Surgery and Chemotherapy for Small Cell Lung Cancer in Stages I–II with or without Radiotherapy

PURPOSE: To analyze the effectiveness of surgery and chemotherapy with or without radiotherapy in the management of limited small cell lung cancer (LSCLC) in stages I and II. PATIENTS AND METHODS: 39 patients (median age 62 years) with LSCLC in stages pT1 or pT2 and pN0 or pN1 (stages IA-IIB) who had a tumor resection and systematic lymph node dissection were reviewed retrospectively. The median follow-up period was 29 months. 35 patients (90%) received a median of four cycles of a platinum-containing chemotherapy postoperatively. 16 patients (41%) received an adjuvant thoracic radiotherapy (TRT, median 50 Gy); 21 patients (54%) received a prophylactic cranial irradiation (PCI, median 30 Gy). RESULTS: The median overall survival for all patients was 47 months, resulting in actuarial 1-, 3-, and 5-year survival rates of 97%, 58%, and 49%, respectively. Distant metastases were found in 13 patients (33%) after a median of 16 months. Patients who received an adjuvant TRT showed a trend toward improved thoracic recurrence-free survival (p = 0.06) and improved overall survival (p = 0.07) compared to those treated with surgery and chemotherapy only. Brain metastasis-free survival (p = 0.01) and overall survival (p = 0.01) were improved significantly in patients who received a PCI. CONCLUSION: Surgical tumor resection may be considered for carefully selected patients. Adjuvant chemotherapy and PCI are recommended for all patients. Adjuvant TRT is currently used in patients with positive lymph nodes (pN1), because the probability of a subclinical involvement of the mediastinal lymphatic system appears to be increased in these patients.     

Inkomplette Resektionen bei Bronchialcarcinom: Morbidität und Prognose

Zusammenfassung. Nach Lungenresektion und ipsilateraler Lymphknotendissektion wegen Bronchialcarcinoms verblieb in 88 von 2464 F?llen (3,6 %) mikroskopisch Residualtumor (R1) am zentralen Bronchusresektionsrand. Sieben Patienten entwickelten eine Insuffizienz der Bronchusnaht, 2 weitere eine Nachblutung bzw. eine Herzluxation (Morbidit?t 8,0 %). Die Hospitalletalit?t betrug 16,6 %. Todesursachen waren Bronchusnahtinsuffizienz (n = 7), Arrosionsblutung (n = 4), respiratorische Insuffizienz (n = 1) und Pleuraempyem (n = 1). Eine postoperative Bestrahlung wurde bei 43 Patienten durchgeführt. Die mediane überlebenszeit aller Patienten nach R1-Resektion war 16 Monate gegenüber 37 Monaten nach R0-Resektion (p < 0,001). Die überlebenszeit war unabh?ngig von Tumorstadium und -histologie, Lokalisation des Residualtumors in der Bronchuswand und einer Nachbestrahlung. Inkomplette Resektionen sind durch intraoperativen Schnellschnitt zu verifizieren. Sofern funktionell vertretbar, sollte in den Stadien I und II eine Nachresektion (R0) angestrebt werden; auch in den Stadien III a und III b ist bei R0-Resektion ein statistisch signifikanter überlebensvorteil gegenüber R1-Resektion zu verzeichnen, jedoch weniger deutlich als in niedrigeren Stadien.      

Female and male partner age and menotrophin requirements influence pregnancy rates with human menopausal gonadotrophin therapy in combination with intrauterine insemination

This study analyses the influence of female and male patient age and human menopausal gonadotrophin (HMG) requirements on clinical pregnancy rates and live birth rates with ovulation stimulation using HMG in combination with intrauterine insemination (IUI). In this study, 363 consecutive HMG/IUI treatment cycles in 184 patients carried out at a university fertility centre were analysed in a retrospective fashion. The main outcomes measured were clinical pregnancy rates and live birth rates. Increased female partner age (> or = 35) and male partner age (> or = 40) were found to negatively influence pregnancy rates with HMG/ IUI therapy. In addition, this study demonstrated a critical threshold of HMG requirements beyond which pregnancy did not occur. No pregnancies occurred in treatment cycles requiring > 25 ampoules (1875 IU) of menotrophins to achieve follicular maturity, irrespective of patient age. In conclusion, female partner age, male partner age, and HMG requirements all significantly influence pregnancy rates with HMG/IUI therapy.      

METHYLATION STATUS OF BCL6 DISTINGUISHES DNA SAMPLES FROM BENIGN AND MALIGNANT LYMPHOPROLIFERATIVE DISORDERS

INTRODUCTION: Core biopsy of the breast has become the method of choice for tissue diagnosis of screen detected microcalcifications and some mass lesions in many breast assessment centres. Biopsy results are not available until the following day. Imprint cytology of fresh breast core samples allows same-day reporting and patient counselling.
AIM: To determine the accuracy of core imprint cytology when compared with core biopsy diagnosis when used in a breast assessment centre setting.
METHODS: Core imprints (CI) were prepared and reported on all fresh core biopsies (CB) performed at the Sir Charles Gairdner Hospital Breast Centre from May to December 2000. Fresh core samples were placed on a glass microscope slide. Core radiographs were taken for microcalcification lesions (MC). A laboratory technician gently and quickly rolled the cores on the slide with fine forceps. The cores were fixed in formalin, processed and reported next day. The imprint slide was air dried and stained with DiffQuik. CI were reported using four categories: Insufficient, Benign, Indeterminate and Malignant. Counselling and planning for management were possible on the same day in women with malignant diagnoses. Clinicians were advised not to discuss negative or indeterminate CI results with women and to defer to the final CB report.
RESULTS: Cores were performed on 381 lesions. There were 83 carcinomas (38 in MC and 45 in masses) and 56 were called malignant on CI (absolute sensitivity 67.5%; 78.9% for MC and 57.8% for masses). 3 malignancies on CB were negative on CI giving a false negative rate of 3.6%. There were no false positive diagnoses. The predictive value of a benign diagnosis was 95.3%. There were no adverse effects in the histology of CB.
CONCLUSION: CI was an accurate method of providing an immediate diagnosis of malignancy in two thirds of malignancies confirmed on CB.     

Isolated pure lipoma of the uterus--a case report

Lipoma primary to uterus is a rare entity among uterine fatty tumors. These create preoperative diagnostic confusion and their histogenesis is still unclear. Only a few cases of pure lipoma of uterus have been reported in the last few decades. A case of isolated pure lipoma primary to uterus diagnosed postoperatively by pathological examination is presented.