Lymphadenectomy in non-small cell lung cancer

392

Abstructs

/ Lung

agnosis, but diabetes (14.3%versus 5%) and fever (286%versus 13.5%) were significantly more frequent in group I than in group II. No statistically significant difference was observed between the two groups in tumor site or endoscopic appearance. Cavitated tumors were I s times larger than the noncavitated lesions. Squamous cell carcinoma was significantly more frequent in group I than in group II (82.8% versus 61%).Survival at 1, 3, and 5 years was, respectively, 58.6%0/o, 36. I%, and 22.2% in group I versus 48.2%. 3S%, and 23.8% in group II. Conclusions. Despite several specific features, there appears to be no justification for considering cavitated neoplasms separately from other forms of lung cancer. Transtracheal aspiration using rigid hronchoscopy and a rigid needle for investigating mediastinal masses Wilsher ML, Gurley AM. Department ofRespiratop Medicine, Green Lane Hospital, Auckland 3. Thorax 1996;s 1: 191-9. Background - Use of the flexible needle via the tibre-optic bronchoscope to aspirate mediastinal nodes or masses has largely superseded the use of the rigid needle via the rigid bronchoscope. However, the yield at fibreoptic bronchoscopy is relatively low, although this improves with the use of a wider gauge needle. In this study the sensitivity and the safety of rigid needle sampling of the mediastinum in the diagnosis of lung cancer is evaluated. Methods - Transtracheal needle aspiration (TTNA) was performed with the rigid bronchoscope and a rigid aspiration needle under general anaesthesia using a previous computed tomographic (CT) scan as a guide to the sample site. A cytopathologist immediately examined the specimens for adequacy and preliminary diagnosis, thus determining the number of aspirations. Results - Twenty four patients were evaluated. The diagnostic sensitivity of TTNA was 88%. This led to a management decision in 2 1 patients. There were no false positives and no complications. Conclusions - TTNA using the rigid bronchoscope with CT scanning and a cytopathologist present is a sensitive and safe way of diagnosing lung cancer in patients with a mediastinal mass or enlarged mediastinal nodes.

Surgery Long-term outcome after pneumonectomy for nonsmall cell lung cancer Rocco PM, Antkowiak JG, Takita H, Urschel JD. Division oJThoracic Surgery, RosweN Park Cancer Institute, Elm and Carlton Streets, Bujjalo, NY 14263-0001. J Surg Oncol 1996;61:278-80. Long-term survivors (5 or more years) of pneumonectomy for nonsmall cell lung cancer are at risk for late death from cancer recurrence, second primary malignancies, and cardiopulmonary insufficiency related to the adverse physiological effects of pneumonectomy. A retrospective study of pneumoncctomy patients was done to quantify the risks of late death from these causes. Of 246 patients treated for nonsmall cell lung cancer by pneumonectomy. medical records of 49 who survived 5 or more years were reviewed. Follow-up for the 49 long-term survivors ranged from 60 to 240 months, with a mean of II 3 months. Twenty-five (5 1%) ofthe long-term survivors were alive at the time of the study. Twenty-four (49%) had died. Causes of death included late lung cancer recurrence (6 patients). second primaly malignancies (7 patients), cardiopulmonary insufficiency (4 patients), and miscellaneous causes unrelated to cancer and its treatment (7 patients). Long-term survival after pneumonectomy for nonsmall cell lung cancer occurs in 20% of patients. Late lung cancer recurrence and second primary malignancies are important causes of death in these patients. Late cardiopulmonary insufficiency related to adverse physiological consequences of pneumonectomy is uncommon. Long-term follow-up is recommended afler pneumonectomy for nonsmall cell lung cancer

Cuncrr

15 (1996)

381-399

Postoperative complications after pneumonectomy for treatment of lung cancer: Multivariate analysis Mitsudomi T, Mizoue T, Yoshimatsu T, Oyama T, Nakanishi R, Okabayashi K et al. Department oJ Thoracic Surgery, Aichi Cancer Center Hospital, I-1 Kanokoden, Chikusa-ku. Nagoya 464. J S~rg On~l 1996,61:218-22. The charts of62 patients with primary lung cancer who underwent a pneumonectomy at our department from 1979 through 1992 were reviewed for the evaluation of postoperative morbidity and mortality. The 30day mortality was 3/62 or 4.8%. Postoperative complication occurred in 37 of 62 patients (60%). The most common complication was a supraventricular tachya@hmia. A major complication, which was detined as one necessitating re-thoracotomy or one which caused death, occurred in 19 patients (31%). We analyzed 43 perioperative variables for their predictive value of postoperative morbidity and mortality. Univariate analysis indicated that an elevated serum LDH, low predicted forced vital capacity, low predicted forced expiratoly volume in I set (FEV,) were significantly associated with the occurrence of a major complication. A multivariate logistic regression model indicated that a high LDH level, a low predicted FEV, and no extubation following surgery were associated independently with a postoperative major complication. Since only the complete removal of a tumor offers a chance for cure for the treatment of non-small cell lung cancer, it is sometimes necessary to perform a pneumonectomy for these high-risk patients. Patients identified as being at high risk of a major complication should be candidates for intensive preoperative evaluation and perioperative care. Prospective analysis of pneumoncctomy: Risk factors for major morbidity and cardiac dysrhytlunias Harpole DH Jr, Liptay MJ, DeCamp MM Jr, Mentzer SJ, Swanson SJ, Sugarbaker DJ. Division Thoracic Surgery, Brigham and Women S Hospital, 75 Francis Street, Boston, UA 02115. Ann Thorac Surg 1996;61:977-82. Background. Data were acquired prospectively on I36 consecutive patients undergoing pneumonectomy for cancer from 1988 to 1993, to define factors that increase the risk of major morbidity and postoperative cardiac dysrhythmias. Methods. There were 81 patients (60%) with non-small cell lung cancer (standard pneumonectomy) and 55 patients (40%) with malignant pleural mesothelioma (extrapleural pneumonectomy). Results. Four perioperative deaths occurred (3%) with no identifiable associated risk factors. tienty-three patients (I 7%) had a major complication with an increase in the median length of stay from 7 to 11 days @ < 0.01). Age greater than 65 years, right-sided procedures, and dysrhythmias were associated with an increased risk of a major complication (p < 0.0s). Thirty-two patients (24%) had supraventricular dysrhythmias, which occurred on postoperative days I to 2 (n = 8). 3 to 4 (n = 13), 5 to 6 (n = 6). and 7 to 12 (n = 5). The median length of stay increased from 8 to 11 days with dysrhythmias (p < 0.05). Factors associated with an increased risk of dysrhythmias (p < 0.05) included age greater than 65 years, intrapcricardial or extrapleural pneumoncctomy, right-sided procedure, and any major complication. Conclusions. Pneumonectomy can be performed safely in selected patients with cancer. Supraventricular dysrhythmia was the most common complication noted with a peak incidence at 3 to 4 days after resection. Lymphadenectomy in non-small cell lung cancer Gellert K, Agnes A, Noack F, Benhidjeb T, Jacobi C. Klinik und Poltklinik fur Chirmgie. llniversitatsklinikum Charite, Schumannst,: 20121, 10098 Berlin. Zentralbl Chir 1996;121:87-9. Since I982 a total number of 1062 patients underwent surgical treatment Of bronchogenic carcinoma. There were 972 men and 89

Ab,~trt~c~t.~ i LUCIA CUIIW~

women, with a mean age of 62.5 years. In 484 cases a squamous cell carcinoma was diagnosed and in 416 patients an adenccarcinoma. An alveolar cell carcinoma was found in 54 and a polymorphocellular carcinoma in 68 patients respectively. 334 patients were found to be in stage 1. 233 in stage II and 438 patients were in stage llla. The 5-year survival rate was 57.2% in stage I and 32.5% in stage Il. The group of patients with N2 lymph node metastasis according stage llla showed a very poor 5-year-survival rate of 12.3%. A standard therapeutical procedure according to a multimodal concept is necessary to improve these patients’ long-term survival. Systemic lymphadenectomy is essential for adequate therapy. Tracheal sleeve pneumonectomy for bronchogenic carcinoma: Report of 55 cases: Updated in 1995 Dartevelle PG, Khahfe I, Chapelier A Marzelle J, Navajas M, Levasseur P el al. Dept. of7?loracicNoscuiarS~~e~, Heart-Lung Hopitol Marie Lannelongue, 133 Ave de la Resistance, Robinson. Ann Thorac Surg 1995;60: 1854-5.

Transphzniation, F-92350 Plessrs-

From I966 to 1986, a total of 55 patients underwent a tracheal sleeve pneumonectomy (53 right and 2 left) for bmnchogenic carcinoma. Preoperative radiotherapy was given in only 5 patients. The overall operative death rate was 10.9%. but no patient has died since 1975 (32 survivors). Seven patients had a postoperative empyema (12.7%): 4 of these patients had a bronchopleural tistula. Twenty-five patiens had postoperative radiotherapy. 5 of whom also had chemotherapy. The actuarial survival rate, after exclusion of the 6 operative deaths, was 38% at 3 years and 23% at 5 years. Survival was correlated to regional lymph node involvement. The actuarial survival rate among patients with tumoral spread to bronchial lymph nodes was 43% at 3 years. Among the 13 patients with only subcarinal involvement, the actuarial survivaI rate was 34% at 3 years. None of the 8 patients with paratrachcal lymph node involvement survived more than 30 months. These results indicate that tracheal sleeve pneumonectomy for bronchogenic carcinoma with extension to the carina is now fully justified considering the low operative mortality and the good results observed when lateral tracheal lymph nodes were not involved.

Chemotherapy A prospective study of pulmonary function in patients receiving mitomycin Castro M, Veeder MH, Mailliard JA, Tazelaar HD, Jett IR. Washington Universily, Box 8052, 660 S. EuclidAve, St. Louis, MO 63110. Chest 1996;109:939-44. Mitomycin is a chemotherapeutic agent that is used to treat a variety of solid tumors. Pulmonary toxic reactions from this agent can be life threatening. We prospectively investigated the utility of pulmonary function tests (PFTs) in monitoring for the occurrence of pulmonary toxicity due to mitomycin. PFTs were obtained at baseline and after three cycles of mitomycin therapy. We analyzed the clinical course, radiologic studies, and PFT results in 133 patients with metastatic squamous cell carcinoma of the lung r?ndomized to treatment with either mitomycin, vinblastine, and cisplatin or mitomycin alone as part of a prospective treatment protocol, of the North Central Cancer Treatment Group (NCCTG). The difhising capacity (DCO) was available in only 40 patients after the third cycle due to a high rate of progression and death from their underlying disease. After three cycles of chemotherapy, there was an average decline in the Den of 14% (p20%change after correcting for hemoglobin) was noted in 1 I of 40 patients (28%). This decline in the Den was not

15 (1996)

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associated with a worse prognosis (p=O.77). Seven patients (5%) developed severe pulmonary toxic reactions attributed to chemotherapy, including noncardiogenic pulmonary edema, interstitial pneumonitis, and pleural effusions. Corticosteroid therapy resulted in temporary subjective improvement in three patients. The Den did not correlate with the development of pulmonary toxic reactions in these seven patients. In conclusion, (I) the incidence of clinically significant pulmonary toxic reactions from mitomycin is relatively low (5%), (2) mitomycin therapy resulted in a greater than 20% decline in the Den in approximately one- fourth of patients receiving three cycles of chemotherapy, and (3) the use of serial PFTs in patients receiving mitomycin was not shown to be predictive of pulmonary toxicity. Cisplatin and UPT modulated with leucovorin for the treatment of advanced non-small-cell lung cancer Feliu J, Gonzalez-Baron M. Espinosa E, De Castro J, Ordonez A, Zamora P. et al.Servicio de Oncologia Medico. Hospital La Paz. Paseo de lo Castellana, 261. Madrid 28046. Am J Clin Oncol Cancer Clin Trials 1996;19:121-4 We performed a phase II study to assess the efftcacy and toxicity of the cisplatin-UFT-leucovorin (LV) combination in patients with advanced non-small~ell lung cancer (NSCLC). Rventy-five patients with measurable disease who had not received prior chemotherapy were entered into the trial. The therapeutic regimen consisted of cisplatin 90 mg/mZ and iv. LV 500 mg/m20n day I, followed by oral IJFI’ 390 mg/ mYday (in two doses) on days 1 through 14. Patients also received oral LV I5 mg/12 h on days 2 through 14. Seventeen patients required reduced doses ofUFI’ (200 mg/m’) due to toxicity. Courses were repeated every 28 days for a minimum of three per patient Three of 25 patients (12%) achieved a partial response (95% Cl: 2.6 to 32.2%) two with 390 mglm’lday and one with 200 mg/m*/day of LIFT. The main side effects were hematological and gastrointestina1. In the courses including 390 mg/mZ/day of UFf, grade 3-4 toxicity was leucopenia in 18% of the courses, nausea/vomiting in 27%, and diarrhea and epigastralgia in 13% each. Grade 3-4 toxicities for 200 mg/m’/day of UFT were leucopenia 2%. nausea/vomiting 9% and diarrhea 7%. In conclusion, this regimen cannot be recommended for the treatment of advanced NSCLC due to its low response rate and high toxicity. Phase II trial of mitoxantrone small-cell lung cancer Feun LG. Savaraj N, Solomon

and cisplatin J, Liebmann

Comprehensive Cancer Ctr, University ofMiami, Avenue, Miami, FL 33136. Am J Clin Oncol

in advanced

non-

A, Hurley

J. Sylvester 147s Northwest 12th

Cancer Clin Trials 1996;19:190-2. Because in vitro data suggest that mitoxantrone may be synergistic with cisplatin, a Phase II trial of mitoxantrone and cisplatin was conducted in patients with advanced or metastatic non-small-cell lung cancer (NSLC). Twenty-four patients were evahtable for response. Toxicity was tolerable. Partial responses occurred in three patients (13%). This response rate is similar to that reported for cisplatin alone in NSLC. Mitoxantrone did not improve the response rate when combined with cisplatin for patients with advanced NSLC. Optimal schedule for administering lating factor in chemotherapy-induced cell lung cancer Soda H, Oka M, Fukuda M, Kinoshita

granulocyte neutropenia A, Sakamoto

colony-stimuin non-smallA, An&i

J et al.

Second Department Internal Medicine, Nagasaki University School Medicine, 7-1 Sakamoto I-Chome, Nagaski 852. Cancer Chemother

Pharmacol

1996;38:9-12.