All possible candidates for surgical intervention are presented at our conference with Thoracic Oncology Divison every Tuesday evening to determine the most appropriate treatment modalities. Selected patients among those who underwent resection are pathologically reviewed on every Friday morning.
Pulmonary carcinomas of non-small cell histology in clinical stages I, II and IIIA and of small cell histology in clinical stages I and II are usually indicated for curative surgical resection of the disease. On the other hand, to improve the poor prognosis of patients with mediastinal lymph node metastases proven clinically and histologically, those with disease invading neighboring vital structures, or who have small cell cancer, the optimal treatment modalities are sought for in clinical trial settings.
Resection of metastatic lung tumors has been attempted for those meeting ThomfoldÕs criteria with slight modification upon consultation with the patient. Histologically, metastases from colorectal carcinomas comprise the majority of cases. The majority of mediastinal tumors were thymic epithelial tumors, and we did not attempt thoracoscopy in these patients.
Ongoing Clinical Trials
1. Surgery alone vs. preoperative chemotherapy followed by surgery for histologically proven cN2 non-small cell lung carcinoma [phase III].
2. No adjuvant treatment vs. postoperative adjuvant chemotherapy for resected non-small cell carcinoma with histologically proven mediastinal lymph node metastases [phase III].
3. No treatment vs. hypotonic cisplatin treatment for resected non-small cell lung carcinoma with positive pleural lavage cytology at the time of thoracotomy [phase III].
Thoracoscopy is now routinely indicated for the resection of benign/undetermined mediastinal or pulmonary tumors, and exploration of the thoracic cavity for accurate staging of lung carcinoma. The difficulty in detecting small and/or deeply situated target nodules has been a major factor limiting the success of thoracoscopic resection. Very recently, we succeeded in marking such nodules with CT-fluoroscopy-guided injection of n-butyl-2-cyanoacrylate, which formed a hard nodule easily detectable thoracoscopically.
In order to reduce surgical invasiveness, especially in elderly and poor-risk patients, major or conservative pulmonary resection with thoracoscopic assistance is being attempted, but only in a small number of patients.
|Metastatic lung tumor||26||14||23|
|Stage||3-yr (%)||4-yr (%)|
(K. Nagai, J. Yoshida)
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