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At least 181 records · Page 10Linked to original sources
PubMed1998

Cerebral blood flow and tissue oxygenation monitoring during aneurysm surgery.

Regional cerebral blood flow may be compromised during aneurysm surgery. This may occur during vessel occlusion by temporary clips or result from malposition of the definitive aneurysm clip. Post-operative cerebral vasospasm may also compromise cerebral blood flow and is an important cause of morbidity. This study addresses the need for a sensitive indicator of compromised cerebral function during aneurysm surgery by measuring brain tissue oxygenation and laser Doppler flow. Four patients were studied, all of whom had ruptured middle cerebral artery aneurysms. Brain tissue oxygenation measurements were made with a closed polarographic sensor placed in the ipsilateral cerebral hemisphere to the aneurysm. A laser Doppler flow probe and intracranial pressure monitor were similarly placed. The data were simultaneously processed using multimodality recording monitoring. The monitoring was continued during the post-operative period and totalled over 190 hours. Data were analysed as specific events and as trends. Initial tissue oxygen levels were low but improved in all cases as the intracranial pressure was reduced. This effect was independent of the cerebral perfusion pressure. Laser Doppler flow provided an indicator of compromised brain function and tissue oxygenation an indicator of established ischemia.

Aged↗
PubMed2004

Stereotactic radiation treatment planning and follow-up studies involving fused multimodality imaging.

OBJECT: Innovative new software solutions may enable image fusion to produce the desired data superposition for precise target definition and follow-up studies in radiosurgery/stereotactic radiotherapy in patients with intracranial lesions. The aim is to integrate the anatomical and functional information completely into the radiation treatment planning and to achieve an exact comparison for follow-up examinations. Special conditions and advantages of BrainLAB's fully automatic image fusion system are evaluated and described for this purpose. METHODS: In 458 patients, the radiation treatment planning and some follow-up studies were performed using an automatic image fusion technique involving the use of different imaging modalities. Each fusion was visually checked and corrected as necessary. The computerized tomography (CT) scans for radiation treatment planning (slice thickness 1.25 mm), as well as stereotactic angiography for arteriovenous malformations, were acquired using head fixation with stereotactic arc or, in the case of stereotactic radiotherapy, with a relocatable stereotactic mask. Different magnetic resonance (MR) imaging sequences (T1, T2, and fluid-attenuated inversion-recovery images) and positron emission tomography (PET) scans were obtained without head fixation. Fusion results and the effects on radiation treatment planning and follow-up studies were analyzed. The precision level of the results of the automatic fusion depended primarily on the image quality, especially the slice thickness and the field homogeneity when using MR images, as well as on patient movement during data acquisition. Fully automated image fusion of different MR, CT, and PET studies was performed for each patient. Only in a few cases was it necessary to correct the fusion manually after visual evaluation. These corrections were minor and did not materially affect treatment planning. High-quality fusion of thin slices of a region of interest with a complete head data set could be performed easily. The target volume for radiation treatment planning could be accurately delineated using multimodal information provided by CT, MR, angiography, and PET studies. The fusion of follow-up image data sets yielded results that could be successfully compared and quantitatively evaluated. CONCLUSIONS: Depending on the quality of the originally acquired image, automated image fusion can be a very valuable tool, allowing for fast (approximately 1-2 minute) and precise fusion of all relevant data sets. Fused multimodality imaging improves the target volume definition for radiation treatment planning. High-quality follow-up image data sets should be acquired for image fusion to provide exactly comparable slices and volumetric results that will contribute to quality contol.

Adult↗
PubMed1998

Multimodality treatment including early high-dose chemotherapy with peripheral blood stem cell transplantation in limited-disease small cell lung cancer.

Combined-modality treatment for limited-disease small cell lung cancer using conventional chemotherapy and chest irradiation achieves high response rates, but most patients relapse over a period of 12 to 16 months. To improve current results, we performed a phase II trial including high-dose chemotherapy and peripheral blood progenitor cell transplantation (PBPCT) as part of an early intensification strategy after two cycles of induction therapy. Moreover, to reduce the risk of local recurrence, the protocol included surgical resection in stages I to IIIA patients as well as chest irradiation. Between January 1991 and July 1994, 16 consecutive patients (median age, 50 years; age range, 30 to 59 years) were treated in this single-center trial. The patients received two cycles of conventional chemotherapy consisting of etoposide 500 mg/m2, ifosfamide 4 g/m2, cisplatin 50 mg/m2, and epirubicin 50 mg/m2 plus granulocyte colony-stimulating factor 5 microg/kg at a 3-week interval, followed by PBPC collection and subsequent high-dose etoposide 1,500 mg/m2, ifosfamide 12 g/m2, carboplatin 750 mg/m2, and epirubicin 150 mg/m2 with PBPCT. The duration of the entire chemotherapy program was 9 weeks. Six of 10 patients in stages I to IIIA and one of six patients in stage IIIB received neoadjuvant or adjuvant surgery before high-dose chemotherapy, followed by thoracic (50 Gy) and prophylactic (30 Gy) cranial irradiation. Hematopoietic reconstitution after high-dose chemotherapy occurred within 11 days (range, 9 to 17 days) for both neutrophils (>0.5 x 10(9)/L) and platelets (>20 x 10(9)/L). Oral mucositis (World Health Organization grade 2 to 4) was the predominant nonhematologic toxicity, which was observed in 12 of 16 patients. One patient developed neutropenic septicemia with fatal multiorgan failure. At a median follow-up of 44 months (range, 32 to 77 months) after PBPCT, nine patients are alive and well, resulting in a disease-free and overall survival rate of 56.3% +/- 12.4%. The median overall survival has not yet been achieved. None of the patients who had surgery relapsed or died after therapy. All relapses occurred within the first 12 months after PBPCT. Patients in stages I to IIIA (10 patients) had a 70% +/- 14% overall survival rate at 4 years, while patients in stage IIIB (six patients) had a 33% +/- 19% survival rate at 4 years, with a median survival of 17 months posttransplant. These data demonstrate that a multimodality treatment including early high-dose chemotherapy with PBPCT may lead to a prolonged disease-free survival in the majority of patients. A randomized phase III study has now been initiated to prospectively investigate the role of high-dose chemotherapy, surgery, and chest irradiation in the multidisciplinary approach to limited-disease small cell lung cancer.

Adult↗
PubMed1984

Serial evoked potential studies in patients with definite multiple sclerosis. Clinical relevance.

Twelve patients with clinically definite multiple sclerosis were examined both clinically and electrophysiologically at repeated intervals over one year to determine the clinical relevance of data obtained by serial multimodality evoked potential studies. We frequently found a disparity between the clinical and electrophysiologic changes, and also an excessive variability between test sessions of the responses to stimulation of a clinically involved afferent pathway even when the clinical deficit was stable. Our findings indicate that though evoked potential studies may provide information of diagnostic relevance, their role in monitoring disease progression has not been established.

Adult↗
PubMed1995

Further characterization of the plasma lipoprotein(a) distribution.

The plasma lipoprotein (a) [Lp(a)] distribution in caucasians is heavily skewed to the right, with evidence of bimodality. As there is a well-described inverse relationship between apolipoprotein(a) [apo(a)] size and Lp(a) concentration, it is likely that the presence of multiple apo(a) isoforms of differing frequency has a significant impact on the final distribution of Lp(a) concentrations. We have previously described an immunoblot method for examining the relationship between apolipoprotein(a) [apo(a)] size and lipoprotein(a) [Lp(a)] mass among samples heterozygous for apo(a) size, thus eliminating confounding by null or undetected apo(a) isoforms. In the present study, this method has been applied to examine the plasma Lp(a) distribution, independent of the effects of apo(a) isoform size and frequency. Seventy subjects heterozygous for apo(a) size were studied. To take into account the inverse relationship (P < 0.001) between apo(a) isoform size and Lp(a) concentration, Lp(a) data associated with each apo(a) isoform were normalized as multiples of the median Lp(a) concentration for that isoform. These apo(a) isoform-independent Lp(a) data demonstrated a strikingly multimodal distribution, with five major peaks. The relative frequencies of Lp(a) peaks 1-5 were 17.1%, 15.0%, 35.7%, 23.6%, and 8.6%, and associated median Lp(a) concentrations were 1.0, 6.2, 15.0, 21.8, and 39.6 mg/dL, respectively. Multivariate analysis demonstrated that apo(a) isoform size accounted for 23% and isoform-independent Lp(a) peaks for 59.5% of the variation in Lp(a) concentration. Further investigation of the characteristics of the apo(a) isoform-independent Lp(a) distribution is warranted.

Adult↗
PubMed1995

Genetic basis for multimodal relationship between apolipoprotein (a) size and lipoprotein (a) concentration in Mexican-Americans.

The reported general inverse relationship between apolipoprotein (a) (apo(a)) size and plasma lipoprotein (a) (Lp(a)) concentrations was further characterized using 927 samples taken from members of 42 Mexican-American families. When all samples were displayed in a scatter plot of apo(a) size versus natural log of Lp(a) concentration, the expected inverse relationship was observed (r2 = 0.24). However, the scatter plot revealed a multimodal pattern with at least two distinct modes of the inverse relationship between apo(a) size and Lp(a) concentration. Plots of 148 single-banded samples also showed the multimodal pattern, indicating that this pattern did not result from a difference between double- and single-banded samples. Also measured was the Lp(a) concentration associated with each of 508 apo(a) isoforms in samples from 254 double-banded phenotype individuals. These separated isoforms also showed the multimodal pattern. Using pedigree information, 29 different alleles were identified which were found in three or more family members. About 85% of variation in Lp(a) was explained by allele information, suggesting a genetic basis for the multimodal pattern. Thus, the data demonstrate at least two series of apo(a) alleles that have distinct relationships between apo(a) size and Lp(a) concentration.

Alleles↗
PubMed1994

Computer-assisted technologies in lung cancer diagnosis and staging.

A paradigm for digital image processing in radiological diagnosis and an appropriate algorithmic instrumentation toolset for the implementation of image processing methods on inexpensive computers and workstations are outlined briefly. Examples of computer-assisted technologies for lung cancer differential diagnosis are given that exhibit considerable increase in diagnostic accuracy. Multimodal image processing and data fusion in lung cancer diagnosis are discussed and a 'road map' for examining lung cancer patients is suggested on the basis of clinical experience in the use of different modalities for lung cancer staging.

Algorithms↗
PubMed2005

MRI-based surface-assisted parcellation of human cerebellar cortex: an anatomically specified method with estimate of reliability.

We revisit here a surface assisted parcellation (SAP) system of the human cerebellar cortex originally described in Makris, N., Hodge, S.M., Haselgrove, C., Kennedy, D.N., Dale, A., Fischl, B., Rosen, B.R., Harris, G., Caviness, V.S., Jr., Schmahmann, J.D., 2003. Human cerebellum: surface-assisted cortical parcellation and volumetry with magnetic resonance imaging. J Cogn Neurosci 15, 584-599. This system preserves the topographic and morphologic uniqueness of the individual cerebellum and allows for volumetric analysis and representation of multimodal structural and functional data on the cerebellar cortex. This methodology integrates features of automated routines of the program FreeSurfer as well as semi-automated and manual procedures of the program Cardviews to create 64 cerebellar parcellation units based on fissure information and anatomical landmarks of the cerebellar surface. Using this technique, we undertook the parcellation of ten cerebella by two independent raters. The reliability of the resulting parcellation units (64 total) was high, with an average Intraclass Correlation Coefficient (ICC) of 0.724 in the vermis and 0.853 in the hemispheres. Clusters of parcellation units were then created, based on lobar and connectivity data and functional hypotheses. These 36 clusters, when treated as anatomical units, had an average ICC of 0.933. Whereas the individual units provide a high level of detail and anatomical specificity, the clusters add flexibility to the analysis by providing higher reliability.

Algorithms↗
PubMed2006

A three-dimensional, histological and deformable atlas of the human basal ganglia. I. Atlas construction based on immunohistochemical and MRI data.

This paper describes the construction of an atlas of the human basal ganglia. The successive steps of the construction were as follows. First a postmortem specimen was subjected to a MRI acquisition prior to extraction of the brain from the skull. The brain was then cryosectioned (70 microm thickness). One section out of ten (80 sections) was Nissl-stained with cresyl violet, another series of 80 sections was immunostained for the calcium binding protein calbindin. Contours of basal ganglia nuclei including their calbindin-stained functional subdivisions, fiber bundles and ventricles (n=80 structures) were traced from histological sections and digitized. A novelty of this atlas is the MRI acquisition, which represents the core data element of the study. MRI was used for the coregistration of the atlas data and permitted, through multimodal (Nissl, calbindin, images of cryosectioning, T1 and T2 MRI) and 3D optimization, the production of anatomically and geometrically consistent 3D surfaces, which can be sliced through any desired orientation. The atlas MRI is also used for its deformation to provide accurate conformation to the MRI of living patients, thus adding information at the histological level to the patient's MRI volume. This latter aspect will be presented in a forthcoming paper.

Basal Ganglia↗
PubMed2002

Long-term prognostic significance of extent of rectal cancer response to preoperative radiation and chemotherapy.

OBJECTIVE: To determine whether selected clinicopathologic factors, including the extent of pathologic response to preoperative radiation and chemotherapy (RT +/- chemo), have an impact on long-term recurrence-free survival (RFS) in patients with locally advanced primary rectal cancer after optimal multimodality therapy. SUMMARY BACKGROUND DATA: Although complete pathologic response to preoperative RT +/- chemo has been detected in up to 30% of rectal cancers, its significance on long-term outcome has not been widely reported. Previous retrospective studies evaluating clinical outcome in patients with complete or near-complete pathologic response documented good prognosis in this population but were limited by median follow-up in the range of 2 to 3 years. METHODS: Sixty-nine patients with locally advanced (T(3-4) and/or N1) primary rectal cancer were prospectively identified. All were treated at one institution with preoperative RT to the pelvis (at least 4,500 cGy). Forty patients received concurrent preoperative 5-fluorouracil-based chemotherapy and 27 received both pre- and postoperative chemotherapy. Patients underwent resection 4 to 7 weeks after completion of RT. TNM stage, angiolymphatic or perineural invasion, and extent of response to preoperative RT +/- chemo were determined by pathologic evaluation. Adverse pathologic features were defined as the presence of angiolymphatic and/or perineural invasion. RFS at 5 years was determined by the Kaplan-Meier method. RESULTS: With a median follow-up of 69 months, 5-year RFS was 79%. RFS was significantly worse for patients with aggressive pathologic features and positive nodal status identified in the postirradiated surgical specimen. Risk ratios for RFS were 3.68 for the presence of aggressive pathologic features and 4.64 for node-positive rectal cancers. In patients with greater than 95% rectal cancer response to preoperative RT +/- chemo, only one patient has died as a consequence of cancer, another has died of an unrelated cause, and the remainder were free of disease with a minimum follow-up of 47 months. CONCLUSIONS: These data suggest that a marked response to preoperative RT +/- chemo may be associated with good long-term outcome but was not predictive of RFS. The presence of poor histopathologic features and positive nodal status are the most important prognostic indicators after neoadjuvant therapy.

Adult↗
PubMed1991

Open surgery assisted by the neuronavigator, a stereotactic, articulated, sensitive arm.

A new computed tomographic-stereotactic device that translates the operating point onto preoperative computed tomographic (CT) images, the Neuronavigator, has been developed. We have applied this system to various neurosurgical procedures to examine its usefulness. The system consists of a 6-joint sensing arm and a 16-bit personal computer. It projects the location of the arm tip onto a corresponding CT slice with a cursor that guides the surgeon toward the intracranial target during open surgery. The system also projects the location of the tip onto angiograms, and when used in conjunction with echography or a transcranial Doppler (TCD) flow meter, the surgeon's ability to navigate is enhanced. Sixty-eight patients underwent operation with the Neuronavigator. The navigation system worked as the core of a multimodal three-dimensional data base that proved to be useful during surgery. The maximum detection error was 2.5 mm, which was considered sufficient for open microsurgery. It also proved useful in designing the position of a craniotomy, in targeting deep-seated mass lesions, and in tracing the tumor edge, which had been identified on a CT scan. When the angiogram was combined with the navigator, it became easy to identify key vessels within a small operating field. The system was also combined with a TCD flow meter. This combination makes it possible to translate the measuring point of the TCD directly into CT coordinates, improving the precision of location of the TCD probe. The Neuronavigator combines various diagnostic images into one database and effectively guides the surgeon during surgery.

Adolescent↗
PubMed1998

Automatic matching of homologous histological sections.

The role of neuroanatomical atlases is undergoing a significant redefinition as digital atlases become available. These have the potential to serve as more than passive guides and to hold the role of directing segmentation and multimodal fusion of experimental data. Key elements needed to support these new tasks are registration algorithms. For images derived from histological procedures, the need is for techniques to map the two-dimensional (2-D) images of the sectional material into the reference atlas which may be a full three-dimensional (3-D) data set or one consisting of a series of 2-D images. A variety of 2-D-2-D registration methods are available to align experimental images with the atlas once the corresponding plane of section through the atlas has been identified. Methods to automate the identification of the homologous plane, however, have not been previously reported. In this paper we use the external section contour to drive the identification and registration procedure. For this purpose, we model the contours by B-splines because of their attractive properties the most important of which are: 1) smoothness and continuity; 2) local controllability which implies that local changes in shape are confined to the B-spline parameters local to that change; 3) shape invariance under affine transformation, which means that the affine transformed curve is still a B-spline whose control points are related to the object control points through the transformation. In this paper we present a fast algorithm for estimating the control points of the B-spline which is robust to nonuniform sampling, noise, and local deformations. Curve matching is achieved by using a similarity measure that depends directly on the parameters of the B-spline. Performance tests are reported using histological material from rat brains.

Animals↗
PubMed1998

Registering coronal histological 2-D sections of a rat brain with coronal sections of a 3-D brain atlas using geometric curve invariants and B-spline representation.

A new approach is proposed for registering a set of histological coronal two-dimensional images of a rat brain sectional material with coronal sections of a three-dimensional brain atlas, an intrinsic step and a significant challenge to current efforts in brain mapping and multimodal fusion of experimental data. The alignment problem is based on matching external contours of the brain sections, and operates in the presence of tissue distortion and tears which are routinely encountered, and possible scale, rotation, and shear changes (the affine and weak perspective groups). It is based on a novel set of local absolute affine invariants derived from the set of ordered inflection points on the external contour represented by a cubic B-spline curve. The inflection points are local intrinsic geometric features, which are preserved under both the affine and the weak perspective transformations. The invariants are constructed from the sequence of area patches bounded by the contour and the line connecting two consecutive inflection points, and hence do make direct use of the area (volume) invariance property associated with the affine transformation. These local absolute invariants are very well suited to handle the tissue distortion and tears (occlusion problem).

Algorithms↗
PubMed2005

Modulation of bone microenvironment with zoledronate enhances the therapeutic effects of STI571 and paclitaxel against experimental bone metastasis of human prostate cancer.

Prostate cancer cells metastasize to the bone where their interaction with osteoclasts and osteoblasts can lead to alterations in the structure of the bone. We determined whether the systemic administration of the bisphosphonate, zoledronate, could prevent bone lysis and halt the proliferation of human prostate cancer cells injected into the tibia of nude mice. Zoledronate did not affect the in vitro proliferation of human prostate cancer PC-3MM2 cells. The in vivo administration of zoledronate produced significant bone preservation but did not inhibit the progressive growth of PC-3MM2 cells. The systemic administration of STI571 (imatinib mesylate, Gleevec), an inhibitor of phosphorylation of the platelet-derived growth factor receptor, in combination with paclitaxel, produced apoptosis of tumor cells and bone- and tumor-associated endothelial cells. The systemic administration of zoledronate with STI571 and paclitaxel produced a significant preservation of bone structure, a decrease in tumor incidence and weight, and a decrease in incidence of lymph node metastasis. This therapeutic activity was correlated with inhibition of osteoclast function, inhibition of tumor cell proliferation, and induction of apoptosis in tumor-associated endothelial cells and tumor cells. Cancer is a heterogeneous disease that requires multimodality therapy. The present data recommend the combination of a bisphosphonate agent with protein tyrosine kinase inhibitor and an anticycling drug for the treatment of prostate cancer bone metastasis.

Animals↗
PubMed1979

Multimodal primary cancer treatment (adjuvant chemotherapy): current results and future prospects.

In the 1970s chemotherapy has been successfully incorporated into curative primary treatment programs for various adult malignancies so that it is no longer solely palliative treatment for advanced disease. For at least three malignancies and tentatively a fourth (breast and colon carcinoma, osteosarcoma, and melanoma), certain groups of patients have had longer disease-free survival produced by the use of chemotherapy after surgical removal of the primary lesion. The potential impact on cancer mortality from these treatment results is obvious. We review here the fundamental laboratory concepts that have led to human trial of multimodal primary therapy regimens. Data from numerous clinical trials are analyzed, with delineation of the problems encountered in the interpretation of their results.

Animals↗
PubMedDate not supplied

The role of surgical staging in esophageal carcinoma.

Given the overall poor prognosis of patients with esophageal carcinoma and considering the new therapeutic options, surgeons should accurately stage patients preoperatively to appropriately tailor their treatment. CT, MRI, PET and EUS are still inaccurate in evaluating local surgical resectability and in detecting abdominal and thoracic lymph node metastases. Minimally invasive surgical staging is a promising adjunct to esophageal cancer staging. The thoracoscopic and laparoscopic staging provide more accurate information for evaluating local invasion, lymph node and distant metastasis. The greater accuracy afforded by minimally invasive staging is essential for patients who should undergo radical surgical or multimodal treatment. According to data reported by many authors, it seems most useful to combine nonoperative staging procedures as CT/MRI and EUS with minimally invasive staging techniques.

Diagnostic Imaging↗
PubMed1996

[Diagnosis and therapy for metastatic liver cancer].

Hepatic metastases occur frequently in patients with colorectal cancer. Patients with advanced cancer should be followed carefully after curative resection of the primary lesions for the early detection of the recurrence. If hepatic metastasis is suspected on the basis of rising CEA levels, more sophisticated imaging techniques, such as ultrasound, computed tomography, magnetic resonance imaging and hepatic angiography should be employed for the diagnosis. However, these tests are not cost-effective and not warranted on a routine follow-up basis. To be more cost-effective, a relatively simple and sensitive test or group of tests should be used. The authors have proposed that the basement membrane producibility of the primary lesion yields the most important information predicting a liver metastasis; the basement membrane producing cancer highly metastasizes to the liver. In contrast, more than 90% of non-producing cancer does not metastasize to the liver. The basement membrane producibility is easily examined by laminin staining. In the treatment of hepatic metastases, hepatic resection is the preferred approach when the metastases are located in a resectable segment or can be encompassed by as many as five wedge resections, but these scenarios are relatively uncommon. For unresectable disease, chemotherapy and intravenous and/or intra-arterial embolization are viable alternatives. Loco-regional treatment may offer a pharmacological advantage since a liver metastasis is almost exclusively fed by the hepatic artery. A pilot study we conducted on hepatic infusion chemotherapy combined with interleukin-2 (IL-2.MF) revealed very encouraging results (response rate: 76%), and further study in a prospective randomized trial confirmed this high response rate. Adjuvant IL-2.MF infusion therapy after curative resection of liver metastases is also effective for the prevention of recurrence in the residual liver. Based on the data, we conclude that multimodal treatments of hepatic resection and loco-regional infusion of immuno-chemotherapy (IL-2.MF) make it possible to control both resectable and unresectable liver metastases.

Animals↗
PubMed1997

[Neoadjuvant chemotherapy and chemoradiotherapy in locally advanced stage IIIA and IIIB of non-small-cell bronchial carcinoma (the Essen concept)].

Induction chemotherapies followed by concurrent chemoradiotherapy and definitive surgery have been tested in Essen since 1991 in a large phase-II study for patients with locally (far) advanced non-small cell lung cancer (NSCLC) stages IIIA (N2) and IIIB (T4, N3). After a median follow-up time of 43 months, mature long-term survival data for this intensive multimodality treatment program can now be reported. With nearly 1/3 of these patients experiencing long-term survival at 4 and 5 years after this approach, a significant improvement of long-term prognosis seems to have been achieved, because retrospective comparisons have demonstrated a rather unfavourable prognosis for these disease stages. However, new standards in the treatment for these disease stages could only be defined in the setting of national or international phase-III trials. Based on these promising results, a prospective randomized phase-III study has been planned for patients with stage IIIA (N2) as well as for centrally far advanced T3-tumors and one year ago patient accrual for this study has been started oligoinstitutionally. The standard arm of this study consists of upfront surgery followed by adjuvant radiation therapy, whereas for the experimental arm our Essen protocol a combination of induction chemotherapy with concurrent chemoradiation followed by surgery has been chosen. Meanwhile this prospective randomized trial has gained national support by the "Deutsche Krebshilfe". For stage IIIB (excluding patients with malignant pleural effusion or supraclavicular nodes) a further prospective randomized trial is on its way testing chemotherapy followed by a definitive concurrent chemoradiation approach up to 65 Gy radiation dose versus a multimodality program similar to our phase-II protocol with the inclusion of definitive surgery. Smaller phase-I and -II trials will search for alternative possibilities to improve the induction protocol first of all by the inclusion of new active drugs and secondly by increasing the chemotherapeutic dose intensity of the substances used so far. Due to the promising long-term results of the multimodality treatment programs published so far, these unfavourable patients with locally advanced NSCLC have now gained particular interest due to the development of now curatively intended treatment approaches.

Carcinoma, Non-Small-Cell Lung↗