- Email: [email protected]
Long term survival for resectable small cell lung cancer
130
Surgery~Miscellaneous
volume (DLCONA) decreased from a median of 1.3 to 1.08 (p .02). Five patients (24.3%) experienced DLCONA% reduction > 20%. Fifteen patients staged Ilia underwent surgery after chemotherapy. Five of them were considered at higher risk for a predicted postoperative DLCO (ppoDLCO) less than 50% (2 of them for DLCO modifications during chemotherapy). No postoperative death was recorded. Overall complication rate was 33%. In 5 patients with ppoDLCO < 50%, 1 complication was recorded (20%); in the remaining patients 4 complications were recorded (40%). Cisplatinum/Gemcitabin regimen used in this protocol showed a slight subclinical pulmonary toxicity (1525%) without clinical evidence of lung damage. Changes in respiratory function do not seem to increase the risk of complication for surgical resection after induction chemotherapy. argon plasma coagulation for 14--2-6-1Bronchoscopic tracheobronchial lesions S. Okada, H. Yamauchi, S. Ishimori, S. Satoh. Department of Thoracic
Surgery and Medicine, Kamaishi Municipal Hospital, Kamaishi, Japan To date, little information is available about bronchoscopic argon plasma coagulation (APC) in the treatment of repiratory tract lesions. We evaluate the effectiveness and outcome of the procedure for tracheobronchial tumors. Materials and Methods: Ten patients, 8 men, 2 women, aged 5284 years, received the APC treatment. The diseases included primary lung cancer in 5 patients, metastatic tracheobronchial tumor in 3, and benign tumor in 3. The aims of the procedure were dilatation of tracheobronchial stenosis in 4 patients, hemostasis in 3, and curative resection in 3. APC was performed under general anesthesia and a laryngeal mask placement with an argon plasma coagulation unit. The probe of APC through the working channel of the flexible bronchoscope was applied to the target lesion. Results: The stenotic site was successfully dilated in 3 of the 4 patients with tracheobronchial stenosis. In the remaining patient, it was a failure because of the tumor extension to the peripheral bronchi of the lower lobe. All of 3 patients with endobronchial bleeding due to protruding tumor had a successful hemostasis. In all of 3 patients with a benign tumor, curative resection of the tumor was achieved. All of the procedures caused little smoke resulting in reduced interruption of the procedure. No complications related to the procedure occurred. Conclusion: Bronchoscopic argon plasma coagulation is very useful and may be an alternative treatment in the respiratory tract surgery.
Carcinoid tumor is a clinicopathologic entity and surgical resection is the only curative therapy. The same surgical treatment criteria applied to lung cancer should be applied to carcinoid tumors. But, in spite of maligant pathological features, bronchopulmonary carcinoid has a good outcome after surgery.
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Long term survival for resectable small cell lung cancer
I. Cataldo, P. Bidoli, P.P. Brega Massone, B. Conti, C. Lequaglie.
Onco/ogic Thoracic Surgery, Istituto Nazionale Tumori, Milano, Italy From 1982 to 1992 at the Thoracic Surgical Oncology Department of the National Cancer Institute of Milan 60 patients, with stage Ill-Ill small cell lung cancer (SCLC), underwent surgical resection and adjuvant chemotherapy. The male/female ratio was 54/6 and the mean age was 60 years (range 40-79). Twenty-four patients were classified as pathological stage I (40%), 14 as stage II (23%) and 22 as stage III (37%). Twenty pneumonectomies (33%), 38 Iobectomies (64%), and 2 segmental resections (3%) were performed with 1 case of operative death (1%). Four patients received no adjuvant treatment due to poor general conditions following surgery: 1 patient refused and 53 were submitted to adjuvant chemotherapy (88%). The initial chemotherapy regimen was CAV later substituted with CEE regimen and CCDP + VP16. The overall mean chemotherapy administration was 80% of the predicted dose. Prophylactic brain irradiation was administered to 25 patients (41%). Seven patients with II disease (11%) and 13 with stage III (21%) received Iocoregional radiotherapy. One patient died because of myelosuppression after chemotherapy (1%). We registered 4 Iocoragional recurrences (6%) and 3 progression of residual disease (R) (5%). Distant metastases were the main modality of failure accounting for 77% of all recurrences.; brain metastases, as exclusive pattern of recurrence, accounted for 20% of all metastases. Observed 5 years survival rate was 40% for stage I, 36% for stage II and 15% for stage III. Our results confirm that long term survival of patients with pTNM stage I and stage II small cell lung carcinoma is improved by surgical resection and postoperative chemotherapy. ~-I
Metachronous second primary lung cancer after bronchial sleeve resection
RE. Van Schil 1, J. Vankeirsbilck2, A. Brutel de la Rivk~re2, P.J. Knaepen 2, H.A. van Swieten 2, R.G. Vanderschueren 2, J.M van den Bosch2. 1University Hospital of Antwerp, Edegem, Belgium,
2Antonius Hospital, Nieuwegein, The Netherlands ~-~
Carcinoid tumors of the lung. A review of 98 cases
V.MS. Vieira, F. Felix, E. Moreira, A.C. Nunes, I. Mendes, J. Ser6dio, A. Pinto Marques, C. Batista, M Ramos, M.T. Magalh:~es Godinho.
Hospital Pulido Valente, Lisboa, Portugal We present a retrospective analysis of 98 patients with histologically proven primary carcinoid tumors of the lung treated between 1987 and 1999. There were 58 females and 40 males with mean age of 48 years (range 15-77). Seventy six (77,6%) carcinoid tumors were central and the remaining 22 (22.4%) were peripheral. Eighteen patients (18.4%) were asymptomatic and the remaining 80 (81.6%) symptomatic. The most common clinical presentation mode was recurrent infection. Fibrotic bronchoscopy was diagnostic in 66 cases. Fifty Lobectomies, 20 Bilobectomies, 10 Lobectomies with bronchoplasty, 12 pneumonectomies, 3 Wedge Resection, 2 Segmentectomies and 1 Exploration, were performed. Five patients (5.1%) had regional nodal metastases (N1) and only 1 patient (1%) had (N2) disease at the time of surgical therapy. Histologically, 68 of the carcinoids were classified as Typical and 30 as Atypical. There were 9 minor and 1 major postoperative complications and there was no mortality occurred. Distant metastases developed in 2 patients (2%) and 1 patient had a regional recurrence after initial treatment. Five patient were lost to follow up after hospital discharge, and the remaining patients were followed up for 4 months-150 months, median follow up 55 months. The overall 5 years predicted survival rate was 95.2%.
Introduction: In a series of 145 patients who underwent bronchial sleeve resection for lung cancer, the prevalence and subsequent treatment of a second primary lung cancer (SPLC) were studied. Methods: Follow-up was updated until 1999. Minimum follow-up was 10 years for surviving patients. Survival curves were calculated according to Kaplan-Meier. A univariate log rank and multivariate Cox analysis were performed. Results: A metachronous SPLC was diagnosed in 15 patients (10.3%), 14 were men. Mean interval between sleeve resection and diagnosis of SPLC was 65.1 months. All SPLC occurred on the contralateral side. The SPLC was of different histologic type from the primary tumor in 7 patients. Seven patients (46.7%) were operated on, 5 underwent Iobectomy and 2 segmentectomy; 3 were irresectable; one patient was treated by radiotherapy and 4 patients with small cell carcinoma by chemotherapy. Follow-up was complete for the 15 patients; 14 patients died, mostly of local recurrence or metastases. Median survival time (MST) after diagnosis of SPLC was 8 months (95% confidence interval [CI] 4-12); 2- and 5-year survival rates were 0.20 +/- 0.10 and 0.07 +/- 0.07. MST for operated patients was 16 months (95% CI 0-37) and for nonoperated patients 7 months (95% CI 4-10); this difference approached significance (p = 0.07). In a Cox multivariate analysis no significant independent factors were identified. MST after sleeve resection for the 15 patients was 78 months (95% CI 19-137), 5- and 10-year survival rates were 0.33 +/- 0.12 and 0.10 +/- 0.09.
Surgery~Miscellaneous
volume (DLCONA) decreased from a median of 1.3 to 1.08 (p .02). Five patients (24.3%) experienced DLCONA% reduction > 20%. Fifteen patients staged Ilia underwent surgery after chemotherapy. Five of them were considered at higher risk for a predicted postoperative DLCO (ppoDLCO) less than 50% (2 of them for DLCO modifications during chemotherapy). No postoperative death was recorded. Overall complication rate was 33%. In 5 patients with ppoDLCO < 50%, 1 complication was recorded (20%); in the remaining patients 4 complications were recorded (40%). Cisplatinum/Gemcitabin regimen used in this protocol showed a slight subclinical pulmonary toxicity (1525%) without clinical evidence of lung damage. Changes in respiratory function do not seem to increase the risk of complication for surgical resection after induction chemotherapy. argon plasma coagulation for 14--2-6-1Bronchoscopic tracheobronchial lesions S. Okada, H. Yamauchi, S. Ishimori, S. Satoh. Department of Thoracic
Surgery and Medicine, Kamaishi Municipal Hospital, Kamaishi, Japan To date, little information is available about bronchoscopic argon plasma coagulation (APC) in the treatment of repiratory tract lesions. We evaluate the effectiveness and outcome of the procedure for tracheobronchial tumors. Materials and Methods: Ten patients, 8 men, 2 women, aged 5284 years, received the APC treatment. The diseases included primary lung cancer in 5 patients, metastatic tracheobronchial tumor in 3, and benign tumor in 3. The aims of the procedure were dilatation of tracheobronchial stenosis in 4 patients, hemostasis in 3, and curative resection in 3. APC was performed under general anesthesia and a laryngeal mask placement with an argon plasma coagulation unit. The probe of APC through the working channel of the flexible bronchoscope was applied to the target lesion. Results: The stenotic site was successfully dilated in 3 of the 4 patients with tracheobronchial stenosis. In the remaining patient, it was a failure because of the tumor extension to the peripheral bronchi of the lower lobe. All of 3 patients with endobronchial bleeding due to protruding tumor had a successful hemostasis. In all of 3 patients with a benign tumor, curative resection of the tumor was achieved. All of the procedures caused little smoke resulting in reduced interruption of the procedure. No complications related to the procedure occurred. Conclusion: Bronchoscopic argon plasma coagulation is very useful and may be an alternative treatment in the respiratory tract surgery.
Carcinoid tumor is a clinicopathologic entity and surgical resection is the only curative therapy. The same surgical treatment criteria applied to lung cancer should be applied to carcinoid tumors. But, in spite of maligant pathological features, bronchopulmonary carcinoid has a good outcome after surgery.
•
8
]
Long term survival for resectable small cell lung cancer
I. Cataldo, P. Bidoli, P.P. Brega Massone, B. Conti, C. Lequaglie.
Onco/ogic Thoracic Surgery, Istituto Nazionale Tumori, Milano, Italy From 1982 to 1992 at the Thoracic Surgical Oncology Department of the National Cancer Institute of Milan 60 patients, with stage Ill-Ill small cell lung cancer (SCLC), underwent surgical resection and adjuvant chemotherapy. The male/female ratio was 54/6 and the mean age was 60 years (range 40-79). Twenty-four patients were classified as pathological stage I (40%), 14 as stage II (23%) and 22 as stage III (37%). Twenty pneumonectomies (33%), 38 Iobectomies (64%), and 2 segmental resections (3%) were performed with 1 case of operative death (1%). Four patients received no adjuvant treatment due to poor general conditions following surgery: 1 patient refused and 53 were submitted to adjuvant chemotherapy (88%). The initial chemotherapy regimen was CAV later substituted with CEE regimen and CCDP + VP16. The overall mean chemotherapy administration was 80% of the predicted dose. Prophylactic brain irradiation was administered to 25 patients (41%). Seven patients with II disease (11%) and 13 with stage III (21%) received Iocoregional radiotherapy. One patient died because of myelosuppression after chemotherapy (1%). We registered 4 Iocoragional recurrences (6%) and 3 progression of residual disease (R) (5%). Distant metastases were the main modality of failure accounting for 77% of all recurrences.; brain metastases, as exclusive pattern of recurrence, accounted for 20% of all metastases. Observed 5 years survival rate was 40% for stage I, 36% for stage II and 15% for stage III. Our results confirm that long term survival of patients with pTNM stage I and stage II small cell lung carcinoma is improved by surgical resection and postoperative chemotherapy. ~-I
Metachronous second primary lung cancer after bronchial sleeve resection
RE. Van Schil 1, J. Vankeirsbilck2, A. Brutel de la Rivk~re2, P.J. Knaepen 2, H.A. van Swieten 2, R.G. Vanderschueren 2, J.M van den Bosch2. 1University Hospital of Antwerp, Edegem, Belgium,
2Antonius Hospital, Nieuwegein, The Netherlands ~-~
Carcinoid tumors of the lung. A review of 98 cases
V.MS. Vieira, F. Felix, E. Moreira, A.C. Nunes, I. Mendes, J. Ser6dio, A. Pinto Marques, C. Batista, M Ramos, M.T. Magalh:~es Godinho.
Hospital Pulido Valente, Lisboa, Portugal We present a retrospective analysis of 98 patients with histologically proven primary carcinoid tumors of the lung treated between 1987 and 1999. There were 58 females and 40 males with mean age of 48 years (range 15-77). Seventy six (77,6%) carcinoid tumors were central and the remaining 22 (22.4%) were peripheral. Eighteen patients (18.4%) were asymptomatic and the remaining 80 (81.6%) symptomatic. The most common clinical presentation mode was recurrent infection. Fibrotic bronchoscopy was diagnostic in 66 cases. Fifty Lobectomies, 20 Bilobectomies, 10 Lobectomies with bronchoplasty, 12 pneumonectomies, 3 Wedge Resection, 2 Segmentectomies and 1 Exploration, were performed. Five patients (5.1%) had regional nodal metastases (N1) and only 1 patient (1%) had (N2) disease at the time of surgical therapy. Histologically, 68 of the carcinoids were classified as Typical and 30 as Atypical. There were 9 minor and 1 major postoperative complications and there was no mortality occurred. Distant metastases developed in 2 patients (2%) and 1 patient had a regional recurrence after initial treatment. Five patient were lost to follow up after hospital discharge, and the remaining patients were followed up for 4 months-150 months, median follow up 55 months. The overall 5 years predicted survival rate was 95.2%.
Introduction: In a series of 145 patients who underwent bronchial sleeve resection for lung cancer, the prevalence and subsequent treatment of a second primary lung cancer (SPLC) were studied. Methods: Follow-up was updated until 1999. Minimum follow-up was 10 years for surviving patients. Survival curves were calculated according to Kaplan-Meier. A univariate log rank and multivariate Cox analysis were performed. Results: A metachronous SPLC was diagnosed in 15 patients (10.3%), 14 were men. Mean interval between sleeve resection and diagnosis of SPLC was 65.1 months. All SPLC occurred on the contralateral side. The SPLC was of different histologic type from the primary tumor in 7 patients. Seven patients (46.7%) were operated on, 5 underwent Iobectomy and 2 segmentectomy; 3 were irresectable; one patient was treated by radiotherapy and 4 patients with small cell carcinoma by chemotherapy. Follow-up was complete for the 15 patients; 14 patients died, mostly of local recurrence or metastases. Median survival time (MST) after diagnosis of SPLC was 8 months (95% confidence interval [CI] 4-12); 2- and 5-year survival rates were 0.20 +/- 0.10 and 0.07 +/- 0.07. MST for operated patients was 16 months (95% CI 0-37) and for nonoperated patients 7 months (95% CI 4-10); this difference approached significance (p = 0.07). In a Cox multivariate analysis no significant independent factors were identified. MST after sleeve resection for the 15 patients was 78 months (95% CI 19-137), 5- and 10-year survival rates were 0.33 +/- 0.12 and 0.10 +/- 0.09.