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Syncronous and metachronous lung cancer
S30
Abstracts
Docetaxel. Patient characteristics: 63 pts. have received 240 cycles. 63 pts are evaluable for toxicity and 56 pts. are evaluable for tumor response. M/F ratio: 49/14, median age 64 (43-75) years, median WHO performance status 1 (0Ð2). Results: Neutropenia NCI-CTC grade 4 occurred in 10% of pts. and grade 3 / 4 occurred in 19% of pts. Other toxicities of NCI-CTC grade 3 / 4 (platelets, anemia, diarrhea, stomatitis, vomiting) occurred in < 5% of pts. No other toxicities of NCI-CTC grade 3 / 4 were observed. Response: In 56 pts.: 27 (48%) PR confirmed by CT-scan [95% confidence interval 35-62%] was achieved. Conclusion: Present results indicate that Docetaxel/Cisplatin given in a circadian timing produces comparable response rates but significantly less grade 4 and grade 3 / 4 Neutropenia than this combination in similar dosages in a time unspecified fashion does. After one year 38% of pts. are still alive. Tissue saving vats resections for peripheral lung cancer V. Porhanov, S. Semendiaev, V. Chaikin, V. Bodnia, V. Kononenko, M. Mamelov, I. Poliakov. Regional Thoracic Surgery Center, Krasnodar, Russia. Surgery is the main method for peripheral lung cancer treatment. Successful surgery depends on the proper choice of resection volume. Since l992 we have performed 72 tissue saving VATS resections in patients with peripheral lung cancer. Age rate was from 34 to 75 years. First group included 46 patients with invasion up to 2 cm, without enlarged lymph nodes on CT scans. Second group comprised 26 patients with limited functional reserves. Open procedure was not indicated in these cases. We observed postoperative period in early and late terms. In the first group there were no perioperative or postoperative complications, all patients were extubated at the end of the procedure. Patients were dischared 5-7 days after surgery. Five year survival was 67%. In the second group 19 patients (73%) where extubated at the end of the procedure and the remaining 6 (23%) were extubated in 1 to 5 hours after surgery. One patient necessitated prolonged controlled mechanical ventilation. One patient developed acute disorder of cerebral blood circulation and died. Five year survival was 33%. Tissue saving VATS resections for peripheral lung cancer treatment improve long-term results in patients with Stage 1 disease and do not worsen life quality in patients with advanced disease, and elder patients. This procedure may be accepted as a procedure of choice taking into consideration absence of postoperative complications caused by operative wound and evident cosmetic advantages. Endobronchial BRT HDR in NSLC. Valuation early clinical results particular fractions M. Maþczko, R. Kabarowski, E. Skrzypczy«nska, W. Ko«sniewski, M. Bieniasiewicz, M. Pamucka, Prov. Hosp. of Oncology Dept of Radiotherapy, Opole, Poland The authors present preliminary efficiency of treatment in patients with NSCL with using BRT-HDR . There were treated 100 pts with NSLC (228 applications). The treatment was radical in 6 cases (6%). This pts were surgical operated first and in pathological exams positive or doubtful margins presented. 94 pts were treated in palliative treatment. The indications were following: necessity to dyspnoea, tumours regrowth after RT residual tumours after CHT, poor ventilation due to bilateral main bronchus invasion. There were gauged the results of treatment in 94 pts after particular fractions. There were used 1-2 standard intrabronchial applicators. The dose of radiation was specified in referent isodose 10 mm interspace from source axle in main bronchials. Dose per fractions was 7.6 Gy (from
6 to 10 Gy) and total dose was 17 Gy (from 10 to 22.5 Gy) divided into 2 or 3 fractions with interval between the fractions 7 days. The treatment in 40 cases (40%) were complemented by external beams. Our results included: subjective effect, neutral effect (basing on bronchoscope view), frequency and increase early postradiation reactions.There were the good paliative results as stopped or decrease of dyspnoea, bleeding and cough in 79% pts after the 1 application, in next 6% after second, but after third application the good results decrease to 41%. Conclusion: BRT-HDR is well tolerated method of endobronchial treatment in NSLC. BRT-HDR is the method which allows to receive good palliative effects. Increase fraction dose above 7 Gy and number of fractions above 2 may lead to increase of complications, but palliative effect is similar. Modicum pts donÕt allows to draw conclusions, but our results are encouraging to routine treatment on this way. Syncronous and metachronous lung cancer CsiszŽr, E., Reindl, I., SoltŽsz, I., FŸlšp, A., Rumszauer, ç.; Kor‡nyi National Institute of TB and Pulmonology, Budapest, Hungary The appearence of synchronous and metachronous primary lung cancer is relatively rare. We analysed six cases of each type, that occurred in our institute in the last two years. Out of six synchronous cases, based on the criteria of Martini, three patients were identified by chest X ray screening, three other patients by complaints. The bilateral shadows of three cases were visible on the chest X ray at the recognition. One patient underwent median sternotomy, two patients bilateral thoracotomy successively. The histology findings were double bronchoalveolar carcinoma and combination of different subtypes of adenocarcinoma. The other three unilateral cases were discovered by bronchoscopy, CT-scan and by histological examination. The tumor pairs of two cases were squamosus cell and microcell carcinoma and adenocarcinoma combined with malignant Schwannoma in one case. The initial operation due to early stage of NSCL was upper lobe resection in four patients and pneumonectomy in the other two cases. Complaints connected with the second lung cancer appeared 78 (25259)months later in five patients, one patient was symptomless identified by screening. Upper lobe resection on the other side was performed in three cases, the histological pattern of the new tumor was different from the original one. The second tumor of three further patients was microcell carcinoma. They received chemo- and radiotherapy. The knowledge and recognition of these entities are important as proper judgement can improve the survival time. Surgical treatment of clinical N2 non-small cell lung cancer A.L. Akopov. State Research Centre of Pulmonology, St. Petersburg, Russia Aim: To compare of clinical with pathologic N stage of NSCLC and evaluate radical resectionsÕ results. Methods: Radical operations with complete ipsilateral mediastinal lymph node dissection were performed in 164 primary NSCLC pts (154 men, 10 women, median age 57,4 years). Histology types were: squamous cell carcinoma in 127 pts, adenocarcinoma in 19, large cell carcinoma in 5, not specified carcinoma in 13. Clinical N2 status was confirmed radiologically, endoscopically, by computed tomography in all cases. No preoperative mediastinoscopy and mediastinotomy were done. Results: Types of pulmonary resection were: pneumonectomy in 148 pts bilobectomy in 5 pts, lobectomy in 11 pts. Combined pericardial resection was done in 72 pts (tumour involved main
Abstracts
Docetaxel. Patient characteristics: 63 pts. have received 240 cycles. 63 pts are evaluable for toxicity and 56 pts. are evaluable for tumor response. M/F ratio: 49/14, median age 64 (43-75) years, median WHO performance status 1 (0Ð2). Results: Neutropenia NCI-CTC grade 4 occurred in 10% of pts. and grade 3 / 4 occurred in 19% of pts. Other toxicities of NCI-CTC grade 3 / 4 (platelets, anemia, diarrhea, stomatitis, vomiting) occurred in < 5% of pts. No other toxicities of NCI-CTC grade 3 / 4 were observed. Response: In 56 pts.: 27 (48%) PR confirmed by CT-scan [95% confidence interval 35-62%] was achieved. Conclusion: Present results indicate that Docetaxel/Cisplatin given in a circadian timing produces comparable response rates but significantly less grade 4 and grade 3 / 4 Neutropenia than this combination in similar dosages in a time unspecified fashion does. After one year 38% of pts. are still alive. Tissue saving vats resections for peripheral lung cancer V. Porhanov, S. Semendiaev, V. Chaikin, V. Bodnia, V. Kononenko, M. Mamelov, I. Poliakov. Regional Thoracic Surgery Center, Krasnodar, Russia. Surgery is the main method for peripheral lung cancer treatment. Successful surgery depends on the proper choice of resection volume. Since l992 we have performed 72 tissue saving VATS resections in patients with peripheral lung cancer. Age rate was from 34 to 75 years. First group included 46 patients with invasion up to 2 cm, without enlarged lymph nodes on CT scans. Second group comprised 26 patients with limited functional reserves. Open procedure was not indicated in these cases. We observed postoperative period in early and late terms. In the first group there were no perioperative or postoperative complications, all patients were extubated at the end of the procedure. Patients were dischared 5-7 days after surgery. Five year survival was 67%. In the second group 19 patients (73%) where extubated at the end of the procedure and the remaining 6 (23%) were extubated in 1 to 5 hours after surgery. One patient necessitated prolonged controlled mechanical ventilation. One patient developed acute disorder of cerebral blood circulation and died. Five year survival was 33%. Tissue saving VATS resections for peripheral lung cancer treatment improve long-term results in patients with Stage 1 disease and do not worsen life quality in patients with advanced disease, and elder patients. This procedure may be accepted as a procedure of choice taking into consideration absence of postoperative complications caused by operative wound and evident cosmetic advantages. Endobronchial BRT HDR in NSLC. Valuation early clinical results particular fractions M. Maþczko, R. Kabarowski, E. Skrzypczy«nska, W. Ko«sniewski, M. Bieniasiewicz, M. Pamucka, Prov. Hosp. of Oncology Dept of Radiotherapy, Opole, Poland The authors present preliminary efficiency of treatment in patients with NSCL with using BRT-HDR . There were treated 100 pts with NSLC (228 applications). The treatment was radical in 6 cases (6%). This pts were surgical operated first and in pathological exams positive or doubtful margins presented. 94 pts were treated in palliative treatment. The indications were following: necessity to dyspnoea, tumours regrowth after RT residual tumours after CHT, poor ventilation due to bilateral main bronchus invasion. There were gauged the results of treatment in 94 pts after particular fractions. There were used 1-2 standard intrabronchial applicators. The dose of radiation was specified in referent isodose 10 mm interspace from source axle in main bronchials. Dose per fractions was 7.6 Gy (from
6 to 10 Gy) and total dose was 17 Gy (from 10 to 22.5 Gy) divided into 2 or 3 fractions with interval between the fractions 7 days. The treatment in 40 cases (40%) were complemented by external beams. Our results included: subjective effect, neutral effect (basing on bronchoscope view), frequency and increase early postradiation reactions.There were the good paliative results as stopped or decrease of dyspnoea, bleeding and cough in 79% pts after the 1 application, in next 6% after second, but after third application the good results decrease to 41%. Conclusion: BRT-HDR is well tolerated method of endobronchial treatment in NSLC. BRT-HDR is the method which allows to receive good palliative effects. Increase fraction dose above 7 Gy and number of fractions above 2 may lead to increase of complications, but palliative effect is similar. Modicum pts donÕt allows to draw conclusions, but our results are encouraging to routine treatment on this way. Syncronous and metachronous lung cancer CsiszŽr, E., Reindl, I., SoltŽsz, I., FŸlšp, A., Rumszauer, ç.; Kor‡nyi National Institute of TB and Pulmonology, Budapest, Hungary The appearence of synchronous and metachronous primary lung cancer is relatively rare. We analysed six cases of each type, that occurred in our institute in the last two years. Out of six synchronous cases, based on the criteria of Martini, three patients were identified by chest X ray screening, three other patients by complaints. The bilateral shadows of three cases were visible on the chest X ray at the recognition. One patient underwent median sternotomy, two patients bilateral thoracotomy successively. The histology findings were double bronchoalveolar carcinoma and combination of different subtypes of adenocarcinoma. The other three unilateral cases were discovered by bronchoscopy, CT-scan and by histological examination. The tumor pairs of two cases were squamosus cell and microcell carcinoma and adenocarcinoma combined with malignant Schwannoma in one case. The initial operation due to early stage of NSCL was upper lobe resection in four patients and pneumonectomy in the other two cases. Complaints connected with the second lung cancer appeared 78 (25259)months later in five patients, one patient was symptomless identified by screening. Upper lobe resection on the other side was performed in three cases, the histological pattern of the new tumor was different from the original one. The second tumor of three further patients was microcell carcinoma. They received chemo- and radiotherapy. The knowledge and recognition of these entities are important as proper judgement can improve the survival time. Surgical treatment of clinical N2 non-small cell lung cancer A.L. Akopov. State Research Centre of Pulmonology, St. Petersburg, Russia Aim: To compare of clinical with pathologic N stage of NSCLC and evaluate radical resectionsÕ results. Methods: Radical operations with complete ipsilateral mediastinal lymph node dissection were performed in 164 primary NSCLC pts (154 men, 10 women, median age 57,4 years). Histology types were: squamous cell carcinoma in 127 pts, adenocarcinoma in 19, large cell carcinoma in 5, not specified carcinoma in 13. Clinical N2 status was confirmed radiologically, endoscopically, by computed tomography in all cases. No preoperative mediastinoscopy and mediastinotomy were done. Results: Types of pulmonary resection were: pneumonectomy in 148 pts bilobectomy in 5 pts, lobectomy in 11 pts. Combined pericardial resection was done in 72 pts (tumour involved main