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N Martini

Publications and source records attributed to N Martini.

At least 19 recordsLinked to original sources
PubMed1992

Lung resection for colorectal metastases. 10-year results.

BACKGROUND: Metastasectomy for colorectal carcinoma to the lung is controversial. We analyzed results of this approach to justify its credibility. METHODS: We studied 144 patients by retrospective review after complete resection of lung metastases from colorectal cancer from 1965 through 1988. Patient selection and prognostic factors influencing survival were analyzed. Survival was analyzed by the Kaplan-Meier method, and comparisons were made by log-rank analysis. RESULTS: A total of 170 thoracotomies were performed in 144 patients. The overall 5- and 10-year survival was 40% and 30%, respectively. Those patients undergoing complete resection of their metastases survived significantly longer than those undergoing incomplete resections. CONCLUSION: It appears that resection of pulmonary metastases from colorectal carcinoma translates into long-term survival benefit.

Adult↗
PubMed1992

Survival after resection of stage II non-small cell lung cancer.

From 1973 to 1989, 214 patients with stage II non-small cell lung cancer were treated by resection and complete mediastinal lymph node dissection. There were 116 adenocarcinomas and 98 squamous cancers. There were 35 T1 N1 and 179 T2 N1 tumors. Whereas T1 tumors were mainly adenocarcinomas (83%), this difference was not apparent in T2 lesions. Regardless of histology, half of the patients had a single involved N1 lymph node. Lobectomy was performed in 68% of the patients, pneumonectomy in 31%, and wedge resection or segmentectomy in 1%. Lobectomy was sufficient to encompass all disease in 34 of 35 T1 N1 tumors. Only 48 patients (22%) received postoperative external irradiation and 11 patients (5%) received chemotherapy. The overall 5-year disease-free survival was 39%. The best survival rates were in patients who had a single node involved and tumors 3 cm or less in diameter (48%). The pattern of recurrence differed by histology. Local or regional recurrence was more frequent in patients with squamous carcinoma whereas distant metastases were more commonly seen in adenocarcinomas (87%) with brain as the most frequent site (adenocarcinoma, 52%; squamous, 34%). It is concluded that in stage II carcinomas, resection remains the treatment of choice, that mediastinal lymph node dissection provides the most accurate staging, and that the best adjuvant treatment to improve survival is yet to be determined.

Adenocarcinoma↗
PubMed1992

Primary bony and cartilaginous sarcomas of chest wall: results of therapy.

Primary bony and cartilaginous sarcomas of the chest wall are uncommon, and data concerning treatment and results are sparse. To assess the results of therapy, we reviewed our 40-year experience. Records of 38 patients with osteosarcoma and 88 with chondrosarcoma arising in chest wall admitted to Memorial Sloan-Kettering Cancer Center from 1949 to 1989 were reviewed. The 88 patients with chondrosarcoma ranged in age from 5 to 86 years (median age, 49 years); the male/female ratio was 1.3:1. Presenting complaint was mass, pain, or both in 93%. Primary therapy was resection (n = 84), radiation therapy (n = 3), or chemotherapy (n = 1). Overall 5-year survival was 64%. Significant adverse prognostic factors included metastases at initial presentation (n = 9), metastases at any time during the course of disease (n = 23), age greater than 50 years (n = 42), incomplete or no resection (n = 13), and local recurrence (n = 24). Sex, grade, and tumor size were not prognostic factors. The 38 patients with osteosarcoma ranged in age from 11 to 78 years (median age, 42 years); the male/female ratio was 1.5:1. Presenting complaint was mass, pain, or both in 95%. Primary therapy included resection (n = 31; alone in 13, with radiation therapy in 3, with chemotherapy in 15), radiation therapy (n = 3), radiation therapy and chemotherapy (n = 2), chemotherapy (n = 1), or no treatment (n = 1). Overall 5-year survival was 15%. Significant adverse prognostic factors included presence of synchronous metastases (n = 13) and metastases at any time during the course of disease (n = 26).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Induction chemotherapy for non-small cell lung cancer with clinically evident mediastinal node metastases: the role of postoperative radiotherapy.

Survival for clinical Stage IIIa (T1-3, N2) non-small cell lung cancer is very poor because of poor local disease control and systemic spread. To address these shortcomings, we initiated a treatment program with induction chemotherapy, surgery, and postoperative radiation reserved for patients with residual disease at thoracotomy. Between 1984 and 1986, 41 patients with clinically evident N2 disease were treated with induction chemotherapy followed by resection and the selective use of intraoperative brachytherapy. All patients with tumor in the resection specimen received two cycles of chemotherapy and 15 patients received radiation therapy. With a median follow-up of 5.4 years, overall survival is 27% at 3 years, and 12% at 5 years. Despite the adverse selection process median survival is 19 months for patients receiving postoperative radiation therapy, and 22 months for the more favorable patients not requiring radiation therapy, supporting the selective use of postoperative radiation in this setting. In summary, this treatment has yielded good median survival and long-term survival for some of the patients. However, the ultimate value of this approach can only be determined by prospective trials which compare it to standard therapy.

Adult↗
PubMed1991

Results of multiple pulmonary resections for metastatic osteogenic sarcoma after two decades.

A 20-year follow-up of children who had complete resection of pulmonary metastases from osteogenic sarcoma of the extremities was undertaken. Four of six 10-year survivors survived more than 19 years even with multiple metastases and as many as nine thoracotomies. Fifty percent of the 10-year survivors developed second primary cancers during the second decade of follow-up.

Adolescent↗
PubMed1991

Malignant esophagorespiratory fistula: management options and survival.

The development of a malignant esophagorespiratory fistula is a devastating complication. Data comparing various treatment options in a large group of patients are sparse. To assess the results of therapy, we reviewed our experience in 207 patients with malignant esophagorespiratory fistula. Records of 207 patients admitted to our institution with malignant esophagorespiratory fistula from 1926 to 1988 were reviewed and results of management analyzed. Age ranged from 21 to 90 years (median, 59 years); the male/female ratio was 3:1. Primary tumor site was esophagus in 161 (77%), lung in 33 (16%), trachea in 5 (2%), metastatic nodes in 4 (2%), larynx in 3 (1%), and thyroid in 1. Symptoms and signs of malignant esophagorespiratory fistula included cough in 116 (56%), aspiration in 77 (37%), fever in 52 (25%), dysphagia in 39 (19%), pneumonia in 11 (5%), hemoptysis in 10 (5%), and chest pain in 10 (5%). Respiratory location of fistula included trachea in 110 (53%), left main bronchus in 46 (22%), right bronchus in 33 (16%), lung parenchyma in 13 (6%), and multiple sites in 5 (2%). The percentage of patients alive at 3, 6, and 12 months by treatment modality was 13%, 4%, and 1% for supportive care (n = 104); 17%, 3%, and 0% for esophageal exclusion (n = 29); 21%, 14%, and 0% for esophageal intubation (n = 14); 30%, 15%, and 5% for radiation therapy (n = 20); and 46%, 20%, and 7% for esophageal bypass, respectively. Patients treated with radiation therapy and esophageal bypass had a significantly prolonged survival compared with patients treated with the other modalities.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1991

Multiple primary lung carcinomas: prognosis and treatment.

From 1955 to 1990, 111 patients have been treated for multiple primary lung carcinomas. Criteria for diagnosis were: (1) different histology (n = 44); or (2) same histology, but disease-free interval at least 2 years (n = 39), origin from carcinoma in situ (n = 19), or metachronous disease in different lobe (n = 9) with no cancer in common lymphatics or extrapulmonary metastasis at the time of diagnosis. The second cancer was synchronous in 33 patients (30%) and metachronous in 78 (70%). Metachronous disease developed at a median interval of 48 months. Five-year survival for patients with metachronous and synchronous disease from the time of initial diagnosis of cancer was 70% and 44%, and 10-year survival was 42% and 23%, respectively. Survival after the development of a metachronous lesion was 23% at 5 years. Survival from the time of initial diagnosis was significantly better for metachronous versus synchronous, late (24 month disease-free interval) versus early metachronous disease, and adenocarcinoma versus epidermoid carcinoma. The first cancer was completely resected in 103 patients (93%), but complete resection of a metachronous tumor was possible in only 54 patients (69%). Complete resection of second primary cancers resulted in significantly (p less than 0.0001) prolonged 5-year survival compared with incomplete resection (38% versus 9%). Excluding patients requiring pneumonectomy, initial resection limited subsequent resection in only 7 patients (9%) with metachronous disease. We conclude that patients surviving treatment of primary lung cancers require lifelong screening for multiple primary lung carcinoma, and complete resection is recommended whenever possible.

Female↗
PubMed1991

Paraspinal tumors: techniques and results of brachytherapy.

Because of their proximity to nerve roots and the spinal cord, it is frequently difficult to achieve complete resection of paraspinal tumors. We have used brachytherapy in an attempt to prevent local recurrence and its associated neurological sequelae. This report analyzes our experience with 35 patients to determine the feasibility, optimal techniques, and efficacy of this approach. The tumor types were non small-cell lung cancer (18), sarcomas (9), and other tumor types (8). Temporary, single plane implants using Ir-192 (median minimum peripheral dose 3000 cGy) were used in 21 patients, and permanent I-125 implants were used in 14 cases (median matched peripheral dose 12,500 cGy). Local control was achieved in 51% (18/35). However, local control was poor when lung cancers were implanted and in cases where the dura was exposed. Radiation myelitis did not occur despite the combined effects of previous external beam radiotherapy (N = 21) and brachytherapy. Our experience demonstrates that combined surgery and paraspinal brachytherapy can be performed with acceptable toxicity and is reasonably effective in preventing local relapse and its neurologic sequelae, particularly for tumors other than lung cancers.

Brachytherapy↗
PubMed1991

The antiemetic activity of high-dose metoclopramide and high-dose alizapride in combination with lorazepam in patients receiving cancer chemotherapy. A prospective, randomized, double-blind study.

The antiemetic efficacy of metoclopramide and lorazepam (MTC + L) versus alizapride and lorazepam (ALZ + L) was compared in 100 patients receiving chemotherapy, in a prospective randomized double-blind study. In highly emetogenic (HE) regimen (including platinum) patients received MTC 1 mg/kg or ALZ 3 mg/kg x 4 doses, and lorazepam 2.5 mg 30 min before therapy. In moderately emetogenic (ME) regimen patients received MTC 0.5 mg/kg or ALZ 1.5 mg kg x 3 doses, and lorazepam 2.5 mg 30 min before therapy. In both HE and ME regimen groups there was no statistically significant difference between MTC + L and ALZ + L treatments as regards the number of vomiting episodes, the duration of emesis and nausea, the intensity of nausea and side effects, but a statistically significant difference between treatments was found in the HE group where MTC-L was superior to ALZ + L in obtaining complete protection from vomiting (37 vs 11%, p = 0.05). No significant difference in side effects was observed.

Adolescent↗
PubMed1991

Limited small-cell lung cancer: do favorable short-term results predict ultimate outcome?

Advances in the treatment of limited small-cell lung cancer (L-SCLC) have led to improved short-term outcome. However, it is not clear how well this predicts the ultimate fate of the patients. This may be affected by late relapse of SCLC, the development of second malignancies, and the long-term toxicity of therapy. To address this issue we report follow-up in excess of 5 years on a cohort of 36 patients who had high short-term survival resulting from treatment with chemotherapy combined with cranial and thoracic irradiation. All patients were followed until death or the time of analysis. The initially promising result of 31% survival at 3 years, was reflected in survival from SCLC of 27% at 5 years, and 23% at 9 years. However, when death from all causes was analyzed, survival was only 19% at 5 years and 7% at 9 years. There were 2 survivors disease-free at 7 and 8 years; 7 patients died of other causes without any evidence of SCLC. Among those not dying of SCLC, 4 patients developed second malignancies with a risk of 22% at 3.2 years and 50% at 8 years. Clinical neurotoxicity developed in 3 patients. These data suggest that cure of SCLC is possible in a modest proportion of patients with limited disease, but that the survivors are at significant risk of developing second malignancies which emerge as the most common cause of death during prolonged follow-up. Successful outcome of treatment is further hampered by the occurrence of neurotoxicity. Clinical strategies to prevent these sequelae of therapy are discussed.

Adult↗
PubMed1990

Surgical treatment of non-small cell lung cancer by stage.

Resection is the treatment of choice for stage I and II non-small cell lung carcinoma. The 5-year survival following resection is 72% in stage I carcinoma and 49% in stage II carcinoma. Resection alone or combined with radiation and/or chemotherapy is also indicated in some patients with stage IIIa disease. The 5 year survival with resection is 56% in tumors invading chest wall (T3N0), 30% in superior sulcus tumors, 30% in patients with N2M0 disease, and 36% in patients with tumors in proximity to carina. Surgery is of very limited value in patients with tumors invading the mediastinum and in patients with stage IIIb or stage IV disease. Details of case selection in each treatment category are presented.

Brain Neoplasms↗
PubMed1990

Surgical approach to non-small cell lung cancer stage IIIA.

Patients with stage IIIa non-small cell carcinoma of the lung who could benefit from surgical treatment include those with tumors that invade chest wall, diaphragm, or mediastinum, as well as patients who present with mediastinal lymph node involvement. As long as surgery remains the most effective mode of treatment in non-small cell lung carcinoma, it is important that it be made available, when indicated, to the greatest number of patients possible. The continuing high incidence of deaths due to distant metastases underscores the need to combine effective chemotherapy and radiotherapy with the surgical treatment.

Carcinoma, Non-Small-Cell Lung↗
PubMed1990

Surgical treatment of lung cancer.

The prognosis for carcinoma of the lung is influenced by the stage of the disease at presentation and by the potential for resectability. The five-year survival rate following resection of stage I carcinoma is as high as 83% for T1N0 lesions and about 65% for T2N0 tumors. Some stage III tumors are also amenable to surgery in the absence of distant metastases. N2 disease tends to be refractory to cure, despite a localized presentation; however, 20% of patients with N2 disease have resectable tumors despite the presence of lymph node metastases, with a 5-year survival rate of 30% following surgery and postoperative external radiation therapy. Surgery is not beneficial for patients with small cell lung cancer. Proper case selection and careful preoperative and perioperative management are necessary to minimize complications.

Carcinoma↗
PubMed1989

Local recurrent mammary carcinoma failing multimodality therapy. A solution.

Chest wall recurrence following radiation and hormonal therapy is an uncommon but serious and disabling condition. A chest wall ulcer secondary to treatment for recurrence also presents the same dilemma. Over the past 35 years, the Thoracic Service at our institution has treated 35 patients for these problems by surgical resection and reconstruction. Eight patients were seen after the first recurrence, six after the second, ten after the third, and ten after the fourth. One patient had chest wall resection with mastectomy when recurrence followed radiation therapy. Following resection of the tumor, 21 patients had reconstruction using mesh or a mesh "sandwich." There were no operative deaths and no respirator need. Twenty patients are alive from five to 120 months, with a median of 50 months. One of 35 patients had chest wall recurrence. Surgical resection of recurrent mammary carcinoma resistant to all other therapy is a viable alternative for both palliation and cure.

Adult↗
PubMed1989

Significance of extramucosal residual tumor at the bronchial resection margin.

Extramucosal microscopic residual disease (MRD) at the bronchial resection margin was identified in 45 (1.6%) of 2,890 patients who underwent resection of primary non-small cell lung cancer between 1975 and 1985. In 9 of these patients, residual tumor was confined to submucosal lymphatics, whereas in the other 36, MRD was found in peribronchial soft tissue. All patients underwent complete mediastinal lymphadenectomy. Three patients had stage I disease, 3 had stage II, 33 had stage IIIa, 4 had stage IIIb, and 2 had stage IV. Recurrent disease developed in 34 (81%) of the evaluable patients; the recurrence was local in 11 (32%). Median time from operation to diagnosis of local recurrence was 8 months. Sixty percent of the recurrences in the N0 group were local, and only 23% of those in the N2 group were local. Extramucosal MRD is most frequently associated with advanced-stage disease. Postoperative therapy had no effect on the development of recurrent disease. We found no difference in survival between patients whose initial site of recurrence was local as opposed to distant. Median survival after the identification of either local or distant recurrence was 5 months. The finding of extramucosal MRD identifies a subset of patients with a poorer prognosis compared with those with clear resection margins.

Adult↗
PubMed1989

Resection and debridement of chest-wall tumors and general aspects of reconstruction.

The main criterion for adequate local control of a chest-wall malignancy remains wide excision. With the available techniques of skeletal and soft-tissue reconstruction, even large lesions can be resected with safe margins. The primary purpose is to achieve a curative resection, although a significant number of symptomatic patients can benefit from palliative resection provided by such procedures. A key element in the success in treating chest-wall tumors is a multidisciplinary approach by all participating physicians, namely the thoracic surgeon, the plastic and reconstructive surgeon, the radiotherapist, and the medical oncologist.

Debridement↗