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ABSTRACT: This study reports the long term outcomes of postoperative radiotherapy in patients with resection for non-small-cell lung cancer (NSCLC).
A total of 98 patients with resected NSCLC who received postoperative radiotherapy (PORT) between January 1994 and December 2004 were retrospectively analyzed. The most frequently performed surgical procedure was lobectomy (59 patients), followed by pneumonectomy (25), wedge resection (8), and bilobectomy (6). Postoperative radiotherapy was delivered as an adjuvant treatment in 71 patients, after a wedge resection in 8 patients, and after an R1 resection in 19 patients. The PORT was administered using a Co-60 source in 86 patients and 6-MV photons in 12 patients. A Kaplan-Meier estimate of overall survival, locoregional control, and distant metastasis-free survival were calculated.
Stages included I (n =13), II (n = 50), IIIA (n = 29), and IIIB (n = 6). After a median follow-up of 52 months median survival was 61 months. The 5-year overall survival, locoregional control, and distant metastasis-free survival rates for the whole group were 50%, 78%, and 55% respectively. The RT dose, Karnofsky performance status, age, lateralization of the tumor, and pneumonectomy were independent prognostic factors for OAS; anemia and the number of involved lymph nodes were independent prognostic factors for LC.
Doses of PORT of greater than 54 Gy were associated with higher death rate in patients with left-sided tumor, which may indicate a risk of radiation-induced cardiac mortality.
International journal of radiation oncology, biology, physics 05/2009; 76(2):433-9. · 4.59 Impact Factor
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ABSTRACT: Traumatic diaphragmatic rupture (TDR) is a rare but potentially life threatening clinical entity with a high incidence of associated injuries. In this article, our experience with this challenging diagnosis is presented.
In this study, a total of 68 patients with TDR, were operated in our center between July 1994 and September 2005. Study group was analyzed retrospectively. The etiological factors, management and outcomes were discussed.
The mean age was 32.9 years with a female to male ratio of 9/59. TDR was right-sided in 16.2% (n=11) and left-sided in 83.8% (n=57). The cause of the rupture was penetrating trauma in 51 (75%), and blunt trauma in 17 (25%). Only three patients (4.4%) had late diagnosis. Associated injuries were seen in 91% (n=62) of the patients. The most common used incision was a laparotomy incision (89.6%). Morbidity and mortality were encountered in 13.1% (n=9) and 16.2% (n=11) patients, respectively.
Although rare, diaphragmatic rupture must be suspected in any patient with thoracoabdominal injury. Early diagnosis of TDR is sometimes difficult and depends on a high index of suspicion. Surgical repair is necessary even for small tears. The most common approach is the transabdominal approach, which allows a complete exploration of the abdominal organs for associated injuries. The transthoracic approach might be used in most cases with latent diaphragmatic rupture.
European Journal of Cardio-Thoracic Surgery 07/2008; 33(6):1082-5. · 2.55 Impact Factor
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ABSTRACT: Congenital cystic adenomatoid malformation (CCAM) of the lung is a rare anomaly which is characterized by a proliferation of dilated bronchiolar-like air spaces. It is generally seen in newborns and infants. When seen in adults, which is more uncommon, it presents itself mostly with recurrent pulmonary infections. In this article, 31-year-old man with cough and purulent expectoration and a history of recurrent pulmonary infections who had cystic changes resembling bronchiectasis at the left lower lobe on the computed tomography of the chest and diagnosed CCAM-type 2 after the histopathological examination of the left lower lobectomy specimen is presented.
Tuberkuloz ve toraks 02/2008; 56(2):201-3.
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ABSTRACT: The combination of gemcitabine and cisplatin is one of the most active chemotherapy regimens against non-small cell lung cancer (NSCLC). This study was designed to evaluate the efficacy and safety of gemcitabine combined with cisplatin in a 3-week cycle regimen for patients with operable, early stage NSCLC. Gemcitabine at a dose of 1000 mg/m(2) on days 1 and 8 of each 21-day cycle for 3 cycles, followed by cisplatin at a dose of 75 mg/m(2) on day 1 was administered to patients with previously untreated, operable, early stage (IB-IIIA) NSCLC. A total of 47 patients (46 male, mean age 56.0+/-8.0 years) who met the eligibility criteria were enrolled. The pathological complete response rate was 5.3% of operated patients and 4.3% of total patients. At visit 4, 57.1% of the patients had partial response, 38.1%, stable disease and 4.8%, progressive disease. The main toxicities - leukopenia, neutropenia and thrombocytopenia - were usually clinically asymptomatic and did not require hospitalization. Non-hematological toxicities were minimal and manageable. Disease free and 12-month overall survival rates were over 70% and 80%, respectively. This study demonstrates that the administration of gemcitabine and cisplatin combination for 3 cycles is effective and tolerable for patients with operable, early stage NSCLC. Low toxicity profile and promising survival outcome suggest that this regimen has an encouraging activity in this subset of patients.
Lung Cancer 12/2007; 58(2):246-52. · 3.43 Impact Factor
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ABSTRACT: Large cell neuroendocrine carcinoma is rare in the group of primary lung cancers and its appropriate treatment and prognosis are controversial. In this report, patients diagnosed as large cell neuroendocrine carcinoma of the lung were presented and discussed in the light of pertaining literature. Between February 1997 and March 2005, eight patients, who were diagnosed as large cell neuroendocrine carcinoma postoperatively among the patients with a preoperative diagnosis of nonsmall cell lung cancer, were analyzed retrospectively, by means of treatment method, disease free survival and overall survival. All eight patients were male and their mean age and age range were 64 +/- 7.6 and 50-72, respectively. Four patients had lobectomy, two had pneumonectomy and two had limited resections. One patient received neoadjuvant chemotherapy and seven patients received adjuvant chemotherapy, radiotherapy, or chemoradiotherapy. Follow-up period was 19.7 +/- 12.5 (3-39) months and disease-free interval was 19 +/- 12.9 (3-39) months. Two patients died of recurrence 14 and 16 months postoperatively, whereas six of the cases are alive with disease-free. Large cell neuroendocrine carcinomas are aggressive tumors with poor prognosis but better prognosis is also revealed after surgery at early stages. Most of the series in the literature are small in number of patients, as in our report, and treatment strategies are tried to be formed according to these data.
Tuberkuloz ve toraks 02/2006; 54(1):30-3.
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ABSTRACT: From January 2001 through June 2002, 128 consecutive patients undergoing lung resection for various diseases were evaluated preoperatively by a cardiologist at our institution in order to predict postoperative cardiac complications in pulmonary surgery. Our assessment algorithm consisted of the following: Smoking, hypertension, hyperlipidemia, advanced age, diabetes mellitus, and history of cardiac disease or angina pectoris were considered as risk factors. A stress test was performed when at least 2 of the first 3 risk factors or at least 1 of the last 3 risk factors was present. Coronary angiography was performed in the case of a positive stress test. Patients were classified as low-risk when there was no need for a stress test. Patients were considered as intermediate-risk when a stress test revealed no ischemia or if there was a history of congestive heart failure or valvular disease. Patients in whom coronary artery disease was detected on angiography were classified as high-risk. Ninety-five of our patients were in the low-risk group, and 29 were in the intermediate-risk group. After lung resection, cardiac complications developed in 4 patients in the low-risk group (atrial fibrillation) and in 8 patients in the intermediate-risk group (5 atrial fibrillation and 3 paroxysmal atrial tachycardia). The overall cardiac complication rate was 9.7%. No death occurred due to cardiac events. The difference in the incidence of arrhythmias between the low- and the intermediate-risk groups was significant (P < 0.05). We present this simple algorithm for preoperative cardiac evaluation in patients scheduled to undergo lung resection, and we suggest that it may be possible to predict postoperative cardiac complications with this method.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital 01/2005; 32(2):159-62. · 0.65 Impact Factor
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ABSTRACT: A 34-year-old woman presented with chest pain and a solitary pulmonary nodule on chest roentgenogram. She was diagnosed with a rare benign lung tumor, alveolar adenoma of the lung, through pathological examination of the surgical specimen resected from the left upper lobe. Clinicians should also keep this entity in mind when making the differential diagnosis of a solitary pulmonary nodule.
Interactive cardiovascular and thoracic surgery 10/2003; 2(3):345-7.
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ABSTRACT: While most pleural neoplasms are malignant and associated with asbestos exposure, benign tumors may also occur. Benign fibrous tumors of the pleura are rare and, unless diagnosed and resected early, they may reach an enormous size and cause severe symptoms. We report the case of a pregnant woman with a giant benign fibrous tumor localized in the pleura.
Surgery Today 02/2003; 33(3):196-8. · 1.22 Impact Factor
