- Email: [email protected]
Decline of posttreatment tumor marker levels after therapy of nonsmall cell lung cancer: A useful outcome predictor
210
Abstractdtung
Gntcer 13 (1995) 185-232
An 8 mm peripheral luog adeoocarcinoma detected by routine sputum cytologic screening Suzuki N, Kitamura S. Department of Pulmonaty Medicine, Jichi Medical School, Tochigt. Jpn J Lung Cancer 1995;35:61-72. A 59-year-old man was admitted to our hospital for evaluation of atypical cells (group E: Class IV or V) found on routine spunmr cytologic screeningfor lung cancer. A chest radiograph showed hilar lymphadenopathy. Computed tomography (CT) of the chest showed a mass of 8 mm in diameter in the periphery of the right lung. However, repeated spubmr cytologic examinations and endoscopy found no evidence ofmalignancy. The tumor size increased over 4 months. Percutaneous ultrasonographyguided fine needle aspiration of the mass showed a cluster of atypical cells, suggesting adenocarcinoma. At surgery, the tumor was found to be accompanied by multiple disseminated nodules and a small amount of cancemus pleural fluid. Histologically, a diagnosis of welldiflbrentiated papillary adenocarcinorna was established. The prognosis of sputum cytology-positive adenocarcinoma is poor, regardless of the tumor size. Immediate diagnostic and therapeutic work-ups are recommended.
Ultra-thin eodoscopic findings of bronchioloalveolar carcinoma Tanaka M, Takl Y, Kohda E, Satoh M, Okada Y, Yamasawa F et al. Department of Diagnostic Radiology, School of Medicine. Keio University, Tokyo. Jpn J Lung Cancer 1995;35:29-34. We reviewed computed tomographic scans and ultra-thin bmnchoscopic findings of 5 cases of bmnchloloalveolar carcinoma, 1 with a solitary nodule (SN),, 1 with diffuse miliary nodules similar to metastatlc tumor @MN), and 3 with radiographic patterns suggestive of pneumonia (RPSP) rcentgenologically. Endoscepictindings showed abundant frothy secretions from respiratory bronchioles, sputum due to occlusion, and diffuse polypoid lesions in patients with RPSP Diffuse polypoid lesions may suggest the invasive pattern of bronchioloalveolar carcinoma. We observed a tumor in the SN patient, stenosis and paleness of the mucosal surface of the bronchioles in the DMN patient.
Clinical study of adenosquamous carcinoma of the lung in 34 patients Mizushima Y, Fujishita T, Sugiyama S, Salto H, Kusajima Y, Noto H et al. IDepartment ofInternolMedicine. ToyamaA4edicaUPharmaceutical Univ., Toyama. Jpn J Lung Cancer 1995;35:23-8. Clinical features of adenosquamous carcinoma of the lung were studied in 34 cases who met the Japan Lung Cancer Society Classification criteria. The male to female ratio was 3: 9, mean age was 63.0 years old, the ratio of peripheral to central type was 34:0, and the positive rate for CEA was 69%, which suggested adenocarcinoma rather than squamous cell carcinoma. The diagnostic accuracy prior to therapy was 6% (2/34). In all cases, adenosquamous carcinoma showed significantly poorer prognosis than $denocarcinoma. Clinical features of adenosquamous carcinoma were reviewed with regard to previous reports. The relationship between the immunodetection of transforming growth factor-0 in lung adenocarcinoma and longer survival rates Inoue T, Ishida T, Takenoyama M, Sugio K, Sugimachi K. Department ojSwgery II, Faculty ofMedicine, Kpshu Universi@, Maidashi 3-11, Higashi-ku, Fukuoka 812. Surg Oncol 1995;4:51-7. We immunohistochemically examined the expression of transforming growth factor-g (TGF-g) on tissue specimens fmm primary 124 human lung adenocarcinoma, using a pelyclonal antibody. The overall mean immunoreactivity of TGF-8 was 25.7 f 22.9, therefore we
separated patients into two groups according to their mean immunoreactivity. There were 59 (48%) with a high TGF-0 and 65 (52%) with a low TGF-g. No correlation was observed between the expression of TGF-13 and clinicopathological factors except for degree of differentiation. The 5-year survival rates of patients with high and low TGF-g were 7l%and 37%, respectively (P < 0.05). A multivariate analysis using the C’ox life table regression model showed TGF-g to be a significantly independent factor. We thus concluded, based on our findings, that the expression of TGF-g was found to be related to a better prognosis. Therefore, estimating the negative cell proliferation activity induced by TGF-g on immunohistochemical technique is considered to he useful for determining the patients’ prognosis in cases of lung adenocarcinoma. Staining pattern of type IV collagen and prognosis in early stage adenocarcinoma of the lung Watanabe N, Nakajima I, Abe S, Ogura S, Iwbe H, Kawakami Y. First Department of Medicine. School of Medicine, Hokkaido CJniversi@, NIS, W7, Kttaku. Sappow 060. J Clin Pathol 1994;47:613-5. Aims - To examine the prognostic value of basement membrane expression in early stage adenocarcinoma of the lung. Methods -Using antibodies to type IV collagen, basement membrane expression at the tumour-stromal border was immunohistcchemically analysed in 30 patients with early stage adenocarcinoma of the lung @stage I and pstage II). lXv0 patterns of staining for type IV collagen were observed: in the first one the staining line was conserved or partially fragmented; in the second the staining Line was widely fragmented or absent in more than 10% of the tumour area. The first staining pattern was categorised as continuous and the second as discontinuous. Results - Ofthe 24 patients with pstage I adenocarcinoma, 12 (50%) cases showed acontinuous pattern. In only one (16.7%) of the six patients with pstage II adenocarcinoma was this pattern evident. Fii year survival was greater in pstage I adenocarcinoma (65%) than in pstage II adenocarcinoma (17%). but the difference was not significant. When the analysis was restricted to the 24 patients with pstage I adenocarcinoma, five year survival was better in continuous pattern cases (88%) than in discontinuous pattern cases (20.5%) @ < 0.05). The survival curve of 12 patients with pstage I adenocarcinoma and a discontinuous pattern resembled that of the six patients with pstage II adenocarcinoma. Conclusion - These findings suggest that patients with pstage I adenocarcinoma and a discontinuous pattern have histopathologially unrecognised micrometastasis when they come to surgery, The staining pattern of type IV collagen could help in the prognosis of pstage I adenocarcinoma of the lung alter surgery. Decline of posttreatmeot tumor marker levels tier therapy of noosmali cell lung cancer: A useful outcome predictor Spiridonidis CH, L&man LR, Stydnicki KA, Noltimier JW, Cho CC, Young DC et al. 8100 Ravines Edge Court, Columbus, OH 43235. Cancer 1995;75:1586-93. Background. The assessment of treatment efficacy in nonsmall cell lung cancer (NSCLC) is limited by the lack of a clear association between clinical response and survival. The prognostic usefulness of treatmentinduced tumor- marker declines in NSCLC has not been established. The authors investigated the prognostic significance of treatmentinduced declination in tumor marker levels ofcarcinoembryonic antigen, CA 19-9, and CA 125 in a group of patients with NSCLC treated with a brief course of cisplatin-based chemotherapy. Metho&. Eighty-three patients with NSCLC enrolled on 2 related treatment protocols had pretreatment tumor-marker determinations. Patients were restaged 10 to 12 weeks after study entry, and clinical and marker responses were determined. Results. Thirty-eight patients (46%) had elevated
Abstracts/Lung
Cancer
pretreatment tumor markers, 36 (42%) of whom were evaluable for both clinical and marker responses. Pretreatment, the latter 36 individuals had measurable or evaluable disease, and at least one elevated tumor marker (greater than twice normal); posttreatment, they had follow-up measurements of both parameters. Of the 36 patients, 8 had normalization of tumor marker levels, 13 had 50-99% marker level declination, and 15 had less than 50% or no declination. In the same group of 36 patients, there were, 1 patient with complete clinical response, 11 with partial response, 19 with stable disease, and 5 with progressive disease. Marker responses occurred with equal frequency in clinical responders and nonresponders. There was no association between clinical response and survival, but there was a strong association between marker response and survival. Conclusions. In patients with nonsmall cell lung cancer with elevated pretreatment tumor marker levels, treatment- induced marker level declination can be a surrogate indicator fur survival.
Clinical Niklinski School,
tumour markers in lung cancer J, Furman M. Department of Thoracic 24a M Skodowsko-Curi
Street,
IIS-276
Surgery. Medical Bialystok. Eur J Can-
cer Prev 1995;4:129-38. Within the past few years, the measurement of serum and tissue markers has had an increasing influence on clinical decisions about initial treatment and follow-up. Lung cancer illustrates the types and importance of these various markers. This renew presents data concerning the most studied and interesting markers in non-small cell (NSCLC) and small cell lung cancer (SCLC). CEA, TPA, SCC-Ag, CYFRA 21-1, fenitin, CA19-9, CASO, CA242, H-K-N-ras mutations and ~53 mutation seem to be the most prolific in NSCLC, while NSE, BN/GRP, CK-BB, NCAM, IL-IR, IGF-I, transferrin, ANP, mAb (cluster 5). Le-y and c-N-L-myc mutation are markers in SCLC patients. Some of these serum markers might be useful adjuncts for monitoring response to therapy, including early detection of turnour reactivation to allow curative therapy and rapid detection of treatment failure to allow change of the regimen. The study of these markers also may lead to a better understanding of the biological characteristics of lung cancer. The information derived from these biological studies represents the most promising avenue towards new treatment strategies, as well as attempts at secondary prevention.
Surgery Immunostains for blood group antigens lack prognostic signiticance in Tl lung carcinoma Dresler CM, Ritter JH, Wick MR, Roper CL, Patterson GA, Cooper JD. Department of Swgegery, Fox Chase Cancer Cente,: 7701 Burholme enue, Philadelphia, PA 19111. Ann Thorac Surg 1995;59:1069-73.
Av-
Recent reports have suggested that the retention of blood group antigen expression on tumor cells may be an important prognostic factor for survival. From 1986 to 1991, 136 patients underwent operative resection for their Tl NO non-small cell lung carcinoma. One hundred twenty tissue blocks were available for antigen testing, and the histologic types were as follows: adenocarcinoma (73 patients), squamous cell (39 patients), large cell/ undifferentiated (7 patients), and mucoepidermoid (1 patient). Follow-up is complete for all patients (mean, 41 months). This. distribution of patients among the blood groups was as follows: A, 56 (47%); 0, 53 (44%); B, 9 (7.5%), and AB, 2 (1.7%). Immunostaining was performed for A, B, and H blood group antigens. The 5-year actuarial survival in the blood group A patients (53%) did not differ significantly from that in the blood group 0 pa-
13 (1995)
211
185-232
tients (59%). Similarly, when tumors were examined for their respective antigens, no significant differences were found in the 5-year survival of either blood group A or 0 patients between the tumors that retain and those that lose blood group antigen expression. Retention or loss of blood groups A or 0 antigen expression does not predict survival in patients with early-stage lung carcinomas.
Thoracoscopy and video-assisted thoracic surgery in the treatment of lung cancer Mentzer SJ, DeCamp MM, Harpole DH Jr, Sugarbaker DJ. Division of Thoracic Surgery, Brigham and Women b Hospital. 75 Francis Boston, ,UA OZIIS. Chest 1995;107:6 Suppl:298S-301s.
Street,
The contemporary surgical repertoire for the evaluation and treatment of patients with lung cancer includes the bronchoscope, mediastinoscope, thoracoscope, and standard surgical instrumentation. The recent advances in video optics and the development of endoscopic instruments have significantly expanded the surgical options for patients with lung cancer. Thoracoscopy, or the more inclusive term of videoassisted thoracic surgery (VATS), has been characterized as ‘minimally invasive’ surgery. Thoracoscopy and VATS have decreased operative trauma and facilitated surgical staging prior to neoadjuvant therapy. An ancillary benefit to diminished surgical morbidity is shorter hospital stays with a concomitant reduction in costs tn the patient and healthcare system. These advantages make VATS ideal for elderly patients or patients with significant comorbidity.
Cardiac arrhythmia 140 pneumonectomy Wu H, Zhou Y, Zhang
after lung cancer surgery cases X. Thoracic
Surgery
Deparment,
- An analysis Shanghai
of
Chest
200030. Chin J Oncol 1994;16:435-7. Among 808 surgically resected lung cancer cases at Shanghai Chest Hospital during the period of January 1991 to December 1992,140 of them (17.3%) underwent pneumonectomy (47 right, 93 left). In the 140 cases: 124 male, 16 female; aged 27 - 74 yrs, pre-operative abnormal EKG was found in 38 cases. Postoperatively, arrhythmia occurred in 76 cases, with an incidence of 54.3%. Of the 76 arrhythmias, atria1 fibrillation was seen in 7 patients, atria1 premature beats in 2, suptaventticular tachycardia in 1 and sinus tachycardia in 66. The results indicate that cardiac arrhythmia is a common complication after pneumonectomy for lung cancer surgery. The major causes of arrhythmia were incisional pain, hypovolemla due to blood loss and respiratory instdliciency due to anoxia. The perioperative measures to prevent arrhythmia were discussed. Hospital,
Shanghai
Survival following resection of clinically cell lung cancer Dalton R Keller S. Department oJConiiothorocic Medical
Cente,:
Cardiovasc
One Gustave
L Levy
Place,
occult
N2 non small
Swgery, Mount New York 10029-6s
Sinai 74. J
Surg 1994;35:Suppl l-6:13-7. The role of resection in Stage IIIA (N2) non-small cell lung cancer (NSCLC) remains controversial despite reported survival rates of 2540%. This study was undertaken to identify factors associated with a high risk of treatment failure after resection of clinically occult Stage IIIA (N2) NSCLC. Such prognostic factors may identify high risk patients as candidates for fuhtre clinical trials of multimodality lung cancer treatment and be important stratification factors in such trials. Methods. The clinical and pathological records of 32 patients with clinical NO pathologic N2 NSCLC who underwent lobectomy (n = 17), pneumonectomy (n = 12). or bilobectomy (n = 3) and complete media&ml lymph node dissection at Fox Chase Cancer Center from Background.
Abstractdtung
Gntcer 13 (1995) 185-232
An 8 mm peripheral luog adeoocarcinoma detected by routine sputum cytologic screening Suzuki N, Kitamura S. Department of Pulmonaty Medicine, Jichi Medical School, Tochigt. Jpn J Lung Cancer 1995;35:61-72. A 59-year-old man was admitted to our hospital for evaluation of atypical cells (group E: Class IV or V) found on routine spunmr cytologic screeningfor lung cancer. A chest radiograph showed hilar lymphadenopathy. Computed tomography (CT) of the chest showed a mass of 8 mm in diameter in the periphery of the right lung. However, repeated spubmr cytologic examinations and endoscopy found no evidence ofmalignancy. The tumor size increased over 4 months. Percutaneous ultrasonographyguided fine needle aspiration of the mass showed a cluster of atypical cells, suggesting adenocarcinoma. At surgery, the tumor was found to be accompanied by multiple disseminated nodules and a small amount of cancemus pleural fluid. Histologically, a diagnosis of welldiflbrentiated papillary adenocarcinorna was established. The prognosis of sputum cytology-positive adenocarcinoma is poor, regardless of the tumor size. Immediate diagnostic and therapeutic work-ups are recommended.
Ultra-thin eodoscopic findings of bronchioloalveolar carcinoma Tanaka M, Takl Y, Kohda E, Satoh M, Okada Y, Yamasawa F et al. Department of Diagnostic Radiology, School of Medicine. Keio University, Tokyo. Jpn J Lung Cancer 1995;35:29-34. We reviewed computed tomographic scans and ultra-thin bmnchoscopic findings of 5 cases of bmnchloloalveolar carcinoma, 1 with a solitary nodule (SN),, 1 with diffuse miliary nodules similar to metastatlc tumor @MN), and 3 with radiographic patterns suggestive of pneumonia (RPSP) rcentgenologically. Endoscepictindings showed abundant frothy secretions from respiratory bronchioles, sputum due to occlusion, and diffuse polypoid lesions in patients with RPSP Diffuse polypoid lesions may suggest the invasive pattern of bronchioloalveolar carcinoma. We observed a tumor in the SN patient, stenosis and paleness of the mucosal surface of the bronchioles in the DMN patient.
Clinical study of adenosquamous carcinoma of the lung in 34 patients Mizushima Y, Fujishita T, Sugiyama S, Salto H, Kusajima Y, Noto H et al. IDepartment ofInternolMedicine. ToyamaA4edicaUPharmaceutical Univ., Toyama. Jpn J Lung Cancer 1995;35:23-8. Clinical features of adenosquamous carcinoma of the lung were studied in 34 cases who met the Japan Lung Cancer Society Classification criteria. The male to female ratio was 3: 9, mean age was 63.0 years old, the ratio of peripheral to central type was 34:0, and the positive rate for CEA was 69%, which suggested adenocarcinoma rather than squamous cell carcinoma. The diagnostic accuracy prior to therapy was 6% (2/34). In all cases, adenosquamous carcinoma showed significantly poorer prognosis than $denocarcinoma. Clinical features of adenosquamous carcinoma were reviewed with regard to previous reports. The relationship between the immunodetection of transforming growth factor-0 in lung adenocarcinoma and longer survival rates Inoue T, Ishida T, Takenoyama M, Sugio K, Sugimachi K. Department ojSwgery II, Faculty ofMedicine, Kpshu Universi@, Maidashi 3-11, Higashi-ku, Fukuoka 812. Surg Oncol 1995;4:51-7. We immunohistochemically examined the expression of transforming growth factor-g (TGF-g) on tissue specimens fmm primary 124 human lung adenocarcinoma, using a pelyclonal antibody. The overall mean immunoreactivity of TGF-8 was 25.7 f 22.9, therefore we
separated patients into two groups according to their mean immunoreactivity. There were 59 (48%) with a high TGF-0 and 65 (52%) with a low TGF-g. No correlation was observed between the expression of TGF-13 and clinicopathological factors except for degree of differentiation. The 5-year survival rates of patients with high and low TGF-g were 7l%and 37%, respectively (P < 0.05). A multivariate analysis using the C’ox life table regression model showed TGF-g to be a significantly independent factor. We thus concluded, based on our findings, that the expression of TGF-g was found to be related to a better prognosis. Therefore, estimating the negative cell proliferation activity induced by TGF-g on immunohistochemical technique is considered to he useful for determining the patients’ prognosis in cases of lung adenocarcinoma. Staining pattern of type IV collagen and prognosis in early stage adenocarcinoma of the lung Watanabe N, Nakajima I, Abe S, Ogura S, Iwbe H, Kawakami Y. First Department of Medicine. School of Medicine, Hokkaido CJniversi@, NIS, W7, Kttaku. Sappow 060. J Clin Pathol 1994;47:613-5. Aims - To examine the prognostic value of basement membrane expression in early stage adenocarcinoma of the lung. Methods -Using antibodies to type IV collagen, basement membrane expression at the tumour-stromal border was immunohistcchemically analysed in 30 patients with early stage adenocarcinoma of the lung @stage I and pstage II). lXv0 patterns of staining for type IV collagen were observed: in the first one the staining line was conserved or partially fragmented; in the second the staining Line was widely fragmented or absent in more than 10% of the tumour area. The first staining pattern was categorised as continuous and the second as discontinuous. Results - Ofthe 24 patients with pstage I adenocarcinoma, 12 (50%) cases showed acontinuous pattern. In only one (16.7%) of the six patients with pstage II adenocarcinoma was this pattern evident. Fii year survival was greater in pstage I adenocarcinoma (65%) than in pstage II adenocarcinoma (17%). but the difference was not significant. When the analysis was restricted to the 24 patients with pstage I adenocarcinoma, five year survival was better in continuous pattern cases (88%) than in discontinuous pattern cases (20.5%) @ < 0.05). The survival curve of 12 patients with pstage I adenocarcinoma and a discontinuous pattern resembled that of the six patients with pstage II adenocarcinoma. Conclusion - These findings suggest that patients with pstage I adenocarcinoma and a discontinuous pattern have histopathologially unrecognised micrometastasis when they come to surgery, The staining pattern of type IV collagen could help in the prognosis of pstage I adenocarcinoma of the lung alter surgery. Decline of posttreatmeot tumor marker levels tier therapy of noosmali cell lung cancer: A useful outcome predictor Spiridonidis CH, L&man LR, Stydnicki KA, Noltimier JW, Cho CC, Young DC et al. 8100 Ravines Edge Court, Columbus, OH 43235. Cancer 1995;75:1586-93. Background. The assessment of treatment efficacy in nonsmall cell lung cancer (NSCLC) is limited by the lack of a clear association between clinical response and survival. The prognostic usefulness of treatmentinduced tumor- marker declines in NSCLC has not been established. The authors investigated the prognostic significance of treatmentinduced declination in tumor marker levels ofcarcinoembryonic antigen, CA 19-9, and CA 125 in a group of patients with NSCLC treated with a brief course of cisplatin-based chemotherapy. Metho&. Eighty-three patients with NSCLC enrolled on 2 related treatment protocols had pretreatment tumor-marker determinations. Patients were restaged 10 to 12 weeks after study entry, and clinical and marker responses were determined. Results. Thirty-eight patients (46%) had elevated
Abstracts/Lung
Cancer
pretreatment tumor markers, 36 (42%) of whom were evaluable for both clinical and marker responses. Pretreatment, the latter 36 individuals had measurable or evaluable disease, and at least one elevated tumor marker (greater than twice normal); posttreatment, they had follow-up measurements of both parameters. Of the 36 patients, 8 had normalization of tumor marker levels, 13 had 50-99% marker level declination, and 15 had less than 50% or no declination. In the same group of 36 patients, there were, 1 patient with complete clinical response, 11 with partial response, 19 with stable disease, and 5 with progressive disease. Marker responses occurred with equal frequency in clinical responders and nonresponders. There was no association between clinical response and survival, but there was a strong association between marker response and survival. Conclusions. In patients with nonsmall cell lung cancer with elevated pretreatment tumor marker levels, treatment- induced marker level declination can be a surrogate indicator fur survival.
Clinical Niklinski School,
tumour markers in lung cancer J, Furman M. Department of Thoracic 24a M Skodowsko-Curi
Street,
IIS-276
Surgery. Medical Bialystok. Eur J Can-
cer Prev 1995;4:129-38. Within the past few years, the measurement of serum and tissue markers has had an increasing influence on clinical decisions about initial treatment and follow-up. Lung cancer illustrates the types and importance of these various markers. This renew presents data concerning the most studied and interesting markers in non-small cell (NSCLC) and small cell lung cancer (SCLC). CEA, TPA, SCC-Ag, CYFRA 21-1, fenitin, CA19-9, CASO, CA242, H-K-N-ras mutations and ~53 mutation seem to be the most prolific in NSCLC, while NSE, BN/GRP, CK-BB, NCAM, IL-IR, IGF-I, transferrin, ANP, mAb (cluster 5). Le-y and c-N-L-myc mutation are markers in SCLC patients. Some of these serum markers might be useful adjuncts for monitoring response to therapy, including early detection of turnour reactivation to allow curative therapy and rapid detection of treatment failure to allow change of the regimen. The study of these markers also may lead to a better understanding of the biological characteristics of lung cancer. The information derived from these biological studies represents the most promising avenue towards new treatment strategies, as well as attempts at secondary prevention.
Surgery Immunostains for blood group antigens lack prognostic signiticance in Tl lung carcinoma Dresler CM, Ritter JH, Wick MR, Roper CL, Patterson GA, Cooper JD. Department of Swgegery, Fox Chase Cancer Cente,: 7701 Burholme enue, Philadelphia, PA 19111. Ann Thorac Surg 1995;59:1069-73.
Av-
Recent reports have suggested that the retention of blood group antigen expression on tumor cells may be an important prognostic factor for survival. From 1986 to 1991, 136 patients underwent operative resection for their Tl NO non-small cell lung carcinoma. One hundred twenty tissue blocks were available for antigen testing, and the histologic types were as follows: adenocarcinoma (73 patients), squamous cell (39 patients), large cell/ undifferentiated (7 patients), and mucoepidermoid (1 patient). Follow-up is complete for all patients (mean, 41 months). This. distribution of patients among the blood groups was as follows: A, 56 (47%); 0, 53 (44%); B, 9 (7.5%), and AB, 2 (1.7%). Immunostaining was performed for A, B, and H blood group antigens. The 5-year actuarial survival in the blood group A patients (53%) did not differ significantly from that in the blood group 0 pa-
13 (1995)
211
185-232
tients (59%). Similarly, when tumors were examined for their respective antigens, no significant differences were found in the 5-year survival of either blood group A or 0 patients between the tumors that retain and those that lose blood group antigen expression. Retention or loss of blood groups A or 0 antigen expression does not predict survival in patients with early-stage lung carcinomas.
Thoracoscopy and video-assisted thoracic surgery in the treatment of lung cancer Mentzer SJ, DeCamp MM, Harpole DH Jr, Sugarbaker DJ. Division of Thoracic Surgery, Brigham and Women b Hospital. 75 Francis Boston, ,UA OZIIS. Chest 1995;107:6 Suppl:298S-301s.
Street,
The contemporary surgical repertoire for the evaluation and treatment of patients with lung cancer includes the bronchoscope, mediastinoscope, thoracoscope, and standard surgical instrumentation. The recent advances in video optics and the development of endoscopic instruments have significantly expanded the surgical options for patients with lung cancer. Thoracoscopy, or the more inclusive term of videoassisted thoracic surgery (VATS), has been characterized as ‘minimally invasive’ surgery. Thoracoscopy and VATS have decreased operative trauma and facilitated surgical staging prior to neoadjuvant therapy. An ancillary benefit to diminished surgical morbidity is shorter hospital stays with a concomitant reduction in costs tn the patient and healthcare system. These advantages make VATS ideal for elderly patients or patients with significant comorbidity.
Cardiac arrhythmia 140 pneumonectomy Wu H, Zhou Y, Zhang
after lung cancer surgery cases X. Thoracic
Surgery
Deparment,
- An analysis Shanghai
of
Chest
200030. Chin J Oncol 1994;16:435-7. Among 808 surgically resected lung cancer cases at Shanghai Chest Hospital during the period of January 1991 to December 1992,140 of them (17.3%) underwent pneumonectomy (47 right, 93 left). In the 140 cases: 124 male, 16 female; aged 27 - 74 yrs, pre-operative abnormal EKG was found in 38 cases. Postoperatively, arrhythmia occurred in 76 cases, with an incidence of 54.3%. Of the 76 arrhythmias, atria1 fibrillation was seen in 7 patients, atria1 premature beats in 2, suptaventticular tachycardia in 1 and sinus tachycardia in 66. The results indicate that cardiac arrhythmia is a common complication after pneumonectomy for lung cancer surgery. The major causes of arrhythmia were incisional pain, hypovolemla due to blood loss and respiratory instdliciency due to anoxia. The perioperative measures to prevent arrhythmia were discussed. Hospital,
Shanghai
Survival following resection of clinically cell lung cancer Dalton R Keller S. Department oJConiiothorocic Medical
Cente,:
Cardiovasc
One Gustave
L Levy
Place,
occult
N2 non small
Swgery, Mount New York 10029-6s
Sinai 74. J
Surg 1994;35:Suppl l-6:13-7. The role of resection in Stage IIIA (N2) non-small cell lung cancer (NSCLC) remains controversial despite reported survival rates of 2540%. This study was undertaken to identify factors associated with a high risk of treatment failure after resection of clinically occult Stage IIIA (N2) NSCLC. Such prognostic factors may identify high risk patients as candidates for fuhtre clinical trials of multimodality lung cancer treatment and be important stratification factors in such trials. Methods. The clinical and pathological records of 32 patients with clinical NO pathologic N2 NSCLC who underwent lobectomy (n = 17), pneumonectomy (n = 12). or bilobectomy (n = 3) and complete media&ml lymph node dissection at Fox Chase Cancer Center from Background.