Induction Chemoradiotherapy and Surgical Resection for Selected Stage IIIB Non-Small-Cell Lung Cancer
Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan. The Annals of Thoracic Surgery
(Impact Factor: 3.85).
01/2004; 76(6):1810-4; discussion 1815. DOI: 10.1016/S0003-4975(03)01075-0
Combination chemotherapy using an oral combination of uracil and tegafur (UFT) plus cisplatin and concurrent thoracic radiotherapy is reported to have a high response rate and less toxicity for locally advanced non-small-cell lung cancer (NSCLC) patients. We performed a phase II trial using this chemoradiotherapy as an induction treatment.
Patients with marginally resectable stage IIIB NSCLC, an age younger than 70 years, a performance status of 0 or 1, and good organ function were eligible. The UFT (400 mg/m(2)) was administered orally on days 1 through 14 and 22 through 35 and cisplatin (80 mg/m(2)) was injected intravenously on days 8 and 29. Radiotherapy with a total dose of 40 Gy was delivered in 20 fractions from day 1. A surgical resection was performed from 3 to 6 weeks after completing the induction treatment.
Twenty-seven patients, 18 male and 9 female with a median age of 56 years and ranging from 36 to 69 years, were entered into the phase II trial. Clinical T4 and N3 cancers were observed in 22 and 7 patients, respectively. Twenty-five (93%) achieved a partial response. The most frequently observed adverse event was grade 3 leukopenia in 26%. Of 25 patients who underwent a thoracotomy, 22 had a tumor resection. In all 22 patients a complex resection including a resection of the superior vena cava, carina, and vertebrae was required. Operative morbidity and mortality rates were 36% and 4% respectively. The calculated 1-year and 3-year survival rates of all 27 patients were 73% and 56% respectively.
Chemotherapy using UFT plus cisplatin and concurrent radiotherapy as induction treatment and a surgical resection for patients with marginally resectable stage IIIB NSCLC is feasible and promising. However it is difficult to conduct multi-institutional trials even for selected stage IIIB disease as a complex resection in almost all patients is necessary.
Available from: Tatsuro Okamoto
- "Based on these findings, and cytology findings a clinical diagnosis of stage IIIB (T4N3M0) non-small cell lung cancer (NSCLC) originating from the apex of the left lung involving both the mediastinum and the supraclavicular lymph nodes was made . The patient received concurrent chemo-radiotherapy (cisplatin 80 mg/m2 for days 8 and 36 + UFT 400 mg/m2, both on days 1–14 and on days 29–42 plus radiotherapy, 2 Gy/day on days 1–20 for a total of 40 Gy) . After this treatment regimen, the tumor size decreased by 35.0%. "
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ABSTRACT: Malignant schwannoma of the upper mediastinum originating from the vagus nerve is extremely rare.
A 46-year-old female was admitted for a left cervical mass which was associated with both hoarseness and Horner's syndrome. Chest computed tomography showed a mass extending from the left upper mediastinum to the left supraclavicular area. A fine needle aspiration cytological examination suggested primary lung cancer stage IIIB large cell carcinoma. After administering induction chemo-radiotherapy, a complete surgical resection was performed. The tumor was found to involve both the left vagus nerve and the left sympathetic nerve. Histological examination of the resected specimen revealed the tumor to be malignant schwannoma.
Despite incorrect preoperative diagnosis, the multimodality treatment administered in this case, including induction chemo-radiotherapy and surgery, proved to be effective.
World Journal of Surgical Oncology 11/2005; 3(1):65. DOI:10.1186/1477-7819-3-65 · 1.41 Impact Factor
Available from: ejcts.ctsnetjournals.org
- "Multimodal concepts of anticancer therapy become increasingly popular even in early stages of non-small cell lung cancer (NSCLC). Previously, it has been shown that NSCLC patients with histologically proven N2/N3-status could benefit from neoadjuvant therapy  . Therefore, mediastinoscopical diagnosis of N2/N3-status may indicate neoadjuvant therapy regimens including chemotherapy. "
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ABSTRACT: Detection of disseminated tumor cells in mediastinoscopic biopsies could improve staging and might be helpful concerning indications for neoadjuvant therapy regimens. This prospective study was performed to evaluate a simple and observer-independent polymerase chain reaction (PCR)-based method for the detection of disseminated tumor cells in regional lymph nodes.
Lymph nodes of 32 consecutive patients without neoadjuvant therapy were removed by systematic lymphadenectomy during resection of primary NSCLC. One hundred of these lymph nodes were cut into two equal halves which were examined using either routine histopathology or quantitative reverse transcriptase PCR (qRT-PCR). qRT-PCR amplification of cytokeratin 19 (CK19) transcripts was applied for the detection of tumor cell-specific RNA. We differentiated between illegitimate marker gene transcription and cancer-specific expression by using a cut-off value that was obtained from the analysis of 18 lymph nodes of patients with benign lung diseases. Subsequent to the evaluation of qRT-PCR, a pilot project with five additional patients was conducted to examine 19 mediastinoscopic biopsies, which were cut into two equal halves and proceeded as described above.
Ninety-four (94%) lymph nodes were tumor-free by histopathology. qRT-PCR detected disseminated tumor cells in 26 (28%) of these lymph nodes. All of the remaining six lymph nodes that were judged by the pathologist to contain tumor cells exhibited CK19 transcripts. Twenty-three patients had a pN0 status. qRT-PCR detected disseminated tumor cells in 13 (56%) of these pN0 patients. The mediastinoscopic biopsies showed disseminated tumor cells in four (21%) out of 19 histopathologically tumor-free samples.
CK19 qRT-PCR is a sensitive and specific tools for the detection of disseminated tumor cells in regional lymph nodes of patients with operable NSCLC. Further studies are required to asses if this molecular method might improve mediastinoscopic staging.
European Journal of Cardio-Thoracic Surgery 08/2005; 28(1):26-32. DOI:10.1016/j.ejcts.2005.03.029 · 3.30 Impact Factor
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ABSTRACT: Lung cancer is classified as N3 when metastases to the contralateral mediastinal and hilar lymph nodes, the supraclavicular
nodes, and the scalene nodes are present at the time of diagnosis. N3 lung tumors have been included in stage IIIB since 1986,
when it appeared clear that such locally advanced disease needs to be grouped in a separate stage III category because of
the extremely poor prognosis. In the large series reported by Mountain, 5-year survival for N3 patients was 3%. These tumors
have always been considered inoperable due to the difficulties in eradicating all the detectable disease that markedly limits
the applicability of primary surgery in this setting.
12/2006: pages 128-139;
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