Randomized trials have confirmed the benefits of adjuvant chemotherapy in improving survival in resected early-stage non-small-cell lung cancer (NSCLC). The extent to which these results have translated into clinical practice is unknown.
To examine the referral pattern of patients with resected lung cancer to adjuvant chemotherapy, and to compare compliance and toxicities with current literature.
A retrospective analysis of all patients who underwent a surgical resection for lung cancer at Laval Hospital (Quebec City, Quebec) from March 2004 to January 2006 was conducted.
A total of 258 patients underwent surgery. Seven patients were excluded because of early postoperative death, and two patients were excluded because of incomplete data. Data from 249 patients were analyzed (94% NSCLC). Fifty per cent were referred to medical oncology for consideration of adjuvant chemotherapy, including 37 of 61 patients with stage II NSCLC. One hundred patients received chemotherapy. No significant difference in age, sex, comorbidities and surgical procedures was observed between those who received chemotherapy and those who did not. Chemotherapy was initiated 47 days (median) after the surgery and consisted mainly of cisplatin-vinorelbine (38%), cisplatin-etoposide (22%) and carboplatin-paclitaxel (20%). Sixty-six per cent of the patients completed all four cycles. Grade 3 or 4 toxicities consisted mainly of fatigue (23%) and cytopenia (40%). No death was registered; 15% had to be hospitalized because of adverse effects.
Although adjuvant chemotherapy is gaining acceptance in clinical practice, more patients should be referred to medical oncology following surgical resection. Compliance and toxicity are similar to or better than those described in published randomized trials.
Notes
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The treatment of extended pulmonary tuberculosis, resistant to antibacterial preparations, constitutes extremely complex problem. The author proposes to apply simultant pulmonary resection and intrapleural thoracoplasty, the simple one or extended, for the treatment of those patients. There were studied up the results of treatment of 401 patients, simultant interventions were used in 134. Analysis of the data obtained permits to consider the operation as the curative-prophylactic one. The indications for application of every variant of intervention were determined, what have had significantly increased the possibilities of treatment of extended pulmonary tuberculosis.
Introduction of bronchoscopic lung volume reduction as a treatment for severe emphysema has been defined as an area of development by The Danish Health and Medicines Authority. We here present the rationale for treatment, in- and exclusion criteria, and ultimately the organization for assessment, treatment and follow-up in Denmark. The treatment aim is to lower dyspnoea. There is a national protocol for patient selection according to in- and exclusion criteria. Different commercial devices are available, but endobronchial valves have been the devices mostly applied. A national database has been established to evaluate cost-effectiveness.
[Clinical-functional characteristics of digestive and bone systems in late follow-up period after pneumonectomy performed for tuberculosis or chronic nonspecific pulmonary disease]
The main compensation--adaptation mechanisms of changes in digestive and osteal systems were determined, basing on analysis of the examination results in 65 patients, to whom pneumonectomy was performed for tuberculosis or chronic nonspecific pulmonary disease. The most pronounced changes in the disposition, form, function of the abdominal cavity organs, in locomotor system had occurred in patients, to whom pneumonectomy was performed in infantile and juvenile age; there are determined the procedures, terms, methods of examination, the prophylactic, rehabilitational and social aid rendered to those patients.
Operations were performed on 3,313 patients for lung carcinoma in the Department of Surgery of the Lungs and Mediastinum of the National Research Center of Surgery, AMS USSR, from 1963 till 1.01.90. Among these patients 263 (7.9%) were treated by combined operations (resection of the lung together with part of the chest wall, trachea and its bifurcation, pericardium, diaphragm, superior vena cava, pulmonary artery, aorta, and atrium, and also with removal of metastatic lymph nodes of the contralateral lung). Three types of combined resections were carried out--vasculo-atrial, tracheo-bronchial, and parieto-diaphragmatic. Postoperative complications developed in 38.6% of patients. Intraoperative mortality was 1.5%, 13.9% of patients died after the operation. More than 5 years survived 21.8% of patients who underwent operation, more than 10 years 10.2%, and more than 15 years 5.6% of patients.
The factors predicting initial readiness of patients with infiltrative pulmonary tuberculosis to give their consent to transthoracic interventions were investigated. It was shown that initial readiness of patients to give their consent to phthisiological treatment directly depended on the indices of "social functioning" and lymphocyte percentage in leukogram. The total prognosis algorithm with 94.1% sensitivity and 75% specificity is presented as discriminative function estimated by "social functioning" data, lymphocyte percentage in leukogram and ordinal evaluation of complaints to sweating.
OBJECTIVE: In 1998 The Danish Lung Cancer Group published the first edition of guidelines for diagnosis and treatment of lung cancer. A national registry was implemented in the year 2000 with the primary objective to monitor the implementation of these guidelines and nationwide to secure and improve the quality of the clinical management of lung cancer. The results of this effort are reported with special focus on surgery. METHODS: Through systematic nationwide registration a total of 24,153 patients have been included in the period 2000-2007. Indicators describing staging, surgical procedures, complications and survival have been registered in those 5007 patients who underwent surgery. Using an Internet based closed circle with a safe program (firewall and encryptation) more than 95% of this subgroup of patients have been notified. Each year the results have been audited locally, regionally and nationally and improvements have been proposed, implemented, monitored and consecutively evaluated by the audit-plenary. RESULTS: This strategy has been a contributory factor to significantly improve the results in mortality, survival and surgical procedures. Thus, the 30-days mortality following surgery has decreased from 5.2% to 3.6% and survival has increased from an overall 1- and 2-year survival of 69% and 50% in 2000 to 77% and 60% in 2007, respectively. A number of other key indicators were also improved: the lobectomy rate has increased from 54% to 73% and the pneumonectomy rate has decreased from 23% to 11%. The proportion of patients having surgery within 14 days from referral has increased from 69% to 87%. CONCLUSIONS: Establishment of a national lung cancer group with the primary tasks to implement updated national guidelines and to secure valid registration of clinical baseline data and quality parameters has been a contributory factor to significantly improve the quality of lung cancer surgery.
Recently there has been an increase in the incidence of polyneoplasias (PNP) of various organs. This is associated with certain advances in the treatment of malignancies with prolonged survival on the one hand and with better diagnosis and the emergence of new instrumental studies. The diagnosis and treatment of lung cancer as a component of PNP) currently remains a great challenge. In 1985 to 2004, the Acad. B. V. Petrovsky Russian Research Center of Surgery, Russian Academy of Medical Sciences, and Moscow Cancer Dispensary One treated 403 patients for lung cancer detected in combination with an extrapulmonary malignant tumor or second lung cancer, which amounted to 8.9% of the patients operated on for lung cancer. Primary malignancy of the lung and secondary neoplasm were synchronously and metachronously diagnosed in 165 (40.9%) and 238 (59.1%) patients, respectively. Lobectomy was performed in 207 (51.4%) patients while 79 (19.6%) patients underwent sublobar resection. Three- and 5-year overall survival was 43.4 and 30.6%, respectively. After radical operations, better 5-year survival rates were observed in patients with metachronous lung cancer in PNP (32.5% than in those with synchronously detected one (27.9%) (p
