Mediastinal staging of lung cancer: The changing role of mediastinoscopy
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Abstracts/Lung Cancer 13 (1995) 18.5-232 205 50% of clinical stage I and 30% to 40% of pathologic stage 1 patients have disease recurrence and die following curative resection. A large number of traditional pathologic and newer molecular markers have been identified, which appear to hove important prognostic significance in this population. This review attempts to summarize these data comprehensively. Methods: Criteria for study selection were English- language reports, identified using Medline and Cancerline, through the fall of 1994. s from the American Society of Clinical Oncology (ASCO) and the International Association for the Study of Lung Cancer (IASLG) were also reviewed. Results: Molecular markers are classified as molecular genetic markers, differentiation markers, proliferation markers, and markers of metastatic propensity. A number of these markers have been reported to be highly predictive of outcome in stage I NSCLC, and several reports conclude that a specific biomarker may be, aside from clinical stage, the most powerful determinant of prognosis in NSCLC. However, little has been done to clarity the relationships between these newer biologic markers, classic clinicopathologic variables, and clinical outcome. Conclusion: At present, a firm con- clusion regarding which biomarkers are most important in predicting outcome is not possible, and a model that reliably integrates all independent prognostic variables cannot be developed. A prospective trial is mandatory to address this issue, and a study design is suggested that would facilitate the development of a prognostic index, while simultaneously asking a therapeutic question. The development of a prognostic index would facilitate tirture trials in which only high-risk stage I patients could be targeted for investigation of postresection adjuvant treatment strategies. Long-term survival in small-cell lung cancer: Posttreatment characteristics in patients surviving 5 to 18+ years - An analysis of 1,714 consecutive patients Lassen U, Osterlind K, Hansen M, Dombernowsky P, Bergman B, Hansen HH. Department of Oncology 5074, Rigshospitolet. 9 Blegdamsvej, DK-2100 Copenhagen. J Clin Gncol 1995;13:1215-20. Purpose: To describe in patients with small-cell lung cancer (SCLC) the characteristics of those who survive for 5 years, to identify long- term prognostic factors, to analyze survival data of J-year survivors, and to study lo-year survival in patients entered before 1981. Patients and Methods: A total of 1,714 unselected patients with SCLC were treated with combination chemotherapy in nine consecutive clinical trials from 1973 to 199 1. All medical records were reviewed and follow- up data obtained to analyze and compare pretreatment and posmeatment characterlstlcs. Results: Sixty patients survived longer than 5 years. Late relapses occmred in 15.0% of 5- year survivors and secondary malignancies in 20.0%. Twenty-six patients are still alive and disease- free 5 to 18 years (median, 9.5 years) from initiation of treatment. Extensive-stage disease, performance status (PS) more than 2, liver and bone marrow metastases, and elevated lactate dehydrogenase. (LDH) and alkaline phosphatase levels were all negative prognostic factors. The S-year survival rate was 3.5% (limited-stage disease, 4.8%; extensive-stage disease, 2.3%). and the IO-year survival rate was 1.8% (limited-stage dimase, 2.5% extensivestage disease, 1.2%). Conclusion: Long-term survival can be. achieved for both stages of SCLC, but without any change in survival rates over the last decade. Long-term survivors continuously seem to have considerable mortality due to late relapses and secondary malignancies especially t-related cancers and other tobacco- related diseases. Mediastinal staging of lung cancer: The changing role of mediaxtinoscopy Weissberg D. Department of Sutgev, Wo(fon Medical Cente,: 58100 Holon. Isr J Med Sci 1995;3 I: 122-4. In order to evaluate the role of mediastinoscopy in determination of resectability in lung cancer, we reviewed retrospectively our experience with this procedure. Of 936 mediastinoscopies performed during the past 22 years, 830 were performed far preoperative evaluation ofpatients with presumably resectable bronchogenic carcinoma. Metastases in superior mediastinal lymph nodes were found in 295 of 798 patients with histologically proven lung cancer (37%). These patients were spared an u~ecessary thoracotomy. There was one death and no other major complications. Computerized tomography of the chest should be performed in all patients with bronchial cancer. If enlarged mediastinal nodes are demonstrated, mediastinoscopy is indicated for histologic evaluation of those nodes and for staging. Mediastinoscopy is a safe and highly reliable procedure with 100% specificity and over 90% accuracy, and is extremely important in staging and predicting resectability in lung cancer. It helps to avoid a futile thoracotomy in patients with incurable disease. A comparative study between planar Ga-67, TI-201 images, chest x-ray, and x-ray CT in inoperable non-small cell carcinoma of the lung Ragheb A, Elgazzar A-HH, Ibrahim AK, Higazi E, Mahmoud A-R, El- Saleh K et al. Nuclear Medical Service, St. l¢ b Hospital, Medical Center of New York, 153 West 11th Street, New York, NY 10011. Clin Nucl Med 1995;20:426-33. Seventy patients with newly diagnosed, pathologically proven inoperable non-small cell lung cancer @JSCLC) had planar Ga67, TI- 20 1, chest x-ray, and cheat CT imaging performed. Tumor/Normal tissue background (T/B) ratio was calculated for 62 Gad7 and 55 TI-201 scintigraphy studies and comparisons were made between Ga-67 and Tl-20 1 imaging results regarding T/B ratios, site of lesion, and histologic type. The impact of the images on the initial knowledge of the extent of the tumor and on the radiotherapy (RT) planning was evaluated for each patient. For primary lesions, Ga-67 imaging results were positive in 94% (66 of 70 patients) versus 71% (50 of 70 patients) for H-201 scans (P < 0.005) and the T/B ratio was > I .5 in 74% (46 of 62 patients) for Ga-67 versus 36% (20 of 55 patients) for TI-201 (P < 0.0001). For centrally located lesions, sensitivity for Ga-67 was 100% (53 of 53 patients) versus 74% (39 of 53 patients) for Tl-201 (P < 0.0005) and the T/B ratio >1.5 in 84% (38 of 45 patients) for Ga-67 versus 38% (15 of 40 patients) for Tl-201 (P > 0.001). For peripheral lesions, sensitivity of Ga- 67 was 76% (13 of 17 patients) versus 64% (11 of 17) for Tl-20 1 (P > 0.05) and the T/B ratio was >I.5 in 47% (8 of 17 patients) for Ga- 67 versus 33% (5 of 15 patients) for TI-201 (P < 0.05). The sensitivity of Gad7 for squamous ccl1 carcinoma was 92% (37 of 40 patients) versus 75% (30 of 40 patients) for Tl-20 1 (P < 0.05). For adenocarcinoma Gad7 sensitivity was 94% (15 of 16 patients) versus 69% (11 of 16 patients) for Tl-201 f,P < 0.05). For undifferentiated carcinoma, Ga-67 sensitivity was 100% (14 of 14 patients) versus 64% (9 of 14 patients) for Tl-201 (P > 0.005). Mediastinal involvement as assessed by CT, Ga-67, and TI-20 1 was present in 89%, 5 l%, and lo%, respectively (P < 0.0001). For determination ofthe local extent of the tumor compared to the chest x-ray, Ga-67 scintigraphy added more information in 49% (34 of70 patients) versus 27% (19 of70 patients) forTI- (P < 0.005). When compared to CT, Gad7 scintigraphy gave additional information in 4% (3 of 70 patients) of the patients versus 3% (2 of 70 patients) for Tl-20 1 imaging. For the purpose of radiation therapy planning, if based on chest x- ray findings, Ga-67 scintigraphy was necessary for proper
Transcript of Mediastinal staging of lung cancer: The changing role of mediastinoscopy
Abstracts/Lung Cancer 13 (1995) 18.5-232 205
50% of clinical stage I and 30% to 40% of pathologic stage 1 patients have disease recurrence and die following curative resection. A large number of traditional pathologic and newer molecular markers have been identified, which appear to hove important prognostic significance in this population. This review attempts to summarize these data comprehensively. Methods: Criteria for study selection were English- language reports, identified using Medline and Cancerline, through the fall of 1994. s from the American Society of Clinical Oncology (ASCO) and the International Association for the Study of Lung Cancer (IASLG) were also reviewed. Results: Molecular markers are classified as molecular genetic markers, differentiation markers, proliferation markers, and markers of metastatic propensity. A number of these markers have been reported to be highly predictive of outcome in stage I NSCLC, and several reports conclude that a specific biomarker may be, aside from clinical stage, the most powerful determinant of prognosis in NSCLC. However, little has been done to clarity the relationships between these newer biologic markers, classic clinicopathologic variables, and clinical outcome. Conclusion: At present, a firm con- clusion regarding which biomarkers are most important in predicting outcome is not possible, and a model that reliably integrates all independent prognostic variables cannot be developed. A prospective trial is mandatory to address this issue, and a study design is suggested that would facilitate the development of a prognostic index, while simultaneously asking a therapeutic question. The development of a prognostic index would facilitate tirture trials in which only high-risk stage I patients could be targeted for investigation of postresection adjuvant treatment strategies.
Long-term survival in small-cell lung cancer: Posttreatment characteristics in patients surviving 5 to 18+ years - An analysis of 1,714 consecutive patients Lassen U, Osterlind K, Hansen M, Dombernowsky P, Bergman B, Hansen HH. Department of Oncology 5074, Rigshospitolet. 9 Blegdamsvej, DK-2100 Copenhagen. J Clin Gncol 1995;13:1215-20.
Purpose: To describe in patients with small-cell lung cancer (SCLC) the characteristics of those who survive for 5 years, to identify long- term prognostic factors, to analyze survival data of J-year survivors, and to study lo-year survival in patients entered before 1981. Patients and Methods: A total of 1,714 unselected patients with SCLC were treated with combination chemotherapy in nine consecutive clinical trials from 1973 to 199 1. All medical records were reviewed and follow- up data obtained to analyze and compare pretreatment and posmeatment characterlstlcs. Results: Sixty patients survived longer than 5 years. Late relapses occmred in 15.0% of 5- year survivors and secondary malignancies in 20.0%. Twenty-six patients are still alive and disease- free 5 to 18 years (median, 9.5 years) from initiation of treatment. Extensive-stage disease, performance status (PS) more than 2, liver and bone marrow metastases, and elevated lactate dehydrogenase. (LDH) and alkaline phosphatase levels were all negative prognostic factors. The S-year survival rate was 3.5% (limited-stage disease, 4.8%; extensive-stage disease, 2.3%). and the IO-year survival rate was 1.8% (limited-stage dimase, 2.5% extensivestage disease, 1.2%). Conclusion: Long-term survival can be. achieved for both stages of SCLC, but without any change in survival rates over the last decade. Long-term survivors continuously seem to have considerable mortality due to late relapses and secondary malignancies especially t-related cancers and other tobacco- related diseases.
Mediastinal staging of lung cancer: The changing role of mediaxtinoscopy Weissberg D. Department of Sutgev, Wo(fon Medical Cente,: 58100
Holon. Isr J Med Sci 1995;3 I: 122-4. In order to evaluate the role of mediastinoscopy in determination of
resectability in lung cancer, we reviewed retrospectively our experience with this procedure. Of 936 mediastinoscopies performed during the past 22 years, 830 were performed far preoperative evaluation ofpatients with presumably resectable bronchogenic carcinoma. Metastases in superior mediastinal lymph nodes were found in 295 of 798 patients with histologically proven lung cancer (37%). These patients were spared an u~ecessary thoracotomy. There was one death and no other major complications. Computerized tomography of the chest should be performed in all patients with bronchial cancer. If enlarged mediastinal nodes are demonstrated, mediastinoscopy is indicated for histologic evaluation of those nodes and for staging. Mediastinoscopy is a safe and highly reliable procedure with 100% specificity and over 90% accuracy, and is extremely important in staging and predicting resectability in lung cancer. It helps to avoid a futile thoracotomy in patients with incurable disease.
A comparative study between planar Ga-67, TI-201 images, chest x-ray, and x-ray CT in inoperable non-small cell carcinoma of the lung Ragheb A, Elgazzar A-HH, Ibrahim AK, Higazi E, Mahmoud A-R, El- Saleh K et al. Nuclear Medical Service, St. l¢ b Hospital, Medical Center of New York, 153 West 11th Street, New York, NY 10011. Clin Nucl Med 1995;20:426-33.
Seventy patients with newly diagnosed, pathologically proven inoperable non-small cell lung cancer @JSCLC) had planar Ga67, TI- 20 1, chest x-ray, and cheat CT imaging performed. Tumor/Normal tissue background (T/B) ratio was calculated for 62 Gad7 and 55 TI-201 scintigraphy studies and comparisons were made between Ga-67 and Tl-20 1 imaging results regarding T/B ratios, site of lesion, and histologic type. The impact of the images on the initial knowledge of the extent of the tumor and on the radiotherapy (RT) planning was evaluated for each patient. For primary lesions, Ga-67 imaging results were positive in 94% (66 of 70 patients) versus 71% (50 of 70 patients) for H-201 scans (P < 0.005) and the T/B ratio was > I .5 in 74% (46 of 62 patients) for Ga-67 versus 36% (20 of 55 patients) for TI-201 (P < 0.0001). For centrally located lesions, sensitivity for Ga-67 was 100% (53 of 53 patients) versus 74% (39 of 53 patients) for Tl-201 (P < 0.0005) and the T/B ratio >1.5 in 84% (38 of 45 patients) for Ga-67 versus 38% (15 of 40 patients) for Tl-201 (P > 0.001). For peripheral lesions, sensitivity of Ga- 67 was 76% (13 of 17 patients) versus 64% (11 of 17) for Tl-20 1 (P > 0.05) and the T/B ratio was >I.5 in 47% (8 of 17 patients) for Ga- 67 versus 33% (5 of 15 patients) for TI-201 (P < 0.05). The sensitivity of Gad7 for squamous ccl1 carcinoma was 92% (37 of 40 patients) versus 75% (30 of 40 patients) for Tl-20 1 (P < 0.05). For adenocarcinoma Gad7 sensitivity was 94% (15 of 16 patients) versus 69% (11 of 16 patients) for Tl-201 f,P < 0.05). For undifferentiated carcinoma, Ga-67 sensitivity was 100% (14 of 14 patients) versus 64% (9 of 14 patients) for Tl-201 (P > 0.005). Mediastinal involvement as assessed by CT, Ga-67, and TI-20 1 was present in 89%, 5 l%, and lo%, respectively (P < 0.0001). For determination ofthe local extent of the tumor compared to the chest x-ray, Ga-67 scintigraphy added more information in 49% (34 of70 patients) versus 27% (19 of70 patients) forTI- (P < 0.005). When compared to CT, Gad7 scintigraphy gave additional information in 4% (3 of 70 patients) of the patients versus 3% (2 of 70 patients) for Tl-20 1 imaging. For the purpose of radiation therapy planning, if based on chest x- ray findings, Ga-67 scintigraphy was necessary for proper
