases underwent combined resection, the result of comprehensive treatments is very poor, because this group not belongs to early stage. Extended operations for TwNsMo lung cancer should be restricted for selected patients.
465 L-L
Outcome of surgery for non small cell lung cancer, without preoperative mediastinoscopy
P.H. Cole. The Prince
Char/es
Hospital
Brisbane,
Australia
This study is a review of 212 sequential patients undergoing surgery for NSCLC from July “87 to Dee ‘91 The commonest presentations were: no symptoms 70 pts, haemoptysis 59 pts and cough 44 pts. The diagnosis was predominantly made by Fine Needle Biopsy (FNA) in 113 pts, or bronchial biopsy 59 pts with the most frequent cell type being Squamous cell 96 pts, then Adenocarcinoma 69 pts. Preoperative respiratory function showed FEVI 77.7% predicted for pneumonectomy and 84% predicted for lobectomy, overall. Mediastinoscopy was used to assess resectability in 13 cases. 7 pts had open/shut thoracotomies. All types of resections were performed, including Pancoast 5 pts and incontinuity chest wall resections (20 pts). Post operative thoracic epidural for pain relief was used in 184 pts, using continuous Fentanyl and Marcaine. Digoxin was required in 22 pts, 16 pts were transfused in the first 48 hrs. Pathology of the cancer and mediastinal node mapping revealed: Stage l-118 pts, Stage 2-31 pts, Stage 3a 53 pts, Stage 3b 3 pts. Post operatively 6 required ventilation, 6 others died, with overall mortality of 3% (Pneumonectomy 6%, Lobectomy 2%)
w Fergus
Evidence-based guidelines for lung cancer management: How much evidence is there? Macbeth.
Scottish
Cancer
Therapy
Network,
Edinburgh,
UK
In December 1995 the Lung Cancer Focus Group of the Scottish Cancer Therapy Network (SCTN) started work on producing evidence-based guidelines for the management of lung cancer, to be validated by the Scottish Intercollegiate Guidelines Network (SIGN). Standard SIGN methodology was used to set up the multiprofessional group, formulate recommendations, collect and review the published evidence, and grade the recommendations on the basis of the evidence (Grade A: randomised controlled trial or metanalysis; Grade 6: well conducted clinical studies; Grade C: expert opinion, no evidence). The draft guidelines were presented to an open meeting in October 1996. Of 66 recommendations 10 (15%) were Grade A; 17 (26%) were Grade B and 39 (59%) were Grade C. Of the 39 Grade C recommendations, only 11 were about clinical management and 28 were about efficiency and professional standards. So, of the clinical recommendations 26% were Grade A, 45% Grade Band 29% Grade C. One clinical recommendation (that chemotherapy for advanced non-small cell lung cancer should not be standard but only as part of clinical trials) was Grade C despite Grade A evidence of effectiveness. This reflects the prevailing national consensus, as well as economic and practical considerations. Conclusions: 1. Research evidence alone is not sufficient to produce comprehensive and practical guidelines for lung cancer management. Both expert and consensus opinion must be considered. 2. initiatives of this type should guide clinical research to areas of insufficient evidence.