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Abramson Cancer CenterNCI CANCERLIT® Search: Radiation, Surgery for Non-small Cell Lung Cancer - May 2002
National Cancer Institute®
Last Modified: May 1, 2002
Table of Contents
1
UI - 11764664
AU - Nestle U; Hellwig D; Fleckenstein J; Walter K; Ukena D; Rube C; Kirsch
TI -
CM; Baumann M
Comparison of early pulmonary changes in 18FDG-PET and CT after combined
radiochemotherapy for advanced non-small-cell lung cancer: a study in 15
patients.
SO - Front Radiat Ther Oncol 2002;37():26-33
AD - Department of Nuclear Medicine, University Hospital of the Saarland,
Homburg/Saar, Germany. raunes@med-rz.uni-sb.de
2
UI - 11978336
AU - van Tinteren H; Hoekstra OS; Smit EF; van den Bergh JH; Schreurs AJ;
TI -
Stallaert RA; van Velthoven PC; Comans EF; Diepenhorst FW; Verboom P;
van Mourik JC; Postmus PE; Boers M; Teule GJ
Effectiveness of positron emission tomography in the preoperative
assessment of patients with suspected non-small-cell lung cancer: the
PLUS multicentre randomised trial.
SO - Lancet 2002 Apr 20;359(9315):1388-93
AD - Comprehensive Cancer Centre Amsterdam, Amsterdam, Netherlands.
h.v.tinteren@nki.nl
BACKGROUND: Up to 50% of curative surgery for suspected non-small-cell
lung cancer is unsuccessful. Accuracy of positron emission tomography
(PET) with 18-fluorodeoxyglucose (18FDG) is thought to be better than
conventional staging for diagnosis of this malignancy. Up to now
however, there has been no evidence that PET leads to improved
management of patients in routine clinical practice. We did a randomised
controlled trial in patients with suspected non-small-cell lung cancer,
who were scheduled for surgery after conventional workup, to test
whether PET with 18FDG reduces number of futile thoracotomies. METHODS:
Before surgery (mediastinoscopy or thoracotomy), 188 patients from nine
hospitals were randomly assigned to either conventional workup (CWU) or
conventional workup and PET (CWU+PET). Patients were followed up for 1
year. Thoracotomy was regarded as futile if the patient had benign
disease, explorative thoracotomy, pathological stage IIIA-N2/IIIB, or
postoperative relapse or death within 12 months of randomisation. The
primary outcome measure was futile thoracotomy. Analysis was by
intention to treat. FINDINGS: 96 patients were randomly assigned CWU and
92 CWU+PET. Two patients in the CWU+PET group did not undergo PET. 18
patients in the CWU group and 32 in the CWU+PET group did not have
thoracotomy. In the CWU group, 39 (41%) patients had a futile
thoracotomy, compared with 19 (21%) in the CWU+PET group (relative
reduction 51%, 95% CI 32-80%; p=0.003). INTERPRETATION: Addition of PET
to conventional workup prevented unnecessary surgery in one out of five
patients with suspected non-small-cell lung cancer.
3
UI - 11782710
AU - Puma F; Urbani M; Santoprete S; Ricci F; Sanguinetti A; Vinci D; Ottavi
TI -
P; Porcaro G; Daddi G
[The role of surgery in the treatment of small cell lung cancer]
SO - Minerva Endocrinol 2001 Dec;26(4):247-53
AD - Chirurgia Toracica, Ospedale Civile S. Maria, Terni, Universita degli
Studi, Perugia, Italy. francesopuma@tiscalinet.it
Small cell lung cancer (SCLC) is a biologically aggressive tumor with a
low long-term survival rate. SCLC is highly responsive to chemotherapy
and surgery has a very limited role in its treatment because the disease
is usually widely disseminated at the diagnosis. Good results from
surgery have been reported in the small subgroup of T1-2 N0 M0 patients.
In N1 peripheral SCLC, surgery in combination with other treatments, can
obtain fair results. Surgical treatment does not influence the prognosis
in SCLC as stage III and IV.
4
UI - 11782711
AU - Busutti L
TI -
[Current role of radiotherapy in the treatment of SCLC]
SO - Minerva Endocrinol 2001 Dec;26(4):255-60
AD - U.O. Radioterapia, Azienda Ospedaliera S. Orsola-Malpighi, Bologna,
Italy.
Microcytoma (SCLC) is generally regarded as a disease requiring
chemotherapy and is only treated with radiotherapy using combined
protocols. A number of different approaches have been proposed, changing
timing, dose and fractionation. A different role is played by
irradiation of the brain in the treatment of metastases. The authors
discuss the role of radiotherapy in the treatment of SCLC and in study
protocols through an analysis of a personal series.
5
UI - 11782713
AU - Pastore V; Santini M; Vicidomini G; D'Aniello G; Fiorello A;
TI -
Parascandolo V
[Role of the surgeon in the treatment of small cell lung carcinoma]
SO - Minerva Endocrinol 2001 Dec;26(4):263-7
AD - Dipartimento di Scienze Cardio-Toraciche e Respiratorie, Cattedra di
Chirurgia Toracica, Seconda Universita degli Studi, Naples, Italy.
Surgery has never played a precise and well consolidated role in the
planned treatment of lung microcytoma (SCLC). The acknowledged
therapeutic strategy associates local treatment (radiotherapy) with
general treatment (chemotherapy). Exeresis is particularly indicated in
limited or peripheral forms, followed by intensive polychemotherapy.
Scintigraphy with octreotide may be used for the initial screening of
patients with widespread disease. Another minor role played by surgery
is in the treatment of neoplastic foci remaining after chemotherapy. In
some cases the use of a radioguided method which, after intravenous
injection of radiolabeled octreotide, allows the accumulation of
somatostatin analog in neoplastic foci to be assayed intraoperatively
using a manual probe, might help the surgeon to check the radical nature
of the operation. In addition, octreotide can be used as a
radiotherapeutic pharmacological agent or to enhance the efficacy of
chemotherapy in microcytoma and other lung tumours with neuroendocrine
differentiation.
6
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9
10
11
12
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14
15
16
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18
19
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24
25
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The above citations and abstracts reflect those newly added to CANCERLIT for the month and topic listed in the title. The citations have been retrieved from CANCERLIT using a predefined search strategy of indexed subject terms. Although the search strategy has been refined as best as possible, citations may appear that are not directly related to the topic, and occasionally relevant references may be omitted.
UI - 11888773
AU - Rena O; Oliaro A; Cavallo A; Filosso PL; Donati G; Di Marzio P; Maggi G;
TI -
Ruffini E
Stage I non-small cell lung carcinoma: really an early stage?
SO - Eur J Cardiothorac Surg 2002 Mar;21(3):514-9
AD - Department of Thoracic Surgery, University of Torino, San Giovanni
Battista Hospital, v. Genova 3, 10126 Turin, Italy.
ottavio.rena@tiscalinet.it
OBJECTIVE: We review our results on surgical treatment of patients with
stage I non-small cell lung carcinoma and we attempted to clarify the
prognostic significance of some surgical--pathologic variables. METHODS:
From 1993 to 1999, 667 patients received curative lung resection and
complete hilar and mediastinal lymphadenectomy for non-small cell lung
cancer. Of these, there were 436 Stage I disease (65%), of whom 144 T1N0
and 292 T2N0. No patients had pre- or postoperative radio- or
chemotherapy. Prognostic significance of the following independent
variables was tested using univariate (log-rank) and multivariate (Cox
proportional-hazards) analysis: type of resection (sublobar vs lobectomy
vs pneumonectomy), histology (squamous cell vs adenocarcinoma), tumour
size (
UI - 11888774
AU - Passlick B; Kubuschock B; Sienel W; Thetter O; Pantel K; Izbicki JR
TI -
Mediastinal lymphadenectomy in non-small cell lung cancer: effectiveness
in patients with or without nodal micrometastases - results of a
preliminary study.
SO - Eur J Cardiothorac Surg 2002 Mar;21(3):520-6
AD - Department of Surgery, University of Munich, Munich, Germany.
passlick@lrz.uni-muenchen.de
OBJECTIVES: So far it has not clearly been demonstrated that systematic
mediastinal lymphadenectomy improves survival in patients with non-small
cell lung cancer. One explanation might be that in some patients an
early spread of tumor cells has occurred which might not be curable by
surgical means. To test this hypothesis lymph nodes of patients which
were treated either by lymph node sampling or systematic lymphadenectomy
were screened for micrometastatic spread of tumor cells and the
influence of nodal micrometastases on the efficacy of lymphadenectomy
was analyzed. METHODS: Lymph nodes from patients (n=94) which were
included in a randomized trial of lymph node sampling (LS, n=41) versus
radical systematic lymphadenectomy (LA, n=53) were screened by
immunohistochemistry for disseminated tumor cells using the antibody
Ber-Ep4. The median observation time was longer than 5 years and
follow-up data were available from all 94 patients. Kaplan-Meier curves
were calculated and tested for statistical significance using the
log-rank test. RESULTS: Standard histopathological analysis revealed no
lymph node involvement (pN0) in 61 patients, pN1 disease in 13 patients
and pN2 disease in 20 patients without significant differences between
LA and LS with respect to T-stage, N-stage or age and sex of the
patients. By immunohistochemistry a minimal nodal spread of tumor cells
was detected in 21 out of 94 patients (LS, n=10 (24%); LA, n=11 (21%)).
Similar to the entire group of patients also in the subset of patients
with nodal micrometastases the type of lymphadenectomy did not
significantly influence the long-term survival (P=0.27 and P=0.39,
respectively). In contrast, in patients with a negative
immunohistochemical analysis systematic lymphadenectomy resulted in an
improved overall survival (P=0.044). CONCLUSIONS: Our data provide some
evidence that systematic lymphadenectomy improves survival in patients
without an early locoregional spread of cancer cells. As long as these
patients can not be identified preoperatively all patients should
undergo a systematic mediastinal lymphadenectomy.
UI - 11888775
AU - Aziz TM; Saad RA; Glasser J; Jilaihawi AN; Prakash D
TI -
The management of second primary lung cancers. A single centre
experience in 15 years.
SO - Eur J Cardiothorac Surg 2002 Mar;21(3):527-33
AD - Division of Thoracic Surgery, Hairmyres Hospital, East Kilbride,
Scotland G75 8RJ, UK.
OBJECTIVE: In patients treated for an initial lung cancer, the
cumulative risk of developing a second primary lung cancer is a
recognised occurrence. This study reviews our experience in the clinical
assessment and surgical management of second primary lung cancer (SPLC).
METHODS: Between 1985-1999 a series of 892 patients with primary
carcinoma of lung underwent surgical resection with curative intent in
our institution. Using criteria set out by Martini and Melamed (J Thorac
Cardiovasc Surg 70 (1975) 606) we were able to identify 51 patients who
had developed a SPLC identified as the first site of re-occurrence.
RESULTS: Forty-one patients developed a metachronous SPLC within a mean
of 46+/-14 months of the first operation while ten patients had
synchronous double lung cancer (six unilateral, four bilateral). The
cumulative probability of cancer free interval for metachronous cancers
was 39% at 3 years, 15% at 5 years and 2% at 10 years. There were three
postoperative deaths among the metachronous cancers (7.5%) and there
were no operative deaths among patients with synchronous cancers. The
overall actuarial 5-year survival for all patients with SPLC was 38%
with a median survival of 40 months (range 1-142 months). The actuarial
5-year survival for metachronous SPLC was 44%, median survival of 49
months (range 1-142 months), while the actuarial 5-years survival for
synchronous SLPC was 10% with a median survival of 31 months (range 4-78
months). CONCLUSION: Aggressive assessment and surgical intervention is
safe, effective and warranted in patients with a second lung primary
cancer if they satisfy the usual criteria of operability after full
assessment. This is true for patients with metachronous cancers, while
patients with synchronous cancers tend to have worse prognosis. A long
term follow-up policy after the initial resection of the primary lung
cancer is recommended at intervals of 6 months for at least 3-5 years
and then annually to enable the early detection of the second cancer.
UI - 11888798
AU - Gunluoglu Z; Solak O; Metin M; Gurses A
TI -
The prognostic significance of skip mediastinal lymphatic metastasis in
resected non-small cell lung cancer.
SO - Eur J Cardiothorac Surg 2002 Mar;21(3):595
UI - 11948039
AU - Brunelli A; Al Refai M; Monteverde M; Borri A; Salati M; Fianchini A
TI -
Stair climbing test predicts cardiopulmonary complications after lung
resection.
SO - Chest 2002 Apr;121(4):1106-10
AD - Department of Thoracic Surgery, University of Ancona, Ancona, Italy.
alexit_2000@yahoo.com
STUDY OBJECTIVE: To evaluate the capability of the stair climbing test
to predict cardiopulmonary complications after lung resection for lung
cancer. DESIGN: A prospective cohort of candidates for lung resection.
Spirometric assessment and the stair climbing test were performed the
day before operation. Univariate and multivariate analyses were
performed to identify predictors of postoperative complications.
SETTING: Tertiary referral center. PATIENTS: A consecutive series of 160
complications were significantly older (p = 0.02), had a significantly
lower FEV(1) percentage (p = 0.007) and predicted postoperative FEV(1)
percentage (p = 0.01), had a greater incidence of a concomitant cardiac
disease (p = 0.02), climbed a lower altitude at the stair climbing test
(p < 0.0001), and had a lower calculated maximum oxygen consumption
(O(2)max) [p = 0.03] and predicted postoperative O(2)max (p = 0.006)
compared to the patients without complications. At multivariate
analysis, the altitude reached at the stair climbing test remained the
only significant independent predictor of complications. CONCLUSIONS:
The stair climbing test is a safe and economical exercise test, and it
was the best predictor of cardiopulmonary complications after lung
resection.
UI - 11955727
AU - Bradley JD; Scott CB; Paris KJ; Demas WF; Machtay M; Komaki R; Movsas B;
TI -
Rubin P; Sause WT
A phase III comparison of radiation therapy with or without recombinant
beta-interferon for poor-risk patients with locally advanced
non-small-cell lung cancer (RTOG 93-04).
SO - Int J Radiat Oncol Biol Phys 2002 Apr 1;52(5):1173-9
AD - Radiation Oncology Center, Washington University Medical Center, St.
Louis, MO 63110, USA. bradley@radonc.wustl.edu
PURPOSE: The results of Phase I/II data testing beta-interferon with
radiation therapy in a non-small-cell lung cancer population were
promising. Based on these data, the Radiation Therapy Oncology Group
(RTOG) initiated a Phase III trial to test the efficacy of
beta-interferon in poor-risk patients with Stages IIIA and IIIB
1998, 123 patients were accrued to this trial. Enrolled patients were
not eligible for other chemoradiation studies within the RTOG.
Eligibility criteria included histologically confirmed Stage IIIA or
IIIB non-small-cell lung cancer (according to American Joint Committee
on Cancer) considered clinically inoperable or unresectable at the time
of surgery. Patients were required to have a Karnofsky performance
status 50-70 or >70 and at least 5% weight loss over the preceding 3
months. Betaseron (recombinant human interferon beta(ser),
rHuIFN-beta(ser),) was the chosen preparation of beta-interferon. The
patients randomized to the investigational arm received 16 x 10(6) IU of
Betaseron by i.v. bolus given 3 days a week (Monday-Wednesday) on Weeks
1, 3, and 5. The Betaseron was given 30 minutes before radiation therapy
for a total of nine doses. Irradiation was delivered at 2 Gy per
fraction, 5 days a week, for a total of 60 Gy over 6 weeks and was
identical for both arms. The primary end point of the trial was overall
survival with local control as a secondary end point. Toxicities
occurring within 90 days of therapy completion were defined as acute.
RESULTS: The median follow-up was 4 years (range: 2.5-6 years) for
surviving patients. Seventy-six percent of all patients completed
beta-interferon. Toxicity was the primary reason for noncompliance.
Radiotherapy (RT) compliance was excellent in the RT-alone arm, with 94%
completing therapy, compared to 82% in the beta-interferon arm (p =
0.0475). Grade 3 and 4 acute toxicities were higher on the
beta-interferon arm (p = 0.0249). Grade 3 and 4 acute toxicities were
primarily related to lung (n = 8) and esophagus (n = 7). No Grade 4 or 5
late toxicities were seen for patients in the radiation-alone arm.
However, three patients on the beta-interferon arm experienced Grade 4
toxicity, and one patient died. The 1-year survival rate for the
RT-alone arm was 44% with a median survival time of 9.5 months. The
1-year survival on the beta-interferon arm was 42% with a median
survival of 10.3 months. There was no statistical difference in survival
times (p = 0.66). CONCLUSIONS: This multicenter, controlled Phase III
trial failed to confirm the efficacy of Betaseron in patients receiving
definitive radiotherapy for locally advanced, nonmetastatic
non-small-cell lung cancer. The use of beta-interferon led to greater
rates of both acute and late treatment-related toxicity. The RTOG
continues to investigate other biologic modifiers that may provide a
nontoxic alternative for this poor-risk population.
UI - 11269482
AU - Weigel TL; Kosco PJ; Dacic S; Rusch VW; Ginsberg RJ; Luketich JD
TI -
Postoperative fluorescence bronchoscopic surveillance in non-small cell
lung cancer patients.
SO - Ann Thorac Surg 2001 Mar;71(3):967-70
AD - Thoracic Surgery Service, Memorial Sloan-Kettering Cancer Center, New
York, New York 10021, USA. weigelt@mskcc.org
BACKGROUND: Second lung primaries occur at a rate of 1% to 3% per
patient-year after complete resections for non-small cell lung carcinoma
(NSCLC). Fluorescence bronchoscopy appears to be a sensitive tool for
surveillance of the tracheobronchial tree for early neoplasias. METHODS:
Patients who were disease-free after complete resection of a NSCLC were
entered into a fluorescence bronchoscopy surveillance program. All
suspicious lesions were biopsied along with two areas of normal mucosa
to serve as negative controls. RESULTS: A total of 73 fluorescence
bronchoscopies were performed after conventional bronchoscopy in 51
patients at a median of 13 months postresection. The majority (46 of 51)
of patients had stage I or II NSCLC, whereas 10% (5 of 51) had stage
IIIA. Three intraepithelial neoplasias and one invasive carcinoma were
identified in 3 of 51 patients (6%), all current or former smokers. Of
the four lesions identified, three were in the 20 patients with prior
squamous cell carcinomas. No intraepithelial neoplasias were identified
by white-light bronchoscopy, whereas two of three were detected by
fluorescence examination. The one invasive cancer detected was apparent
on both white-light and fluorescence bronchoscopic examinations.
CONCLUSIONS: Surveillance with fluorescence bronchoscopy identified
lesions in 6% of postoperative NSCLC patients thought to be
disease-free. Patients with prior squamous cell carcinomas appear to be
a population that may warrant future prospective study of postoperative
fluorescence bronchoscopic surveillance.
UI - 11837246
AU - Moghissi K; Thorpe JA; Dixon K
TI -
Postoperative fluorescence bronchoscopic surveillance: a worthwhile
procedure in a subset of patients.
SO - Ann Thorac Surg 2002 Jan;73(1):348
UI - 11834059
AU - Demos NJ
TI -
Durability of the intercostal muscle pedicle.
SO - Ann Thorac Surg 2002 Jan;73(1):349
UI - 11757291
AU - Petrova MV; Voskresenskii SV; Krasnova TE
TI -
[Changes in mechanical properties of the lungs in thoracic surgery in
cancer patients]
SO - Anesteziol Reanimatol 2001 Sep-Oct;(5):16-9
Mechanical characteristics of the lungs and time course of their changes
at various stages of thoracal surgery were studied in 119 cancer
patients. Lung compliance significantly decreased during transfer of the
patients into lateral position. The ranges of normal values of lung
compliance and aerodynamic resistance at the stage of one-lung
ventilation were determined. The studies confirmed the necessity of
intraoperative spirometry in the complex of thoracal operation
monitoring.
UI - 11742697
AU - Santo A; Pedersini R; Pasini F; Terzi A; Pari F; Cartei G; Sibau A;
TI -
Molino A; Maiorino A; Panza N; Oletti MV; Maluta S; Calabro F; Cetto GL
A phase II study of induction chemotherapy with gemcitabine (G) and
cisplatin (P) in locally advanced non-small cell lung cancer: interim
analysis.
SO - Lung Cancer 2001 Dec;34 Suppl 4():S15-20
AD - Department of Medical Oncology, University of Verona, Verona, Italy.
antonio.santo@univr.it
BACKGROUND: Gemcitabine-cisplatin (GP) combination is one of the most
active and well tolerated regimens in advanced non-small cell lung
cancer (NSCLC). The aim of this study is to evaluate the activity and
toxicity of the GP regimen as a 21-day schedule in patients (pts) with
2000, 47 pts entered the study: 43 were eligible (40 men and three
women); median age was 61 years (range 45-73); ECOG PS 0-1; histology
was squamous (20 pts), adenocarcinoma (12 pts), large cell (five pts),
and undifferentiated (six pts); stage was IIIAN2 (14 pts, 32.56%), and
IIIB (29 pts, 67.44%). Malignant pleural effusion or superior vena cava
syndrome was criteria of exclusion. Induction treatment consisted of
three cycles of GP (G 1250 mg/m(2) i.v. on days 1 and 8, and P 100
mg/m(2) on day 8 every 3 weeks). Responding and stable pts underwent
surgery (S) and/or radiotherapy (RT). RESULTS: Following a minimum of
two cycles, 39 pts were evaluable for response and 42 for toxicity. Two
pts had complete responses (CR; 5.2%), 24 had partial response (PR;
61.5%), eight had stable disease (SD; 20.5%), and five had progressive
disease (PRO; 12.8%). WHO grades 3 and 4 anaemia, neutropenia and
thrombocytopenia were observed in two, four and two pts, respectively;
non-haematological toxicity was moderate. After induction, stable and
responding pts received either RT (18 pts) or S+RT (13 pts). Among the
16 resected pts, a radical complete resection was possible in 13 cases
(81.3%), whereas tumour down-staging was observed in nine pts (56.2%).
CONCLUSION: GP, as a 3-week neoadjuvant schedule, appears a safe and
active regimen.
UI - 11742698
AU - Mattson K; Abratt R; Ten GV; Krofta K; Tonelli D; Avril I
TI -
Docetaxel as neo-adjuvant therapy for radically treatable stage III
non-small cell lung cancer: early results of an international phase III
study.
SO - Lung Cancer 2001 Dec;34 Suppl 4():S21-3
AD - Department of Medicine, Helsinki University Central Hospital, PB 340,
FIN 00029 HUS Helsinki, Finland. karin.mattson@hus.fi
UI - 11742699
AU - Rinaldi M; Crino L
TI -
Induction chemotherapy with gemcitabine and cisplatin in stage III
non-small cell lung cancer.
SO - Lung Cancer 2001 Dec;34 Suppl 4():S25-30
AD - Oncologia Medica B, Istituto Regina Elena, Via E. Chianesi 53, 00144
Rome, Italy. mas_rinaldi@yahoo.it
The necessity of improving the long-term survival of patients with
locally advanced non-small cell lung cancer (NSCLC) points out on the
one hand the limit of surgery alone and, on the other hand, the need of
combined modality therapy, in which the role of chemotherapy to control
distant metastases is prominent. Recent experiences support the efficacy
of neoadjuvant chemotherapy with or without radiotherapy. Phase II
studies show response rates of 50-80% and median survival longer than 2
years. Phase III studies suggest that neoadjuvant chemotherapy improves
survival and objective responses, and induces higher percentages of
complete resections compared with surgery alone or chemotherapy and
radiotherapy. The gemcitabine-cisplatin regimen has proved its efficacy
in NSCLC advanced disease with response rate greater than 40% in phase
II and III trials. Representing one of the regimens most used in Europe,
its activity has been investigated also in the neoadjuvant setting.
Phase II studies have reported an average response rate greater than
60%, complete surgical resections in 60-70% of the cases, and 1-year
survival of about 60%. A modern tendency is to use neoadjuvant
chemotherapy in very early stages of NSCLC. Gemcitabine-cisplatin
regimen has been used as a randomised clinical trial (chemotherapy for
early stages trial, CHEST) to compare the efficacy of surgery alone
versus surgery plus preoperative chemotherapy in early-stage disease
(T2-3N0, T1-2N1, T3N1), and to evaluate the progression free survival.
UI - 11742696
AU - Novello S; le Chevalier T
TI -
Is there a standard strategy in the management of locally advanced
non-small cell lung cancer?
SO - Lung Cancer 2001 Dec;34 Suppl 4():S9-14
AD - Departement of Medicine, Institut Gustave-Roussy, Villejuif, France.
Lung cancer is the leading cause of cancer mortality in the United
States for both men and women. Twenty to thirty percent of patients with
non-small cell lung cancer (NSCLC) present with locally advanced,
unresectable tumors. While small improvements in outcome have occurred
for this group of patients in the last decade, 5-year survival remains
low, ranging from 5 to 20%. Distant metastases and loco-regional
progression remain significant patterns of failure. Up to the late
1980s, the standard management was conventional thoracic radiotherapy
for locally advanced NSCLC, but when treated with radiotherapy alone,
less than 10% of patients survived for 5 years or more. Sixty to seventy
percent failed at distant sites and less than 20% achieved durable local
control. The addition of chemotherapy reduces the rate of distant
failure, improves survival and the combination of chemotherapy and
radiotherapy has become the standard of care of patients with locally
advanced NSCLC. Current developments aim to optimise individual
components of combined modality schedules, increase their synergism and
minimise toxicity.
UI - 11753236
AU - Cuccurullo V; Cascini GL; Rambaldi PF; Mansi L
TI -
[Role of somatostatin analogs in the treatment of neuroendocrine
tumours]
SO - Minerva Endocrinol 2001 Sep;26(3):135-43
AD - Medicina Nucleare, Dipartimento di Internistica Clinica Sperimentale F.
Magrassi-A. Lanzara, Seconda Universita degli Studi, Naples, Italy.
Current therapeutic approaches in neuroendocrine tumours include
surgery, radiotherapy and polychemotherapy. Different metabolic patterns
of neuroendocrine tumours allow the use of a wide range of diagnostic
options in nuclear medicine, due to the presence of a wide spectrum of
radiotracers electively concentrating in these neoplasms. Nuclear
medicine, and in particular 111In Octreotide (OCT) scintigraphy, 123I
Methaiodobenzylguanidine (MIBG) and pentavalent 99mTc-DMSA (V-DMSA),
together with biohumoral markers, are currently able to locate tumours
also not detectable using traditional diagnostic techniques.
Somatostatin analogs, such as octreotide have become increasingly
important over the years in the treatment of patients with
neuroendocrine tumours. At present the therapeutic use of somatostatin
analogs can be schematised as 1) pharmacological treatment (with cold
octreotide); 2) surgical treatment (radioguided surgery); 3)
radiometabolic treatment (with marked octreotide). The development of
new synthetic molecules and new radiocompounds will probably open up
interesting scenarios in the near future.
UI - 11996241
AU - Katakura H; Tanaka F; Oyanagi H; Miyahara R; Yanagihara K; Otake Y; Wada
TI -
H
Clinical significance of nm23 expression in resected pathologic-stage I,
non-small cell lung cancer.
SO - Ann Thorac Surg 2002 Apr;73(4):1060-4
AD - Department of Thoracic Surgery, Faculty of Medicine, Kyoto University,
Japan.
BACKGROUND: Clinical significance of the status of nm23 gene, originally
identified as an antimetastatic gene, in non-small cell lung cancer
remains unestablished, whereas many clinical studies have demonstrated
that reduced nm23 expression is correlated with tumor progression and
poor prognosis in a variety of malignant tumors such as breast
carcinoma. METHODS: nm23 expression was examined immunohistochemically
in a total of 117 patients with completely resected pathologic stage I
non-small cell lung cancer. RESULTS: nm23 expression was positive in 73
(62.4%) patients, and there was no correlation between nm23 expression
and age, sex, performance status, pathologic T factor, histologic type,
or degree of cancer cell differentiation. The 5-year survival rates of
nm23-positive and nm23-negative patients were 79.7% and 57.8%,
respectively, demonstrating a significantly poorer prognosis in
nm23-negative patients (p = 0.013), which was confirmed by a
multivariate analysis. nm23 was not correlated with the incidence of
apoptosis, proliferative activity, or p53 status. CONCLUSIONS: nm23
expression was a significant factor for predicting a favorable
prognosis, suggesting antimetastatic potential of the nm23 gene in
non-small cell lung cancer.
UI - 11996242
AU - Thomas P; Doddoli C; Thirion X; Ghez O; Payan-Defais MJ; Giudicelli R;
TI -
Fuentes P
Stage I non-small cell lung cancer: a pragmatic approach to prognosis
after complete resection.
SO - Ann Thorac Surg 2002 Apr;73(4):1065-70
AD - Department of Thoracic Surgery and Lung Transplantation, Ste Marguerite
Hospital, University Mediterranee (Aix-Marseille II), School of
Medicine, France. pathomas@ap-hm.fr
BACKGROUND: Long-term results of the surgical treatment of stage I
non-small cell lung cancer (NSCLC) are disappointing. METHODS:
Univariate and multivariate analyses were conducted on 515 consecutive
lung resections for stage I NSCLC performed from 1990 to 1999 and
identified by reviewing a database into which data were entered
prospectively. Tumors were staged as stages IA (n = 147) and IB (n =
348) according to the 1997 UICC (Union Internationale Contre le Cancer)
pTNM classification. RESULTS: Operative mortality rates were 6.2%, 5.3%,
2.3%, and 0% for pneumonectomy, bilobectomy, lobectomy, and lesser
resections, respectively. Overall survival rate was 61.1% (55.8% to
66.5%) at 5 years. Univariate analysis identified three significant
adverse prognosticators: arteriosclerosis as comorbidity, pathologic T2
status, and blood vessel invasion. Male sex (p = 0.056) and performance
of pneumonectomy (p = 0.057) were at the threshold of statistical
significance. At multivariate analysis, three independent
prognosticators entered the model: arteriosclerosis, blood vessels
invasion, and performance of pneumonectomy. CONCLUSIONS: Long-term
survival of patients with completely resected stage I NSCLC was
adversely influenced in a relatively balanced way by factors related to
the clinical status of the patient, to the tumor, and to the treatment.
UI - 11996245
AU - Piltz S; Meimarakis G; Wichmann MW; Hatz R; Schildberg FW; Fuerst H
TI -
Long-term results after pulmonary resection of renal cell carcinoma
metastases.
SO - Ann Thorac Surg 2002 Apr;73(4):1082-7
AD - Department of Surgery and Thoracic Surgery, Klinikum Grosshadern,
Ludwig-Maximilians-University Munich, Germany.
spiltz@gch.med.uni-muenchen.de
BACKGROUND: Until now no conclusive data exist regarding the factors
influencing long-term survival after pulmonary resection of renal cell
carcinoma metastases. The aim of the present study, therefore, was to
discover definitive prognostic factors for survival using a large and
homogeneous single center patient cohort. METHODS: Between 1980 and
2000, 105 patients, after curative resection of lung metastases from
renal cell carcinoma, were followed in this long-term study. These
patients underwent a total of 150 surgical procedures. Survival analysis
was done using the Kaplan-Meier method and the log-rank test.
Multivariate analysis of prognostic factors was performed using the Cox
multivariate proportional hazard model. RESULTS: Median survival after
curative resection reached 43 months (range, 1 to 218 months). Survival
at 3, 5, and 10 years was 54%, 40%, and 33%, respectively. Univariate
analysis revealed that a complete resection, a less than 4-cm diameter
of the metastases and tumor-free lymph nodes at the time of primary
operation, were highly significant dependent prognostic factors (p <
0.001). These factors were also shown to be independent prognostic
factors as suggested by multivariate analysis (p < 0.05). CONCLUSIONS:
The size of the metastatic nodule, the completeness of pulmonary
resection, and the lymph node status at the time of nephrectomy are the
most important prognostic factors that influence survival after
resection of pulmonary metastases. Recurrence of resectable pulmonary
metastases does not impair survival, thus favoring repeated resection in
patients with recurrent disease.
UI - 11769336
AU - Polednak AP
TI -
Disparities in surgical treatment of early-stage non-small-cell lung
cancer.
SO - Yale J Biol Med 2001 Sep-Oct;74(5):309-14
AD - Connecticut Tumor Registry, Connecticut Department of Public Health,
Hartford 06134-0308, USA. anthonypolednak@po.state.ct.us
This study involved 1,564 black or white patients diagnosed in 1992 to
1997 with non-small-cell lung cancer, reported to the population-based
Connecticut Tumor Registry, who were linked with a statewide hospital
discharge database that provided information on comorbid conditions.
While only 11.4 percent of patients did not receive surgical treatment
(lung resection), this proportion increased with rising age and was
higher among patients who resided in a census tract in the highest
poverty-rate quintile, were black, not married and had one or more
selected comorbid conditions. These associations persisted in logistic
regression models that included all of the variables as predictors of
surgery. Studies are needed to explain these disparities.
UI - 11844444
AU - Rodriguez Suarez P; Rodriguez De Castro F; Freixinet Gilart J
TI -
[On the diagnosis and treatment of bronchogenic carcinoma associated
with spontaneous pneumothorax and bullae]
SO - Arch Bronconeumol 2002 Feb;38(2):99
UI - 11839661
AU - Brabender J; Danenberg KD; Metzger R; Schneider PM; Lord RV; Groshen S;
TI -
Tsao-Wei DD; Park J; Salonga D; Holscher AH; Danenberg PV
The role of retinoid X receptor messenger RNA expression in curatively
resected non-small cell lung cancer.
SO - Clin Cancer Res 2002 Feb;8(2):438-43
AD - Department of Molecular Biology and Biochemistry, Norris Comprehensive
Cancer Center, University of Southern California/Keck School of
Medicine, Los Angeles, CA 90033, USA.
BACKGROUND: Retinoid X receptors (RXRs) have inhibitory effects on
non-small cell lung cancer (NSCLC) cell growth, and RXRbeta expression
is reduced in NSCLC specimens compared with normal lung tissue. We
hypothesized that suppressed RXR expression might be a prognostic factor
of worse clinical outcome in patients with NSCLC. EXPERIMENTAL DESIGN:
Using a quantitative real-time reverse transcription-PCR (TaqMan)
method, we analyzed RXRalpha, RXRbeta, and RXRgamma mRNA expression in
normal lung tissue and matching tumor samples from 88 patients with
NSCLC. RESULTS: The median mRNA expression levels of all three RXR
subtypes were frequently decreased in tumor tissues compared with
matching normal lung tissue (RXRalpha, 67%; RXRbeta, 55%; RXRgamma,
89%). The RXRalpha(P = 0.001) and RXRgamma(P < 0.001) median expression
levels were significantly lower in the tumors. Patients whose tumors
exhibited low RXRbeta expression levels had a statistically significant
worse overall survival (P = 0.0005), whereas a trend toward worse
survival was observed for patients with low RXRalpha expression.
Multivariate analysis indicated that low RXRbeta expression is an
independent predictor of worse survival in patients with NSCLC (P =
0.017). CONCLUSION: Suppressed mRNA expression of all three RXR subtypes
is a frequent event in NSCLC. Reduced RXRbeta expression might be an
important biomarker for more aggressive disease in patients with NSCLC.
UI - 11905749
AU - Jassem J
TI -
Combined chemotherapy and radiation in locally advanced non-small-cell
lung cancer.
SO - Lancet Oncol 2001 Jun;2(6):335-42
AD - Department of Oncology and Radiotherapy, Medical University of Gdansk,
Poland. jjassem@amg.gda.pl
The efficacy of radiotherapy in locally advanced non-small-cell lung
cancer is limited. One attempt to improve survival uses a combination of
radiation and chemotherapy. These two modalities can be applied in
sequence or concurrently, but results from phase III trials of combined
therapy versus radiation alone have been inconsistent. Early studies
were mostly negative, but more recent trials using platinum-based
regimens have shown some survival benefit for combined treatments. The
positive impact of chemotherapy has also been shown in a meta-analysis.
In recent studies, concurrent chemotherapy and radiation appears better
than sequential application. However, the benefit of the combined
approach is modest and should be balanced against increased early and
late toxicity. The role of new agents such as taxanes, vinorelbine,
gemcitabine, and topoisomerase inhibitors in combined modality therapy
of non-small-cell lung cancer warrants further clinical investigation.
UI - 11763820
AU - Potanin VP; Taziev RM; Sigal EI; Krasin VV; Khalimov ID; Potanin AV;
TI -
Sigal RI; Latypov AG
[Thienam treatment in early postoperative period after pneumonectomy in
patients with lung cancer]
SO - Khirurgiia (Mosk) 2001;(10):47-8
UI - 11750710
AU - Suzuki M; Iizasa T; Ko E; Baba M; Saitoh Y; Shibuya K; Sekine Y; Yoshida
TI -
S; Hiroshima K; Fujisawa T
Serum endostatin correlates with progression and prognosis of non-small
cell lung cancer.
SO - Lung Cancer 2002 Jan;35(1):29-34
AD - Department of Thoracic Surgery, Graduate School of Medicine, Chiba
University, Inohana 1-8-1, Chuo-ku, 260-8670, Chiba, Japan.
The relationship between non-small cell lung cancer and platelet counts,
serum levels of vascular endothelial growth factor (VEGF) and
endostatin, is unclear. Platelet counts and serum VEGF and endostatin
levels were measured preoperatively in 99 patients with non-small cell
lung cancer, and the relationship between these factors and
clinicopathological features, including prognosis, was examined. Mean
serum VEGF level was slightly higher in patients than in healthy
subjects (P=0.23). Mean serum endostatin level was 42.4+/-40.4 ng/ml in
patients compared to 16.3+/-10.3 ng/ml in healthy subjects (P=0.0003).
Serum endostatin levels were significantly higher in patients with
involvement greater than T2 or stage IB, compared to other patients.
Platelet count and serum endostatin level greater than the median were
associated with poor prognosis. Our results suggested that platelet
count and serum endostatin level may be useful markers for non-small
cell lung cancer.
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