Residual N2 Research Articles

Nitrogen gas (N2), by near-ambient pressure XPS

Near-ambient pressure x-ray photoelectron spectroscopy (NAP-XPS) is a less traditional form of XPS that allows samples to be analyzed at relatively high pressures, i.e., at ca. 2500 Pa, or even higher in some cases. With NAP-XPS, XPS can probe moderately volatile liquids, biological samples, porous materials, and/or polymeric materials that outgas significantly. In this submission, we show NAP-XPS survey and narrow scans from nitrogen gas (N2), a material that could not be analyzed at moderate pressures by conventional approaches. Nitrogen gas is an important reference material for NAP-XPS because residual N2 from the air and/or venting produces an N 1s signal in many NAP-XPS spectra. Nitrogen gas may also be deliberately employed as the gaseous background for NAP-XPS experiments. The survey spectrum of N2 gas contains N 1s, N 2s, N KLL (Auger), and valence band signals. This submission is part of a series of articles on NAP-XPS that has been submitted to Surface Science Spectra.

Production of BioSNG from waste derived syngas: Pilot plant operation and preliminary assessment

Bio-substitute natural gas (or BioSNG) produced from gasification of waste fuels and subsequent methanation of the product gas could play a crucial role in the decarbonisation of heating and transportation, and could be a vital part of the energy mix in the coming decades. The BioSNG demonstration plant described in this paper seeks to prove the technical feasibility of the thermal gasification of waste to renewable gas, through a preliminary experimental programme to take an existing stream of syngas, methanate it and show that it can be upgraded to gas grid quality requirements. The syngas used in the project is a waste-derived syngas from a two-stage fluidised bed - plasma pilot facility, which is then converted and upgraded in a new, dedicated conversion and clean up plant. Extensive trials were undertaken on methanation and gas upgrading units for over 60 h of continuous operation. The fundamentals of a once-through methanation process train have been established on the demonstration facility and a model built to extend the analysis over different operational parameters. Over the trials, methane outputs of greater than 50 kWth output were routinely produced from three methanation reactors in series, with a total CO conversion exceeding 90% at pressures as low as atmospheric, in line with kinetic model predictions. Retention of CO2 as well as adequate partial pressure of H2O in the process stream was important for process control. The plant provided demonstration of the efficacy of a PSA system for separation of CO2 (99% removal efficiency) as well as the potential to remove a proportion of residual H2, N2 and CO, although this was associated with appreciable CH4 slip. The process can be optimized primarily by reducing inlet temperature to methanation reactors, controlling syngas composition and using adequate steam to carbon ratio, depending on the type of waste. This information can be used to inform the design and economics of subsequent planned commercial plants that could significantly increase the potential of renewable gas in the UK and elsewhere in Europe, providing a low cost route to low carbon heat and transport.

SC01.02 PET-CT for Response Assessment During Induction Therapy of N2 NSCLC

Approximately 30% of patients with non-small cell lung cancer (NSCLC) are found to have locally advanced stage III tumors at initial diagnosis. For these patients the curative therapeutic options include definitive high-dose radiotherapy with concurrent chemotherapy or, alternatively, induction treatment followed by surgery. Preoperative chemotherapy or combined radiochemotherapy protocols followed by resection result in cure rates of 25-35 percent at 3 years for locally advanced NSCLC. However, surgical resection in patients with stage IIIa N2 remains an issue of controversy depending on the extent of lymph node involvement. Neoadjuvant chemo- or radiochemotherapy is being used to reduce disease burden in the mediastinum before surgery since patients who are downstaged via neoadjuvant therapy and then undergo resection experience a significantly longer 5-year survival of 40% to 50% than those who are found to have residual N2 disease at the time of surgery. Thus, identification of patients who are N2 negative after completion of their neoadjuvant therapy is a critical component for patient selection for thoracotomy. However, clinical restaging in these patients often is challenging. Endoscopic ultrasound guided biopsies (EUS/EBUS-FNA) have increasingly become available and are currently preferred procedures for staging and restaging before surgery due to their high diagnostic accuracy.1 Serial PET-CT imaging captures anatomical changes and additionally offers semiquantitative information about morphometric and metabolic tissue changes during induction treatment. Issues of PET-CT performance and quality assurance concerning standardization have been clarified during recent years and the validity of repeated measurements has been approved.2 Successful induction treatment regimens have been frequently found to reduce 18F-FDG uptake and thus PET-CT allows to assess the therapeutic response. Reduction in FDG-uptake of mediastinal lymph nodes after induction therapy has been shown to correlate well with histopathologic response,3 while postinduction PET avidity taken alone was not consistently found to be associated with pathological N2 involvement.4 In the direct comparison of EUS-FNA with PET-CT for restaging after induction chemoradiotherapy, concordance between findings of restaging EUS-FNA and metabolic response of lymph node metastases was observed in 63% patients treated within a prospective study but the diagnostic accuracy of PET-CT was limited.5 Nevertheless, serial FDG-uptake measurements seem to provide prognostic information during induction therapy. Data collected in prospective trials suggest that a decrease in SUVmax between 45% to 60% optimally separates between responders and non-responders.6-9 In a recent large retrospective analysis, a decrease in SUVmax greater than 60% in the involved mediastinal nodes was the best predictor of overall survival, better than changes seen in the primary tumor site.10 An analysis of a randomized trial in potentially resectable stage III NSCLC of induction treatment (including a hyperfractionated accelerated radiotherapy phase) and definitive radiochemotherapy compared with induction treatment followed by surgery confirmed that as early as after two cycles of cisplatin-based induction chemotherapy percentage of SUVmax remaining represents a significant prognostic parameter.9 PET-response was of higher importance than all other clinical factors. Cut-off levels between 0.45 and 0.55 were predictive for freedom from extracerebral progression in all randomized patients. No important differences in the predictive value were observed comparing resection versus definitive radiochemotherapy. PET-response was closely related to extracerebral distant metastases but not to local recurrences, independent of treatment. One might conclude that less PET-responsive tumors are successfully controlled by intensified hyperfractionated accelerated radiochemotherapy or neoadjuvant radiochemotherapy and resection at loco-regional sites so that the highest risk of relapse remains at extracerebral distant sites. Therefore, a selection or intensification of the local therapy according to SUV-decrease is not warranted by these data. Functional imaging has not yet been fully established for treatment guidance but prospective evaluation is underway. In the group of poor-responding patients, treatment intensification by independent systemic options such as targeted therapy or immunomodulating therapy may become emerging new treatment options within clinical trials. 1. De Leyn EJCTS 2014, 2. Young, EJC 1999, 3. Pöttgen CCR 2006, 4. Ripley JTCS 2016, 5. Stigt, Lung Cancer 2009, 6. Hoekstra, JCO 2005, 7. Eschmann, Lung Cancer 2007, 8. Dooms, JCO 2008, 9. Pöttgen, JCO 2016, 10. Barnett ATS 2016. PET-CT; N2; induction, restaging

N-rich fluid inclusions in octahedrally-grown diamond

Nitrogen is generally considered a trace component in the Earth's mantle. Mantle volatiles sampled from mid-ocean ridge basalts or preserved as fluid inclusions in xenoliths are dominated by CO2, with only traces of nitrogen. Here we describe CO2–N2 fluid inclusions with 40 mol% N2 and silicate melt inclusions with ∼0.1 wt% dissolved N2 in mantle-derived diamonds from 3 different cratons. The diamonds are octahedrally-grown, which is the most common growth habit and rarely reported to contain fluid inclusions. The inclusions have C/N ratios <1, more than two orders of magnitude below typical mantle values. We propose that nitrogen can become concentrated to high degrees by processes related to diamond growth. A growing diamond does not readily consume the nitrogen available, suggesting incompatible behaviour. Residual N2 from this process represents a concentrated nitrogen flux escaping the convecting mantle. Hidden nitrogen fluxes like this might be significant in counteracting the large apparent net influx by subduction. Based on nitrogen and carbon speciation in the inclusions, we propose that redox processes control the liberation of nitrogen from the convecting mantle, by the oxidation of NH+4 in silicates to mobile N2, concurrent with a parallel oxidation process releasing carbonate melt from the asthenosphere. Isotopic fractionation accompanying changes in nitrogen speciation could help account for the apparent isotopic mismatch between surficial and mantle nitrogen.

Effect of pulsed bias on the properties of ZrN/TiZrN films deposited by a cathodic vacuum arc

ZrN/TiZrN multilayers are deposited by using the cathodic vacuum arc method with different substrate bias (from 0 to −800 V), using Ti and Zr plasma flows in residual N2 atmosphere, combined with ion bombardment of sample surfaces. The effect of pulsed bias on the structure and properties of films is investigated. Microstructure of the coating is analyzed by X-ray diffraction (XRD), and scanning electron microscopy (SEM). In addition, nanohardness, Young's modulus, and scratch tests are performed. The experimental results show that the films exhibit a nanoscale multilayer structure consisting of TiZrN and ZrN phases. Solid solutions are formed for component TiZrN films. The dominant preferred orientation of TiZrN films is (111) and (220). At a pulsed bias of −200 V, the nanohardness and the adhesion strength of the ZrN/TiZrN multilayer reach a maximum of 38 GPa, and 78 N, respectively. The ZrN/TiZrN multilayer demonstrates an enhanced nanohardness compared with binary TiN and ZrN films deposited under equivalent conditions.

Development of Zr-Ti-N Coatings for Micro Drills for Machining of PCBs

A group of Zr-Ti-N coatings was prepared and studied to access their potential as a protective layer for micro drills to obtain cutting tool wear improvement. The coatings were grown using an industrial-scale four-target closed-field unbalanced magnetron sputtering ion plating system, employing one Ti and three Zr targets working in residual N2 atmosphere. To achieve Zr-Ti-N coatings with varying Ti doping content, the current applied to the Ti target was subjected to change from 0A to 3.6A while those to the Zr targets were kept constant. The coatings were characterized using GDOES, XRD, SEM, Vickers microhardness tester, scratch tester and Rockwell C indentation tester. Evaluation of wear improvement by Zr-Ti-N coatings for microdrills was conducted by machining of FR4 print circuit boards. It was found that the coatings with 16.5 at.% Ti doping content showed the highest microhardness and wear improvement for microdrills. Wear of microdrills with this coating could be reduced by a factor of two as compared with traditional TiN coated ones.

Restaging After Induction Therapy for Non-Small-Cell Lung Cancer

SUMMARY Select patients with stage IIIa-N2 non-small-cell lung cancer will benefit from treatment with induction chemoradiotherapy followed by surgical resection. The identification of patients with residual N2 disease may allow for selection of those patients most likely to benefit from resection. The optimal strategy for restaging of mediastinal lymph nodes following induction therapy is controversial. Noninvasive, imaging-based strategies are largely ineffective. Minimally invasive approaches such as endobronchial ultrasound-transbronchial needle aspiration and endoscopic ultrasound-guided fine needle aspiration may identify residual nodal disease, but require surgical confirmation of negative results. Repeat mediastinoscopy may be effective at centers that specialize in this technique, but in the authors opinion its use cannot be broadly recommended. A thoughtful and minimally invasive approach to initial staging of N2 nodes is recommended, reserving mediastinoscopy for restaging whenever possible.

Hyperfractionated Irradiation with 3 Cycles of Induction Chemotherapy in Stage IIIA‐N2 Lung Cancer

The purpose of the present study was to improve the prognosis of patients with stage IIIA-N2 non-small cell lung cancer (NSCLC). To achieve that goal, we performed induction chemoradiotherapy followed by surgery. The criteria for this phase II study were ≤75-year-old patients with pathologically diagnosed stage IIIA-N2 NSCLC who had performance statuses of 0 or 1 with good organ function. Three cycles of chemotherapy with paclitaxel and carboplatin were carried out, with concurrent hyperfractionated irradiation (42 Gy). After re-evaluation, pulmonary resections were considered unless patients showed progressive disease. The primary endpoint was overall survival (OS), and the secondary endpoints were disease-free survival (DFS) and absence of toxicity. All 22 patients enrolled in this study completed the induction chemoradiotherapy without any severe complications. In these 22 patients, the 2- and 5-year OS were 81 and 47%, respectively. There were no therapy-related deaths. Surgery was subsequently performed in 19 patients (86%). Pathological complete responses were seen in 6 patients (27%), while node downstaging was obtained in 10 patients (45%). In the 19 patients who underwent surgery, the 2- and 5-year OS rates were 83 and 62%, respectively, and the 2-year DFS rate was 63%. All 6 patients with pathological complete responses survived without disease. Patients with residual multiple-station N2 showed worse OS and DFS rates than did those with downstaged and single-station N2 (P=0.026 and P<0.0001, respectively). This trimodal therapy was effective and well tolerated, and it is an acceptable therapeutic option for patients with locally advanced stage IIIA-N2 NSCLC. Patients without persistent multiple-station N2 showed promising survival.

Surgery for patients with persistent pathological N2 IIIA stage in non-small-cell lung cancer after induction radio-chemotherapy: the microscopic seed of doubt☆

The surgical treatment of residual N2 disease following induction radio-chemotherapy (IT) for locally advanced cIIIA-N2 non-small-cell lung cancer (NSCLC) is still debated. The long-term results after resection in a pN2 series are at the focus of this study. From January 1992 to December 2008, 161 consecutive pathologically proven Stage IIIA-N2 NSCLC patients underwent IT. Among these, 40 pN2s were included in this retrospective analysis. The associations between the mortality and the disease-free status with potential risk factors were explored by means of the Kaplan-Meier and Cox regression analysis. Mean age and male/female ratio were 58.7 ± 9.7 years and 36/4, respectively. Twelve patients (30%) showed a clinical partial response and 28 (70%) showed stable disease. There was one (3%) perioperative death and four (10%) major complications. In the total group, the 3- and 5-year survival rates were 24.2% and 19.3%, respectively. The Cox regression analysis suggested that the macroscopic pN2 status proved to be a negative prognostic factor (hazard ratio (HR)=2.8, confidence interval (CI) 95%: 1.1-7.3; p=0.04). The recurrence rate flattened at 30.8% at the 3rd year. Furthermore, the bilobectomy-pneumonectomy group had a risk of relapse 6.9 times higher than the lobectomy group (CI 95%: 2.5-18.8; p < 0.001). The persistence of disease at the N2 level after IT and surgery for cIIIa-N2 NSCLC does not exclude favorable outcome after resection, in particular in those patients with minor residual disease.

Survival of patients with clinical stage IIIA non–small cell lung cancer after induction therapy: Age, mediastinal downstaging, and extent of pulmonary resection as independent predictors

In clinical stage IIIA non-small cell lung cancer, the role of surgical resection, particularly pneumonectomy, after induction therapy remains controversial. Our objective was to determine factors predictive of survival after postinduction surgical resection. We retrospectively reviewed a prospectively collected database of 136 patients who underwent surgical resection after induction chemotherapy (n = 119) or chemoradiation (n = 17) from June 1990 to January 2010. One hundred five lobectomies or bilobectomies and 31 pneumonectomies were performed. There was 1 perioperative death (pneumonectomy). Seventy-one patients had downstaging to N0 or N1 nodal status (52%). There were 2 complete pathologic responses. Median follow-up was 42 months (range, 0.69-136 months). Overall 5-year survival for entire cohort was 33% (36% lobectomy, 22% pneumonectomy, P = .001). Patients with pathologic downstaging to pN0 or pN1 had improved 5-year survival (45% vs 20%, P = .003). For patients with pN0 or pN1 disease, survival after lobectomy was better than after pneumonectomy (48% vs 27%, P = .011). In patients with residual N2 disease, there was no statistically significant survival difference between lobectomy and pneumonectomy (5-year survival, 21% vs 19%; P = .136). Multivariate analysis showed as independent predictors of survival age (hazard ratio, 1.05; P = .002), extent of resection (hazard ratio, 2.01; P = .026), and presence of residual pN2 (hazard ratio, 1.60; P = .047). After induction therapy for patients with clinical stage IIIA disease, both pneumonectomy and lobectomy can be safely performed. Although survival after lobectomy is better, long-term survival can be accomplished after pneumonectomy for appropriately selected patients. Nodal downstaging is important determinant of survival, particularly after lobectomy.

Restaging of the mediastinum

Patients diagnosed with stage IIIA lung cancer because of N2 positive disease are generally considered to have a short survival. However, recent studies have shown that patients who are downstaged via neoadjuvant therapy and subsequently undergo resection may have a significant increased 5-year survival rate (as high as 40-50%) when compared with patients who have residual N2 disease. The identification of patients who are N2 negative after the completion of their neoadjuvant therapy is a critical component of proper patient selection and counseling for thoracotomy and resection, especially if a pneumonectomy needs to be considered. The question, how to reassess patients with stage IIIA non-small-cell lung cancer after neoadjuvant therapy, is broader than just looking at downstaging of mediastinal lymph nodes, but also involves prediction of partial or complete pathologic response on the primary tumor and long-term outcome prediction. On the basis of the published data every technique has indications and limitations. The comparison of the different techniques is still problematic for various reasons. In this article we review the best ways to restage patients with N2 disease after they have completed their neoadjuvant therapy.

Results of Surgical Treatment After Neoadjuvant Chemotherapy for Stage III Non‐Small Cell Lung Cancer

The potential benefits of an approach combining neoadjuvant chemotherapy and surgery in stage IIIA and IIIB NSCLC have to be weighed against a potential increase in postoperative complications. We evaluated the results in terms of postoperative complications and survival in patients with stage III NSCLC who underwent complete surgical treatment after neoadjuvant chemotherapy with two regimens: mitomycin, vinblastine, and cisplatin (MPV) versus gemcitabine and cisplatin (GC). From March 1991 to September 2005, 110 patients with stage III NSCLC (86 stage IIIA and 24 stage IIIB) underwent complete surgical treatment after neoadjuvant chemotherapy. Ninety-two patients were men and 18 were women, with a mean age of 59 (range, 39-80) years. The neoadjuvant chemotherapy regimen was MPV in 72 patients and GC in 38. The overall response (>50%) to chemotherapy was 84%. Postoperative mortality and morbidity were 1.8% and 20%, respectively. Overall 5-year survival was 46%. Minor response to neoadjuvant chemotherapy (<50%) and residual nodal N2 involvement in stage IIIA had an adverse impact on survival (p < 0.05). Favorable long-term survival was observed after neoadjuvant chemotherapy with MPV and GC regimens in stage IIIA and IIIB NSCLC, with relatively low postoperative mortality and morbidity. Caution should be taken when offering surgical treatment to patients with minor response to induction chemotherapy and residual N2 disease in view of the significantly reduced survival.

“Watch-and-see” policy for the clinically positive neck in head and neck cancer treated with chemoradiotherapy

Chemoradiotherapy (CRT) is becoming more widely used for head and neck cancer. However, there are conflicting theories regarding the best management options for patients with advanced nodal disease. From 1990 to 1999, we treated 96 patients with N1-N2 neck disease by concomitant CRT for organ preservation, using weekly carboplatin or a low daily dose of cisplatin, followed by a "watch-and-see" policy for the neck. In the present study, we retrospectively analyzed the treatment outcome in 63 of these patients who received definitive CRT for primary and neck diseases and were monitored for neck disease for more than 2 years. In 12 of the 22 (55%) N1 patients, CRT successfully controlled the neck disease. CRT was successful in 18 of the 41 (44%) patients with N2 disease. In 6 (60%) of 10 patients with residual or recurrent N1 disease, salvage surgery was successful. Of the 23 patients with residual or recurrent N2 disease, salvage surgery was successful in 8 patients (35%). The group of patients who showed a clinical complete response (CCR) to CRT had an overall survival rate of 62.4% (33 patients), whereas for those with a less than complete response (<CCR), the figure was 13.3% (30 patients; P < 0.001). Among the <CCR-neck group, patients who underwent neck dissection (ND) as well (n = 20) did not have a significantly better overall survival than those who did not undergo ND (n = 10; P = 0.069). We propose a treatment plan for neck disease that involves observing the neck closely following CRT. ND should be planned only when there is evidence that neck disease exists.

The possibility of surgery for small cell lung cancer (state of art)

The author provides information about epidemiology as well as surgical practice for small cell lung cancer (SCLC) in Hungary. It is emphasized that, based on the author's experience and on international consensus, TNM system is the basis of accurate oncological treatment. The oncological management of SCLC is summarized, which is based on surgery. SCLC, especially cases undergoing surgery, are often detected as a peripheral nodule which should be examined preoperatively by special algorithm. Despite the published favorable results, surgical treatment alone is not accepted nowadays as a correct oncological point of view. The aim of adjuvant therapy is to improve survival and to decrease local recurrence. The 5-year survival of SCLC according to stages is between 4 and 60%. After the late 80's, the complex multimodality oncotherapy has started, with neoadjuvant treatment. SCLC is chemosensitive, even at N2 stage after down-staging surgery might be available. The late results show 20-46% cumulative 5-year survival rate. However, in the case of N2 disease, only 15-30% 5-year survival is achieved. This is a critical question for surgery of SCLC, because the dominant opinion is that for N2 disease and especially residual N2 surgery does not prolong survival. SCLC often occurs in combination with NSCLC. Therefore, salvage operation is a possible choice to remove the residual chemo/radiation resistant SCLC and NSCLC components. In conclusion, surgery has an advantage for SCLC therapy especially in patients with stage I-II disease. Value of surgery for stage III/a disease is under discussion and it is not recommended in Hungarian practice. To use a complex neoadjuvant protocol is advised which provides from 20 up to 40% five-year survival rate.

2454: Residual N2 or N3 Disease After Induction Chemoradiation in Stage III Non Small Cell Lung Cancer Predicts for Distant Recurrence

2454: Residual N2 or N3 Disease After Induction Chemoradiation in Stage III Non Small Cell Lung Cancer Predicts for Distant Recurrence

Restaging patients with N2 (stage IIIa) non–small cell lung cancer after neoadjuvant chemoradiotherapy: A prospective study

The accuracy of restaging in patients with stage IIIa non-small cell lung cancer after neoadjuvant chemoradiotherapy is unknown. A prospective trial of patients with biopsy-proven N2 disease who underwent initial clinical staging with mediastinoscopy, integrated positron emission tomography/computed tomography (PET/CT), and CT. Patients then were clinically restaged by the same imaging techniques 4 to 12 weeks after their induction chemoradiation therapy and then underwent definitive pathologic staging. Ninety-three patients had their lymph nodes pathologically restaged. Repeat PET/CT after neoadjuvant therapy missed residual N2 disease in 13/65 (20%) patients and falsely suggested it in 7 of 28 (25%). It was more accurate than repeat CT for restaging at all pathologic stages (stage 0, 92% vs 39%, P = .03; and stage I 89% vs 36%, P = .04). When the maximum standardized uptake value of the primary tumor is decreased by 75% or more, it is highly likely (likelihood ratio, +LR, 6.1) the patient is a complete responder; when it decreased by 55% or more, it is highly likely (+LR, 9.1) the patient is a partial responder. When the maximum standardized uptake value of the N2 node initially involved with metastatic cancer is decreased by more than 50%, it is highly likely (+LR, 7.9) the node is now benign. Repeat integrated PET/CT is superior to repeat CT for the restaging of patients with stage IIIa non-small cell lung cancer. The percent decrease in the maximum standardized uptake value of the primary and of the involved lymph node is predictive of pathology; however, nodal biopsies are required since a persistently high maximum standardized uptake value does not equate to residual cancer.

Results of pulmonary resection following neoadjuvant therapy for locally advanced (IIIA–IIIB) lung cancer

We performed this study to determine the role and prognostic factors of neoadjuvant therapy followed by surgery for locally advanced non-small cell cancer. One hundred patients with clinical stage III non-small cell lung cancer (79 IIIA, 21 IIIB; 78 males, 22 females; average age 60.5 years) received neoadjuvant therapy, of whom 84 received two cycles of platinum chemotherapy combined with an average radiation dose of 41.5Gy, and 16 patients underwent chemotherapy alone. The mean follow-up duration was 80.9 months. Survival rate was estimated by the Kaplan-Meier method, and a Cox proportional hazards model was applied to determine the prognostic factors. The operative procedures included 74 lobectomies, 7 bi-lobectomies, and 19 pneumonectomies. Two patients died within 30 days due to adult respiratory distress syndrome and acute pulmonary embolism, respectively. The overall 5-year survival rate was 39.7% with a median survival time (MST) of 39.6 months. The 5-year survival rate for downstaged (pN1,2) patients was 53.5% while it was 16.3% for patients with residual N2. There was no difference in survival between lobectomy and pneumonectomy (MST 38 months vs 42 months). Univariate and multivariate analyses revealed that nodal status and tumor size after neoadjuvant therapy were independent prognostic factors. Neoadjuvant therapy was shown to deliver the optimal effect for surgery for cIIIA/IIIB NSCLC with acceptable mortality. Re-staging to exclude the residual multiple nodal metastasis can lead to the proper patient selection. A pneumonectomy, as a last option, following neoadjuvant therapy did not affect the mortality.

Nitride Formation on Titanium under Irradiation of Intense Pulsed Ion Beam

Nitriding of titanium was achieved in a vacuum of ~2×10-2 Pa by applying intense pulsed ion beam (IPIB) irradiation. Various phases including ‘pure’ nitrides (e.g. Ti2N, TiN) as well as carbonitrides (e.g. TiC0.3N0.7) were found on the IPIB-irradiated surfaces that depended on the ion beam intensity, shot number, and sample position with respect to the ion beam axis. It was found that the nitrides were preferably produced at moderate beam intensity by which the nitriding depth increased greatly with multi-shot irradiation. No or less nitrides were produced under irradiation of very high intensity or less number of shots. It is demonstrated that the IPIB nitriding process is very efficient even in vacuum where the residual N2 can readily react with melted Ti surfaces under IPIB irradiation. The origin of incorporated C in the nitrides is mainly attributed to the anode material of ion diode used in the IPIB apparatus.

Nodal downstaging predicts survival following induction chemotherapy for stage IIIA (N2) non-small cell lung cancer in CALGB protocol #8935

CALGB 8935 was a phase II protocol for mediastinoscopically staged IIIA (N2) non-small cell lung cancer. Induction cisplatin/vinblastine chemotherapy was followed by surgical resection, adjuvant cisplatin/vinblastine, and radiotherapy. We now evaluate the prognosis of pathologic nodes. Failure-free survival was calculated from a landmark 3 months after resection to account for heterogeneity in adjuvant therapy. Nine of 42 (21%) resected patients had no residual N2 disease. This subset of 9 had a median failure-free interval of 47.8 months from landmark, whereas the 33 patients (79%) with persistent N2 disease had a median failure-free survival of 8.2 months from landmark (P=0.01). Although 21/42 (50%) had an incomplete resection (positive highest resected node and/or margin), completeness of resection did not influence failure-free survival. There were 3 distant and no local recurrences among the N2 negative group, and 12 local recurrences among patients with residual N2 disease (P=0.041). These data suggest: (1) persistent N2 disease following induction chemotherapy is unfavorable; (2) patients downstaged to N2 negative may benefit from surgical resection; however, (3) 33% of N2 negative patients suffered disease relapse.

Five-year survival after sleeve pneumonectomy combined with the superior vena cava replacement for lung cancer

The authors report an excellent long-term survival after sleeve pneumonectomy combined with the superior vena cava (SVC) replacement for T4N2M0 non-small cell lung cancer. N2 disease was objectified by mediastinoscopy before an inductive treatment. After three cycles of platinum-paclitaxel combination a partial response was proved. Right pneumonectomy with ePTFE graft replacement of directly invaded SVC was performed. The carinal resection was forced intraoperatively, because of the positive resection margins of the right main bronchus. The direct invasion into SVC, residual N2 disease and definitive free resection margins were confirmed histologically. This patient has survived for 5 years after combined extended lung resection without any relapse; the SVC graft still remains functional.