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T W Rice

Publications and source records attributed to T W Rice.

At least 91 records · Page 5Linked to original sources
PubMed1995

Accelerated induction therapy and resection for poor prognosis stage III non-small cell lung cancer.

BACKGROUND: Induction therapy and resection may improve the survival of patients with poor prognosis stage III non-small cell lung cancer, at the cost of significant treatment prolongation. The purpose of this study was to assess toxicity, response, and survival of an accelerated induction regimen and resection in poor prognosis stage III non-small cell lung cancer. METHODS: Forty-two surgically staged patients with poor prognosis stage III non-small cell lung cancer received 11 days of induction treatment consisting of 96 hours of continuous chemotherapy infusions of cisplatin (20 mg.m-2.day-2), 5 fluorouracil (1,000 mg.m-2.day-2), and etoposide (75 mg.m-2.day-2) concurrent with accelerated fractionation radiation therapy (1.5 Gy twice a day, to a dose of 27 Gy). Induction was followed in 4 weeks by resection. Postoperatively, a second course of continuous chemotherapy and concurrent accelerated fractionation radiation therapy (postoperative dose 13 to 36 Gy) was given. RESULTS: Despite some degree of induction toxicity in all patients there was only one induction death (2.4%). A clinical partial response was seen in 24 patients (57%). Thirty-six patients (86%) underwent thoracotomy, and resection was possible in 33 (79%). Pathologic downstaging was seen in 17 patients (40%), and 2 patients (5%) had no residual carcinoma at operation. There were 11 postoperative complications (31%) and 4 postoperative deaths (11%). Thirteen patients (31%) are alive and disease-free, 24 (57%) have persistent disease or have recurred (15 distant, 5 locoregional, 4 both), and 9 patients are alive with disease. The median survival is 21 months and the 2-year Kaplan-Meier survival is 43%, with no differences identified between stages IIIA and IIIB patients (p = 0.63). CONCLUSIONS: We conclude that accelerated induction therapy and resection in poor prognosis stage III non-small cell lung cancer (1) is toxic, with a 12% treatment mortality; (2) is effective with a 79% resection rate and 40% pathologic downstaging rate; (3) provides excellent local control; (4) may prolong survival; and (5) is of value in stage IIIB as well as stage IIIA patients.

Adult↗
PubMed1995

Superficial esophageal carcinoma.

BACKGROUND: The detection of superficial esophageal carcinomas by surveillance endoscopy and the downstaging of advanced carcinomas to superficial carcinomas by induction therapy have increased the number of patients with these carcinomas undergoing resection. The natural history of these carcinomas is not well defined. METHODS: To evaluate the results of surgical resection and identify predictors of improved survival, a retrospective review of (1) patients with superficial esophageal carcinoma at presentation (SECP) and (2) patients with advanced carcinomas that were downstaged to no residual carcinoma or superficial esophageal carcinoma after induction therapy (SECD) was conducted. RESULTS: There were 54 patients with SECP (19 Tis and 35 T1). Survival was significantly better for patients with Tis carcinomas (85.3% at 5 years) and patients with intramucosal T1 carcinomas (79.4%) than for patients with submucosal T1 carcinomas (16.3%) (p = 0.007 and p = 0.045, respectively). Survival at 5 years for the 49 patients without regional lymph node metastases (N0) was 65.2%, whereas none of the 5 patients with regional lymph node metastases (N1) have survived more than 3 years (p = 0.054), and 3 died of recurrent disease. There were 21 patients with SECD (13 T0, 2 Tis, and 6 T1). Survival at 4 years was 58.2%. In this group, survival was not related to depth of tumor invasion (p = 0.76) or regional lymph node status (p = 0.68). CONCLUSIONS: We conclude that (1) patients with Tis and intramucosal T1 SECP have a significantly better survival than those with submucosal T1 SECP, (2) patients with N0 SECP have a significantly better survival than those with N1 SECP, and (3) survival of patients with SECD is not related to depth of tumor invasion or regional lymph node status.

Adenocarcinoma↗
PubMed1995

Epithelioid angiosarcoma of the pulmonary artery.

Pulmonary artery angiosarcoma is a rare entity. We report a case of an epithelioid angiosarcoma developing from the right pulmonary artery with pulmonary parenchymal invasion. The patient was a 69-year-old man who presented with massive hemoptysis and shortness of breath. Right middle and lower lobectomies were performed because of uncontrollable bleeding. An angiosarcoma was observed developing from the right pulmonary artery with contiguous spread down smaller artery branches with invasion of the pulmonary parenchyma. Although typical angiosarcomatous areas were observed, the neoplasm was dominated by cells with an epithelioid morphology. Immunohistochemically, the majority of cells stained for endothelial markers factor VIII-related antigen and CD34, but in addition, the cells with an epithelioid morphology stained intensely for cytokeratin. Knowledge of cytokeratin positivity in epithelioid vascular neoplasms is critical to avoid a misdiagnosis of carcinoma, particularly at sites where carcinoma is a much more likely diagnosis.

Aged↗
PubMed1995

Prognosis of esophageal cancers preoperatively staged to be locally invasive (T4) by endoscopic ultrasound (EUS): a multicenter retrospective cohort study.

BACKGROUND: Endosonography is a significant advance in the preoperative staging (TNM classification) of esophageal cancer. Its accuracy for evaluating depth of tumor invasion is over 80%. METHODS: A multicenter retrospective cohort study of patients with esophageal carcinomas defined to be invasive (T4) by endosonography was performed to compare the survival of surgically and nonsurgically treated patients. Median survival time, overall mortality, and Kaplan-Meier survival curves were compared by treatment group. Univariate and Cox regression analysis were used to evaluate the effects of various prognostic factors and treatment on the risk of death. RESULTS: A total of 79 patients were studied. The surgical group (Group I, n = 42) was significantly younger and had more distal tumors (adenocarcinomas) than the nonsurgical group (Group II, n = 37). Endosonography was significantly more accurate than CT scanning in identifying tumor invasion (87.5% versus 43.8%, respectively, p = .0002). Overall mortality rate was not significantly different between treatment groups; 59.5% of the surgical group and 64.9% of the nonsurgical group were dead at follow-up (p = 0.65). Similarly, the median survival times of Group I and Group II patients were similar (5.2 and 7.0 months, respectively, p = 0.50). Survival curves for the two groups were almost overlapping (log rank test, p = 0.84). Even after adjusting for age, histologic diagnosis, tumor location, and regional lymph node status, surgical treatment did not significantly influence survival (p = 0.24). CONCLUSIONS: Endosonography accurately identifies patients with invasive T4 tumors who have a poor prognosis. This prognosis is independent of mode of therapy.

Adenocarcinoma↗
PubMed1995

Postoperative screening for anastomotic recurrence of esophageal carcinoma by endoscopic ultrasonography.

BACKGROUND: The usefulness of endoscopic ultrasonography (EUS) in the preoperative staging of esophageal carcinoma is well established. Alternatively, the role of EUS in the early diagnosis of anastomotic recurrence is less well accepted. METHODS: EUS was used to evaluate 30 asymptomatic and 10 symptomatic patients (i.e., with dysphagia) who had previously undergone resection of esophageal carcinoma. RESULTS: There were 3 (10%) unsuspected anastomotic recurrences in the asymptomatic group. EUS correctly identified locally recurrent cancer in all cases, whereas endoscopy confirmed the presence of only one anastomotic recurrence. Computed tomography was not diagnostic in any of the three recurrences. Sensitivity of EUS for recurrence of esophageal carcinoma was 100% compared with 33% for endoscopic diagnosis while the specificity was 96% for EUS compared with 100% for endoscopic biopsy. There was one false positive diagnosis of recurrence by EUS because of postoperative fibrosis resulting in concentric hypertrophy of the esophageal wall near the surgical anastomosis. Of the 10 symptomatic patients, 4 were diagnosed with tumor recurrence. EUS correctly predicted recurrences in all symptomatic patients (100% sensitivity and specificity), as did upper endoscopy with biopsy. CONCLUSIONS: EUS is more sensitive than upper endoscopy and CT scan for the evaluation of anastomotic recurrence of esophageal carcinoma and should be considered as an adjunctive modality to conventional endoscopy for the postoperative surveillance of these patients.

Aged↗
PubMed1995

Lobectomy--video-assisted thoracic surgery versus muscle-sparing thoracotomy. A randomized trial.

Video-assisted thoracic surgery has been adopted by some thoracic surgeons as the preferred approach over thoracotomy for many benign and malignant diseases of the chest. However, little concrete evidence exists to support this technique as the superior approach. This randomized study was carried out to define the advantages of video-assisted lobectomy over muscle-sparing thoracotomy and lobectomy. Sixty-one patients with presumed clinical stage I non-small-cell lung cancer were entered into the study. Each patient was randomized to muscle-sparing thoracotomy and lobectomy or video-assisted lobectomy. Six patients were excluded from the study either because final pathologic results revealed nonmalignant disease (3 patients) or because an attempted video-assisted lobectomy was converted to a thoracotomy. This left 30 patients in the thoracotomy group and 25 patients in the video-assisted group. No significant differences existed between the two groups in operating time, intraoperative blood loss, duration of chest tube drainage, or length of hospital stay. Significantly more postoperative complications occurred in the thoracotomy group (p < 0.5), the majority of which were prolonged air leaks. Return to work time was not an issue because the majority of the patients were either retired or not working at the time of the operation. Only three patients had persistent postthoracotomy pain (thoracotomy, n = 2; video-assisted lobectomy, n = 1). We conclude that video-assisted lobectomy was not associated with a significant decrease in duration of chest tube drainage, length of hospital stay, postthoracotomy pain, or, in this group of patients, a faster recovery time and return to work. Video-assisted lobectomy continues to expose the patient to the risk of a major pulmonary resection being done in an essentially closed chest. These results illustrate the need for critical evaluation of video-assisted thoracic surgery before the procedure is accepted as a superior approach based on presumed and thus far unproved advantages.

Carcinoma, Non-Small-Cell Lung↗
PubMed1995

Endosonographic evaluation of the patient with achalasia: appearance of the esophagus using the echoendoscope.

BACKGROUND AND STUDY AIMS: Endoscopic ultrasonography (EUS) provides high-resolution images of the esophageal wall and adjacent structures. The purpose of this study was to evaluate the usefulness of EUS using the echoendoscope in the evaluation of patients with achalasia. PATIENTS AND METHODS: Seventeen patients with achalasia underwent esophagogastroduodenoscopy (EGD), esophageal manometery, and EUS. The esophageal wall thickness was measured endosonographically in four quadrants at the gastroesophageal junction (GEJ) and at 1 cm intervals proximally. Of the 17 patients evaluated, five had a tortuous esophagus (Group A) and 12 had a relatively straight esophagus (Group B). Six patients without esophageal symptoms served as controls (Group C). RESULTS: There was no significant difference in the mean esophageal wall thickness measured at the GEJ between the groups (4.0 mm, 3.3 mm, and 2.9 mm for Groups A, B, and C, respectively). Esophageal wall thickness was significantly greater in Group A than Group C when measured 2, 3, and 4 cm above the GEJ (4.2 mm vs. 2.8 mm; 4.1 mm vs. 2.4 mm; 4.0 mm vs. 2.4 mm, respectively) (p < .05). When measured 2 cm above the GEJ, the esophageal wall in Group A patients was significantly thicker (4.2 mm) than in patients in either Group B (3.2 mm) or Group C (2.8 mm) (p < 0.05). CONCLUSIONS: The appearance of esophageal wall thickening was common in patients with achalasia. Positioning of the echoendoscope in some patients with an irregularly-shaped, tortuous esophagus may result in tangential imaging and the production of artifacts simulating submucosal lesions. The production of such imaging artifacts suggests that caution must be exercise when EUS with the echoendoscope is used to evaluate patients with achalasia and a tortuous esophagus. Based on the present level of knowledge, EUS is not recommended in the routine evaluation of patients with achalasia.

Esophageal Achalasia↗
PubMed1995

Concurrent cisplatin/etoposide plus chest radiotherapy followed by surgery for stages IIIA (N2) and IIIB non-small-cell lung cancer: mature results of Southwest Oncology Group phase II study 8805.

PURPOSE: To assess the feasibility of concurrent chemotherapy and irradiation (chemoRT) followed by surgery in locally advanced non-small-cell lung cancer (NSCLC) in a cooperative group setting, and to estimate response, resection rates, relapse patterns, and survival for stage subsets IIIA(N2) versus IIIB. PATIENTS AND METHODS: Biopsy proof of either positive N2 nodes (IIIAN2) or of N3 nodes or T4 primary lesions (IIIB) was required. Induction was two cycles of cisplatin and etoposide plus concurrent chest RT to 45 Gy. Resection was attempted if response or stable disease occurred. A chemoRT boost was given if either unresectable disease or positive margins or nodes was found. RESULTS: The median follow-up time for 126 eligible patients [75 stage IIIA(N2) and 51 IIIB] was 2.4 years. The objective response rate to induction was 59%, and 29% were stable. Resectability was 85% for the IIIA(N2) group eligible for surgery and 80% for the IIIB group. Reversible grade 4 toxicity occurred in 13% of patients. There were 13 treatment-related deaths (10%) and 19 others (15%) died of causes not related to toxicity or tumor. Of 65 relapses, 11% were only locoregional and 61% were only distant. There were 26 brain relapses, of which 19 were the sole site or cause of death. There was no survival difference (P = .81) between stage IIIA(N2) versus stage IIIB (median survivals, 13 and 17 months; 2-year survival rates, 37% and 39%; 3-year survival rates, 27% and 24%). The strongest predictor of long-term survival after thoracotomy was absence of tumor in the mediastinal nodes at surgery (median survivals, 30 v 10 months; 3-year survival rates, 44% v 18%; P = .0005). CONCLUSION: This trimodality approach was feasible in this Southwest Oncology Group (SWOG) study, with an encouraging 26% 3-year survival rate. An Intergroup study is currently being conducted to determine whether surgery adds more to the risk or to the benefit of chemoRT.

Adult↗
PubMed1995

The impact of thoracoscopy on the management of pleural disease.

STUDY OBJECTIVE: To describe the diagnostic efficacy, morbidity, and patient outcome of thoracoscopy; to quantify the direct impact of thoracoscopy on clinical management; and to determine preoperative variables associated with finding malignancy at thoracoscopy to aid patient selection. DESIGN: Retrospective chart review of consecutive cases of thoracoscopy for pleural disease. SETTING: Single tertiary medical center. PATIENTS: One hundred eighty-two consecutive patients who underwent thoracoscopy for pleural disease over a 5-year period (from 1987 through 1992). MEASUREMENTS AND RESULTS: Final diagnoses were 98 (54%) malignant, 58 (32%) benign, and 26 (14%) idiopathic. Thoracoscopy had a diagnostic sensitivity of 95% for malignancy and 100% for benign disease. Malignancy was shown by thoracoscopy in 27 of 41 (66%) patients who had a preoperative nondiagnostic closed pleural biopsy, and in 24 of 35 (69%) patients who had at least 2 preoperative negative pleural cytologic specimens. Chart review by preestablished criteria showed information obtained from thoracoscopy directly influenced treatment in 155 (85%) patients. Thirty-seven (20%) patients, however, had at least one perioperative complication (15% major, 8% minor). Ten (6%) patients died during the same hospitalization in which a thoracoscopy was performed, although none died within 48 h. There was one thoracoscopy-related death. Sixty-two (34%) patients died within 6 months of thoracoscopy (death by all causes). Forty-seven (48%) patients who had intrathoracic malignancy present at thoracoscopy died within 6 months. Patients found to have malignant pleural disease by thoracoscopy were more likely to have a preoperative history of a malignancy (p = 0.001). Age more than 50 years was associated with finding malignancy at thoracoscopy (p = 0.04). A combined lymphocytic and hemorrhagic effusion was associated with malignancy (p = 0.004). Preoperative pleural data showed that idiopathic effusions had a significantly lower median lactate dehydrogenase (LDH) value (192, which was normal) compared with malignant or benign effusions. CONCLUSIONS: (1) Thoracoscopy increases yield for malignant and benign disease when thoracentesis and closed pleural biopsy are nondiagnostic. (2) Thoracoscopy directly affects clinical management in 85% of patients. (3) Significant complications can occur in patients receiving tertiary care. (4) For the evaluation of suspected malignant pleural disease, thoracoscopy has its greatest diagnostic yield in older patients who have a history of malignancy and who present with a lymphocytic, hemorrhagic, high LDH effusion.

Female↗
PubMed1995

The diagnosis and medical management of pulmonary parenchymal mycobacterial diseases.

Pulmonary mycobacterial infections are an increasing clinical problem. The complex task of isolation and identification of the specific mycobacteria requires special stains, cultures, biochemical testing, and nucleic acid probes. Once the organism has been identified, the therapy with multiple drugs will be dictated by the type of organism and its drug susceptibility. An increasing number of patients presenting with drug-resistant tuberculosis or nontuberculous pulmonary mycobacterial infections require individualized, prolonged multi-drug regimens. The thoracic surgeon must be aware of the subtleties of mycobacterial pulmonary infections because diagnosis and failed medical treatment may require surgical intervention.

Antitubercular Agents↗
PubMed1995

Lung abscess and empyema.

The problems of lung abscess and empyema were recognized by physicians in ancient times, and continue to pose a challenge for contemporary practitioners. Until the current century, anaerobic bacterial infections were undoubtedly the most common cause of lung abscess and empyema. However, other infectious causes are becoming increasingly common as more patients present with complex comorbidities and/or severe immunosuppression. Most lung abscesses respond to appropriate antimicrobial therapy; only about 10% of patients require external drainage or surgical therapy. Noninfected parapneumonic effusions usually respond to systemic antibiotic therapy alone. However, complete drainage of the pleural space is indicated if an effusion is infected or has the characteristics of frank pus. Some parapneumonic effusions that are not grossly turbid and that have negative cultures are nevertheless "complicated"; that is, these effusions have a high risk for causing pleural loculations unless drained early in their course. Over the past 20 years, it has been demonstrated that chemical analysis of parapneumonic effusions (eg, pH, glucose, LDH) is helpful in identifying apparently noninfected, but nevertheless "complicated," parapneumonic effusions. Optimum diagnosis and management of lung abscess and empyema require the coordinated efforts of thoracic surgeons and medical specialists.

Diagnosis, Differential↗
PubMed1995

bcl-2 protein expression in the Barrett's metaplasia-dysplasia-carcinoma sequence.

The bcl-2 proto-oncogene encodes a protein that blocks programmed cell death (apoptosis). Although bcl-2 has been shown to be involved in the development of follicular lymphoma via a chromosomal translocation t(14;18), little is known about its function in non-hematolymphoid neoplasms. The bcl-2 protein is normally expressed in the regenerative crypt compartment of the colon, small intestine, and stomach, and has been found to be abnormally overexpressed as an early event in the dysplasia-carcinoma sequences of both ulcerative colitis-related and gastric neoplasias. This study was undertaken to evaluate the role of bcl-2 in the Barrett's metaplasia-dysplasia-carcinoma sequence. Thirty-six esophageal resection specimens were studied, using a monoclonal antibody to the bcl-2 protein on fixed paraffin-embedded specimens. Barrett's mucosa was present in each specimen: low-grade dysplasia in 35, high-grade dysplasia in 34, intramucosal carcinoma (IMC) in 23, and submucosal carcinoma in 13. In addition, a section of the gastric resection margin was evaluated for bcl-2 immunoreactivity in each case. In all cases, the regenerative compartment of the gastric mucosa in the resection margins stained for bcl-2; however, no immunoreactivity was seen in any of the cases of Barrett's mucosa with or without dysplasia or carcinoma. We conclude that, in contrast to its role in gastric neoplasia, bcl-2 alterations are not an important molecular marker in the neoplastic progression of Barrett's mucosa.

Adenocarcinoma↗
PubMed1994

Aggressive concurrent chemoradiotherapy and surgical resection for proximal esophageal squamous cell carcinoma.

BACKGROUND: Proximal esophageal cancer has been a disease associated with relatively poor treatment success, partly due to advanced disease at presentation and the morbidity of the surgery required. Therefore, most patients receive palliative radiation therapy, and disease control is poor. METHODS: Between July 1990 and December 1992, nine consecutive patients with proximal esophageal squamous cell carcinoma were treated with aggressive concurrent chemoradiotherapy followed by surgical resection. Treatment consisted of cisplatin (20 mg/m2/day) and 5-fluorouracil (1000 mg/m2/day), both given as continuous intravenous infusions over 4 days concurrent with accelerated fractionation external beam radiation therapy (150 cGy twice a day to a dose of 2400 cGy). Three weeks after beginning treatment, a second course of chemotherapy and accelerated fractionation radiation therapy was administered to a total preoperative radiation therapy dose of 4500 cGy. After restaging of their disease, patients next underwent surgical resection. A single postoperative course of chemotherapy and 2400 cGy of concurrent accelerated fractionation radiation therapy was administered to those patients with residual tumor in the resection specimen. Two of these nine patients also were given 4-day etoposide infusions (75 mg/m2/day) as part of their chemotherapy and received lower induction radiation therapy doses. RESULTS: Although significant toxicity was experienced, there were no deaths attributable to the chemoradiotherapy and only one perioperative death. All nine patients underwent surgery; five required pharyngolaryngoesophagectomy. No residual tumor was found in the resection specimen in three of the nine patients. Continuous locoregional tumor control was achieved in all patients. Only two developed distant metastases. CONCLUSIONS: These results, using aggressive multimodality treatment, suggest that excellent locoregional control and long term, disease free survival can be achieved in selected patients with proximal esophageal cancer.

Adult↗
PubMed1994

A phase I trial of intrapleural recombinant human interferon alpha (rHuIFN alpha 2b) in patients with malignant pleural effusions.

The use of intrapleural sclerosing agents to control reaccumulation of pleural fluid in patients with malignant effusions has been widely investigated. A phase I trial of intrapleural recombinant human interferon alpha (rHuIFN alpha 2b) was initiated to determine the toxicity and maximal tolerated dose in this group of patients. rHuIFN alpha 2b was instilled as a single dose following chest tube (15/16) or percutaneous (1/16) drainage of cytologically proven malignant effusions. Doses of rHuIFN alpha 2b were escalated from 25 x 10(6) to 200 x 10(6) U/m2 in cohorts of three to four patients. Toxicity was mild to moderate, and included chills, fever and chest pain, and resembled that produced by systemic administration of rHuIFN alpha 2b. Dose-limiting toxicity occurred at 200 x 10(6) U/m2 and consisted of hepatic enzyme elevations and renal failure. Partial control of the effusions was noted in two patients, with two additional patients having stable disease. Phase II trials of rHuIFN alpha 2b should utilize up to 150 x 10(6) U/m2 for intrapleural instillation.

Adult↗
PubMed1994

Aggressive multimodality therapy for malignant pleural mesothelioma.

Nineteen patients with clinical stage I malignant pleural mesothelioma were treated with aggressive multimodality therapy. Nine patients underwent pleurectomy and decortication followed by immediate intrapleural chemotherapy with cisplatin and mitomycin C. Ten patients required pleuropneumonectomy followed within 1 week to 2 weeks by intrapleural administration of cisplatin (100 mg). Four to 8 weeks after operation, 15 patients underwent postoperative adjuvant cisplatin-based systemic chemotherapy. There were three postoperative complications (16%) requiring reoperation and one postoperative death (5%). Intrapleural chemotherapy was well tolerated with no complications. Systemic chemotherapy was poorly tolerated, and there was one chemotherapy-related death. Sixteen patients (84%) experienced good to excellent palliation. Three patients are currently alive with no evidence of recurrent disease at 10, 35, and 43 months. The median overall survival was 13 months and the median disease-free survival, 11 months. Overall and disease-free 3-year survivals were 17% and 22%, respectively. Patients with epithelial malignant pleural mesothelioma had significantly better overall survival (p = 0.037) and disease-free survival (p = 0.02) than patients with sarcomatous or biphasic malignant pleural mesothelioma. We conclude that despite major toxicity, in select patients with clinical stage I malignant pleural mesothelioma, aggressive multimodality therapy offers effective palliation and occasional long-term disease-free survival.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1994

Neoadjuvant therapy: a novel and effective treatment for stage IIIb non-small cell lung cancer. Southwest Oncology Group.

Neoadjuvant therapy has become an accepted treatment for stage IIIa, but not for stage IIIb, non-small cell lung cancer, which is usually considered incurable and treated nonsurgically. We determined the feasibility of neoadjuvant therapy in the setting of stage IIIb non-small cell lung cancer in a prospective multi-institutional trial. For patients to be eligible for entry into the study, they had to have pathologically documented T1-4 N2-3 disease. Treatment consisted of: (1) cisplatin (50 mg/m2) given on days 1, 8, 29, and 36 plus VP-16 (50 mg/m2) given on days 1 to 5 and 29 to 33, together with concurrent radiotherapy (4,500 cGy; 180 cGy per daily fraction); and (2) surgical resection performed 3 to 5 weeks after induction of medical therapy, if the response was stable, partial, or complete. Of the 126 total eligible patients entered into the study, 51 patients had stage IIIb tumors (24 with T4 tumors and 27 with N3 disease). This consisted of 34 men and 17 women with a median age of 57 years. Thirty-two (63%) patients (18 with T4 tumors and 14 with N3 disease) underwent resection of the primary tumor, with a 5.2% operative mortality. There was no difference in the operative time, blood loss, and length of hospital stay for the T4 versus the N3 patients. For all 51 patients, survival at 2 years was 39%. Sites of relapse in all patients were mainly distant, even though patients with N3 disease did not initially have involved N3 nodes resected.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗