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The significance of a cytologically negative pleural effusion in bronchogenic carcinoma.

Bronchogenic carcinoma complicated by ipsilateral cytologically positive effusion is considered unresectable. Bronchogenic carcinoma with cytologically negative effusion, even if bloody, has also been thought by many to be unresectable. Seventy-three patients with bronchogenic carcinoma and ipsilateral cytologically negative effusions were studied. Sixty-six underwent exploratory thoracotomy for staging or therapy; five had pleural biopsies and two had mediastinoscopies, all disclosing metastatic carcinoma. Four of the 73 patients (5.5 percent) had surgically resectable disease. They have remained free of disease for 3, 6, 7, and 14 years. Sixty-nine patients (94.5 percent) had unresectable carcinoma with metastases. Seventeen (94 percent) of 18 patients with bloody effusions had unresectable cancer. Carcinoma was resected in one patient with cytologically negative bloody effusion, and the patient remained free of disease during the 14-year follow-up period. Unresectability must be documented surgically in these patients to exclude those in whom curative resection can be performed.

Adenocarcinoma

[Clinical protocol for study and treatment of bronchogenic carcinoma (author's transl)].

Bronchogenic carcinoma constitutes one of the primary causes of death in our population. The only means of controlling the disease in a significant way is by surgery, which about a third of the patients undergo. This fact, together with the age at which the pathology appears, its frequent association with chronic pulmonary disease, and the rapidity of its metastatic spread, make it necessary to establish a protocol for the study, diagnosis, and treatment of bronchogenic carcinoma. These norms should be applicable in prospective epidemiologic studies and for evaluating methods of diagnosis and treatment. The Interhospital Bronchogenic Carcinoma Co-operative Group has established a protocol, which includes the criteria of operability, resectability, preoperative examinations, indications of mediastinoscopy, etc. The authors mention the histopathologic classification, the TNM criteria, and the characteristics of localized or advanced disease.

Biopsy

Pseudo-chondrosarcoma: solitary osseous metastases from atypical bronchogenic carcinoma.

A patient with bronchogenic carcinoma with a solitary metastases to the femur in whom the clinical, radiologic, and pathologic setting suggested that the primary tumor was the bone lesion (chondrosarcoma) and the pulmonary lesion was a solitary metastasis is presented. This case is added to the limited literature indicating that mucin-secreting tumors metastatic to bone may simulate primary bone tumors radiographically.

Adenocarcinoma, Mucinous

[Functional and oncologic results after bronchial or blood vessel anastomosis in the resection therapy of bronchogenic carcinoma].

In treatment of bronchogenic carcinoma twelve selected patients had economical resections. To avoid a pneumonectomy, lobectomies or bilobectomies were associated twice with bronchial excision, 8 times with bronchial resection (sleeve resection) and twice with resection and anastomosis of pulmonary artery. Nine patients underwent clinical, radiologic and szintigraphic control. Except one case all patients showed good functional results. The anastomosed lobes were perfused and ventilated proportionally to the number of segments. The quality of life after partial pulmonary resections had deteriorated only to a small extent compared with the preoperative state. These results were emphasized by the only poor result which (after atelectasis of the anastomosed lung) corresponded functionally to a pneumonectomy. --The two cases of anastomosis of pulmonary artery showed a short survival. Both corresponded to a stage II of tumor classification. Of the other patients (all stage I) three are alive more than five years.

Aged

[Classification of the disease and pathologic type of bronchogenic carcinoma (III) (author's transl)].

The classification of bronchogenic carcinoma according to its extension and evolutive stages is useful in order to be able to organize epidemiologic and therapeutic studies, as well for exchanging information. At the present time, however, it is very difficult to establish a common classification for all of the groups working on bronchogenic carcinoma. The Bronchogenic Carcinoma Cooperative Group classified the cases following parameters such as operability, resectability, localized or generalized disease, and do not completely agree with the value of the TNM classifications. In the same way in respect to the different pathologic type of bronchogenic carcinoma, the traditional decision not to operate that follows the presentation of the undifferentiated types comes under discussion. This is due to the wide diagnostic variability in the evaluation of the different pathologic types according to the experience of various pneumopathologists published in the literature.

Carcinoma, Bronchogenic

[Epidemiologic data on bronchogenic carcinoma (author's transl)].

The Bronchogenic Carcinoma Co-operative Group analyzed the epidemiologic data of 240 cases of bronchogenic carcinoma in a prospective study. When risk factors (exposure to potencial pathogenic substances) were studied, a relationship was noted between the incidence at an early age and the presence of nondifferentiated small cell carcinoma. The number of years of exposure to tobacco had a direct effect on the curative value of the thoracotomy and the survival rate. Forty years of smoking appeared to be borderline for a poor prognosis. Localization of the tumor by bronchoscopy showed a frequency in the left main bronchus (18 percent) more than twice than in the right (8 percent). In 25 percent of the cases the tumor was more peripheral than the subsegmental situation according to the bronchofiberoptic examination. Evaluation of clinical data only showed a lack of correlation between the different symptoms and the various means of evaluation and the prognosis of the disease. For example, a patient with hemoptysis has a statistically higher probability of having an epidermoid tumor and a greater possibility of a successful curative thoracotomy (23 percent as opposed to 17 percent for the rest). The group of incidental cases (9 percent of the total) was analyzed. The degree of resectability was higher as compared with the rest (62 percent against 34 percent) as well as the absence of nondifferentiated small cell type carcinomas.

Adenocarcinoma

[Mediastinoscopy and thoracotomy in bronchogenic carcinoma (V) (author's transl)].

The opinion of the Bronchogenic Carcinoma Cooperative Group is that mediastinoscopy is at present an irreplaceable method for the determination of the resection limits in patients with bronchogenic carcinoma. Mediastinoscopy cannot be replaced by roentgenologic or isotopic studies of the mediastinum, since the invasion of the ganglionar capsule or of the mediastinal fat can only be determined by histopathologic examination. Following a classification based on macro- and microscopic morphological criteria, surgery has achieved a 64 percent of thoracotomies with "presumably curative" resections. Patients with epidermoid carcinomas were the main candidates to surgery. Lastly the role of the so-called bronchogenic carcinoma "markers" or substances that can indirectly indicate the course of the disease is discussed. The value of humoral and cell-mediated immunologic studies for introducing other therapeutic variants after curative surgery is pointed out. The definite conclusions regarding the clinical and surgical therapeutic aspects of the Bronchogenic Carcinoma Cooperative Group are detailed.

Adenocarcinoma

[Chemotherapy in bronchogenic carcinoma (author's transl)].

Therapy results in bronchogenic carcinoma remain unchanged since the establishment of thoracic surgery. Prognosis depends on the two main factors: histological type and extension of disease at the time of diagnosis. Both factors are mutually dependent. Small cell carcinoma of the bronchus represents a special entity with its early hematogenous spread and the poorest prognosis of all bronchogenic carcinomas. The tumor is highly sensitive to radioor chemotherapy. A marked prolongatoion of medium survival time can be obtained by combination chemotherapy. This is usually accompained by an obvious improvement in the patient's general condition. In certain cases results can be further improved by irradiation of the primary tumor and the mediastinum. Prophylactic cranial irradiation is often indicated because of the frequent cerebral metastases. Results of chemotherapy are much less impressive in adenoor squamous-cell carcinomas of the bronchus. Such therapy can only be recommended for the exceptional case. Pilliative radiotherapy should be used freely. Till now, adjuvant chemotherapy after surgery has only proven its value in small cell bronchogenic carcinoma.

Antineoplastic Agents

Effect of oral prophylactic broad spectrum nonabsorbable antibiotics on the gastrointestinal absorption of nutrients and methotrexate in small cell bronchogenic carcinoma patients.

Patients with small cell bronchogenic carcinoma, in a study utilizing laminar-air-flow-protected environments, oral prophylactic broad spectrum non-absorbable antibiotics (PNAA), and intensive combination chemotherapy, were examined to determine the effects of PNAA on serum biochemical values and on gastrointestinal absorption of both nutrients and methotrexate. With use of PNAA the following abnormalities were observed; serum carotene and folate decreased, D-xylose absorption was impaired, fat globules and muscle fibers were demonstrable in the stool, and the mean weight loss in 6 weeks was 10.2% as compared with 4.3% in patients not treated with antibiotics. Methotrexate absorption decreased from a mean of 69% prior to antibiotic use to 44% on PNAA. Thus, PNAA causes malabsorption of both nutrients and drugs. It appears unwise to treat patients on PNAA with oral antineoplastic drugs. Nutritional status must also be closely monitored and supplemental nutrition, either intravenously or with elemental diets, must be considered.

Administration, Oral

Bronchogenic carcinoma in chronic lymphocytic leukemia.

Fourteen cases of bronchogenic carcinoma were found in 191 patients with chronic lymphocytic leukemia seen at the Rosewell Park Memorial Institute, Buffalo, NY, from 1951 to 1976. Four of these were not diagnosed until the time of autopsy. There was an average lag of nine months between the onset of symptoms and signs suggestive of bronchogenic carcinoma and its diagnosis. In patients with chronic lymphocytic leukemia, a high index of suspicion for bronchogenic carcinoma is necessary fo its early detection.

Adult

Spontaneous regression of bronchogenic carcinoma.

Two cases of spontaneous regression of bronchogenic carcinoma were discovered in the literature, and the pertinent findings are described. Six equivocal cases of spontaneous regression are also presented. The reasons for the scarcity of spontaneous regression of bronchogenic carcinoma are discussed; no apparent reasons for spontaneous regression in these two cases could be determined.

Adenocarcinoma

Combination chemotherapy with methyl-CCNU (NSC-95441), cyclophosphamide (NSC-26271), vincristine (NSC-67574), methotrexate (NSC-740), and bleomycin (NSC-125066) in advanced bronchogenic carcinoma.

Forty consecutive eligible patients with advanced bronchogenic carcinoma and no prior chemotherapy were treated with a 5-drug combination of methyl-CCNU, cyclophosphamide, methotrexate, vincristine, and bleomycin. Of the 36 patients who completed at least one 6-week course of treatment and were considered evaluable, 4 (11%) had partial tumor response. Response by cell type was as follows: 2(14%) of 14 patients with squamous cell carcinoma, 2(18%) of 11 with oat cell carcinoma, and none of 11 with adenocarcinoma. Toxicity in the group of 36 evaluable patients consisted of nausea and vomiting in 24 patients (67%), severe leukopenia (white blood cell count less than 1000 cells/-mm3) in 7 patients (19%), severe thrombocytopenia (platelet count less than 100,000 platelets/mm3) in 14 patients (39%), and bleomycin pulmonary toxicity in 2 patients (6%). This combination does not appear to be more effective than single-agent chemotherapy for bronchogenic carcinoma.

Adenocarcinoma

CCNU-adriamycin therapy in bronchogenic carcinoma.

Forty-eight patients with advanced bronchogenic carcinoma were treated with a combination of CCNU and Adriamycin. There was an overall objective response rate of 38%. This consisted of 1 of 12 (8%) patients with epidermoid carcinoma, 5 of 15 (33%) with adenocarcinoma, 2 of 5 (40%) with large cell undifferentiated carcinoma and 10 of 16 (63%) with small cell undifferentiated carcinoma. The overall median survival time (MST) from initiation of therapy was 28 weeks. The MST was 18 weeks for patients with epidermoid carcinoma, 30 weeks for those with adenocarcinoma, 39 weeks for those with large cell carcinoma, and 30+ weeks for those with small cell carcinoma. Objective tumor response was associated with prolonged survival. There were no drug related deaths and toxicity was minimal.

Adenocarcinoma

Prognostic value of pre-treatment lymphocyte count and T cell levels in localized bronchogenic carcinoma.

In the patient with clinically localized bronchogenic carcinoma, the pre-treatment peripheral blood lymphocyte count and the thymus-dependent lymphocyte (T cell) level correlated with the prognosis of the tumor histology was either squamous cell, oat cell, or undifferentiated carcinoma. Patients whose pre-treatment lymphocyte count was less than 1,000/ml or whose T cell level was less than 750/ml either died or developed distant metastases by nine months after treatment of their localized tumor. By contrast, 55% of patients whose pre-treatment T cell level was greater than 750/ml were alive and without evidence of metastases nine months after treatment (P less than 0.02). Analysis of survival of these patients by the life-table method through the first post-treatment year further demonstrates the prognostic value of a low pre-treatment lymphocyte count or T cell level. The pre-treatment lymphocyte count and T cell level in patients with adenocarcinoma did not correlate with prognosis.

Adult

Treatment of bronchogenic carcinoma with simultaneous or sequential combination chemotherapy, including methotrexate, cyclophosphamide, procarbazine and vincristine.

One hundred and eighteen patients with inoperable carcinoma of the lung were randomly selected for treatment with methotrexate, cyclophosphamide, procarbazine, and vincristine. These drugs were adminsitered simultaneously to one group of patients and sequentially to the second group. As the statistically sicame evident (51% vs. 21%), an additional 85 cases were treated in this manner without randomization. The objective clinical responses were associated with prolonged survival. A higher response rate with the simultaneous treatment was also evident in patients with anaplastic small cell carcinoma (65% vs. 36%) as well as those with epidermoid carcinoma (33% vs. 13%). These differences were not statistically significant. Toxicity remained within acceptable limits, with a 2% drug related mortality, and was similar in both treatment regimens. Initial performance status was definitely related to survival, but not to tumor response. Patients with epidermoid carcinomas showing stabilization of tumor growth under treatment had the longest survival. Maintenance therapy with continued four-drug polychemotherapy was not superior to single agent maintenance with cyclophosphamide.

Adenocarcinoma