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PubMed2004

Role of curative resection in octogenarians with malignancy.

BACKGROUND: Major resective surgery in octogenarians with malignancy is considered risky. Because elderly people are growing in number, there is a greater need to define the role of curative resection (CR) in these patients. METHODS: In this retrospective, consecutive review patients > or = 80 years with malignancy treated by surgery were included and categorized into 3 groups: group 1 = CR group, i.e., no residual disease; group 2 = non-CR group, i.e., microscopic tumor invasion of one or more resection margins; and group 3 = palliative surgery (PS) group. RESULTS: One hundred eighty-two patients were treated surgically with curative intent. Gastric and colorectal cancers were the most frequent (34% and 31.8%, respectively) followed by bile duct and esophageal cancers (15.3% and 5.5%, respectively). CR was performed in 53.3%, non-CR in 14.8%, and palliative surgery in 31.9% of patients. Thirty-day mortality in the 3 groups was 3.1%, 0%, and 5.2%, respectively. Mean hospital stay was similar among all 3 groups. In the CR group, gastric and colorectal cancers were the most common (41.2% and 42.2% respectively). Average survival and actuarial survival were significantly higher in the CR group. Disease-free survival was 645 +/- 744 days. Five-year actuarial survival was 45.4 % in the CR group, and no patient survived 5 years in the other 2 groups. In the CR group, mean survival was significantly better in patients with good performance status and > or = 3 supportive family members per univariate analysis. However, no significant difference was observed in patients with gastric and colorectal malignancy. Multivariate analysis revealed that TNM stage and family size affected survival the most. CONCLUSIONS: Gastric and colorectal cancers were most frequent among octogenarians reporting to our unit. CR was performed in elderly patients with low mortality and was associated with significantly better average and actuarial survival. TNM stage I to III, family size > or = 3 members, and performance status "0" to "1" were favorable factors.

Aged↗
PubMed2004

Tumor dihydropyrimidine dehydrogenase in stage II and III colorectal cancer: low level expression is a beneficial marker in oral-adjuvant chemotherapy, but is also a predictor for poor prognosis in patients treated with curative surgery alone.

The aim of this study was to evaluate the prognostic significance of tumor dihydropyrimidine dehydroganase (DPD) in curatively resected colorectal cancer patients who received or did not receive oral 5-FU based-adjuvant chemotherapy. Among 182 patients with stage II-III colorectal cancers, 89 patients (adjuvant chemotherapy group) received oral 5-FU based-adjuvant chemotherapy, and 93 patients (surgery alone group) did not receive 5-FU. DPD expressions in the tumors and in the normal colonic mucosa were measured by enzyme-linked immunosorbent assays. The mean DPD expression of the tumors was significantly lower than that of the normal mucosa (54.4 +/- 40.4 versus 72.3 +/- 23.3 Unit/mg protein, P < 0.01). For survival analyses, we designated the cut-off value of tumor DPD as its median value (46.3). In the adjuvant chemotherapy group, high tumor DPD levels were associated with poor survival (HR, 5.24; P = 0.03). In the surgery alone group, high tumor DPD levels were associated with better survival (HR, 0.32; P = 0.02). In conclusion, tumor DPD level is an efficacious marker in oral 5-FU based-adjuvant chemotherapy for colorectal cancer; however, low tumor DPD predicts reduced survival in patients treated with curative surgery alone.

Administration, Oral↗
PubMed2004

Platelet-derived endothelial cell growth factor expression is an independent prognostic factor in colorectal cancer patients after curative surgery.

AIMS: Platelet-derived endothelial cell growth factor (PD-ECGF) is an angiogenic factor that undergoes increased expression in colorectal carcinomas, but its prognostic value is a topic of debate. The aim of this study is to clarify the prognostic value of PD-ECGF expression in colorectal carcinomas. METHODS: PD-ECGF expression was measured by enzyme-linked immunosorbent assay in frozen materials from 134 colorectal cancer patients who had received curative resections. Patients were divided into high expression and low expression groups based upon selected cut-off value. Correlations among PD-ECGF expression, clinicopathologic features, and disease-free interval were studied by univariate and multivariate analysis. To evaluate the origin of PD-ECGF, serial sections of the 134 tumours were stained for PD-ECGF and CD68. RESULTS: PD-ECGF expression in the normal mucosa was 34.4+/-15.5 (Units/mg protein) and the cut-off value was 65.4 (mean+2SD). There were no significant correlations between clinicopathological features and PD-ECGF expression. The disease-free interval for the high PD-ECGF expression group was significantly longer than that of the low expression group (P=0.05). A multivariate Cox's regression analysis revealed that high PD-ECGF expression is an independent factor for better outcome. In immunohistochemical study, almost all tumour cells were negative for PD-ECGF, but stromal macrophages were predominantly positive for PD-ECGF. CONCLUSIONS: The PD-ECGF expression originated from stromal macrophages was a predictor for favorable outcome after curative resections for colorectal cancer.

Adult↗
PubMed2006

A prospective comparison of multidisciplinary treatment of oesophageal cancer with curative intent in a UK cancer network.

AIMS: Combined modality therapy (with chemotherapy+/-radiotherapy) has become a standard treatment for locally advanced oesophageal cancer. However, there appears to be no compelling evidence for one treatment type or combination to suit all and at this time the clinical multi-disciplinary team (MDT) forms an important role in selecting optimal therapies for the individual. This prospective comparison in one cancer network, looks at the outcomes of this decision making process. METHODS: Over a five year period 1998-2003, data were prospectively collected on all 330 consecutive patients, referred to a tertiary specialised MDT for whom curative treatment was the planned intent. Patients were managed according to an agreed local protocol and allocated to receive one of 5 treatments: surgery alone (S), pre-operative chemotherapy (C+S), pre-operative chemo-radiotherapy (CRT+S), definitive chemo-radiotherapy (CRT) and radiotherapy alone (RT). RESULTS: The 2 and 5 year survival for all patients receiving potentially curative treatment were 49% and 26% respectively. With 2 and 5 year survival for S, CRT+S, C+S, CRT and RT being 53,21; 57,40; 37,27; 50,27; 23,0 months respectively. Of the surgical therapies, mortality was highest in the CRT+S group, versus C+S and S; 12.5%, 1.6%, 4.5% respectively (p=0.025). Non-surgical based therapies had more than double the incidence of local relapses compared to surgical based therapies; however the CRT group had an overall survival comparable with S alone. The commonest sites of distant relapse were liver (56%), lung (38%), bone (32%) and non-regional lymph nodes (24%). CONCLUSION: The results suggest that in patients who are deemed unfit for surgical intervention, definitive chemoradiotherapy remains a viable alternative; they also lend further support to selected case triple modality therapy. These areas should be further examined in the context of randomised controlled phase III trials.

Aged↗
PubMed2006

Patterns of recurrence after curative resection of pancreatic cancer, based on autopsy findings.

The autopsy findings of patients who died of recurrence after curative resection of pancreatic cancer may afford a reliable guide to increase long-term survival after surgery. Recurrence patterns were analyzed for 27 autopsied patients who had undergone potentially curative resection of pancreatic cancer. The pattern of recurrence was classified as follows: (1) local recurrence, (2) hepatic metastasis, (3) peritoneal dissemination, (4) para-aortic lymph node metastasis, and (5) distant metastasis not including hepatic metastasis, peritoneal dissemination, and para-aortic lymph node metastasis. Of the 27 autopsied patients, recurrence was confirmed for 22 of 24 patients, except for three who died of early postoperative complications. Eighteen (75%) of the 24 patients had local recurrence, 12 (50%) had hepatic metastasis, and 11 (46%) had both. For four patients, local recurrence confirmed by autopsy was undetectable by computed tomography, because the recurrent lesions had infiltrated without forming a tumor mass. Peritoneal dissemination, para-aortic lymph node metastasis, and distant metastasis were found for eight (33%), five (21%), and 18 (75%) of the cases, respectively. Twenty patients died of cancer, but local recurrence was judged to be the direct cause of death of only four. Local recurrence frequently occurs, but is rarely a direct cause of death, and most patients died of metastatic disease. Therefore, treatment that focuses on local control cannot improve the survival of patients with resectable pancreatic cancer, and thus, treatment regimens that are effective against systemic metastasis are needed.

Adult↗
PubMed2004

Thrombospondin-1 treatment prevents growth of dormant lung micrometastases after surgical resection and curative radiation therapy of the primary tumor in human melanoma xenografts.

PURPOSE: Intradermal D-12 human melanoma xenografts develop pulmonary micrometastases in BALB/c nu/nu mice, and these metastases are kept dormant for prolonged times, because the primary tumor secretes thrombospondin-1 (TSP-1) into the blood circulation of the host. In this study, we report on the development of macroscopic metastases after surgical resection and curative radiation treatment of the primary tumor, the mechanisms involved, and the effects of treating the host with exogenous TSP-1 after the eradication of the primary tumor. METHODS AND MATERIALS: Xenografted tumors of the D-12 human melanoma were used as tumor model. Macroscopic metastases were scored by using a stereomicroscope. Micrometastases were detected by histologic examinations. Angiogenesis was studied by using an intradermal angiogenesis assay. Apoptotic endothelial cells were detected by immunohistochemistry by using an in situ apoptosis detection kit. RESULTS: Surgical resection as well as curative radiation treatment of the primary tumor resulted in accelerated growth of dormant micrometastases. This growth could be prevented by treating the host with exogenous TSP-1 after the surgery or the irradiation. Endogenous and exogenous TSP-1 prevented metastatic growth by suppressing angiogenesis, i.e., by inducing apoptosis in activated endothelial cells adjacent to dormant micrometastases. CONCLUSIONS: TSP-1 has antiangiogenic and antimetastatic effects that should be investigated further in clinical studies. Cancer patients with TSP-1-producing primary tumors may benefit from combined local treatment and antiangiogenic/antimetastatic treatment with TSP-1.

Angiogenesis Inhibitors↗
PubMed2006

The role of paraaortic lymph node involvement on early recurrence and survival after macroscopic curative resection with extended lymphadenectomy for pancreatic carcinoma.

BACKGROUND: Early recurrence of invasive pancreatic cancer is common even after curative resection. To establish appropriate selection criteria for radical surgery, it is essential to identify the patient population at risk for early recurrence. STUDY DESIGN: One hundred thirty-three of 136 patients who underwent potentially curative pancreatectomy for invasive ductal adenocarcinoma of the pancreas between 1999 and 2003 were divided into two groups: patients whose recurrence developed within 1 year after operation and those whose recurrence did not develop within 1 year. Clinicopathologic factors were retrospectively analyzed between these groups using univariate and multivariable methods. RESULTS: One postoperative death occurred, yielding an in-hospital mortality rate of 0.7% (of 136 patients). Eighty-one patients (61% of 133) were identified as having recurrent pancreatic carcinoma within a year. Paraaortic nodal involvement and positive washing cytology were independent predictors of early recurrence. The median survival time in 26 patients with paraaortic nodal involvement was 13 months, versus 30 months in 106 patients without paraaortic nodal involvement (p < 0.001). Paraaortic lymph node involvement was notably associated with elevated CA19-9 a month after operation (p = 0.03), larger tumor size (p = 0.02), and a positive surgical margin (p = 0.04). CONCLUSIONS: Sampling of paraaortic lymph nodes is recommended as a routine examination at laparotomy. When positive nodes are confirmed by frozen section, early recurrence and poor survival are inevitable, even after radical operation including extended lymphadenectomy.

Adenocarcinoma↗
PubMed2006

Preventive and curative effect of Lygodium flexuosum (L.) Sw. on carbon tetrachloride induced hepatic fibrosis in rats.

The preventive and curative effect of Lygodium flexuosum on experimentally induced hepatic fibrosis by carbon tetrachloride (CCl(4)) was evaluated in rats. Hepatic fibrosis was induced in male Wistar rats by CCl(4) administration (150 microL/100g rat weight, oral) twice a week for 10 weeks. In preventive treatment daily doses of Lygodium flexuosum n-hexane extract (200 mg/kg, p.o) was administered for 10 weeks. In curative treatment Lygodium flexuosum extract (200 mg/kg, p.o) was given for 2 weeks after the establishment of fibrosis for 10 weeks. Treatment with CCl(4) caused a significant decrease in body and liver weight. Lygodium flexuosum n-hexane extract prevented or reversed the decline in body and liver weight. Treatment with the extract prevented or restored the elevation of serum AST, ALT and LDH levels. Lygodium flexuosum treatment remarkably prevented or reversed an increase in liver hydroxyproline content in chronically treated rats. Histopathological changes of hepatic lesions induced by CCl(4) were significantly (p < or = 0.05) improved by treatment with Lygodium flexuosum. These results support that Lygodium flexuosum exerts effective protection in carbon tetrachloride induced hepatic fibrosis in rats.

Alanine Transaminase↗
PubMed2005

Presentations of endometrial activity after curative radiotherapy for cervical cancer.

OBJECTIVES: The treatment of choice for patients with advanced stage cervical cancer is (chemo)radiotherapy. Gynaecologic side effects consist of loss of ovarian function and destruction of the endometrium, resulting in infertility and premature ovarian failure. In premenopausal patients estrogens are prescribed to prevent climacteric symptoms. In general, no progestagens are added to the hormone replacement therapy because of the assumption of complete destruction of the basal layer of the endometrium after pelvic radiotherapy. The aim of this report is to show the different presentations of endometrial activity after curative radiotherapy in patients with cervical cancer. METHODS: Presentation of four patients who developed symptoms of residual endometrial activity. RESULTS: In two patients, proliferation of functional endometrium led to hematocolpos and hematometrum with abdominal pain. The third patient underwent ovarian transposition and developed regular periods 3 months after finishing the radiotherapy. The fourth patient underwent trachelectomy with radiotherapy because of narrow tumour free margins. She developed vaginal blood loss after starting estrogens. CONCLUSIONS: These patients show that in premenopausal patients, curative radiotherapy until 80Gy, may lead to symptoms of residual functional endometrium, e.g. hematometrum, hematocolpos, (ir)regular vaginal blood loss. In our opinion patients should be advised to use estrogens in combination with a progestogen, instead of unopposed estrogens, to prevent stimulation of residual functional endometrium. Tibolone may be an appropriate alternative hormone replacement therapy especially with the advantage of low androgen effects which might support the sexual functions, and the decrease of breast density.

Adult↗
PubMedDate not supplied

Follow-up of colorectal cancer patients after resection with curative intent-the GILDA trial.

PURPOSE: Surgery remains the primary treatment of colorectal cancer. Data are lacking to delineate the optimal surveillance strategy following resection. A large-scale multi-center European study is underway to address this issue (Gruppo Italiano di Lavoro per la Diagnosi Anticipata-GILDA). METHODS: Following primary surgery with curative intent, stratification, and randomization at GILDA headquarters, colon cancer patients are then assigned to a more intensive or less intensive surveillance regimen. Rectal cancer patients undergoing curative resection are similarly randomized, with their follow-up regimens placing more emphasis on detection of local recurrence. Target recruitment for the study will be 1500 patients to achieve a statistical power of 80% (assuming an alpha of 0.05 and a hazard-rate reduction of >24%). RESULTS: Since the trial opened in 1998, 985 patients have been randomized from 41 centers as of February 2004. There were 496 patients randomized to the less intensive regimens, and 489 randomized to the more intensive regimens. The mean duration of follow-up is 14 months. 75 relapses (15%) and 32 deaths (7%) had been observed in the two more intensive follow-up arms, while 64 relapses (13%) and 24 deaths (5%) had been observed in the two less intensive arms as of February 2004. CONCLUSIONS: This trial should provide the first evidence based on an adequately powered randomized trial to determine the optimal follow-up strategy for colorectal cancer patients. This trial is open to US centers, and recruitment continues.

Adolescent↗
PubMed2004

Evaluation of the prophylactic effect and curative efficacy of fipronil 1% pour on (Topline) on post-castration scrotal myiasis caused by Cochliomyia hominivorax in cattle.

A field trial was carried out during a summer-fall period on a commercial beef cattle farm in Minas Gerais State, located in the Southeast of Brazil. In order to evaluate the prophylactic effect and the curative efficacy of fipronil in a 1% solution, 200 Zebu crossbred bulls, with ages varying from 20 to 30 months and weights from 233 to 362 kg, were selected. The bulls were assigned by ranked pair to an untreated control group (A) or to a treated group (B), resulting in 100 animals per group. All experimental animals were surgically castrated on day 0, following routine procedures. After castration all animals in the group B were treated with 10 mg/kg bw of a 1% fipronil solution, topically on the dorsal mid-line. The wounds were individually inspected on days: 2, 4, 7, 10, 14, 17, 21, 28 and 35. After castration the animals were naturally exposed to Cochliomyia hominivorax and remained in the same pasture throughout the trial. Among the animals in the control group, 83 were observed to harbor C. hominivorax eggs, with a total of 97 ovipositions, and among those 73 animals had active myiasis. In group B (fipronil 1%), 66 animals showed C. hominivorax eggs, with 92 ovipositions and five animals with active myiasis. Most ovipositions and active myiasis were detected until seven days post-castration for both groups. Wound parasite infestation evidenced bleeding, serous purulent exudation and presence of active C. hominivorax larvae. Treatment with fipronil 1% had a prophylactic effect on scrotal wounds against the development of C. hominivorax larvae in more than 95% of the treated animals for up to 17 days after castration. The treatment showed partial protection of 66% and 50% on days 21 and 28 post-treatment (pt), respectively. Three animals from the control group and one from the treated group showed active screwworms on day 21 pt, and one animal from the treated group and two from the control group also presented C. hominivorax larvae on scrotal wounds on day 28 pt. By the end of the observation period (day 35 pt), the castration wound had healed in all animals. All experimental animals presenting scrotal wounds infested with C. hominivorax larvae were treated with a 1% pour-on formulation of fipronil, on the same day that infestation was observed. Active C. hominivorax larvae were not seen during the monitoring period immediately after treatment. The curative efficacy of fipronil 1% against C. hominivorax larvae infestation in castration wounds was 100%.

Administration, Topical↗
PubMed2000

[Surgical treatment of pancreatic cancer: curative resections].

Curative resection of pancreatic adenocarcinoma can only be performed in 10% of patients. This review article reports resectability rates and criteria, results of pancreatic resection and prognostic factors. Lymph node and/or vascular involvement and retroperitoneal tissue invasion constitute very poor prognostic factors; however, lymph node involvement limited to the first draining nodes and limited invasion of the mesenteric-portal vein do not constitute contraindications to surgical resection. Cephalic pancreaticoduodenectomy is still the reference procedure and its postoperative mortality has greatly decreased. The risk of pancreatic fistula mainly depends on the friability of the pancreatic stump. Median survival rate after tumour resection is usually limited between 12 and 18 months. Five-year actuarial survival rate is no more than 5%, but after curative resection (RO), it may be as high as 20 to 25% in recent surgical series. Concomitant or neoadjuvant chemotherapy-radiotherapy, currently under evaluation, may increase resection and survival rates.

Adenocarcinoma↗
PubMed2003

[Patients surviving 5 years after curative oesophagectomy for oesophageal cancer].

AIM OF THE STUDY: To analyse the clinical and pathological parameters of 5-year survival patients after curative oesophageal resection for cancer and to identify factors predictive of long-term survival. METHODS: The data of 370 patients who underwent oesophagectomy with curative intent from January 1982 for oesophageal squamous cell carcinoma (n = 320) or adenocarcinoma (n = 50) were reviewed. After excluding postoperative deaths (n = 20), these patients were surviving (S group, n = 113) or dead (NS group, n = 237) with a 60-month follow-up. Uni- and multivariate analysis allowed comparison between the two groups. RESULTS: Postoperative mortality and morbidity rates were 4.0% and 37.6%, respectively. Parameters related to 5-year survival were: absence of preoperative malnutrition or dysphagia, transhiatal resection, no reoperation, limited tumour, histological response to neoadjuvant treatment, absence of lymph node capsular invasion, number of invaded lymph nodes < or = 4, invaded lymph node ratio < or = 0.1, absence of tumour recurrence or metachronous primary cancer. On multivariate analysis, factors predictive of 5-year survival were: absence of preoperative dysphagia (P < 0.001), stage 0-I-IIA tumour (P<0.001) and absence of metachronous cancer (P = 0.016). CONCLUSION: Complete surgical resection allows 5-year survival. Factors predictive of long-term survival assessed in preoperative evaluation, dysphagia and tumour stage, should be useful to select patients for neoadjuvant treatment.

Adenocarcinoma↗
PubMed1996

Intraoperative ultrasound in colorectal cancer patients undergoing apparently curative surgery: correlation with two year follow-up.

Conventional ultrasound (US) and computerized tomography (CT) are well recognized to be limited in the detection of small liver metastases. In this study, we assessed the use of intraoperative ultrasound (IOUS) in the detection of 'occult' liver metastases in colorectal cancer patients undergoing apparently curative surgery of the primary colonic carcinoma. Ninety three colorectal cancer patients undergoing apparently curative surgery on the basis of preoperative US, CT and laparotomy were studied. All patients underwent IOUS examination of the liver. After two year follow-up, 27 of these 93 patients developed overt liver metastases and of these 27, only five had been detected by IOUS examinations at the time of laparotomy. The results suggest that IOUS is relatively insensitive in the detection of occult colorectal liver metastases. Its routine use as a screening tool during primary surgery is therefore not recommended.

Colorectal Neoplasms↗
PubMed1996

A prospective trial of self-expanding metal stents in the palliation of malignant esophageal obstruction after failure of primary curative therapy.

BACKGROUND: Self-expanding metal stents have been shown to be safe and effective for the primary palliation of patients with inoperable malignant esophageal obstruction. We sought to determine their safety and efficacy in patients who fail curative therapy. METHODS: Seventeen patients with esophageal carcinoma who had recurrent dysphagia after radiation, surgery, or chemoradiation therapy for esophageal carcinoma were studied. All patients had recurrent dysphagia, and an uncovered metal stent was inserted for palliation. Patients were followed-up at 4-week intervals until death. Palliation was measured by a dysphagia score and the Karnofsky index. RESULTS: Seventeen patients with recurrent dysphagia after primary treatment with surgery (n = 4), radiation (n = 11), and chemoradiation (n = 2) received uncovered Wallstents for palliation of dysphagia. The dysphagia score improved by at least 1 point in all patients. Thirteen of 17 patients had a 2 point improvement in the dysphagia score. The Karnofsky index improved significantly (from 58 +/- 3 to 66 +/- 3, p = 0.0002). Fourteen of the 17 patients had patent stents until death. Three of 12 patients (25%) died of stent-related complications (bleeding in 1, septic complications in 2 patients). CONCLUSIONS: Patients with recurrence of esophageal carcinoma after surgery can be successfully treated with metal stents, but patients who have received radiation therapy with curative intent may be at greater risk for complications because of radiation-induced tumor necrosis and vascular changes in the esophageal wall. Larger prospective studies are necessary to clarify this issue.

Aged↗
PubMed2003

Follow-up strategies after curative resection of colorectal cancer.

Consensus is lacking as to the best strategy for following patients who have undergone definitive surgical medical treatment for colon cancer. The goal of any surveillance program should be detection of recurrent disease at a sufficiently early time to allow subsequent curative therapy. Although periodic clinical examinations, laboratory tests, radiographic imaging, and carcinoembryonic antigen (CEA) testing have been utilized as a form of surveillance, such aggressive and costly intervention has not been validated through clinical studies. Four of the five randomized trials comparing such an intensive surveillance strategy to less frequent testing have not demonstrated the intensive approach to lead to an improvement in overall survival. Furthermore, intensive testing is both costly and has been shown not to improve quality of life. Further research designing appropriate postoperative testing is needed to guide physicians and patients after the curative resection of a colorectal cancer.

Biomarkers, Tumor↗
PubMed1994

Efficacy of immunochemotherapy as adjuvant treatment after curative resection of gastric cancer. Study Group of Immunochemotherapy with PSK for Gastric Cancer.

In Japan the standard adjuvant treatment after resection of gastric cancer is intravenous mitomycin plus oral fluorouracil. We have assessed the efficacy of protein-bound polysaccharide (PSK) in addition to standard chemotherapy in patients who had undergone curative gastrectomy at 46 institutions in central Japan. 262 patients were randomly assigned standard treatment alone or with PSK. The minimum follow-up time was 5 years (range 5-7 years). PSK improved both the 5-year disease-free rate (70.7 vs 59.4% in standard treatment group, p = 0.047) and 5-year survival (73.0 vs 60.0%, p = 0.044). The two regimens had only slight toxic effects, consisting of nausea, leucopenia, and liver function impairment, and there were no significant differences between the groups. The treatments were clinically well tolerated and compliance was good. Addition of PSK to adjuvant chemotherapy with mitomycin and fluorouracil is beneficial as treatment after curative gastrectomy.

Adjuvants, Immunologic↗
PubMed2001

The curative treatment by radiation therapy alone of Stage I non-small cell lung cancer in a geriatric population.

This review was initiated to assess the outcome of treatment with radical radiation therapy with curative intent for elderly patients diagnosed to have Stage I non-small cell lung cancer (NSCLC). The study involved a retrospective review of 347 patients with T1 and T2N0M0 tumours treated at the Queensland Radium Institute (QRI) during the period 1985-1992. The main reasons for not proceeding to surgery included poor performance status, old age or refusal to submit to surgery. The median age for the group was 70 years with the range being 34-90 years. Patients in this group were all treated by a standard technique involving external beam radiation therapy to a dose of 50 Gray Minimum Tumour Dose in 20 fractions over 4 weeks. When the study group was divided into those patients aged < 70 years and those patients age > or = 70 years, the overall survival at 5 years was 22 and 34%, respectively (median survival 22 months for age < 70 years, and 26 months for age > or = 70 years). The same division in terms of recurrence free survival yielded 5-year survival rates of 18% for the age < 70 years group and 30% for the age > or = 70 years group with the median survival being 17 months in both sub-groups. Both the difference in overall survival and recurrence free survival between the two age groups approached, but did not reach, statistical significance at the P < 0.05 level of significance. Further sub-division into 5-year age groups failed to confirm the hypothesis that older age groups had a poorer outcome. The 75-79-year group showed better survival than other age groups with the 5-year overall survival for this group being 53%, while the 5-year recurrence free survival was 45%. We conclude from this large series of Stage I NSCLC that radical radiation therapy with curative intent may be a viable alternative to surgery in those elderly patients who either refuse surgery or are judged to be unfit for operation. In view of the fact that comparable results can be achieved in elderly lung cancer patients at the price of minimal toxicity, a nihilist approach to treatment in the elderly can no longer be justified.

Adult↗