Prognosis in primary, resected non-small cell carcinoma cases with intrapulmonary metastasis

Abstracts/Lung

342 Combined pulmonary lung cancer

and thoracic

wall resection

Gmcer

for stage III

Shah SS, Goldsttaw P Deparmentof Thoracic Suqery, RoyaiBmnpton Hospital, Sydney Stmet, London SW3 6NP Thorax 1995;50:782-4. Backgmund - Carcinoma of the lung with thoracic wall involvement

constitutes stage III disease. The management of patients with this condition is complicated. However, improvement in perioperative care coupled with advances in surgical technique have enabled a more aggressive approach to tbe problem to be adopted. Methods - A retrospective review was carried out of 58 patients (40 men) of mean age 63 years who underwent thorawtomy for lung cancer with chest wall invasion between 1980 and 1993. Results - Chest wall resection was performed in 55 patients (94.8%); in three patients the discovery of N2 disease at operation precluded resection. The TNM status was T3NOMO in 38 patients, T3NIMO in 13, and T3N2MO in seven. Squamous cell carcinoma was the commonest cell type (26 patients). ReconsU’uction of the chest wall was performed in 29 patients (Marlex mesh in six, Marlex-methacrylate in 22, myocutaneous flap in one patient). The morbidity and mortality were 22.4% and 3.4% respectively. Follow up was complete in 5 I patients. Nineteen (37 2%) survived 5 years. The absolute five year survival for NO and Nl disease was 44.7% and 38.4%. respectively. No patients with N2 disease survived five years. Conclusions - In patients with carcinoma of the lung and chest wall invasion, combined pulmonary and thoracic wall resection offers he prospect of cure with minimal morbidity and mortality. The prognosis of patients with coexistent N2 disease remains poor. Prognosis in primary, resected non-small cell carcinoma cases with intrapulmonary metastasis Fujisawa T. Yamaguchi Y. Saito Y. Iizasa T. Baba M. Shiba M et al. Department of Sutge~, UniversitySchoolofMedicine,

Inst.

of Pulmonary Cancer Reseamh, Chiba Chiba. Jpn JLung Cancer 1995;35:247-

52. The objective was to evaluate the prognosis of primary non small cell carcinoma cases in a total of 794 casea resected during the past 10 years, including 64 cases with intrapulmonary metastasis (pm) and 730 cases without intrapulmonic metastasis (control). The overall 5 year survival rates in the pm group was 25% and there were no significant differences in survival between adenocarcinoma and squamous cell carcinoma, or between cases of Tl, T2, T3 and T4 disease. However, the survival rates of cases with metastasis to primary lobe tended to be better than cases of ipsilateral metastasis to non-primary lobe(s). Furthermore, significant differences of survival curves were demonstrated between cases with NO and NZ diseases and between cases with solitary and multiple metastasis (both P < 0.05, Cox Mantel test). The survival rates of cases with intrapulmonary metastasis were rcemhtated according to the classification proposed by the AJCC and no significant differences were demonstrated in TZNO, T3N0, T4N0, Nl, N2 diseases between the pm group and control group without intrapulmomuy metastasis, supporting the suitability ofthe AJCC stage criteria for intrapulmonary metastasis. Predicting postoperative pulmonary function in patients undergoing lung resection Z&her BG, Gross TJ, Kern JA, Lanza LA, Peterson MW. Univ. ofIowu Hospitals and Clinics, Iowa City, LA 52242. Chest 1995;108:68-72. Objective: Our aim was to determine the effect of lung resection on spirometric lung function and to evaluate the accuracy of simple calculation in predicting postoperative pulmonary tiction in patients undergoing lung resection. Design: We reviewed preoperative and postoperative pulmonary function test results on patients who were followed in the multidisciplinary lung cancer clinic between July 1991

13 (1995)

323-356

and March 1994 and who underwent lung resection. The predicted postoperative FEV, and FVC were calculated based on the number of segments resected and mere wmpared with the actual postoperative FEV, and FVC. Setting: Tbis study was conducted at a university, tertiary referral hospital. Patients: All patients were evaluated at a multidisciplinary lung cancer clinic and underwent lung resection by one surgeon (L.A.L.). A4emutwnents and main results: Sixty patients undergoing 62 pulmonary resections were reviewed The predicted postoperative FEV, and FVC were calculated using the following formula: predicted postoperative FEV, (or FVC)lpreoperative FEV, (or FVC)x(l-fSxO.O526)); where S=number of segments resected. The actual postoperative PEV, and FVC correlated well with the predicted postoperative FEV, and FVC for patients undergoing lohectomy (r=O.867 and H.832, respectively); however, the predicted postoperative FEV, consistently underestimated the actual postoperative FEV, by approximately 250 mL. For patients undergoing pneumonectomy, the actual postoperative FEV, and FVC did not correlate as well with the predicted postoperative FEV, and FVC (r=0.677 and r=0.741, respectively). Although there was considerable variability, the predicted postoperative FEV, consistently underestimated the actual postoperative FEV, hy nearly 500 mL. Of the patients undergoing lobectomy, eight also received postoperative radiation therapy. When analyzed separately, patients receiving combined therapy lost an average of 5.47% of FEV per segment resected. This contrasts with a 2.84% per segment teductior in FEV, for patients who did not rtive radiation therapy. Conclusions This simple calculation of predicted postoperative FEV, and FVC correlates well wilh the actual postoperative FEV, and FVC in-patients undergoing lobectomy. The predict4 postoperative FEV, consistently underestimated the actual postoperative FEV, by approximately 250 tuL. The. postoperative FEV, and FVC for patients undergoing pneumonectomy is not accurately predicted using this equation. The predicted postoperative FEV, for patients undergoing pneumonectomy was nr~derestimatcd by an average of 500 mL and by greater than 250 mL in 12 of our 13 patients. Thus, by adding 250 mL lo the above calculation of predicted postoperative FEV,, we improve our ability to estimate FEV, for patients undergoing lobectomy and we identify a minimal postoperative FEV, for patients undergoing pneumonectomy. Finally, combined modality treatment with surgery followedby radiation therapy may result in additive lung function loss. Results of a limited resection for compromised or poor-risk patients with clinical stage I non-small cell carcinoma of the lung Yano T, Yokoyama H. Yoshino I, Tayama K, Asoh H, Hata K et al. Department of Chest Sugery. National Kyushu Cancer Cente,: 3-1-l. Notame, Afinomi-ku, Fukuoka 815. J Am Coll Surg 1995;181:33-7. Bockgtvund: Patients with stage I non-small cell carcinoma of the lung may be unable to undergo a standard curative resection, such as lobectomy, due to various medical reasons. Whether or not a limited resection is superior to radiotherapy in these patients, both in terms of long-term prognosis and treatment morbidity, is unknown. Stu&designt We retrospectively reviewed our results in treating compromised or poorrisk patients with clinical stage I non-small cell carcinoma ofthe lung who had received either a limited resection or radiotherapy. Seventeen patients underwent a limited resection (nine wedge resections and eight segmentectomies), while 18 patients received radiation therapy. Rest&s: The five-year survival rates for patients in the limited resection group and the radiation treatment group were 55.0 and 14.4 percent, respectively. A log-rank analysis showed a significant difference between the two groups @=0.004). Furthermore, the survival rate of the patients having a limited operation was significantly better than that of patients achieving either complete response or partial response from radiotherapy (18.8 percent at five years, p=O.OOS). Recurrence at the surgical margin