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Robert J Korst

Publications and source records attributed to Robert J Korst.

At least 19 recordsLinked to original sources
PubMed2006

Long-term survival and recurrence in patients with resected non-small cell lung cancer 1 cm or less in size.

OBJECTIVE: With the widespread use of computed tomography and the emergence of screening programs, non-small cell lung cancer is increasingly detected in sizes 1 cm or less. We sought to examine the long-term survival and recurrence patterns after resection of these tumors. METHODS: We conducted a retrospective review over a 15-year period to identify patients with surgically resected non-small cell lung cancer measuring 1 cm or less. Medical records were reviewed, and survival data were analyzed by the Kaplan-Meier method. RESULTS: There were 83 patients (26 men, 57 women) with a median age of 67 years (range 43-88 years). Median tumor size was 0.90 cm. Lobectomy was performed in 71 patients, bilobectomy in 1, pneumonectomy in 1, segmentectomy in 5, and wedge resection in 5. Postoperative stage was IA in 67 patients, IB in 4, IIA in 1, IIB in 4, IIIA in 2, and IIIB in 5. Median follow-up was 31 months. There was 1 operative death (1.2%). In 5 (31.3%) of the 16 patients with non-IA disease, recurrent cancer developed after resection. No recurrences were observed in the 67 patients with stage IA disease. The 5- and 10-year overall survivals for the entire cohort were 86% and 72%, respectively, and the disease-specific survival was 91% at both time points. For patients with stage IA disease, 5- and 10-year survivals were 94% and 75%, respectively, and the disease-specific survival was 100% at both time points. CONCLUSION: Eighty-one percent of patients with resected non-small cell lung cancer measuring 1 cm or less had stage IA disease. After surgical resection, recurrence is rare and long-term survival is excellent.

Adult↗
PubMed2006

Accuracy of surveillance computed tomography in detecting recurrent or new primary lung cancer in patients with completely resected lung cancer.

BACKGROUND: To determine the eventual outcome of abnormalities detected on surveillance computed tomography (CT) in patients with previously resected nonsmall-cell lung cancer (NSCLC), and to assess the accuracy of CT when used by the thoracic surgeon, and to determine the characteristics of abnormalities on CT that correlate with the development of recurrent NSCLC. METHODS: A cohort of patients who had abnormal postoperative CT scans of the chest and upper abdomen in 2002 were followed up into 2005. Abnormalities consisted of pulmonary nodules, pleural effusions, or adenopathy. Data collected included recurrence patterns, the availability of previous scans for comparison, the interval between initial resection and the abnormal CT, nodule size, growth, and multiplicity, as well as progression of pleural effusions or adenopathy. RESULTS: In all, 105 scans in 92 patients were read as abnormal in 2002 by the radiologist. After further investigation or follow-up, or both, for a mean of 3.2 years, 78% of patients who had recurrent NSCLC had their site of first recurrence inside the chest. The negative predictive value of CT when used by the thoracic surgeon was 99%; however, the positive predictive value was only 53%. Abnormalities that correlated with the diagnosis of recurrent cancer included pulmonary nodules that either grew or were larger than 1 cm and pleural effusions that developed after the first postoperative year. CONCLUSIONS: Intrathoracic recurrent NSCLC was rarely missed by the surgeon utilizing surveillance CT, but a significant number of negative investigations were generated by its use. Characteristics of abnormal surveillance CT findings exist that correlate with the presence of malignancy.

Calcinosis↗
PubMed2006

Downstaging of T or N predicts long-term survival after preoperative chemotherapy and radical resection for esophageal carcinoma.

BACKGROUND: The purposes of this study were to determine the frequency of downstaging of T or N after neoadjuvant chemotherapy and radical resection in patients with carcinoma of the esophagus, and to evaluate the effect of tumor downstaging on survival. METHODS: A cohort of patients who underwent neoadjuvant chemotherapy followed by radical surgical resection for carcinoma of the esophagus was identified from a large, prospectively maintained, single-institution database of esophageal cancer patients. Patients were included if they had an accurate pretreatment clinical stage determined by the authors. Data collected included demographic data, the type of staging regimen, the chemotherapy agents used, clinical and pathologic data and stages, and survival data. Downstaging of T or N was determined by comparing the pretreatment, clinical stage to the postresection, pathologic stage. Downstaging was then evaluated in the context of survival. RESULTS: Seventy-seven patients were identified who had an accurate clinical stage assigned and underwent neoadjuvant chemotherapy followed by radical resection. Patients were clinically staged before treatment using computed tomography, positron emission tomography, and endoscopic ultrasonography. Thirty-seven patients (48%) experienced downstaging of T or N, and this group of patients had a 5-year overall actuarial survival of 63%, compared with 23% for those who were not downstaged (p = 0.002). Three patients had a complete pathologic response to neoadjuvant chemotherapy (3.9%). CONCLUSIONS: Patients who experience downstaging of T or N after neoadjuvant chemotherapy and radical surgical resection for esophageal carcinoma have a significantly higher survival rate compared with those who do not experience downstaging. This enhanced survival is comparable to survival rates reported in complete pathologic responders after neoadjuvant chemoradiation.

Adult↗
PubMed2005

Surgical resection for esophageal carcinoma: speaking the language.

The terminology used to describe esophagectomy for carcinoma can be confusing, even for specialists in gastrointestinal disease. As a result, specific terms are often used out of their intended context. To simplify the nomenclature, two points regarding procedures for surgical resection of the esophagus are critical: the extent of resection (radical vs standard) and the operative approach (choice of incisions). It is important to understand that the radicality of the resection may have little to do with the operative approach, with the exception of esophagectomy without thoracotomy (transhiatal esophagectomy), which mandates the performance of a standard or non-radical resection. Esophagectomy has emerged as the standard curative treatment option for patients with esophageal carcinoma; however, unlike the surgical resection of other types of solid tumors, many different surgical options and/or approaches exist for these patients. This heterogeneity of care may result from the fact that the esophagus is accessible through more than one body cavity (left hemithorax, right hemithorax, abdomen). In addition, and partially as a result of its accessibility, different types of surgical specialists harbor this operation in their armamentarium, including general surgeons, thoracic surgeons, and surgical oncologists. Despite this enthusiasm amongst surgeons, little consensus exists as to which option is most oncologically sound. Further, the details of the various surgical approaches and procedures for resection of the esophagus are often difficult to comprehend, even for specialists in gastrointestinal disease, with much of the relevant terminology used out of its intended context. To facilitate the understanding of the surgical options for esophageal carcinoma, it is useful to view the operation from two angles: the extent of resection (Aradical@ vs Astandard@) and the operative approach (choice of incisions).

Esophageal Neoplasms↗
PubMed2005

Surgical resection for residual N2 disease after induction chemotherapy.

BACKGROUND: Induction therapy is a common treatment modality for patients with stage IIIA non-small cell lung cancer (NSCLC). Although mediastinal nodal downstaging after induction therapy is generally considered a favorable prognostic feature, the benefit of resection in the presence of residual N2 disease is controversial. In this study we analyzed our experience with resection after induction chemotherapy in patients with residual N2 disease to more precisely define the role of surgical resection in this group of patients. METHODS: In this retrospective analysis, we reviewed the records of 78 patients with N2 disease who received induction therapy with preoperative intent between 1990 and 2003. All patients had potentially resectable disease. Survival analysis was performed using the Kaplan-Meier method. A Cox proportional hazards regression model was used to evaluate multiple prognostic factors. RESULTS: There were 78 patients (39 men) with a median age of 64 years. Sixty had nonsquamous histology. Resection was performed in 52 patients (47 R0). Hospital mortality was 1.9%. A complete pathologic response occurred in 2 of 52 (3.8%) patients and 19 of 52 (36%) patients had no residual N2 disease. Overall 5-year survival for resected patients was 23%. Overall 5-year survival was 30% for N0-N1 patients and 19% for those with residual N2 disease. Multivariable analysis identified clinical response to therapy (p = 0.0007) and histology (p = 0.01), but not residual N2 disease (p = 0.65), as important prognostic variables. CONCLUSIONS: Surgical resection may be a viable option for patients with residual N2 disease after induction chemotherapy, provided an R0 resection can be performed.

Adult↗
PubMed2005

Cost effectiveness of chest computed tomography after lung cancer resection: a decision analysis model.

BACKGROUND: Postoperative surveillance with chest computed tomography (CT) is often performed in patients who have undergone resection of non-small cell lung cancer (NSCLC), despite lack of supporting data. This study involves the creation of a decision analysis model to predict the cost effectiveness of postoperative surveillance CT. METHODS: A decision analysis model was created in which a hypothetical cohort of patients underwent annual chest CT after resection of a stage IA NSCLC. The incidence of second primary lung cancer (SPLC), sensitivity and specificity of CT, as well as survival after resection of initial primary and SPLC were derived from published literature. The cost of CT and other procedures prompted by a positive finding on CT was calculated from Medicare reimbursement schedules. Cost effectiveness was defined as a cost of less than 60,000 dollars per quality-adjusted life-year gained in the cohort under surveillance compared with controls under no surveillance. RESULTS: In the initial (base case) analysis, the cost of surveillance CT was 47,676 dollars per quality-adjusted life-year gained, implying cost effectiveness. However, factors that rendered surveillance CT cost ineffective were (1) age at entry into the surveillance program greater than 65 years, (2) cost of CT greater than 700 dollars, (3) incidence of SPLC of less than 1.6% per patient per year of follow-up, and (4) a false positive rate of surveillance CT greater than 14%. CONCLUSIONS: Surveillance with postoperative CT may be a cost-effective intervention to detect SPLC in selected patients with previously resected stage IA NSCLC.

Adult↗
PubMed2005

Intrathoracic manifestations of cervical anastomotic leaks after transthoracic esophagectomy for carcinoma.

BACKGROUND: A purported advantage of the cervical esophagogastrostomy is that drainage is easily accomplished should anastomotic dehiscence occur after esophagectomy. However, support for this statement stems mainly from studies of transhiatal esophagectomy, with little data published when a transthoracic resection is performed. The purpose of this study was to determine the incidence and clinical significance of intrathoracic manifestations of cervical anastomotic leaks after transthoracic esophagectomy. METHODS: A retrospective analysis of a prospectively collected esophageal carcinoma database (1988 to 2004) was performed at a single institution. Operative and pathologic data were collected, as well as details concerning the incidence, clinical features, treatment, and outcome of anastomotic leaks. Patients with leaks were further analyzed on the basis of whether or not intrathoracic manifestations of anastomotic leakage were present. RESULTS: Two hundred, forty-two patients underwent transthoracic esophagectomy with a cervical anastomosis during the study period. There were 27 (11.1%) anastomotic leaks. Of these, 14 patients (52%) had intrathoracic manifestations of their cervical leaks, with empyema being the most common. Patients with intrathoracic spread of sepsis had significantly longer in-hospital (p < 0.001) and anastomotic healing times (p < 0.05) and required more drainage procedures (including reoperation; p < 0.005) than those with leaks confined to the neck. However, no difference in operative mortality or long-term survival was appreciated. CONCLUSIONS: Intrathoracic manifestations of cervical anastomotic leaks are more common after transthoracic esophagectomy than what has historically been reported for transhiatal esophagectomy. This discrepancy may be due to anatomical or technical differences, or both, between the two procedures. Early diagnosis and aggressive drainage are necessary for achieving a favorable outcome.

Abscess↗
PubMed2005

Surveillance computed tomography after complete resection for non-small cell lung cancer: results and costs.

OBJECTIVE: We sought to determine the prevalence of defined abnormalities on surveillance computed tomography after complete resection for non-small cell lung cancer, as well as the nature and cost of further testing prompted by these abnormalities. We also sought to determine whether resectable metachronous lung cancer can be detected with surveillance scans. METHODS: A retrospective analysis was performed of all patients who presented for follow-up in 2002 after complete resection for non-small cell lung cancer. Data collected included demographics, clinicopathologic features of the initial lung cancer, the number and results of surveillance computed tomographic scans performed in 2002, the attending surgeons' impressions of the surveillance scans, the nature of any abnormalities and further diagnostic testing prompted by these abnormalities, and the nature of any lung cancer detected on surveillance scans, as well as the treatment rendered. The cost of surveillance scanning and associated diagnostics was computed by using Medicare fee schedules. RESULTS: Two hundred thirteen patients met the criteria for inclusion in the study cohort. One hundred sixty-eight surveillance scans were performed in 140 of these patients. One hundred five scans were interpreted as abnormal by the radiologist with regard to pulmonary nodules, adenopathy, or pleural fluid, but the surgeon was suspicious for recurrent or new primary lung cancer in only 32 of 105 scans. Further workup revealed recurrent or new primary lung cancer in 16 of 32 patients, with 6 undergoing resection for localized disease. The cost of the surveillance scans and associated care in the study cohort were 16.6% higher than the cost of care in a hypothetically identical cohort not subjected to surveillance scanning. CONCLUSIONS: Surveillance computed tomography is frequently abnormal after complete resection for non-small cell lung cancer; however, the majority of these abnormalities are not clinically suspicious. Resectable metachronous lung cancer is detected by using surveillance scanning; however, the use of this modality can be associated with increased cost.

Aged↗
PubMed2005

Positron emission tomographic scanning in the diagnosis and staging of non-small cell lung cancer 2 cm in size or less.

OBJECTIVE: Several studies have suggested that positron emission tomography is more accurate than computed tomography for the staging of non-small cell lung cancer and can reduce the rate of unnecessary thoracotomy in patients with potentially resectable disease. However, there are few data on the utility of positron emission tomography in the diagnosis of patients with tumors of 2 cm or less in size. METHODS: Patients with cT1/cT2 tumors of 2 cm or less in size were retrospectively reviewed. All had a computed tomographic scan, as well as a positron emission tomographic scan on a dedicated scanner, with a standard uptake value reported. A standard uptake value of 2.5 g/mL or greater was considered positive. The results of computed tomography and positron emission tomography were correlated with pathologic results after either resection (n = 60) or mediastinoscopy (n = 4). RESULTS: Sixty-four patients (38 women; mean age, 66 years) had a mean tumor size of 1.4 cm (range, 0.7-2.0 cm). Forty-three patients had adenocarcinoma, 13 had adenocarcinoma-bronchioloalveolar carcinoma, 5 had squamous cell carcinoma, and 3 had other tumor types. Twenty-nine (45%) tumors had negative positron emission tomographic results. Both tumor size (>1 cm vs < or =1 cm) and cell type (adenocarcinoma-bronchioloalveolar carcinoma vs all other cell types) were significant predictors of positron emission tomography uptake in the primary tumor (P = .05 and .01, respectively). Nodal metastases were detected pathologically in 11 (17%) patients (5 N1 and 6 N2). Positron emission tomographic sensitivity and specificity for nodal metastases were only 45% and 89%, respectively. There was no statistically demonstrable survival difference between positron emission tomography-positive and positron emission tomography-negative tumors (3-year survival of 87% vs 100%, respectively). CONCLUSION: Positron emission tomographic scanning has no demonstrable benefit in the diagnosis, staging, or prognosis of patients with tumors of 2 cm or less in size.

Aged↗
PubMed2005

Tumor size is a determinant of stage distribution in t1 non-small cell lung cancer.

STUDY OBJECTIVE: Despite renewed interest in early detection of lung cancer, the relationship between tumor size and survival remains controversial. The objective of this study was to evaluate the relationship between size and stage in patients with T1 (< or = 3.0 cm) non-small cell lung cancer (NSCLC). PATIENTS AND METHODS: A retrospective review of a lung cancer database from 1995 to 2003 identified 503 patients with completely resected invasive NSCLC with tumors < or = 3 cm. All clinical and pathologic characteristics were recorded. Univariate associations between nodal status and other prognostic factors were explored by chi2 and t tests. The independent effect of tumor size > 2 cm vs < or = 2 cm on the risk of nodal disease was analyzed using a logistic regression model. RESULTS: Of the 503 patients, 324 patients (64.4%) had stage IA disease, 52 patients (10.3%) had stage IB disease, 37 patients (7.4%) had stage IIA disease, 15 patients (3%) had stage IIB disease, 43 patients (8.6%) had stage IIIA disease, 24 patients (4.8%) had stage IIIB disease, and 8 patients (1.6%) had stage IV disease. One hundred patients (19.9%) had nodal metastases. The mean (+/- SD) tumor size of cases without nodal disease was 1.90 +/- 0.67 cm, compared to 2.18 +/- 0.69 cm for node-positive tumors (p = 0.0003; 95% confidence interval [CI] for mean difference, 0.13 to 0.43). Forty-eight of 308 patients (15.6%) with smaller carcinomas (< or = 2.0 cm) compared to 52 of 195 patients (26.7%) with carcinomas > 2.0 cm had nodal metastases (p = 0.002). Exploratory multivariate analysis revealed that only tumor size (< or = 2.0 cm [referent] vs > 2.0 cm) affected nodal status and thus stage (adjusted odds ratio, 2.0; 95% CI, 1.3 to 3.1; p = 0.002). CONCLUSIONS: Primary invasive NSCLC > 2.0 cm was twice as likely to have nodal metastases than carcinomas < or = 2.0 cm. Our results suggest that in lung cancer smaller lesions may represent earlier stage disease. These results also suggest the need for further subclassification by tumor size within the current International Union Against Cancer/American Joint Committee on Cancer stage I, with tumors < 2 cm in size contained in a separate substage. This refinement may help to better clarify which patients might benefit from novel adjuvant or neoadjuvant therapeutic interventions.

Adult↗
PubMed2004

A simple solution for management of the postpneumonectomy empyema cavity.

Postpneumonectomy bronchopleural fistula with empyema is a difficult problem. Once the fistula is healed, successful closure of the pleural space is associated with varying degrees of success, as well as the potential for major reconstructive surgery. My colleagues and I describe a simple approach for the definitive management of the open pleural space involving split-thickness skin grafts to marsupialize the pleural cavity.

Absorbable Implants↗
PubMed2004

Effect of inhibition of multiple steps of angiogenesis in syngeneic murine pleural mesothelioma.

BACKGROUND: Angiogenesis is a multistep process in which the endothelial cell plays a pivotal role. We hypothesized that the combination of two antiangiogenic agents with distinct mechanisms of action would more effectively inhibit tumor growth than either agent alone in a murine mesothelioma model. METHODS: A syngeneic murine mesothelioma flank tumor model (AB-12) was established in BALB/c mice. Separate adenovirus vectors expressing the cDNAs for human pigment epithelium-derived factor (AdPEDF) and a soluble form of the human vascular endothelial growth factor receptor-1 (Adsflt-1) were administered intratumorally. End points measured included tumor size, animal survival, and microvessel density using CD31 immunohistochemistry. An orthotopic model of mesothelioma was established by implanting AB-12 cells into the murine pleural cavity. Simultaneously, AdPEDF and Adsflt-1 were instilled intrapleurally and tumor burden and survival were recorded. The development of pulmonary emphysema was also assessed by calculating the mean linear intercept (a measure of interalveolar septal distance) in histologic lung sections from tumor-free mice after vector administration. RESULTS: In the flank tumor model, the combination of AdPEDF and Adsflt-1 inhibited tumor growth, prolonged survival, and decreased microvessel density more profoundly compared with either AdPEDF or Adsflt-1 alone. In the orthotopic model, the combination was also more effective in prolonging survival. Intrapleural AdPEDF or Adsflt-1 did not increase the mean linear intercept compared with controls in tumor-free mice. CONCLUSIONS: In this murine model, inhibiting multiple mechanisms of angiogenesis using two agents is a more effective antineoplastic strategy than using either agent alone. In addition, instillation of antiangiogenic gene transfer vectors into the pleural space does not result in histologic evidence of pulmonary emphysema.

Angiogenesis Inhibitors↗
PubMed2004

Augmenting major histocompatibility complex class I expression by murine tumors in vivo enhances antitumor immunity induced by an active immunotherapy strategy.

OBJECTIVE: Tumors down-regulate major histocompatibility complex class I expression, escaping recognition by the cellular immune response. We hypothesized that augmentation of tumor cell class I expression by interferon-gamma would enhance the cellular antitumor immune response and cure rate of an active immunotherapy strategy. METHODS: B16.F10 tumor cells were exposed to interferon-gamma in culture, and class I expression was quantified using flow cytometry. Syngeneic mice bearing established tumors were injected with interferon-gamma (5000 U, intraperitoneal), and class I expression was assessed using immunohistochemistry. Tumor-specific cytotoxic T lymphocytes were induced in mice by an intratumoral injection of AdCD40L (5 x 10(10) particles), an adenovirus gene transfer vector-based immunotherapy strategy previously demonstrated to augment cellular antitumor immunity. A conjugate-formation assay and the enzyme-linked immunospot assay were used to evaluate the binding and activation of cytotoxic T lymphocytes, respectively. Interferon-gamma was administered to tumor-bearing mice concomitantly with intratumoral AdCD40L. End points measured included the frequencies of cytotoxic T lymphocytes using the enzyme-linked immunospot assay, tumor size, and mouse survival. The role of class I expression was further evaluated by monoclonal antibody blockade in both in vitro and in vivo experiments. RESULTS: B16.F10 cells exposed to interferon-gamma expressed significantly more class I, both in vitro and in vivo, and were able to bind to and activate cytotoxic T lymphocytes more efficiently than untreated cells. Cytotoxic T-lymphocyte frequencies, tumor regression, and the cure rate induced by AdCD40L were augmented by the addition of a single dose of interferon-gamma in tumor-bearing mice. These in vitro and in vivo effects of interferon-gamma were attenuated by class I monoclonal antibody blockade. CONCLUSIONS: Up-regulation of class I expression using interferon-gamma enhances the cellular antitumor immune response and cure rate of AdCD40L, an active immunotherapy strategy. This approach may be useful for human tumors that lack class I expression.

Animals↗
PubMed2004

Intrapleural administration of a serotype 5 adeno-associated virus coding for alpha1-antitrypsin mediates persistent, high lung and serum levels of alpha1-antitrypsin.

alpha1-Antitrypsin (alpha1AT) is a serine proteinase inhibitor that protects the lung from degradation by neutrophil proteases. In alpha1AT deficiency, an autosomal recessive disorder resulting from mutations in the alpha1AT (approved symbol SERPINA1) gene, serum alpha1AT levels of < 570 microg/ml are associated with development of emphysema. Adeno-associated virus (AAV) serotype 2 (AAV2) vectors expressing alpha1AT administered intramuscularly or intravenously mediate sustained serum levels of alpha1AT in experimental animals. Since the lung is only 2% of the body weight, AAV vector delivery to the muscle or liver is inefficient, as most of the alpha1AT does not reach the lung. The present study evaluates AAV2- and AAV5-mediated delivery of human alpha1AT (halpha1AT) to C57BL/6 mice using the intrapleural space as a platform for local production of alpha1AT. Intrapleural administration of either an AAV5-halpha1AT or an AAV2-halpha1AT vector achieves higher lung and serum levels of alpha1AT than intramuscular delivery. AAV5-mediated serum and lung alpha1AT levels were 10-fold higher than those achieved by AAV2 delivery via either route. The diaphragm, lung, and heart are the major sites of transgene expression following intrapleural administration of an AAV5 reporter vector. At 40 weeks postadministration, intrapleural administration of the AAV5-halpha1AT vector mediated serum alpha1AT levels of 900 +/- 50 microg/ml, 1.6-fold higher than the accepted therapeutic level of 570 microg/ml. In the context that the pleura is a safe site for administration, intrapleural administration using AAV5 vectors may represent an attractive gene therapy strategy for alpha1AT deficiency in humans.

Animals↗
PubMed2004

Positron emission tomography scanning poorly predicts response to preoperative chemotherapy in non-small cell lung cancer.

BACKGROUND: The ability to accurately predict pathologic response to preoperative chemotherapy may have a significant impact on the treatment strategy for non-small cell lung cancer (NSCLC). The purpose of this study was to examine the accuracy of positron emission tomography (PET) scanning in predicting the pathologic response to preoperative chemotherapy in the primary tumor and draining lymph nodes. METHODS: A total of 25 patients were enrolled in two separate phase II trials investigating induction chemotherapy for NSCLC. All patients underwent pre-treatment and post-treatment PET scans followed by surgical resection. A significant PET scan response was defined as a reduction in the standard uptake value by 50% or more. We defined a major pathologic response as either no disease or microscopic disease only in the primary tumor. The percentage change in standard uptake value was then calculated and correlated with pathologic response in the primary tumor. In addition, the presence or absence of nodal metastases as determined by the postchemotherapy PET scan was compared with final pathologic nodal stage. RESULTS: The positive and negative predictive values for PET detection of major pathologic response in the primary tumor were 43% and 100%, respectively. Positron emission tomography did not accurately predict nodal status in 52% of patients. The positive and negative predictive values of PET to detect node-positive disease were 73% and 64%, respectively. For N2 disease the positive predictive value of PET scans was less than 20%. CONCLUSIONS: Positron emission tomography scanning does not reliably predict pathologic response to preoperative chemotherapy in NSCLC in either the primary tumor or the draining lymph nodes.

Carcinoma, Non-Small-Cell Lung↗
PubMed2004

Imaging for esophageal tumors.

Carcinoma of the esophagus must be staged accurately before a treatment plan is initiated, and imaging studies play a major role in this process. Imaging for esophageal carcinoma involves evaluation of the locoregional extent of the tumor and distant metastatic disease. A CT scan of the chest and upper abdomen provides the most comprehensive information about esophageal carcinoma; however, accurate assessment of the depth of primary tumor invasion and lymph node status remains limited, even with newer generation scanners. Endoscopic US is a user-dependent modality that has emerged as a highly accurate technique in experienced hands to evaluate the depth of penetration of esophageal tumors, but its ability to detect metastatic lymph nodes is less impressive, leading some investigators to perform confirmatory needle aspiration of suspicious nodes. FDG-PET is a physiologic examination that is the subject of intense investigation in patients who have esophageal carcinoma. Preliminary studies have suggested that FDG-PET can detect otherwise radiographically occult distant metastatic disease in these patients, and changes in FDG uptake might correlate with the response to therapy. These findings need to be confirmed in larger studies. More sophisticated technology continues to be developed for imaging carcinoma of the esophagus, which will more than likely affect staging algorithms in the future.

Contrast Media↗
PubMed2004

Surgical resection for lung cancer in the octogenarian.

BACKGROUND: As the US population ages, clinicians are increasingly confronted with octogenarians with resectable non-small cell lung cancer. Earlier reports documented substantial risk for surgical resection in this age group. METHODS: We reviewed our surgical experience in octogenarians who underwent curative resection from 1990 to 2003. RESULTS: Sixty-one patients underwent resection: 46 lobectomies, 6 segmentectomies, 5 wedge resections, and 4 pneumonectomies. There was one perioperative death (1.6%). The overall complication rate was 38% with a major complication rate of 13%. The average postoperative length of stay was 7 days. Overall 5-year survival was 38%, and 82% for stage IA patients. Patients with more advanced disease had a significantly worse survival. CONCLUSIONS: Appropriately selected octogenarians with early stage disease should be offered anatomic surgical resection for cure. These patients can anticipate a long-term survival, and should not be denied an operation on the basis of age alone.

Aged↗