ISSN:8756-0437    

DOI:10.1002/ssu.2980060503

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractThe author reviews the various noninvasive and invasive techniques for preoperatively staging patients with lung cancer who are potentially operable. The value of computed tomography and mediastinoscopy is emphasized and their role in treatment decisions is outlined. Prior to consideration of surgery in patients with lung cancer, preoperative staging, as accurate as possible, is required in order to determine the best treatment. Complete staging is only available after surgical resection and pathologic examination.

ISSN:8756-0437    

DOI:10.1002/ssu.2980060504

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractResection is the treatment of choice for stage I and II non‐small cell lung carcinoma. The 5‐year survival following resection is 72% in stage I carcinoma and 49% in stage II carcinoma. Resection alone or combined with radiation and/or chemotherapy is also indicated in some patients with stage IIIa disease. The 5 year survival with resection is 56% in tumors invading chest wall (T3NO), 30% in superior sulcus tumors, 30% in patients with N2MO disease, and 36% in patients with tumors in proximity to carina. Surgery is of very limited value in patients with tumors invading the mediastinum and in patients with stage IIIb or stage IV disease. Details of case selection in each treatment category are presen

ISSN:8756-0437    

DOI:10.1002/ssu.2980060505

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractAny neoadjuvant or preoperative treatment program that would increase survival in clinically advanced non‐small cell lung cancer (NSCLC) patients would be of significant benefit. In addition to improving patient survival, the program should be associated with minimal toxicity and surgical mortality. The rationale for any preoperative program is that the ability to resect the advanced cancer will be enhanced and micrometastasis will be eradicated. We have analyzed 323 patients enrolled in various types of neoadjuvant and preoperative studies. Review of this data indicates that cisplatin containing regimens produce relatively high responder rates in locally advanced NSCLC patients, resectability rate can be increased by a neoadjuvant program and chemotherapeutic toxicity and operative mortality are not prohibitive. Survival data frequently includes T3NO‐1 patients, but there does appear to be increased survival at 3 and 4 years. These studies remain experimental and continued analysis is necessary before they can be accepted as standard therapy for clinically advanced NSCLC can

ISSN:8756-0437    

DOI:10.1002/ssu.2980060506

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractThere have been many attempts to develop effective postoperative adjuvant therapy in patients with resected lung cancer. Metastatic disease is the commonest site of first recurrence. In squamous cell carcinoma local failure is another major problem and in adenocarcinoma brain metastases are frequent.There is evidence to suggest that radiotherapy can prevent local recurrence but does not appear to impact on survival. Response rates to chemotherapy alone and chemo‐radiotherapy with prolongation of diseasefree survival have been encouraging in locally advanced (resected stage II, III) disease when treated postoperatively.Results of clinical trials using immunotherapy or chemotherapy in early stage disease have been disappointing. Several prospective randomized studies by the Lung Cancer Study Group were undertaken to assess the merits of various adjuvant treatments and are presente

ISSN:8756-0437    

DOI:10.1002/ssu.2980060507

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractNeoadjuvant, or pre‐operative, chemotherapy for esophageal cancer has become an area of increasing interest because of the failure of conventional therapy (surgery or radiation) to improve disease‐free or overall survival. Several autopsy series have demonstrated that, in many symptomatic Western patients, esophageal cancer is a systemic disease. Neoadjuvant chemotherapy thus, in theory, allows a simultaneous attack on both the primary and metastatic disease. A number of single‐arm, phase II multi‐modality trials have been completed. Toxicities of chemotherapy, while substantial, have been tolerable. With careful attention to detail, operative morbidity and mortality has not been increased. Large‐scale randomized trials, needed to evaluate the impact of this technique on disease‐free and overall survival, have been designed and will shortly b

ISSN:8756-0437    

DOI:10.1002/ssu.2980060508

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractAdenocarcinoma arising in association with the columnar‐lined esophagus is now recognized with increasing frequency. The incidence of malignant degeneration in Barrett's esophagus, its etiology, and pathogenesis are all issues of ongoing debate. The role of gastroesophageal reflux in driving the malignant change remains unproven. Surgical resection is the treatment of choice; however, prognosis is generally poor. Surveillance of patients with non‐malignant Barrett's esophagus permits detection of early lesions where resection results in excellent long‐term sur

ISSN:8756-0437    

DOI:10.1002/ssu.2980060509

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractPleural mesotheliomas are uncommon tumors. They can be broadly classified as localized and diffuse. The localized form is a non‐epithelial neoplasm that occurs as commonly in women as in men and is not related to asbestos exposure. It is usually asymptomatic, and is occasionally associated with paraneoplastic syndromes. Localized mesotheliomas arise more frequently from the visceral than from the parietal or mediastinal pleura. The long‐term outcome of these tumors is determined mainly by their clinical presentation, and by whether or not they can be completely resected.Diffuse pleural mesotheliomas are invariably malignant. They are clearly related to asbestos exposure, and are far more common in men than in women. Histologically, they are completely or partially epithelial tumors. Diffuse mesotheliomas present with dyspnea, chest pain, and weight loss and are not associated with paraneoplastic syndromes. Distinguishing malignant mesothelioma from metastatic adenocarcinoma can be difficult and usually requires a large tissue biopsy on which immuno histochemistry and electron microscopy can be performed. The management of diffuse malignant mesothelioma remains controversial. Treatment appears to prolong survival which ranges from 6 to 12 months with supportive care alone. Surgical resection, either with extrapleural pneumonectomy or by pleurectomy/decortications remains the mainstay of treatment because of the relative ineffectiveness of radiation and chemotherapy. Surgical resection alone, however, is inadequate, so most current treatment regimens combine operation with radiation and/or chemotherapy. Even with aggressive multimodality treatment, the median survival currently ranges from 18 to 24 months. A better understanding of prognostic factors, a better staging system, and innovative treatment strategies are desperately needed in this dise

ISSN:8756-0437    

DOI:10.1002/ssu.2980060510

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractThe most common neoplasms of the anterior mediastinum are thymomas, lymphomas, and germ cell tumors. Surgical exploration was the routine approach to the diagnosis and management of these tumors. This is no longer true. The appropriate initial treatment of these neoplasms varies from surgical resection to radiation therapy to systemic chemotherapy. Except for the small well‐encapsulated anterior mediastinal mass, it is imperative that a definitive tissue diagnosis be obtained before initiating treatment. An overview of these tumors and the specific approaches to their treatment are detaile

ISSN:8756-0437    

DOI:10.1002/ssu.2980060511

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractPulmonary metastases from different primary neoplasms have different biological characteristics which may correlate with patient survival. Objective criteria to reliably select or exclude patients who would benefit from resection of these metastases are not available; however, various prognostic indicators have been studied for their correlation with postresection survival. Prognostic indicators differ among various tumor histologies. Prognostic indicators identified preoperatively which may influence post‐resection survival include age, sex, histology and location of the primary tumor, tumor doubling time, disease free interval, the number of nodules on preoperative roentgenographic studies, and the number of metastases resected. Following surgery, resectability, and the number of metastases resected may predict expected survival for patients meeting certain criteria. No single criterion should be used to exclude patients from surgery as resection will provide numerous patients with significant postresection surviva

ISSN:8756-0437    

DOI:10.1002/ssu.2980060512

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY