ISSN:8756-0437    

DOI:10.1002/ssu.2980090202

出版商:John Wiley&Sons, Inc.    

年代:1993

数据来源: WILEY

摘要:

AbstractLung cancer is currently the leading cause of cancer death in the United States and also the most common tumor worldwide. Changes in the distribution of histologic types over the past two decades in the United States, as well as high rates of lung cancer in certain subpopulations, require explanation. While cigarette smoking and specific occupational exposures are firmly established as important risk factors for lung cancer, recent work provides evidence that other factors may play a role either as independent risk factors or as modifiers of the effect of smoking. This paper reviews the epidemiology of lung cancer, with an emphasis on developments in the past decade.

ISSN:8756-0437    

DOI:10.1002/ssu.2980090203

出版商:John Wiley&Sons, Inc.    

年代:1993

数据来源: WILEY

摘要:

AbstractSurvival rates were studied in 1,297 screen‐detected and 1297 symptom‐detected patients with lung cancer. Resections took place in 20 hospitals and institutions in the Japanese Lung Cancer Screening Research Group. 60.6% of the screen‐detected lung cancer patients were from stage 0 to 11 and 39.4% were from stage III and TV. On the other hand, 27.1% of symptom‐detected patients were from stage 0 to 11 and 72.9% were stage III to IV. In the screen‐detected group, the tumor was peripheral in 83%, adenocarcinoma in 52.4% and the resectability rate was 66.5%. Five‐ and 10‐year survival rates were 32.4% and 22.5% respectively in the screen‐detected patients and 13.7% and 9.9% in symptom‐

ISSN:8756-0437    

DOI:10.1002/ssu.2980090204

出版商:John Wiley&Sons, Inc.    

年代:1993

数据来源: WILEY

摘要:

AbstractImproved diagnostic imaging has the potential to guide the surgeon in choice of invasive procedures required for staging and treatment of lung cancer.In the evaluation of a solitary pulmonary nodule, absence of growth for 2 years or certain typical calcifications are strong evidence of benignity, but we do not advocate following indeterminate nodules without a diagnosis because even small nodules may be carcinomas. In assessing chest wall invasion, computed tomography has no greater predictive value than a history of localized pain. The absence of nodes greater than 1.0 cm in short axis diameter on computed tomograms of the thorax is associated with low risk of tumor in mediastinal nodes, but tissue diagnosis is required for certainty. The finding of nodes larger than 1.0 cm may be useful in guiding the surgeon during staging procedures. Currently, there is no advantage of magnetic resonance imaging over computed tomography in evaluation of mediastinal nodes.Complete history and physical examination with routine serum chemistries will identify patients at high risk for metastases and will guide selection of appropriate special studies.It is emphasized that accurate staging requires histologic diagnosis and that CT and thorough surgical evaluation of the mediastinum are complementary procedures in staging of lung cancer.

ISSN:8756-0437    

DOI:10.1002/ssu.2980090205

出版商:John Wiley&Sons, Inc.    

年代:1993

数据来源: WILEY

摘要:

AbstractAsymptomatic coin lesions without specific patterns of benign calcifications can and should have a diagnosis established. Surgical diagnosis can be accomplished with very low morbidity. Accurate staging of lung cancer requires tissue confirmation of mediastinal node status either by thorough sampling or by complete node dissection. Complete resection with lobectomy is the preferred treatment providing better results than lesser resections. Segmental or wedge resections and internal radiotherapy are appropriate for patients unable to tolerate lobectomy. Video assisted thoracoscopy may prove useful in wedge excision for patients with poor pulmonary reserve.

ISSN:8756-0437    

DOI:10.1002/ssu.2980090206

出版商:John Wiley&Sons, Inc.    

年代:1993

数据来源: WILEY

摘要:

AbstractThe lung cancer incidence and mortality rates have risen steadily each year. Survival rates during the same period have improved marginally even by the best treatment approaches. A small proportion of patients with limited disease can be offered surgical resection as the primary curative treatment. In a significant number of cases, complete resection of cancer is not possible either because the patient could not tolerate radical surgical approach or because the tumor is attached to important structures in the mediastinum precluding any surgical intervention. Intraoperative brachytherapy by various techniques offers the greatest advantage in these patients to deliver higher doses of radiation to the tumor without damage to the normal lung. Numerous intraoperative brachytherapy techniques are described to adapt to different clinical situations.Experience over the past 30 years has shown that these procedures are safe and well tolerated and can be used alone or as a boost in conjunction with external beam radiation. Published data show encouraging local control rates and survival compared with treatment by external radiation to higher doses.

ISSN:8756-0437    

DOI:10.1002/ssu.2980090207

出版商:John Wiley&Sons, Inc.    

年代:1993

数据来源: WILEY

摘要:

AbstractThirty‐nine patients with mediastinoscopy stage IIIA, N2 non‐small cell lung cancer received two cycles of MVP (mitomycin C, vindesine, cisplatin). Responders underwent thoracotomy for resection and two further courses of MVP.Overall response rate was 64% (25 / 39) with three complete and 22 partial responses. Twenty‐two patients were resected, which included radical mediastinal node dissection. Eighteen resections were complete and four were incomplete. Pathologically, three patients (7.7%) had no remaining tumor. Toxicity included two postoperative deaths with B‐P fistula, mitomycin pulmonary toxicity in two patients, and four septic deaths. Twenty‐eight patients have died, 20 with recurrent or progressive disease. Of the 18 patients completely resected, eight have recurred with a median time to recurrence of 20.6 months. Sites of recurrence include two locoregional, five distant (two in brain) and one in both. Median survival of the entire 39 patients is 18.6 months, with a three year survival of 26%). The median survival for those patients completely resected was 29.7 months with a 3‐year surv

ISSN:8756-0437    

DOI:10.1002/ssu.2980090208

出版商:John Wiley&Sons, Inc.    

年代:1993

数据来源: WILEY

摘要:

AbstractAn intensive multimodality therapy protocol incorporating neoadjuvant chemotherapy was initiated in July 1985 for patients with either borderline resectable or unresectable non‐small cell carcinoma of the lung. Thirty‐five patients, 21 men and 14 women were entered till March 1991. The median age was 58 years (27–74). Histology was squamous in 15, adenocarcinoma in 11, large cell in 6, and adenosqua‐mous carcinoma in 3. Initial stages were IIIA in 19 patients, IIIB in 14 and II in 2. All patients tolerated preoperative chemotherapy with 5‐FU, etoposide and cisplatin (FED). The response to chemotherapy was complete response in 2 (6%), and partial response in 22 (63%). Thirty‐two patients underwent surgery. 26 patients were rendered disease free including two found disease free at surgery. Fifteen underwent pneumonectomy, 14 lobectomy and 3 biopsy only. Interstitial radiation therapy was used in 7 patients. The median survival of all patients was 19 months, those who underwent incomplete surgical resection was 12 months and patients rendered disease free at operation 21 months. Thirteen patients are alive and free of disease, including 6 patients alive longer than 5 years. Only patients who responded to chemotherapy and also had compete resection survived more than 2 years. Aggressive neoadjuvant therapy with FED, followed by resection, brachytherapy, postoperative radiation therapy, and adjuvant chemotherapy can be safely accomplished with encouraging survival in Stage I

ISSN:8756-0437    

DOI:10.1002/ssu.2980090209

出版商:John Wiley&Sons, Inc.    

年代:1993

数据来源: WILEY

摘要:

AbstractWe designed our study to evaluate the safety and efficacy of simultaneous chemoradiation therapy in an accelerated, twice‐a‐day schedule to improve local control and survival in advanced lung cancer patients. Forty‐one patients were entered into the study. Twenty‐three had stage IIIB and 18 had stage IIIA disease. They received cisplatin 30 mg/m2, VP‐16 80 mg/m2, and 5‐Fluorouracil (5‐FU) 900 mg/m2in iv infusion. Radiation therapy consisted of 2G twice a day for 5 days, followed by a 2‐week rest. This cycle was repeated 3 times. Patients were evaluated for surgical resection after the second cycle.Acute toxicity was acceptable: 3 patients expired (1 congestive heart failure, 1 sepsis, 1 pulmonary embolism). The 1‐year actuarial survival was 60.3%; the 2‐year actuarial survival was 55.3%. Our results show that this regimen is well tolerated and that the 2‐year actuarial survival appears to be comparable to that repor

ISSN:8756-0437    

DOI:10.1002/ssu.2980090210

出版商:John Wiley&Sons, Inc.    

年代:1993

数据来源: WILEY

摘要:

AbstractAs one of the few chemo‐ and radiosensitive neoplasms among the common epithelial solid tumors of adults, small‐cell lung cancer has long tantalized clinical investigators. Although for the last 15‐20 years therapy has yielded high remission rates, including substantial complete remission rates, results have not improved very much over nearly two decades of intensive therapeutic research, and long‐term disease‐free survival remains an elusive goal for the large majority of patients. At this point the number of promising untested hypotheses in therapy is quite small, and major advances will probably have to await either the serendipitous discovery of much more active drugs than we now possess, or else the purposeful development of new approaches based on insights into the nature of the transformed state and the biology of SC

ISSN:8756-0437    

DOI:10.1002/ssu.2980090211

出版商:John Wiley&Sons, Inc.    

年代:1993

数据来源: WILEY