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Extrapleural pneumonectomy for diffuse malignant mesothelioma
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Tochigi-ken, Japan. Although presurgical e~aluation of mediastinal lymph node metastasis is facilitated by an introduction of computed tomography, its information is rather limited on its transverse diameter. Therefore, we are appling an ultrasonic endoscope equipped with a linear real-time probe on the head of fiberesophagoscopy, because the approach can measure both transverse and sagittal diameters of the nodes in subcarinal, tracheo-bronchial, subaortic and retrotracheal area. Subjects were 38 cases of pr-mary lung cancer, 37 of which were operated and one autopsied. All 116 nodes visualized by this approach were pathologically checked for metastasis. The measured sagittal and transverse diameters are depicted in the figure on abscissa and ordinate respectively. The lymph nodes with and without metastases are shown with 0 and 0. The results suggest that the metastasized lymph nodes generally increases its transverse and sagittal diameters simultaneously, but the accuracy by their sizes are 80%, when the mean + one S.D. values of transverse and sagittal °- ~ 0.':~ diameters of the nodes without metastasis (12 ° . . . . . and 21 mm) are assumed as their upper limits.
Incidence of Central Nervous System (CNS) Metastases in Small Cell Lung Cancer (SCLC). Drings, P., Hohenstadt, B., Abel, U., van Kaick, G. Chest Hospital Rohrbach, Heidelberg FRG, German Cancer Research Center, Heidelberg FRG. Metastases in CNS of 368 patients (308 men, 60 women) have been subject to analyses retrospectively. 335 patients proved to be evaluable. In 67 of them were observed metastases in CNS. Patients with metastases in CNS have been classified significantly more as advanced tumor stage already in the beginning of disease. In ii out of 67 patients (16.4%) metastases in CNS have been diagnosed in primary staging procedure. Refered to all patients this number amount to 3,3% (11/335). In the further course 41 patients (41/67=61,2%; 41/335=12.2%) developed metastases in CNS, while 15 patients (15/67=22.4%; 15/335=4.4%) only showed clinical symptoms, leading to the suspicion on involvement of CNS. The Karnofsky-scale of all our patients ranged around 70% at the time of diagnosis. The median age was 58 years. Distant metastases could be proven in 32% of our
patients in liver, in 40% in sceleton, in 20% in CNS, in 12% in the retroperitoneal space. Only 14 patients (4% of all patients)developed metastases in CNS exclusively as only hint of progressive tumor growth. On 28 out of 42 patients brain metastases have been the only localization of distant metastases. CT showed best results in detecting metastases in CNS. Nevertheless it is not necessarely required in primary staging of asymptomatic patients routinely. 8 out of ii patients with primary metastases in CNS showed already clinical symptoms. CT detected metastases only in 3 additional asymptomatic cases (3 of 335=1%). Metastases in CNS have been detected in average 7,8 months after diagnosis. After detection of metastases, patients survived 2,7 months. Extrapleural Pneumonectomy for Diffuse Malignant Mesothelioma. Faber, L.P., Kittle, C.F., Jensik, R.J., Warren, W.H. Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois. Extrapleural pneumonectomy for malignant mesothelioma is a radical procedure that entails an en bloc removal of the parietal pleura, lung, pericardian diaphragm. Minimal tumor remains after this procedure and good palliation and occasional long term survival can be achived in properly selected patients. We have performed extrapleural pneumonectomy for diffuse malignant epithelioma in.32 patients. There were 17 procedures performed on the left and 15 on the right in 25 male patients and 7 female patients. A history of exposure to asbestos was obtained in 16 patients (50%). Pathology study revealed that 21 tumors were epithelial, 9 were of the mixed type and 2 were sarcomatous. Good palliation, defined as survival over 24 months with a return to fairly normal activities, was obtained in 8 patients (25%). Survival over 36 months was achieved in 5 patients and 3 patients expired of their disease at 59 months, 60 months and 82 months respectively. The 3 year survival is 15%. Operative deaths occurred in 3 patients (9.4%). Serious complications occurred in 8 patients (25%) and consisted of bronchopleural fistula 2, persistent contralateral effusion i, left vocal cord paralysis 2, chylothorax i, tracheostomy 1 and cardiac arrhythmia i. Postoperative adjunctive therapy consisting of chemotherapy or radiation was given to the majority of patients. These findings indicate that extrapleural pneumonectomy for malignant mesothelioma can be done with an acceptable morbidity and mortality and little residual disease remains. Palliation is achieved in 25% of patients and an occasional long term survivor is identified. Adjunctive therapy may further extend the length of survival. Bronchogenic Carcinoma in Patients Under 40
Tochigi-ken, Japan. Although presurgical e~aluation of mediastinal lymph node metastasis is facilitated by an introduction of computed tomography, its information is rather limited on its transverse diameter. Therefore, we are appling an ultrasonic endoscope equipped with a linear real-time probe on the head of fiberesophagoscopy, because the approach can measure both transverse and sagittal diameters of the nodes in subcarinal, tracheo-bronchial, subaortic and retrotracheal area. Subjects were 38 cases of pr-mary lung cancer, 37 of which were operated and one autopsied. All 116 nodes visualized by this approach were pathologically checked for metastasis. The measured sagittal and transverse diameters are depicted in the figure on abscissa and ordinate respectively. The lymph nodes with and without metastases are shown with 0 and 0. The results suggest that the metastasized lymph nodes generally increases its transverse and sagittal diameters simultaneously, but the accuracy by their sizes are 80%, when the mean + one S.D. values of transverse and sagittal °- ~ 0.':~ diameters of the nodes without metastasis (12 ° . . . . . and 21 mm) are assumed as their upper limits.
Incidence of Central Nervous System (CNS) Metastases in Small Cell Lung Cancer (SCLC). Drings, P., Hohenstadt, B., Abel, U., van Kaick, G. Chest Hospital Rohrbach, Heidelberg FRG, German Cancer Research Center, Heidelberg FRG. Metastases in CNS of 368 patients (308 men, 60 women) have been subject to analyses retrospectively. 335 patients proved to be evaluable. In 67 of them were observed metastases in CNS. Patients with metastases in CNS have been classified significantly more as advanced tumor stage already in the beginning of disease. In ii out of 67 patients (16.4%) metastases in CNS have been diagnosed in primary staging procedure. Refered to all patients this number amount to 3,3% (11/335). In the further course 41 patients (41/67=61,2%; 41/335=12.2%) developed metastases in CNS, while 15 patients (15/67=22.4%; 15/335=4.4%) only showed clinical symptoms, leading to the suspicion on involvement of CNS. The Karnofsky-scale of all our patients ranged around 70% at the time of diagnosis. The median age was 58 years. Distant metastases could be proven in 32% of our
patients in liver, in 40% in sceleton, in 20% in CNS, in 12% in the retroperitoneal space. Only 14 patients (4% of all patients)developed metastases in CNS exclusively as only hint of progressive tumor growth. On 28 out of 42 patients brain metastases have been the only localization of distant metastases. CT showed best results in detecting metastases in CNS. Nevertheless it is not necessarely required in primary staging of asymptomatic patients routinely. 8 out of ii patients with primary metastases in CNS showed already clinical symptoms. CT detected metastases only in 3 additional asymptomatic cases (3 of 335=1%). Metastases in CNS have been detected in average 7,8 months after diagnosis. After detection of metastases, patients survived 2,7 months. Extrapleural Pneumonectomy for Diffuse Malignant Mesothelioma. Faber, L.P., Kittle, C.F., Jensik, R.J., Warren, W.H. Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois. Extrapleural pneumonectomy for malignant mesothelioma is a radical procedure that entails an en bloc removal of the parietal pleura, lung, pericardian diaphragm. Minimal tumor remains after this procedure and good palliation and occasional long term survival can be achived in properly selected patients. We have performed extrapleural pneumonectomy for diffuse malignant epithelioma in.32 patients. There were 17 procedures performed on the left and 15 on the right in 25 male patients and 7 female patients. A history of exposure to asbestos was obtained in 16 patients (50%). Pathology study revealed that 21 tumors were epithelial, 9 were of the mixed type and 2 were sarcomatous. Good palliation, defined as survival over 24 months with a return to fairly normal activities, was obtained in 8 patients (25%). Survival over 36 months was achieved in 5 patients and 3 patients expired of their disease at 59 months, 60 months and 82 months respectively. The 3 year survival is 15%. Operative deaths occurred in 3 patients (9.4%). Serious complications occurred in 8 patients (25%) and consisted of bronchopleural fistula 2, persistent contralateral effusion i, left vocal cord paralysis 2, chylothorax i, tracheostomy 1 and cardiac arrhythmia i. Postoperative adjunctive therapy consisting of chemotherapy or radiation was given to the majority of patients. These findings indicate that extrapleural pneumonectomy for malignant mesothelioma can be done with an acceptable morbidity and mortality and little residual disease remains. Palliation is achieved in 25% of patients and an occasional long term survivor is identified. Adjunctive therapy may further extend the length of survival. Bronchogenic Carcinoma in Patients Under 40