Non-small Cell Carcinoma Of The Lung Research Articles

Flexible Bronchoscopy and Helical Computed Tomography with Three-Dimensional Reconstructions in Non-small Cell Carcinoma of the Lung

The purpose of this study was to demonstrate the existing correlation between bronchoscopic examination and helieal computed tomography with three-dimensional reconstructions. Eighteen patients with non-small cell carcinoma of the lung were studied. A good correlation was observed in patients with stenosis of stem and lobar bronchi, either intrinsic or extrinsic. The three-dimensional images reveal the spatial location of the tumoral mass, the alterations of intrathoracic structures, and the lung parenchyma secondary to tumoral growth. The internal and external views of the bronchial tree also correlate well with the bronchoscopic findings and permit visualizations of the airway changes beyond the stricture. In some patients, this information permits better planning of laser therapy and a better understanding of the actual pathology of the neoplastic process. However, the staging and diagnosis of the patients are not substantially modified.

Adjuvant Chemotherapy for Resected Non‐Small Cell Carcinoma of the Lung: Why We Still Don't Know

The role of adjuvant chemotherapy in resected non-small cell carcinoma of the lung (NSCLC) remains controversial. A critical review of the 11 cisplatin-based randomized trials addressing this issue was performed using methodology adapted from the CONSORT statement. The 11 trials were divided into those that included predominantly node-negative patients (n = 5) and those that included predominantly node-positive patients (n = 6). In the node-negative trials, which included 1,084 evaluable patients, no evidence of heterogeneity of treatment effect between the trials was found. The composite five-year survival rate for chemotherapy patients was 61% versus 55% for control patients, which reached marginal significance (p = 0.06). In the node-positive trials, which included 880 evaluable patients, a marginal lack of homogeneity of treatment effect between trials was found (p =.013). The composite two-year survival rate for chemotherapy patients was 48% versus 40% for control patients, which reached marginal significance (p = 0.06). Although not definitive, these trials suggest a benefit to postoperative adjuvant chemotherapy in resected NSCLC. The cumulative experience of the 11 trials is notable for: A) the small number of patients; B) heterogenous patient populations; C) substandard chemotherapy regimens; D) inadequate chemotherapy delivery, and E) less than optimally executed clinical trials. The 11 trials are discussed in detail, and recently completed and ongoing trials of adjuvant chemotherapy in resected NSCLC are reviewed.

238 Response, failure patterns and survival in five radiation therapy oncology group (RTOG) trials of sequential and/or concurrent chemotherapy (CT) radiation therapy (RT) for locally advanced non-small cell carcinoma of the lung (NSCLC)

238 Response, failure patterns and survival in five radiation therapy oncology group (RTOG) trials of sequential and/or concurrent chemotherapy (CT) radiation therapy (RT) for locally advanced non-small cell carcinoma of the lung (NSCLC)

244 Toxicity in five radiation therapy oncology group (RTOG) trials of sequential and/or concurrent chemotherapy (CT) radiation therapy (RT) for locally advanced non-small cell carcinoma of the lung (NSCLC)

244 Toxicity in five radiation therapy oncology group (RTOG) trials of sequential and/or concurrent chemotherapy (CT) radiation therapy (RT) for locally advanced non-small cell carcinoma of the lung (NSCLC)

P53 gene product expression in resected non-small cell carcinoma of the lung, with studies of concurrent cytological preparations and microwave antigen retrieval.

AIM: To document the frequency and extent of p53 gene product expression in paraffin sections of resected non-small cell carcinoma of the lung and in cytological preparations of the same...

Cell Kinetics Analysis of Surgically Resected Non-Small Cell Carcinoma of the Lung Using the AgNOR Silver Stain

Cell kinetics analysis of lung carcinoma using DNA flow cytometry has shown a significant correlation with the biological behavior of these neoplasms. Ploidy has shown a more significant association with aggressive behavior. The method may however not be available in all centers. Two counts of the AgNOR silver stain have been correlated with ploidy and proliferative activity (PA). The first count, which is the mean number of AgNOR granules (mAgNOR), correlates with ploidy. The second count is the percentage of cells with > 5 AgNORs/nucleus (pAgNOR), reflects PA. We performed the AgNOR silver stain using the two above-mentioned counts in 41 cases of surgically resected nonâsmall cell carcinoma of the lung. The cases included 14 adenocarcinomas, 24 squamous cell carcinomas, and three undifferentiated nonâsmall cell carcinomas. Follow-up data were available on 36 of the patients, ranging from 10 to 31 months (median 18 months). Thirteen of these patients (36%) developed progressive disease. Adenocarcinomas showed mAgNOR counts suggestive of aneuploidy (> 2.4) in nine of the 14 patients (64%) and 16 of the 24 squamous carcinomas (66%). The adenocarcinomas showed high pAgNOR counts (> 8%) in eight of the 14 cases (57%), in contrast to 15 of the 24 squamous carcinomas (62%). The AgNOR counts did not show any statistically significant correlation with tumor type, grade or stage of disease. The mAgNOR counts were aneuploid in all 13 progressive cases and in only 10 of the 23 stable cases (43%)(P=0.001). The pAgNOR counts were high in 12 of the 13 cases that progressed (92%), in contrast to 10 of the 23 stable cases (43%)(P=0.01). There is no significant evidence that squamous carcinoma of the lung may have a higher incidence of aneuploidy and high PA than adenocarcinoma. Our data also confirm previous data showing that aneuploid lung carcinomas have more aggressive behavior than diploid ones. This study also indicates that, despite the short-term follow-up data, the use of the AgNOR silver stain for cell kinetics analysis of nonâsmall cell carcinoma of the lung may potentially provide useful predictive information on the biologic behavior of lung carcinoma. Long-term follow-up may provide more significant information.

Phase II study of patients with metastatic nonsmall cell carcinoma of the lung treated with paclitaxel by 3‐hour infusion

Phase II study of patients with metastatic nonsmall cell carcinoma of the lung treated with paclitaxel by 3‐hour infusion

Phase II study of patients with metastatic nonsmall cell carcinoma of the lung treated with paclitaxel by 3-hour infusion

Single-agent chemotherapy produces partial responses in the range of 7-27% in patients with Stage IV nonsmall cell lung carcinoma (NSCLC). Cisplatin-based combination regimens have achieved higher response rates but with significant toxicity. Two prior studies employing 24-hour infusions of paclitaxel showed responses of 21% and 24%. The purpose of this Phase II study was to determine the effects of paclitaxel administered by short duration infusions on response rate, toxicity, and quality of life (QOL) in patients with NSCLC. Twenty patients with histologically proven Stage IV NSCLC were enrolled in this study. All were treated on an outpatient basis with standard premedication followed by paclitaxel 200 mg/m2 infused intravenously over 3 hours. Treatments were repeated every 21 days for a maximum of 6 cycles. The objective response rate was 6/19 (32%; 95% confidence interval, 13-57%). The median duration of response was 6.0 months (range, 2-13 months). The median survival of the entire group was 6.0 months (range, 2-24+ months), and the 1-year survival rate was 22%. Toxicity was mild, with only one hospitalization required for treatment of catheter-related thrombosis. Nonresponding patients were found to have worsening Functional Assessment of Cancer Therapy (FACT)-G and FACT-L scores. Because this was a small clinical study, it did not demonstrate consistent improvement in FACT-G or FACT-L in responding patients. Paclitaxel given as a 3-hour infusion is a well-tolerated, active single agent in the treatment of Stage IV NSCLC, worthy of further study. Baseline QOL scores predicted those more likely to respond to treatment, but changes in QOL status did not correlate well with objective response status.

Autologous tumor killing activity as a prognostic factor in primary resected nonsmall cell carcinoma of the lung

Cytotoxic activity of peripheral blood lymphocytes obtained during surgery against autologous fresh tumor cells has been reported. However, the role of lymphocyte autologous tumor killing or natural killer activity during the postoperative period remains obscure. In this article, the authors describe the importance of postoperative autologous tumor killing activity as a prognostic factor in patients with primary resected nonsmall cell lung carcinoma (NSCLC) after long term follow-up. Forty-two patients who had resection of NSCLC, with primary culture of autologous tumor cells taken successfully, were studied. Cytotoxic activity against autologous, allogenic NSCLC and K562 leukemia cells was examined using peripheral blood lymphocytes obtained during the 2 weeks immediately following surgery. Factors related to prognosis were analyzed by univariate and multivariate analyses. The overall 5- and 10-year survival rates for the NSCLC patients were 40.5% and 27.5%, respectively. Statistical analysis of survival curves revealed a significant difference with regard to T classification (P = 0.025), N classification (P = 0.0015), stage (P = 0.028), and postoperative autologous tumor killing activity (P = 0.0008); there were no significant differences in relation to age, gender, histology, differentiation, visceral pleural invasion, resectability, surgical method, allogeneic tumor killing activity, or natural killer activity. Multivariate analysis demonstrated a significant correlation between disease recurrence and N classification (P = 0.0003), T classification (P = 0.023), stage (P = 0.001), and autologous tumor killing activity (P = 0.007), indicating independent prognostic significance. The phenotypes of the effector cells involved in autologous tumor killing activity were CD3(+), CD4(-), CD8(+), and CD11b(-). Autologous tumor killing activity was inhibited by competing unlabeled autologous tumor cells. Autologous tumor killing activity during the 2 weeks immediately following surgery is an important prognostic factor in resected NSCLC.

Autologous tumor killing activity as a prognostic factor in primary resected nonsmall cell carcinoma of the lung

Autologous tumor killing activity as a prognostic factor in primary resected nonsmall cell carcinoma of the lung

120 Response, toxicity, failure patterns and survival in five radiation therapy oncology group (RTOG) trials of sequential and/or concurrent chemotherapy (CT) and radiation therapy (RT) for locally advanced non-small cell carcinoma of the lung (NSCLC)

120 Response, toxicity, failure patterns and survival in five radiation therapy oncology group (RTOG) trials of sequential and/or concurrent chemotherapy (CT) and radiation therapy (RT) for locally advanced non-small cell carcinoma of the lung (NSCLC)

123 The toxicity of elective nodal irradiation in the definitive treatment of non-small cell carcinoma of the lung

123 The toxicity of elective nodal irradiation in the definitive treatment of non-small cell carcinoma of the lung

Postoperative immunostimulation after complete resection improves survival of patients with stage I nonsmall cell lung carcinoma

approximately 40% of primary lung carcinoma patients who die within 1 month after a complete resection have residual tumor in regional or distant organs, emphasizing the importance of postoperative adjuvant therapy. In this study, the effectiveness of transfer factor (TF) and nocardia rubra-cell wall skeleton (N-CWS) as adjuvant therapy for patients with primary, completely resected nonsmall cell carcinoma of the lung was evaluated in a randomized controlled trial A total of 82 patients with Stage I disease who had a complete resection were allocated randomly into 2 groups: TF + N-CWS (n = 41) or control (surgery only) (n = 41). The distributions of age, sex, histology, differentiation, T classification, tumor size, visceral pleural invasion, and the site of origin, were similar in the two groups. The 5- and 10-year disease specific survival rates in the TF + N-CWS group were 85% and 85%, respectively, and those in the control group were 72% and 64%, respectively. There was a statistically significant difference between the two groups (P = 0.041). When the survival was analyzed according to clinical characteristics, significant differences were observed in patients with no visceral pleural invasion or with T1 disease. The frequency of distant metastasis was significantly less in the TF + N-CWS group than in the control group. These results indicate that TF + N-CWS is beneficial as adjuvant therapy after surgical treatment of Stage I nonsmall cell carcinoma of the lung.

A Phase II Trial of Prolonged Oral Etoposide (VP-16) as Second-Line Therapy for Advanced and Recurrent Endometrial Carcinoma: A Gynecologic Oncology Group Study

Prolonged oral etoposide is an active regimen in small and nonsmall cell carcinoma of the lung, carcinomas of the breast and ovary, germ cell tumors, and in lymphoma. A Phase II trial was conducted by the Gynecologic Oncology Group to determine its activity in endometrial carcinoma. Twenty-six patients with advanced or recurrent endometrial carcinoma were entered into study; one patient was ineligible because of an incorrect cell type. The remaining eligible patients were treated with etoposide at a starting dose of 50 mg/m2/day (30 mg/m2/day with prior radiotherapy) for 21 days. Based on hematologic toxicity, a dose escalation to a maximum dose of 60 mg/m2/day was prescribed. Twenty-two patients were evaluable for response and 25 were evaluable for toxicity. Fourteen had received prior radiotherapy and 24 had received prior chemotherapy. A median of two courses were given (range, 1–10). Grade 3 or 4 leukopenia occurring in 52% was the most common complication (grade 3, 36%; grade 4, 16%). Grade 4 thrombocytopenia occurred in 16% of patients. There were no objective responses including four patients with serous papillary carcinoma. This regimen is not significantly active as second-line therapy in endometrial carcinoma.

Comparison of DNA topoisomerase IIα expression in small cell and nonsmall cell carcinoma of the lung: In search of a mechanism of chemotherapeutic response

Comparison of DNA topoisomerase IIα expression in small cell and nonsmall cell carcinoma of the lung: In search of a mechanism of chemotherapeutic response

The curative treatment by radiotherapy alone of stage I nonsmall cell carcinoma of the lung

This review was initiated to assess the outcome of treatment with radical radiotherapy with curative intent for patients diagnosed as having stage I non-small cell lung cancer. The study involved a retrospective review of 347 patients with T1 and T2N0M0 tumors treated at the Queensland Radium Institute during the period 1985 to 1992. The main reasons for not proceeding to surgery included poor performance status, old age, or refusal to submit to surgery. The median age for the group was 70 years, with the range being 34 to 90 years. Patients in this group were all treated by a standard technique involving external-beam radiotherapy to 50 Gy, minimum tumor dose, in 20 fractions over 4 weeks. The overall survival rate was 27% at 5 years with a median survival of 27.9 months. The 5-year recurrence-free survival was 23% with the median being 19.5 months. There was a strong correlation of survival to tumor size with 5-year survival rates being 32% and 21% for T1 and T2 tumors, respectively. Multivariate analysis found only T stage to be associated with overall survival (p

Integrin expression in non-small cell carcinoma of the lung

Integrin expression in non-small cell carcinoma of the lung

Blood and lymphatic vessel invasion as prognostic factors for patients with primary resected nonsmall cell carcinoma of the lung with intrapulmonary metastases

Blood and lymphatic vessel invasion as prognostic factors for patients with primary resected nonsmall cell carcinoma of the lung with intrapulmonary metastases

Phase II trial and cost analysis of fazarabine in advanced nonsmall cell carcinoma of the lung: A southwest oncology group study

Phase II trial and cost analysis of fazarabine in advanced nonsmall cell carcinoma of the lung: A southwest oncology group study

Concurrent paclitaxel/cisplatin with thoracic radiation in patients with stage IIIAB non-small cell carcinoma of the lung

Nine patients with stage IIIB non-small cell lung cancer were entered into a phase II trial designed to determine the feasibility of giving a combination of paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) plus cisplatin concurrent with thoracic radiation. Paclitaxel was given as a 24-hour infusion (135 mg/m2) followed by cisplatin (75 mg/m2) every 4 weeks, for a total of four cycles. Thoracic radiation was given concurrently with the first two cycles of chemotherapy, for a total dose of 64.8 Gy over 6 weeks. Neutropenia and esophagitis were the most common toxicities, with 66% of patients experiencing grade 3 or 4 neutropenia and 55% experiencing grade 3 or 4 esophagitis. Grade 3 pulmonary toxicity developed in 33% of patients. All patients were able to receive the full dose of radiation, although half of the patients required some modification of the chemotherapy regimen. There was one complete response and four partial responses, yielding a 56% overall response rate. This study demonstrates that it is feasible to treat patients with stage IIIB non-small cell lung cancer with paclitaxel/cisplatin plus concurrent thoracic radiation, with a degree of toxicity comparable with that associated with a degree of toxicity comparable with that associated with other concurrent combined-modality regimens for this disease.