Prospective study of 445 lung carcinomas with mediastinal lymph node metastases.
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Biomedical subjects
Publications and source records attributed to N Martini.
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This chapter presents an overview of the current concepts in the diagnosis and treatment of carcinoma of the lung. Emphasis is placed on the increasing incidence, methods of detection, and diagnosis, and on the importance of staging before treatment. Best treatment recommendations are detailed by stage of disease and by presentation, with supporting evidence from institutional experience and the literature. Although surgical treatment is emphasized, other forms of management appropriate to the stage of the disease are included. The use of intraoperative irradiation to supplement surgery in the control of localized lung carcinoma is also described.
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From 1960 to 1977, 663 resections for pulmonary metastases were performed in 448 patients, 202 with a sarcoma and 246 with a carcinoma. The majority of the patients (70%) had wedge resection or segmentectomy. Operative mortality was 1.0% (7 patients in 663 thoracotomies). With the increased effectiveness of chemotherapy in some specific areas--osteogenic sarcoma and carcinoma of the testis, breast, and colon--the role of surgery is changing. Surgery is now indicated to establish the histology of a solitary lesion, resect metastases unresponsive to chemotherapy, and to reclassify lesions that stabilize but do not disappear totally with chemotherapy.
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A retrospective review and evaluation of systemic cephalosporin therapy in 15 hospitals of various italian Regions was conducted. In any hospital the Pharmacy Service has examined a random sample of medical records of hospitalized patients exposed to cephalosporin therapy over a twelve month period (January-December 1976). In the years 1974-1976 were also examined the consumption and cost for Penicillin G, Ampicillin and Cephalosporins. A standard protocol and methodology for homogeneous collection of data was developed. On the base of collected data, the patterns of choice, the rational and irrational use, the role of cephalosporins in hospital practice are discussed.
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Between 1966 and 1976, 34 patients had 42 thoracotomies for resection of recurrent or residual metastatic germinal cell carcinoma primary in the testes in addition to chemotherapy. Of the 34, 18 (53%) are alive and well free of evidence of disease from 4 months to 104 months. Systemic chemotherapy of this group of tumors has improved markedly and many patients are now rendered free of disease and are potentially cured. In some however, an occasional pulmonary nodule did not completely respond or recurred after complete disappearance. The surgery was done to remove the last evidence of disease, and to establish the histology of the metastases.
Resection of pulmonary metastases in osteogenic sarcoma has been reported by us to result in a five-year survival rate of 27 percent. A later report of surgical management of pulmonary metastases from all types of sarcomas showed a five-year survival rate of 26%. This report reviews the experience with 188 patients treated surgically for pulmonary metastasis from a variety of carcinomas, demonstrating that a similar rate of survival is obtainable by surgical excision of these metastases. A total of 188 patients underwent 242 thoractomies for metastatic pulmonary carcinomas. The most frequent sites of origin were the colon, melanoma, breast, and testicular carcinoma. Surgical treatment of these metastases is justified when the following criteria are adhered to: (1) primary site controlled or controllable; (2) no extrapulmonary metastatic sites demonstrable; (3) good surgical risk; and (4) no effective treatment available by nonsurgical means.
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A study of the feasibility of using specially trained radiologic technologists to screen chest radiographs was undertaken as part of an early lung cancer detection program. In their initial examination, 8,000 men had posteroanterior and lateral chest films which were prepared and evaluated by two specially trained technologists prior to interpretation by a radiologist. The technologists' accuracy in screening was subsequently assessed by comparison with the radiologist's interpretation and with clinical follow-up information. There were differences in the level of suspicion of the two technologists, but both were effective in selecting a subset of the screened population that contained the men with radiologically identifiable lung cancer.
The results of surgical treatment in 470 patients with carcinoma of the lung were analyzed by stage of disease and by histologic cell type. The need for accurate staging in selecting treatment and in prognosis for survival is emphasized. Surgical resection improved survival time in all categories of patients by effective local control of the lesion. The over-all five year survival rate was 14 per cent. Early stages of carcinoma of the lung were more amenable to surgical cure. The highest five year survival rate was 43 per cent and was observed in resected Stage I carcinomas. Only 29 per cent of this group died of the disease and 28 per cent, of other causes. The continued high incidence of death due to distant metastases underlines the necessity of combining operation with other forms of treatment.