Stereotactic radiation therapy for non small cell lung cancer

Stereotactic radiation therapy (SRT) is a highly effective treatment for brain metastases from non-small cell lung cancer (NSCLC). Primary lesions of NSCLC may also be controlled by SRT. Between 1994 and 1999, 50 patients with pathologically confirmed T1-2N0 M0 NSCLC were treated with SRT. With a median follow-up period of 36 months, 3-year cause-specific survival was 88%. SRT is a very safe and effective treatment for early stage NSCLC.     

Isolated splenic metastasis from non small cell lung cancer.

Lung cancer is amongst the commonest cancers in the world. Most patients present in advanced stages precluding curative treatment. Distant metastases usually occur in the liver, brain, bones and adrenals. Isolated splenic metastases are rare and are restricted to anecdotal reports in medical literature. We report a middle-aged man who presented to us with locoregionally advanced non small cell lung cancer, progressed on neoadjuvant chemotherapy and developed isolated splenic metastasis.     

非小细胞肺癌脊柱转移治疗现状及进展

目前,肺癌仍是全球肿瘤相关死亡的首要原因,在发达国家,肺癌的发生率占男性恶性肿瘤的首位,而非小细胞肺癌(non-small-cell lung cancer,NSCLC)占肺癌总数的80%～85%[1]。肺癌是最容易发生骨转移的恶性肿瘤之一,据报道30%～40%的晚期肺癌会发生骨转移,而脊柱转移最为常     

CD44s在非小细胞肺癌中的表达研究

目的　探讨标准型 Ｃ Ｄ４４（ Ｃ Ｄ４４ｓ） 在非小细胞肺癌（ Ｎ Ｓ Ｃ Ｌ Ｃ） 中的临床应用价值。方法　用免疫组织化学方法检测 Ｎ Ｓ Ｃ Ｌ Ｃ１８０ 例和淋巴结 Ｎ Ｓ Ｃ Ｌ Ｃ 转移癌５１ 例的石蜡标本 Ｃ Ｄ４４ｓ 表达强度,并对１８０ 例 Ｎ Ｓ Ｃ Ｌ Ｃ 的术中情况进行记录,对其中１４１ 例病人进行随访分析。结果　 Ｃ Ｄ４４ｓ 强表达的 Ｎ Ｓ Ｃ Ｌ Ｃ 多为Ⅰ期,术中淋巴结转移率及４ 年转移率较低,病人生存期较长;淋巴结 Ｎ Ｓ Ｃ Ｌ Ｃ 转移癌的 Ｃ Ｄ４４ｓ 表达率较原发灶低。结论　 Ｃ Ｄ４４ｓ 强表达的 Ｎ Ｓ Ｃ Ｌ Ｃ 病人多为早期,发生转移可能性较少,生存期较长,可能是 Ｎ Ｓ Ｃ Ｌ Ｃ 一个预后良好的指标。     

Guide line for the treatment of stage I and stage II non small cell lung cancer

Evidence based treatment modalities should be established as more than 55,000 patients die of lung cancer every year and its number is increasing. For stage I and stage II non small cell lung cancer (NSCLC), surgery is strongly recommended if there are no contraindications such as impaired pulmonary function and other medical disorders. Although lobectomy (bilobectomy or pneumonectomy) with mediastinal lymphnode dissection is standard operation for stage I and stage II NSCLC, limited operation (segmentectomy or extended segmentectomy) for peripherally located small sized cancer (less than 2 to 3) is now being performed to assess if there is survival difference between standard operation. Also numbers of patients undergoing video-assisted thoracoscopic surgery (VATS) is increasing and studies to compare postoperative survival rate and postoperative quality of life with standard operation is performed. To improve postoperative survival, pre and postoperative treatment such as chemotherapy, radiotherapy or combination of these treatments have been undertaken. Very recently usefulness of postoperative adjuvant chemotherapy with Uracil-Tegafur for stage I adenocecinoma was reported from Japan. For patients with stage I and stage II NSCLS in whom operation is not feasible for medical reasons, radical radiation therapy is recommended.     

Estrogen and progesterone receptors in non small cell lung cancer patients.

The role of sex hormones in the pathogenesis of lung cancer is still unknown. There are conflicting results regarding immunohistochemical detection of the estrogen and progesterone receptors expression in non small cell lung cancer. To clarify these discrepancies 32 samples of lung carcinoma tissues obtained by lobectomy or pneumonectomy were studied. Two monoclonal antibodies (6F11 and ID5) for estrogen receptor detection and one (1A6) for progesterone receptor detection were used. Eighteen adenocarcinoma and 14 squamous cell carcinoma cases were investigated. There were 11 women and 7 men with adenocarcinoma and 4 women and 10 men with squamous cell carcinoma. Weak (+1) nuclear estrogen hormone receptor expression was detected in only one specimen of a woman with adenocarcinoma and in one specimen of a man with squamous cancer. None of the 32 blocks of paraffin embedded specimens expressed progesterone receptor. The positive estrogen and progesterone receptors expression in cancer tissue is an important argument against the pulmonary origin of the unknown primary tumor.     

Diagnosis and treatment of lung cancer – Non-small cell lung cancer, small cell lung cancer and carcinoids

Summary BACKGROUND: The prognosis of lung tumors is determined by histology and staging (nodal status). The most common tumor is non-small cell lung carcinoma (NSCLC) with a 5-year survival rate of 67 % (stage IA) to <5 % (stage IV). METHODS: By reviewing the literature guidelines for diagnosis and treatment of non-small cell lung cancer and neurendocrine tumors are presented. RESULTS: Functional operability provided, (bi)lobectomy or pneumonectomy with mediastinal lymph node dissection are the standard procedures. In case of positive mediastinal lymph nodes (stage IIIA/IIIB) induction chemo(radio)therapy is indicated. Cervical mediastinoscopy is performed in patients with enlarged mediastinal nodes (CT >1 cm), especially in PET-positive cases. Adjuvant chemotherapy is used in clinical trials. Small-cell lung cancer (SCLC, neuroendocrine tumor grade III) has a poor prognosis, and is treated with chemotherapy; resection may be performed in early stages. Neuroendocrine tumors grade I (typical carcinoid) are resected by segmentectomy, lobectomy, or bronchoplastic resection. Neuroendocrine tumors grade II (atypical carcinoids) are treated like NSCLC. CONCLUSIONS: The incidence of lung cancer is decreased by tobacco control, and the chances of survival are improved by early detection and multimodality regimens.      

Multimodal therapy of small cell lung cancer in TNM stages I through IIIa.

Since 1977, Innsbruck University Hospital has been employing a multimodal therapy concept for small cell bronchial carcinomas in stages I to IIIa. This concept includes all three treatment forms effective in this tumor, namely, chemotherapy, surgery, and radiotherapy. The therapy scheme is stage-dependent and begins in stages T1-3 N0-1 with lung resection and in stage N2 with chemotherapy. To date, 45 patients have been included in a prospective, nonrandomized (phase II) trial: 7 in TNM stage I, 11 in stage II, and 27 in stage IIIa (6 T3 and 21 N2). The actuarial 5-year survival rate of the entire group (including therapy-related lethality, early recurrences, and protocol violations) is 36%; it is 57% for those in stage I, 28% for those in stage II, and 34% for those in stage IIIa. Median survival time is 18 months. Patients with completed multimodal treatment have a 5-year survival rate of 56% regardless of disease stage. Three patients died of tumor-unrelated causes after 47, 52, and 54 months.     

P21ras在非小细胞肺癌中表达的研究

目的:探讨ras癌基因产物P21ras在非小细胞肺癌(NSCLC)中的表达及其意义。方法:采用免疫组织化学ABC法对61例NSCLC肺癌组织及癌旁正常肺组织进行了P21ras的检测。结果:P21ras在肺癌组织中呈高表达(62.3％,38/61),而在癌旁正常肺组织中无表达,二者差异显著(P<0.05)。在肺鳞癌及腺癌中的阳性表达率为57.1％(20/35)和69.2％(18/26),无显著差异。P21ras表达随NSCLC有淋巴结转移,病程进展及分化程度的降低而明显增高(P<0.05),结论:P21ras表达可能与NSCLC发生发展有关,并可作为判断其预后的参考指标。     

Multimodal treatment for squamous cell esophageal cancer

Preoperative chemotherapy (CTx) and combination radiochemotherapy (RTx/CTx) in patients with squamous cell esophageal carcinoma has recently received increasing attention. Although several prospective randomized trials could not show any benefit of neoadjuvant therapy in patients with potentially resectable tumors, preoperative CTx and combination RTx/CTx appear to increase the resection rate, the rate of complete tumor resection, and survival time in patients with locally advanced tumors. Most available studies show that a survival benefit from multimodal therapy can be expected primarily in patients who have a complete histopathologic response to preoperative treatment (i.e., no viable tumor in the resected specimen). Preoperative RTx/CTx increases the response rate and improves local tumor control compared to preoperative CTx alone, but it is associated with substantial perioperative mortality and morbidity. Distant tumor recurrences are insufficiently controlled with current combined modality protocols. These data indicate that neoadjuvant therapy must be considered investigational in patients with potentially resectable esophageal carcinoma but may soon become standard in patients with locally advanced tumors. Research must focus on modalities that allow pretherapeutic identification of those patients who will respond to neoadjuvant therapy. Furthermore, more effective and less toxic preoperative therapy regimens are required to increase the response rates and combat systemic recurrences. Finally, randomized prospective studies are essential to assess the role, extent, and timing of surgical resection for the combined modality approach to patients with squamous cell esophageal carcinoma.

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Resumen La quimioterapia preoperatoria (CTx) y la combinación radioquimioterapia (RTx/CTx) en los pacientes con carcinoma escamocelular del esófago se constituye en motivo reciente de atención. En tanto que varios ensayos prospectivos y randomizados no han logrado demostrar beneficio de la terapia neoadyuvante en pacientes con tumores potencialmente resecables, la CTx preoperatoria o la combinación RTx/CTx parece aumentar la tasa de resección, la tasa de resección tumoral completa y el tiempo de sobrevida en los pacientes con tumores localmente avanzados. La mayoría de los estudios disponibles demuestra que el beneficio de supervivencia puede esperarse en los pacientes que exhiben respuesta histopatológica completa al tratamiento preoperatorio, o sea aquellos en que no se encuentran células viables en el espécimen de resección. Una combinación de RTx/CTx preoperatoria aumenta las tasas de respuesta y mejora el control tumoral local en comparación con la CTx preoperatoria sola, pero también se asocia con morbilidad y mortalidad perioperatorias considerables. Las recurrencias tumorales a distancia todavía no pueden ser bien controladas mediante los protocolos de terapias combinadas actualmente en boga. Estos datos indican que la terapia neoadyuvante debe ser considerada todavía como de tipo investigativo en los pacientes con carcinoma esofágico potencialmente resecable, pero que tal vez pronto puedan convertirse en tratamiento estandarizado en los pacientes con tumores localmente avanzados. La investigación debe enfocarse sobre las modalidades que permiten la identificación preterapéutica de aquellos pacientes que habrán de responder a la terapia neoadyuvante. Por lo demás, se requieren regímenes terapéuticos preoperatorios más eficaces y menos tóxicos con el objeto de aumentar las tasas de respuesta y de controlar las recurrencias sistémicas. Finalmente, es esencial ejecutar estudios prospectivos randomizados para determinar el rol, la magnitud y el momento de realizar la resección quirúrgica en el aproche multimodal de los pacientes con carcinoma escamocelular del esófago.

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Résumé L'association chimiothérapie et radiochimiothérapie préopératoire a reçu beaucoup d'attention dernièrement. Alors que plusieurs études prospectives randomisées n'ont pu démontrer les bénéfices d'une thérapeutique néoadjuvante chez des patients ayant une tumeur potentiellement résécable, la chimiothérapie seule ou associée à la radiothérapie préopératoires semble augmenter le taux de résécablitié et la survie chez les patients avant des tumeurs locorégionates. La plupart des études disponibles démontrent une amélioration de survie lorsque la thérapeutique est multimodale, lorsque la réponse histologique initiale à la chimiothérapie préoperatoire est positive, c'est à dire, s'il n'y ait aucune tumeur visible dans la pièce opératoire. La radiochimiothérapie préopératoire augmente le taux de réponse et améliore le contrôle local, par rapport à la chimiothérapie seule, mais elle augmente également la mortalité et la morbidité périopératoires. Les métastases à distance ne sont pas bien controlées par la radiochimiothérapeutique associée. Ces donnécs indiquent que la thérapeutique néoadjuvante est encore au stade expérimental chez le patient ayant un cancer de l'oesophage résecable, mais est en voie de devenir la thérapeutique de l'avenir en ce qui concerne les tumeurs locorégionales. La recherche actuelle cherche à identifier les patients qui répondront au mieux à cette thérapeutique néoadjuvante. De plus, des drogues moins toxiques et plus efficaces sont nésessaires pour améliorer le taux de réponse et combattre les récidivcs systémiques. Enfin, des études randomisécs sont essentielles pour évaluer le rôle, l'étendue et le meilleur moment de la résection chirurgicale dans cette optique thérapeutique chez le patient ayant un cancer épithélial de l'oesophage.

     

α-连接素在非小细胞肺癌中的表达及其与预后的关系

目的探讨非小细胞肺癌(NSCLC)肿瘤组织中α-连接素(alpha-catenin,α-cat)的表达以及与其临床分期和预后的关系. 方法采用SP免疫组织化学染色方法分析NSCLC组织中α-cat的表达. 结果肿瘤的临床分期与α-cat的表达呈显著相关(r=0.978, P<0.05),Ⅲ期患者α-cat的异常表达高于Ⅰ期患者; α-cat的表达与NSCLC患者组织学类型和术后生存时间无关(P＞0.05 ). 结论 NSCLC组织中α-cat的表达不能作为临床判断NSCLC患者预后的指标.     

康艾配合化疗治疗晚期非小细胞肺癌10例临床观察

目的:探讨康艾注射液配合化疗药物治疗晚期非小细胞肺癌的临床疗效.方法:采用康艾注射液配合化疗药物治疗晚期非小细胞肺癌10例,在每个化疗用药期间,同时静点康艾注射液10天.对不能进行化疗的患者,单用康艾注射液,每个疗程20天,连用8～15个疗程.结果:康艾注射液配合化疗用药,患者的食欲、睡眠改善、周身不适减轻、肝功肾功、心脏反应较轻,白细胞及血小板下降得到改善,疼痛明显减轻.结论:康艾注射液配合化疗药物,有增强免疫功能、缓解疼痛、清热解毒、提升白细胞的作用,有扶正祛邪、不伤患者正气的作用,通过长期应用,提高了晚期非小细胞肺癌的生活质量、延长了生存期.     

晚期非小细胞肺癌内科治疗的探讨

目的 观察健择/顺铂、泰素/顺铂、泰索帝／顺铂、易瑞沙治疗晚期非小细胞肺癌的疗效、毒副反应及费用情况。方法 经病理学证实的99例晚期非小细胞肺癌患者分成四组。A组：健择1000mg／m^2d1.8.15＋顺铂100mg／m^2d1，4周为1个周期，连用4个周期；B组：泰素135mg／m^2d1＋顺铂75mg/m^2d2．3周为1个周期，连用4个周期；C组：泰索帝75mg/m^2d1＋顺铂75mg/m^2d1，3周为1个周期，连用4个周期；D组：易瑞沙250mg，每日1次，30d为1个周期，连用6个周期。结果 总有效率：A组为23．3％，B组21．4％，C组26．0％，D组23．5％；中位生存期：A组为8．1个月，B组7．8个月，C组8．0个月，D组7．6个月；毒副反应A、B、C三组骨髓抑制及消化道症状比较常见，但三组间无明显的差异性（P〉0．05），而D组这些毒副反应则明显减少；费用：D组最高，其次为C组，A、B两组相当。结论 选择A、B组比较适合于普通群众，而对于经济条件比较好的或者不能耐受化疗药物毒副反应的病人可选用易瑞沙。     

Postoperative recurrence of the patients with the stage I, II non small cell lung cancer

The study population consisted of 42 patients with squamous cell carcinoma and 46 patients with adenocarcinoma of stage I, 12 patients with squamous cell carcinoma and 7 patients with adenocarcinoma of stage II lung cancer who underwent curative surgical resection. Local recurrence and metastasis was not significant in both histological types in stage I, II. Lung and bone metastasis was dominant in the both cases of squamous cell carcinoma, adenocarcinoma and brain metastasis in the cases of adenocarcinoma. Concerning the period to first recurrence following the operation, the recurrences of stage I squamous cell carcinoma occurred 28% within 1 year after surgery, 28% during 1-2 years after surgery and those of stage II squamous cell carcinoma occurred 11% within 1 year. On the other hand, the recurrences of stage I adenocarcinoma occurred 25% within 1 year, 31% during 1-2 years, 25% over 2 years after surgery and those of stage II adenocarcinoma occurred 13% within 1 year. In the cases with squamous cell carcinoma, the 5-year survival rate (56%) of stage I was not significant compared with those (59%) of stage II. On the other hand, in the adenocarcinoma, the 5-year survival rate (54%) of stage I was significantly better than those (29%) of stage II (p less than 0.05).     

Surgery in small cell lung cancer

Surgery in small cell lung cancer (SCLC) was abandoned in the late 1960s but is currently being cautiously reassessed, after the Armed Forces Asymptomatic Pulmonary Nodule Study demonstrated an unexpectedly prolonged 5-year survival (36%) with surgery. Subsequent prospective studies have reported five-year survival following resection in 22 to 83% of patients with Stage I disease and in 0 to 50% of patients with Stages II and III disease. Ten percent of patients with SCLC may be amenable to this approach. Additional patients may become candidates for resection following intensive combination chemotherapy. The optimal postoperative management remains unsettled. Combination chemotherapy and prophylactic cranial irradiation is recommended following complete resection. Postoperative thoracic irradiation may benefit patients with pathologically involved mediastinal nodes. Correlation of clinical response with our new understanding of the molecular biology of SCLC may further improve our approach to this disease.     

Lower airway bacterial microbiome may influence recurrence after resection of early-stage non–small cell lung cancer

ObjectiveThe lower airway bacterial microbiome influences carcinogenesis and response to immunotherapy in non–small cell lung cancer (NSCLC). We investigated the association of this microbiome with recurrence in early NSCLC.MethodsMicrobiomes of presurgery bronchoalveolar lavage (BAL) and saliva, and resected stage I NSCLC tumor and adjacent lung tissues of 48 patients were examined by 16S gene sequencing. Tumor gene expression was measured by RNA sequencing.ResultsSpatial relationships of the different biospecimen types was reflected in their microbiomes, with microbiomes of BAL intermediate to those of saliva and lung tissue. BAL and saliva microbiomes were less dissimilar in patients with high α-amylase levels in BAL, indicating oral aspiration as a source of lower airway microbiota. BAL microbiomes of patients with recurrence within 32 months of surgery differed from those without recurrence during ≥32 months of follow-up (n = 18 each), despite no difference for age, sex, smoking history, and tumor histology and grade. The recurrence-associated BAL microbiome signature was present in 16 of the 18 recurrence cases but in only two of the others. Signature presence was associated with shorter recurrence-free survival (log-rank test P < .001; hazard ratio = 14.5), and greater expression in tumors of genes for cell proliferation and epithelial mesenchymal transition. Immune cellular composition of the tumor microenvironment was not different between patients with and without the signature.ConclusionsPresurgery composition of lower airway microbiome may be associated with recurrence of early NSCLC. This association may reflect an influence of the microbiome on tumor biology.