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Current chemotherapy of small cell lung cancer
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was false negative. WhereAs in 34 cases the extension of the tu~Qu~ after "having reached the T and N stage, was responsible for conducting exploratory thoracotomy, whereas in 49 cases the T stage alone and in 30 cases the M stage alone was decisive with regard to the technical and/or prognostic inoperability. Perioperative mortality was 8%. None of the patients on whom exploratory thoracotomy had been performed, had a 5-year survival time. Indications for Surgery in Patients with Lung Cancer. Remarks on 714 Cases. Ghiringhelli, P. Ospedale di Gallarate, Divisione di Medicina la, Gallarate, Italy. Minerva. Med. 77: 351-365, 1986. Selection modes for surgery were studied in a group of lung cancer patients. Selection is based on the certain diagnosis of the disease, its histological classification and stage, respiratory function tests and the assessment of any surgical indications. A total of 714 lung cancer cases were examined. Of these, 28.4% were at stage i, 19.8% at stage 2 and 51.8% at stage 3. Only 141 patients or 19.8% of all cases examined were judged fit for radical exeresis. In the absence of metastasis all three stages of epidermoid carcinomas and adenocarcinomas were judged operable. In the case of microcytomas indication for surgery was limited to very few cases and only those in the first two stages. In the presence of metastasis to the hilar lymph nodes, surgery was only indicated where the metastasis was small. Exeresis was also indicated in the presence of single metastases to mediastinal lymph nodes on the same side as the neoplasia especially if these were considered intranodal. The difficulty of precise assessment of metastases to the hilar and mediastinal lymph nodes, even with the aid of modern techniques like CAT scanning and mediastinoscopy, was also noted. In 87 of 141 patients operated on it was possible to check the result which was radical in 84 cases. In all, 19 pneumonectomies, 49 lobectomies and 16 bilobectomies were performed. The operative mortality rate was 3.4%. The various surgical indications were also examined in relation to the diverse clinical situations presented by lung cancers. In conclusion, the modalities to be followed in order to enhance the value of radical resections in lung cancer are outlined. Above all diagnostic means must be refined to a point where the disease can be staged with maximum precision, patients for surgery must be selected with the utmost care and diagnosis must be as early as possible. Repeated Thoracotomies Due to Bronchial Carcinoma: Case Report.
Mollinedo, J., Krumhaar, D. Lungenklinik Havelhohe, D-1000 Berlin, Germany. Prax. Klin. Pneumol. 39: 843, 1985. A total of 4 thoracotomies were performed during a period of 17 years in a male patient who is now 58 years of age, the reason being a metastasising adenocarcinoma. In 1967, resection of the left lower lobe was performed, in 1978 peripheral resections from the right and left upper lobe, and in 1983 an extended upper lobe 'cuff' resection on the right side with vascular plasty. Prognosis finally became infaust because of multiple metastases in the brain detected by means of computed tomography in the autumn of 1984.
7,
CHEMOTHERAPY
Current Chemotherapy of Small Cell Lung Cancer. Livingston, R.B. Department of Medicine, Division of Oncology, University of Washington, Seattle, WA, U.S.A. Chest 89: 258S-263S, 1986. Since the advent of effective combinations in the early 1970s, results from chemotherapy for small cell lung cancer have improved very little. Maintenance chemotherapy appears of no benefit. Although attractive theoretically, 'non-cross-resistant~ combinations may not yet exist, and most data do not support alternating 1 regimen with another. Anticoagulant therapy with warfarin probably does not have a meaningful impact on survival, at least in exten= sire stage disease. To date the addition of VP-16, an active new agent, has not produced improvement in survival over earlier programs. The most promising leads to date involve does escalation, especially with cyclophosphamide. Moderate 'outpatient' escalation in limited disease induction therapy produced survival benefit in a randomized trial, and several studies indicate that the incidence of complete response can be increased by more intensive, inpatient 'consolidation' with cyclophosphamide with or without other drugs after the induction period. Some form of local therapy, however, will be necessary to control disease in the chest, even with maximal dose intensification. Fifteen-Year Follow-Up of All Patients in a Study of Post-Operative Chemotherapy for Bronchial Carcinoma. Girling, D.J., Stott, H., Stephens, R.J., Fox, W. Medical Research Council Tuberculosis and Chest Diseases Unit, Brompton Hospital, London SW3 6HP, U.K. Br. J. Cancer 52: 867-873, 1985. The 15-year findings are presented of a double-blind, randomised study planned in 1964 in which cytotoxic chemotherapy with
was false negative. WhereAs in 34 cases the extension of the tu~Qu~ after "having reached the T and N stage, was responsible for conducting exploratory thoracotomy, whereas in 49 cases the T stage alone and in 30 cases the M stage alone was decisive with regard to the technical and/or prognostic inoperability. Perioperative mortality was 8%. None of the patients on whom exploratory thoracotomy had been performed, had a 5-year survival time. Indications for Surgery in Patients with Lung Cancer. Remarks on 714 Cases. Ghiringhelli, P. Ospedale di Gallarate, Divisione di Medicina la, Gallarate, Italy. Minerva. Med. 77: 351-365, 1986. Selection modes for surgery were studied in a group of lung cancer patients. Selection is based on the certain diagnosis of the disease, its histological classification and stage, respiratory function tests and the assessment of any surgical indications. A total of 714 lung cancer cases were examined. Of these, 28.4% were at stage i, 19.8% at stage 2 and 51.8% at stage 3. Only 141 patients or 19.8% of all cases examined were judged fit for radical exeresis. In the absence of metastasis all three stages of epidermoid carcinomas and adenocarcinomas were judged operable. In the case of microcytomas indication for surgery was limited to very few cases and only those in the first two stages. In the presence of metastasis to the hilar lymph nodes, surgery was only indicated where the metastasis was small. Exeresis was also indicated in the presence of single metastases to mediastinal lymph nodes on the same side as the neoplasia especially if these were considered intranodal. The difficulty of precise assessment of metastases to the hilar and mediastinal lymph nodes, even with the aid of modern techniques like CAT scanning and mediastinoscopy, was also noted. In 87 of 141 patients operated on it was possible to check the result which was radical in 84 cases. In all, 19 pneumonectomies, 49 lobectomies and 16 bilobectomies were performed. The operative mortality rate was 3.4%. The various surgical indications were also examined in relation to the diverse clinical situations presented by lung cancers. In conclusion, the modalities to be followed in order to enhance the value of radical resections in lung cancer are outlined. Above all diagnostic means must be refined to a point where the disease can be staged with maximum precision, patients for surgery must be selected with the utmost care and diagnosis must be as early as possible. Repeated Thoracotomies Due to Bronchial Carcinoma: Case Report.
Mollinedo, J., Krumhaar, D. Lungenklinik Havelhohe, D-1000 Berlin, Germany. Prax. Klin. Pneumol. 39: 843, 1985. A total of 4 thoracotomies were performed during a period of 17 years in a male patient who is now 58 years of age, the reason being a metastasising adenocarcinoma. In 1967, resection of the left lower lobe was performed, in 1978 peripheral resections from the right and left upper lobe, and in 1983 an extended upper lobe 'cuff' resection on the right side with vascular plasty. Prognosis finally became infaust because of multiple metastases in the brain detected by means of computed tomography in the autumn of 1984.
7,
CHEMOTHERAPY
Current Chemotherapy of Small Cell Lung Cancer. Livingston, R.B. Department of Medicine, Division of Oncology, University of Washington, Seattle, WA, U.S.A. Chest 89: 258S-263S, 1986. Since the advent of effective combinations in the early 1970s, results from chemotherapy for small cell lung cancer have improved very little. Maintenance chemotherapy appears of no benefit. Although attractive theoretically, 'non-cross-resistant~ combinations may not yet exist, and most data do not support alternating 1 regimen with another. Anticoagulant therapy with warfarin probably does not have a meaningful impact on survival, at least in exten= sire stage disease. To date the addition of VP-16, an active new agent, has not produced improvement in survival over earlier programs. The most promising leads to date involve does escalation, especially with cyclophosphamide. Moderate 'outpatient' escalation in limited disease induction therapy produced survival benefit in a randomized trial, and several studies indicate that the incidence of complete response can be increased by more intensive, inpatient 'consolidation' with cyclophosphamide with or without other drugs after the induction period. Some form of local therapy, however, will be necessary to control disease in the chest, even with maximal dose intensification. Fifteen-Year Follow-Up of All Patients in a Study of Post-Operative Chemotherapy for Bronchial Carcinoma. Girling, D.J., Stott, H., Stephens, R.J., Fox, W. Medical Research Council Tuberculosis and Chest Diseases Unit, Brompton Hospital, London SW3 6HP, U.K. Br. J. Cancer 52: 867-873, 1985. The 15-year findings are presented of a double-blind, randomised study planned in 1964 in which cytotoxic chemotherapy with