Natural History Of Lung Cancer Research Articles

Implications of tumor growth rate for the natural history of lung cancer.

The growth rate of lung cancer may be described by an exponential model in which the volume doubling time, or growth rate, is constant. The doubling time may vary from case to case by an order of magnitude so it is probably the most important factor in the natural history of the disease. While some aspects are uncertain, the exponential model seems to be reasonably valid because it is coherent with what we already know about the course of the disease. It helps explain the long interval between onset of carcinogen exposure and clinical manifestation, the reversibility of risk after cessation of smoking, the results of periodic roentgenographic screening, and the variability of prognosis. As a result, the exponential model has certain medicolegal implications.

The natural history of lung cancer with pericardial metastases.

Sixty-five lung cancer patients with pericardial metastases were reviewed. The diagnosis was established antemortem in 30 patients. Median survival of the treated group for pericardial metastasis from the date of primary diagnosis of lung cancer was 22.5 weeks. Patients who did not receive treatment had a median survival of 1.75 weeks (P 0.01). Median survival, in the treated group, from the date of pericardial metastases was 21 weeks. Prolonged survival was seen in those who had involvement of pericardium only as the site of first metastases. Median survival of this group was 32.5 weeks as opposed to those who had pericardial as well as other metastases whose survival was 17.25 weeks (P 0.03). Radiation therapy appeared to be the best modality of treatment in this group of patients.

The natural history of lung cancer: A review based on rates of tumour growth

Out of 100 patients with lung cancer discovered, fewer than 10 will live five years. Eighty will have inoperable disease at the time of diagnosis and most of these will die within three years; only one or two will be alive after five years. The 20 patients with localized disease will have an operation and about six of them will be alive after five years. These statistics have not changed over the past 30 years and this is in spite of many attempts at earlier diagnosis as well as a considerable improvement in operative mortality. In the face of these gloomy statistics there is a surprising lack of information about the natural history of the disease. There are no proper controlled studies of unselected patients in the literature. The few studies which have included an untreated control group have always been done on ‘inoperable’ patients, i.e. those with the most advanced disease. Trials of radiotherapy and chemotherapy show very little, if any, benefit in terms of survival and untreated control patients sometimes do better than those who are treated (Laing et al. 1975). The role of surgery appears at first sight to be better defined. Surgery is better than radiotherapy for squamous but not for oat-cell carcinomas (Morrison et al. 1963 ; Miller et al. 1969). However, since patients with early localized disease are considered to be curable, treatment cannot be withheld in the interests of a controlled trial. The result is that the natural history of limited operable disease is unknown. Radiotherapists and chemotherapists can justifiably complain that their treatment is never given to the patients with the best prospects of cure. Against this background of doubt about the best form of treatment, and certainty that most treatment is ineffective, is the obvious need for a better understanding of the natural history of the disease. Such understanding should help in three ways. First in assessing the true value of existing treatments. Second in judging an individual patient’s prognosis and so in choosing the most appropriate treatment. Third, and most important, in planning a rational search for new and more effective forms of treatment. We have used the considerable literature on tumour growth rates in lung cancer in an attempt to calculate the natural history of the disease.

The natural history of lung cancer: A review based on rates of tumour growth

The natural history of lung cancer: A review based on rates of tumour growth

Immunologic Aspects of Lung Cancer

Surgeons are often puzzled by variations in the natural history of lung cancer. Some patients with large neoplasms of borderline resectability may survive for many years after surgical treatment, whereas others with smaller, easily resectable carcinomas die from disseminated metastatic disease within a few months. The occasional success encourages the surgeon to treat lung cancer, but it is obvious that any improved survival in patients with lung cancer cannot come from further progress in surgical therapy.

Current and Future Concepts of Lung Cancer

We discuss here some of the last decade's diagnostic and therapeutic advances in the treatment of lung cancer, as well as current and future research objectives. Roentgenographs from selected patients illustrate the natural history of lung cancer. We present perspectives concerning selection from the growing diagnostic armamentarium, with comments upon early detection and localization of "occult" cancers with the help of flexible bronchoscopy. Operative approaches have changed over the past 4 decades; we review how and why they evolved, including perspectives concerning mediastinoscopy. There is a presentation on a radiotherapeutic research approach to oat-cell cancers and the current status of immunotherapy. Such issues as animal models available for lung cancer research emerge in the general discussion, and it becomes clear that lung cancer merits a truly interdisciplinary approach in order to bring meaningful advances to the patient's bedside.

Letter: Screening for lung cancer.

To the Editor.— Dr. William Weiss and I would like to answer Dr. Robert Fontana's EDITORIAL criticism (225:1372,1973) of our article, Is Curable Lung Cancer Detected by Semiannual Screening? (224:1361-1365, 1973). To correct Dr. Fontana's impression of our objective, it was not the hope that enough 'curable' cases of lung cancer would be found to justify continuation or amplification of the program, but, from the start, to delineate the natural history of lung cancer. 1 We have reported our findings in more than two dozen articles over the past 18 years. After more than two decades of research and analysis, we have concluded that our method does not produce a rewarding yield of cured lung cancer cases. The 6,136 men we studied for ten years were undoubtedly a self-selected population. First, they were people who were seeking a free chest x-ray film for one reason or another and, second,

The Role of Surgery in the Cure of Lung Cancer

INTERNISTS and thoracic surgeons often differ regarding the curability of lung cancer. While there is no question that resection is the only current cure, the magnitude of the surgical contribution to the overall conquest of lung cancer cannot be impressive when the five-year survival rate continues to be about 5%.^1-3Under such circumstances, many physicians whose professional relationships to their patients and their patients' families are on a continuing basis, have serious reservations as to the propriety of urging the expense and discomfort of thoracic surgery. Evaluation of therapy requires that effectiveness be measured against a sound knowledge of the natural history of disease. Realizing how little is known about the natural history of lung cancer, we began the Philadelphia Pulmonary Neoplasm Research Project in 1951 to delineate the chronologic relationship of roentgenographic changes to symptoms, smoking habits, etc. <h3>Method</h3> Over a four-year period from Dec 4, 1951, every

Bronchogenic Carcinoma

ESSENTIALLY the only patients with lung cancer who survive for more than five years after diagnosis are those treated by surgical excision. The combined clinical material of the 23 hospitals of the Veterans Administration Surgical Adjuvant Cancer Chemotherapy Group organized in 1957 to study the possible benefits of chemotherapy in conjunction with surgery provided an excellent opportunity to compile information on the pathology, surgical management, and natural history of lung cancer.1By July 1965, there were 147 patients living who had been operated upon more than five years previously. There were 203 additional three-year survivors for a total of 350. From the outset, the Follow-up Agency of the National Research Council has participated in the design of protocols as well as the collection, processing, and analysis of data. Thus far, the studies have failed to show any beneficial effect from any of the chemotherapy drugs used as surgical adjuvants

Bronchogenic Carcinoma Stage I

The successful treatment of lung cancer by any modality alone remains highly disappointing. It is for this reason that combined approaches using surgery, irradiation, and chemotherapy are being widely explored. The natural history of lung cancer and host resistance determines which lesions remain localized, which ones spread regionally, and which will disseminate widely. Since the most elaborate preoperative diagnostic methods cannot predict the development of metastatic spread microscopically, adjuvant therapy has been instituted with the hope of increasing salvage in favorable cases. The main advocates of preoperative irradiation were interested in determining if irradiation could arrest the local growth and sterilize reginal hilar, mediastinal, and scalene nodes, extending the number of patients who could be managed surgically. The possibility of rendering inoperable cases operable has been studied in the process. The gains in survival, the lowering of regional recurrences, and the prevention of metastases have also been analyzed in reference

CELL TYPE AND THE NATURAL HISTORY OF LUNG CANCER.

Bronchogenic carcinoma is a deadly disease with steadily increasing incidence especially in men, 1,2 and high early mortality rates reported for treated and untreated patients, even for those with supposedly small, asymptomatic lesions. From 70% to 88% of consecutive, unselected bronchogenic carcinoma patients, when first seen in general hospitals, are found to have nonresectable lesions, about 12% to 15% of these after thoracotomy. Periodic x-ray screening has revealed that survival after the last negative x-ray finding was so poor as to suggest that metastases in many cases have occurred before a pulmonary mass is detectable by present methods. 3 Multiple forms of therapy have been reported in the past, usually in small groups of patients and without adequate controls. Case reports of single or small numbers of patients who have survived for periods of time beyond the expected have often led to the erroneous conclusion that the therapy used in

APPEARANCE OF FIRST ROENTGENOGRAPHIC ABNORMALITIES DUE TO LUNG CANCER.

To study the natural history of lung cancer, 6,137 men aged 45 years or more were followed by semiannual photofluorograms and symptom questionnaires for eight to ten years. Seventy-six histologically confirmed carcinomas developed during this period. In 45 cases the lung cancer appeared within nine months of a normal film so that the first radiological appearance of the tumor could be characterized; 27 arose peripherally and 9 as solitary nodules. More than half of the 76 cancers arose in men whose earlier films revealed abnormalities of the lungs or pleurae. Pulmonary fibrosis preceded the x-ray evidence of cancer in 24% of the cancer patients, all of whom smoked; fibrosis was present in 24% of a matched sample of smokers without cancer, and in only 13% of a matched sample of nonsmokers.

THE PHILADELPHIA PULMONARY NEOPLASM RESEARCH PROJECT: AN INTERIM REPORT

Excerpt The Philadelphia Pulmonary Neoplasm Research Project was begun in 1951, primarily to study the natural history of lung cancer with special emphasis on the chronologic relationship between s...

Preliminary studies on the natural history of lung cancer.

It is, of course, not possible in a literal sense to discuss the unadorned, unmodified evolution of cancer in man, or what has been called its natural history. Many factors operative in the host and related to the anatomical location of the primary disease may act to vary or direct its course. A variety of complications may occur which, as far as the host is concerned, can overshadow the presence of cancer or prove fatal before it is well advanced. Treatment, even if not curative, can delay growth of the neoplasm in certain sites, or alleviate or prevent complications so that the disease can more fully realize its preordained course. Furthermore, our methods of observation are so limited, our clinical data so contaminated with errors of fact, omissions, and faulty interpretations, that what we believe genuinely to be true may only be misleading. At the outset we must emphasize that it is difficult even to approximate the ideal of a true and accurate description of the behavior of a cancer in anyone. Despi...