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G Stamatis

Publications and source records attributed to G Stamatis.

At least 19 recordsLinked to original sources
PubMed2006

Induction chemotherapy, concurrent chemoradiation and surgery for Pancoast tumour.

The traditional treatment of Pancoast tumour with local approaches (surgery, radiotherapy or a combination of both) leads to a poor outcome due to the high rate of incomplete resection and the lack of systemic control. The aim of the present prospective feasibility study was to determine whether a trimodality approach improves local control and survival. Patients with stage IIB-IIIB Pancoast tumour received induction chemotherapy (three courses of split-dose cisplatin and etoposide or paclitaxel) followed by concurrent chemoradiotherapy (a course of cisplatin/etoposide combined with 45 Gy hyperfractionated accelerated radiotherapy). After restaging, eligible patients underwent surgery 4-6 weeks post-radiation. A total of 31 consecutive patients with T3 (81%) or T4 (19%) Pancoast tumour were enrolled in the study. Induction chemoradiotherapy was completed in all patients without treatment-related deaths. Grade 3-4 toxicity was observed in 32% of cases. In total, 29 (94%) patients were eligible for surgery. Complete resection was achieved in 94% of patients. The post-operative mortality rate was 6.4% and major complications arose in 20.6% of the patients. The median survival was 54 months with 2- and 5-yr survival rates of 74 and 46%, respectively. In conclusion, this intensive multimodality treatment of Pancoast tumour is feasible and improves local resectability rates and long-term survival as compared with historical series.

Adult↗
PubMed2006

Solitary pulmonary nodule with growth and contrast enhancement at CT: inflammatory pseudotumour as an unusual benign cause.

Small (< or =10 mm) pulmonary nodules are frequently detected at modern chest CT. As most of these nodules are benign, non-invasive classification is required--usually based on assessment of growth and perfusion. Absence of growth and no evidence of perfusion, as demonstrated by lack of enhancement at contrast-enhanced CT or MRI, strongly suggest a benign nodule. On the other hand, growth with a doubling of the nodule's volume between 20 days and 400 days or enhancement suggest a malignant nature of the lesion. We present an example of a nodule with strong contrast enhancement and a doubling time of approximately 260 days, which histologically represented a benign inflammatory pseudotumour.

Diagnosis, Differential↗
PubMed2005

[Operative and interventional therapy of lung metastases].

Almost every third patient succumbing to a malignant disease has metastases in the lungs. However, these are often asymptomatic and are detected fortuitously during a routine examination. Today, the surgical removal of lung metastases is associated with a risk of less than 1%, but only one-third of the patients meet the criteria for such a procedure. The long-term outcome after resection of lung metastases depends in particular on the nature of the primary tumor, the number of metastases, the duration of the period between the occurrence of the primary and development of metastases, and the completeness of the resection. In the case of inoperable metastases, interventional measures may suffice to achieve local tumor control. For the treatment of lung metastases, radiofrequency ablation in particular is currently being investigated.

Bronchoscopy↗
PubMed2005

Repeat mediastinoscopy as a restaging procedure.

BACKGROUND: Repeat cervical mediastinoscopy is a diagnostic surgical procedure for preoperative nodal staging in patients with insufficient first mediastinoscopy, with recurrent or second primary lung neoplasms, and following induction chemotherapy or chemo-/radiotherapy for locally advanced lung cancer. The aim of this study was to critically analyse indications, technical characteristics, intra- and postoperative complications, also to define selection criteria for patients with a higher probability of successful complete resection. MATERIAL AND METHODS: 279 patients with lung cancer (66 female and 213 male patients, mean age 58 years, range 28 to 78 years) underwent repeat mediastinoscopy from 1968 to 2004, 12 because of inadequate first procedure (group A), 67 because of recurrent lung cancer (group B) 35 because of second primary lung cancer (group C), and 165 following induction chemo-/radiotherapy for IIIa and IIIb disease (group D). The interval between first and second procedure was 17 days (range, 12 - 38) in group A, 14 months (range, 5 - 29) in group B, 27 months (range, 19 - 124) in group C, and 132 days (range, 113 - 145) in group D. RESULTS: No intra- or postoperative deaths were observed, 7 patients developed minor complications. N2 or N3 disease was found in 3/12 patients of group A (25 %), in 17/67 patients of group B (25.4 %) and in 6/35 patients of group C (17.1 %). Of the 116 patients with N2, and 49 with N3 disease before induction treatment (group D), repeat mediastinoscopy showed 126 N0, 20 N2 and 14 N3 status. Because of the presence of inseparable adhesions repeat mediastinoscopy was not possible in 5 cases. Five-year survival for patients with persistent N2 in repeat mediastinoscopy was despite surgery only 5 %. CONCLUSION: Repeat mediastinoscopy is a safe explorative procedure for the restaging of patients with primary locally advanced, recurrent or second primary lung cancer. In patients after induction treatment it is, however, less sensitive than the primary mediastinoscopy because of adhesions and fibrotic tissue. Patients with persistent N2 or N3 disease in repeat mediastinoscopy have a poor survival so that the indication for surgery has to be taken into consideration very carefully.

Adult↗
PubMed2004

Melanoma associated antigen (MAGE)-A3 expression in Stages I and II non-small cell lung cancer: results of a multi-center study.

OBJECTIVES: Adjuvant immunotherapy is an innovative therapeutic option that might potentially improve outcome of early-stage non-small cell lung cancer. Melanoma associated antigen (MAGE)-A3 is a promising target for immunotherapy because it is exclusively presented on the cell surface of cancer cells and might be associated with an aggressive cancer phenotype. The present study was performed to determine the rate of MAGE-A3 expression in early-stage non-small cell lung cancer (NSCLC). PATIENTS AND METHODS: Primary tumor samples from 204 patients with operable clinical Stages I or II NSCLC were collected between March and November 2001. Pathological Stage was determined by the local pathologist in each of the 16 participating institutions. Tissue samples were stored immediately after surgery in a RNA-stabilizing solution and were frozen at -20 degrees C. MAGE-A3 expression was analyzed by detection of MAGE-A3 transcripts using reverse-transcriptase polymerase chain reaction. RESULTS: MAGE-A3 expression was observed in 80 out of the 204 (39.2%) examined Stages I-II primary tumors. Stratification into UICC-Stages showed that 31 out of 105 (29.5%) Stage I non-small cell lung cancers and 49 out of 99 (49.5%) Stage II non-small cell lung cancers expressed MAGE-A3. In comparison to Stage I, the rate of MAGE-A3 positive tumors was significantly increased in Stage II (P=0.004; Chi-square test). CONCLUSION: The MAGE-A3 expression rate showed that a promising proportion of operable patients with early-stage non-small cell lung cancers are possible candidates for trials investigating adjuvant therapy with MAGE-A3 immunization. Currently, a phase two trial of adjuvant MAGE-A3 vaccination is in progress.

Antigens, Neoplasm↗
PubMed2004

High-dose chemotherapy with autologous stem cell transplantation in patients with oligometastatic breast cancer.

The purpose of this prospective trial was to study a combined-modality treatment including local consolidation by surgery or radiotherapy and high-dose chemotherapy (HDC) followed by peripheral-blood stem-cell (PBSC) transplantation. In all, 48 patients with oligometastatic breast cancer amenable to local treatment after induction chemotherapy with epirubicin and cyclophosphamide or paclitaxel and cisplatin, depending on prior adjuvant chemotherapy, were enrolled. The median follow-up was 41 months (range, 7-85 months). PBSC were collected in 47 patients, and 40 received one or two courses of HDC. Local therapy was given in 37 patients. No treatment-related deaths occurred. Of 47 evaluable patients, 36 (75% of intention-to-treat population) had no evidence of disease or complete remission after completion of therapy. Six patients (12.5%) had partial response, two patients (4%) no change, and three patients (6%) progressive disease. The median time to progression and overall survival was 17.5 (95% confidence interval (CI), 14-21 months) and 42.2 months (95% CI, 33-52 months), respectively, and 27% of patients were progression free after 5 years. In conclusion, patients with oligometastatic breast cancer can be treated safely with this combined modality protocol with promising relapse-free survivals.

Adult↗
PubMed2002

Long-term results of lung volume reduction surgery.

OBJECTIVE: Lung volume reduction surgery (LVRS) is effective in the short and intermediate term for the improvement of pulmonary function and subjective symptoms in selected patients with advanced emphysema. The purpose of this study was to examine the long-term functional results of LVRS and to investigate which subgroups would benefit in terms of long-term survival. METHODS: All records of the patients who underwent LVRS between 1994 and, 1998 at our hospital were reviewed. RESULTS: Eighty-eight consecutive patients underwent LVRS during the period. There were 62 men and 26 women with an average age of 56.1 years (range 34-72 years). Eleven patients with alpha1-antitrypsin deficiency were included. The perioperative mortality rate (<90 days) was 2.3% (n=2). Total lung capacity (7.5+/-0.3 l) and residual volume (4.8+/-0.3 l) at 3 years remained lower than baseline (9.2+/-0.2 l, 6.5+/-0.2 l, each) (P<0.001). The mean forced expiratory volume in 1 s (FEV(1)) at 3 years (0.86+/-0.08 l) was higher than baseline (0.78+/-0.02 l), but the difference did not reach statistical significance. The FEV(1) of the patients with alpha1-antitrypsin deficiency and of those with respiratory bronchiolitis returned to baseline at one year after LVRS and showed further deterioration. Overall survival rate at 5 years was 71.0% with the mean length of follow-up of 54.2 months. The survival difference was statistically significant between patients with preoperative FEV(1) >or=28.5% and those with FEV(1)<28.5% (P=0.0152). CONCLUSIONS: The improvement of total lung capacity and residual volume persisted long after the operation. Patients with alpha1-antitrypsin deficiency and those with bronchiolitis showed early deterioration of the lung function. Patients with higher preoperative FEV(1) had a survival benefit. The favorable long-term survival might justify LVRS for the treatment of selected patients with severe emphysema.

Bronchiolitis↗
PubMed2002

[Indication, type of resection and results of surgery in cases of lung tuberculosis. A historical and regional overview].

Pulmonary tuberculosis has become a rare indication for surgical intervention in all industrial nations. Over a period of 10 years we overview 193 patients who were suffering this disease and underwent thoracotomy. Main indication (79.8 %) was pulmonary nodules, of unknown origin. In this cases wedge resection was performed. Expanded resectional techniques were necessary in cases of cavernes, superinfected bronchiectasis, bronchial stenosis, hemoptysis and destroyed lungs due to tuberculosis. Considering the heterogenous groups of patients, the perioperative morbidity (21.8 %) and mortality (0.5 %) has to be regarded in comparison to the data found in the literature.

Developed Countries↗
PubMed2002

[Significance of pulmonary lymph node metastases in locally advanced non-small cell lung cancer].

BACKGROUND: The locally advanced (T3 - 4) non-small cell lung cancer with pulmonary lymph node metastases (N1) is a mixture of different subgroups of disease with varying pattern of tumor extension and long-term survival rates. PATIENTS AND METHODS: We retrospectively reviewed hospital records and follow-up data of 181 patients operated on between 1990 and 1995 with pathological stage IIIA-pT3N1 and IIIB-pT4N1. Median age was 62 years (range 34 - 80). RESULTS: The operative mortality was 3.7 %. The analysis was carried out on the 181 hospital survivors. The operative procedure was a pneumonectomy in 110 cases (60.8 %) and a lobectomy/bilobectomy in 71 (39.26 %). The pathological stage according to the UICC TNM-Classification of 1997 was T3N1 in 128 (70.7 %) and T4N1 in 53 (29.3 %). We observed a metastatic involvement of the hilar, interlobar and lobar lymph nodes in 44 (24.3 %), 17 (9.4 %), and 27 (14.9 %) patients, respectively, whereas a direct infiltration in 93 patients (51.4 %). The actuarial overall 3-, 5- and 10-year survival rates for N1 hilar was 23 %, 13 % and 8 %, for N1 interlobar was 18 %, 6 % and 0 %, for N1 lobar was 48 %, 37 % and 22 %, and for N1 direct was 32 %, 27 % and 21 %, respectively. The involvement of hilar lymph nodes correlates with a worse prognosis (p =.0366). CONCLUSIONS: Metastases to the hilar lymph nodes in locally advanced NSCLC can be considered an initial N2-disease and should be treated correspondingly. Lymph node involvement by direct invasion is associated with a relatively more favourable prognosis for the patients.

Actuarial Analysis↗
PubMed2002

Induction chemotherapy followed by concurrent chemotherapy and definitive high-dose radiotherapy for patients with locally advanced non-small-cell lung cancer (stages IIIa/IIIb): a pilot phase I/II trial.

BACKGROUND: Overall prognosis of patients with locally advanced non-small-cell lung cancer (LAD-NSCLC) is still unfavourable. Different attempts to improve treatment results have been made using combinations of chemotherapy and radiotherapy. The aim of this pilot phase I/II investigation was to test the feasibility and toxicity of a definitive multimodality protocol in patients with irresectable NSCLC stages IIIA (N2) and IIIB. PATIENTS AND METHODS: Thirty LAD-NSCLC patients (stages IIIA/IIIB: 3/27; median age: 54 years, range 34-70; male/female: 17/13) who were consecutively enrolled onto our ongoing neoadjuvant multimodality protocol from October 1996 to February 1999 remained inoperable after induction treatment. Three cycles of cisplatin/etoposide (PE) were followed by hyperfractionated accelerated radiotherapy (HF-RTx: 1.5 Gy bid up to a total dose of 45 Gy in 3 weeks) concurrent with one cycle of PE. Definitive local treatment was completed with a small volume boost of 20 Gy (qd), adding up to a total dose of 65 Gy to the primary. Patients were routinely offered prophylactic cranial irradiation (PCI; 30 Gy; 2 Gy qd). RESULTS: Overall toxicity of the definitive CTx/RTx protocol-the main endpoint of this investigation-turned out to be acceptable (oesophagitis grade 3/4: 6/4 patients; pneumonitis grade 3/4: 0/1 patients; no treatment-related deaths). Actuarial survival at 2 years was 31% with a loco-regional control rate of 21%. CONCLUSIONS: This regimen turned out to be feasible with acceptable toxicity and will serve as a reference arm in a planned randomised trial in stage IIIB NSCLC, testing the value of surgery in this setting: preoperative induction CTx/RTx followed by surgery versus definitive CTx/RTx.

Adult↗
PubMed2001

Current strategy for surgical management of bronchiectasis.

BACKGROUND: There are few current reports of surgical management for bronchiectasis because of its decline in prevalence, and it remains controversial as to which subgroups of patients would benefit from surgical management. METHODS: We reviewed the medical records of all patients who underwent surgical resection for bronchiectasis between January 1, 1990, and December 31, 1997, at our hospital. RESULTS: Ninety patients underwent 92 operations for bronchiectasis. The mean age was 44.7 years. The presenting symptoms were productive cough in 82 patients, fever in 47 patients, hemoptysis in 35 patients, chest pain in 6 patients, and dyspnea on effort in 4 patients. The disease was bilateral in 13 patients. Complete resection was achieved in 75 patients. There was no operative mortality, and the morbidity rate was 19.6%. Postoperatively the patients were asymptomatic in 45.6%, improved in 38.0%, and showed no improvement in 16.4%. Logistic regression extracted the type of bronchiectasis, the existence of sinusitis, and the type of resection for prognostic discrimination with statistical significance. CONCLUSIONS: Surgery for bronchiectasis can be performed with acceptable morbidity and mortality. Patients with cylindrical bronchiectasis are good surgical candidates and chronic sinusitis is a risk factor for surgical resection. Complete resection should be done whenever possible.

Adolescent↗
PubMed2001

Therapy of localized non-small cell lung cancer (take home messages).

Surgery remains the mainstay in curative therapy of stage I and II NSCLC and selected patients with stage III disease. The high rate of distant metastases occurring in patients after complete surgical resection demonstrates the need for effective adjuvant systemic therapy. However, outside of trials, (neo)adjuvant chemotherapy is currently not considered as an established standard in localized NSCLC. Postoperative radiotherapy increases local tumor control in completely resected N2 disease and after R1/R2 resections and is generally recommended in these situations. In inoperable patients radiotherapy offers the only chance of cure. Combined radiochemotherapy and the highly accelerated CHART radiotherapy have been shown to be superior to standard radiotherapy. Progress in the treatment of localized NSCLC over the last decades has been only modest and with the exception of favourable subgroups, prognosis of NSCLC remains grim. In the light of the high rate of local and distant metastases multidisciplinary approaches appear necessary in the vast majority of patients.

Antineoplastic Agents↗
PubMed2001

Preoperative treatment strategies in stage III non-small cell lung cancer.

Recent experience has emphasized the need to include systemic chemotherapy in combined-modality management of locally advanced non-small cell lung cancer stage III. If definitive surgery is planned in these situations, preoperative application of drugs-induction chemotherapy-has many advantages in comparison to postoperative delivery. Patients' compliance to treatment, achievable dose intensities of drugs, possible locoregional downstaging, and frequent postoperative problems following complex resections are some of the arguments favouring preoperative chemotherapy. Despite numerous phase-II investigations, little evidence from randomized phase-III trials has been generated. Early inclusion of radiotherapy prior to definitive resection may help to improve preoperative downstaging. Besides available mature phase-II data, phase-III results from ongoing randomized trials are lacking to define the overall value of such a complex approach. Important issues in the future will aim at individualizing these intensive programs according to findings in clinical prognostic factor analyses and to prospectively validate a prognostic risk stratification. Data from translational and molecular research may further help to develop such evidence-based guidelines.

Carcinoma, Non-Small-Cell Lung↗
PubMed2001

Completion pneumonectomy: current indications, complications, and results.

OBJECTIVE: Completion pneumonectomy is reported to be associated with high morbidity and mortality, especially when done in patients with benign disease. We review our 9 years of experience with this operation to evaluate the postoperative outcome and long-term results of various indications. METHODS: Between January 1990 and December 1998, 66 consecutive patients underwent completion pneumonectomy (6.8% of all pneumonectomies), and their cases were retrospectively reviewed. The indication was benign disease in 17 patients and malignant disease in 49 patients. In patients with malignant indications there were 14 local recurrences, 4 second primary tumors, 5 metastatic diseases, and 26 indications because of incomplete initial resection. RESULTS: There were no intraoperative deaths, and the postoperative mortality rate was 7.6%. Complications were encountered in 32 (53%) patients, without any significant difference between benign indication (71%) and malignant indication (47%; P =.0923). Bronchopleural fistula was encountered in 5 (7.6%) patients, and empyema was encountered in 7 (11%) patients. The actuarial 5-year survival was 57% for all patients, 65% for those with benign indications, and 54% for those with malignant indications (60% for local recurrence, 50% for second primary tumor, and 56% for incomplete resection), without any difference between benign and malignant indications (P =.9478). CONCLUSIONS: Completion pneumonectomy can be performed with acceptable mortality and morbidity, even in patients with benign disease. Patients with preoperative infection can be managed with bronchial stump covering and adequate postoperative drainage. Although complications are common, they can successfully be managed with a proper understanding of them.

Adult↗
PubMed2001

[Neoadjuvant chemotherapy and chemoradiotherapy in surgically treated non-small-cell stage III bronchial carcinoma].

Patients with unfavorable stages of lung cancer are rarely cured with local treatment modalities alone. Aim of our phase II trial was to investigate the effectivity of a multimodality treatment. Ninety-four patients with NSCLC (stage IIIA/IIIB) were treated preoperatively with chemoradiotherapy (cisplatin and etoposide, 45 Gy hyperfractionated accelerated radiotherapy). After repeat mediastinoscopy patients underwent surgery. Complete resection (R0) was achieved in 53% of all patients with NSCLC. Two patients died of sepsis preoperatively and four postoperatively (90-days lethality: 6.4%). The median survival time was 20 months for IIIA and 18 months for IIIB. Calculated survival rates at 6 years were 34% for IIIA and 17% for IIIB. This multimodality treatment demonstrates high efficacy in prognostically unfavorable NSCLC compared with historical controls.

Carcinoma, Non-Small-Cell Lung↗