Prevalence and outcome of lung cancer in lung transplant recipients.

BACKGROUND: Lung transplant is the only available therapy for patients with advanced lung disease. The goal of this study was to examine the prevalence, origin, management and outcome of lung cancer in recipients of lung transplant at our institution. METHODS: After institutional review board approval, we conducted a retrospective chart review of all lung transplantations in our institution from January 1990 until June 2012. RESULTS: The prevalence of lung cancer in the explanted lung was 6 (1.2%) of 462 and all cases were in subjects with lung fibrosis. All 4 subjects with lymph node involvement died of causes related to the malignancy. Nine (1.9%) of 462 patients were found to have bronchogenic carcinoma after lung transplant. The most common location was in the native lung in recipients of a single lung transplant (6 out of 9 patients). In one case, the tumor originated in the allograft and was potentially donor related. The median time to diagnosis after lung transplant was 28 months with a range from 9 months to 10 years. Median survival was 8 months, with tumors involving lymph nodes or distant metastases associated with a markedly worse prognosis (median survival 7 months) than stage I disease (median survival 27 months). CONCLUSIONS: The prevalence of lung cancer in lung transplant recipients is low. Using accepted donor screening criteria, donor derived malignancy is exceptionally rare. While stage I disease is associated with improved survival in this cohort, survival is still not comparable to that of the general population, likely influenced by the need for aggressive immune suppression.

[Resected non-small cell bronchogenic carcinoma stage pIIIA-N2. Which patients will benefit most from adjuvant therapy?]. / Carcinoma broncogénico no microcítico resecado, estadio pIIIA-N2. ¿En qué pacientes la adyuvancia ofrece mayor beneficio?

BACKGROUND: Controversy persists as regards the indications and results of surgery in the treatment of patients with stage pIIIA-N2 non-small cell lung cancer (NSCLC). The objective of this study was to analyze the overall survival of a multicentre series of these patients and the role of adjuvant treatment, looking for factors that may define subgroups of patients with an increased benefit from this treatment. METHODS: A retrospective study was conducted on 287 patients, with stage pIIIA-N2 NSCLC subjected to complete resection, taken from a multi-institutional database of 2.994 prospectively collected consecutive patients who underwent surgery for lung cancer. Adjuvant treatment was administered in 238 cases (82.9%). Analyses were made of the age, gender, histological type, administration of induction and adjuvant chemotherapy and/or radiation therapy treatments. RESULTS: The 5-year survival was 24%, with a median survival of 22 months. Survival was 26.5% among patients receiving with adjuvant treatment, versus 10.7% for those without it (P=.069). Age modified the effect of adjuvant treatment on survival (interaction P=.049). In patients under 70 years of age with squamous cell carcinoma, adjuvant treatment reduced the mortality rate by 37% (hazard ratio: 0,63; 95% CI; 0,42-0,95; P=.036). CONCLUSIONS: Completely resected patients with stage pIIIA-N2 NSCLC receiving adjuvant treatment reached higher survival rates than those who did not. Maximum benefit was achieved by the subgroup of patients under 70 years of age with squamous cell carcinoma.

Are the 18F-FDG positron emission tomography/computed tomography findings in bronchopulmonary carcinoid tumors different than expected?

Bronchopulmonary carcinoid tumors (BPCT) are known as low malignity tumors. Different surgical methods are therapeutically used, ranging from simple excision of the mass to large regional resections. Also, the role of positron emission tomography in the diagnosis and staging of BPCT is controversial as false negative results has been reported in literature. Our aim was to study the diagnostic value of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and the therapeutic effect of specific surgical treatment on BPCT. We studied retrospectively from 2005 to 2011 75 cases of BPCT. Preoperative investigations included computerized tomography (CT), bronchoscopy and 18F-FDG PET. Statistical comparisons were performed based on tumor type, extent of the resection and the standardized uptake value (SUV). Fifty six cases were typical, 15 atypical and 4 oncocytic (a subtype of typical carcinoid). Of these patients, 27 (17 with typical, 8 with atypical and 2 with oncocytic carcinoid) had undergone a 18F-FDG PET scan. Operatory mortality was 0%, while the 7 years survival rate amounted to 97.5%. No recurrences were seen. Mean SUV was 5.28 for typical and 5.08 for atypical BPCT. The oncocytic type exhibited a particularly high SUV. In conclusion, our study, contrary to the findings of others, showed that the 18F-FDG uptake of BPCT was similar to that of malignant diseases. Aggressive surgical treatment resulted in a very good prognosis for these carcinoid tumors.

Risk factors of postoperative nosocomial pneumonia after resection of bronchogenic carcinoma.

BACKGROUND: Postoperative pneumonia following resection of bronchogenic carcinoma is a severe complication with a high rate of morbidity and mortality. The objective of this study is to determine the clinical and epidemiologic characteristics and the risk factors of postoperative pneumonia in patients undergoing resection of bronchogenic carcinoma in a third-level university hospital. METHODS: We performed a study of cases (with postoperative pneumonia) and controls (without pneumonia) nested in a prospective cohort of 604 patients who had undergone surgery for bronchogenic carcinoma in clinical stages I-IIIa between January 1999 and June 2004, where each case was grouped with 3 controls (3:1) of the same age (±5 years) and cancer staging by means of TNM classification. RESULTS: The incidence of postoperative pneumonia was 22 cases (3.6%). Overall in-hospital mortality of patients who underwent resection of bronchogenic carcinoma was 32 patients (5.3%). In-hospital mortality due to postoperative pneumonia was 7 cases (31.8%). In the postoperative pneumonia group, microorganisms were isolated in 10 cases (45.5%). The following factors appear in the multivariate analysis as statistically significant independent risk factors for postoperative pneumonia: body mass index <26.5 kg/m(2) (adjusted odds-ratio (OR) per unit 0.64, 95% confidence interval (CI) 0.45-0.90, p = 0.011), predicted postoperative FEV(1) <50% pred. (adj. OR per unit 0.92, 95% CI 0.85-0.99, p = 0.037), and reintubation after surgery (adj. OR 18.1, 95% CI 1.3-256.6, p = 0.032). CONCLUSIONS: Identifying the risk factors (some of which can by modified by medical intervention) may improve the course of lung cancer treated with surgery.

Long-term results of curative intraluminal high dose rate brachytherapy for endobronchial carcinoma.

BACKGROUND: The treatment strategy of central lung tumors is not established. Intraluminal brachytherapy (ILBT) is widely used for palliative treatment of endobronchial tumors, however, it is also a promising option for curative treatment with limited data. This study evaluates the results after ILBT for endobronchial carcinoma. METHOD: Sixteen-endobronchial carcinoma of 13 patients treated with ILBT in curative intent for 2000 to 2008 were retrospectively reviewed. ILBT using high dose rate 192 iridium thin wire system was performed with 5 Gy/fraction at mucosal surface. The patient age ranged from 57 to 82 years old with median 75 years old. The 16 lesions consisted of 13 central endobronchial cancers including 7 roentgenographically occult lung cancers and 3 of tracheal cancers. Of them, 10 lesions were treated with ILBT of median 20 Gy combined with external beam radiation therapy of median 45 Gy and 6 lesions were treated with ILBT alone of median 25 Gy. RESULTS: Median follow-up time was 32.5 months. Two-year survival rate and local control rate were 92.3% and 86.2%, respectively. Local recurrences were observed in 2 lesions. Three patients died due to lung cancer (1 patient) and intercurrent disease (2 patients). Complications greater than grade 2 were not observed except for one grade 3 dyspnea. CONCLUSIONS: ILBT combined with or without EBRT might be a curative treatment option in inoperable endobronchial carcinoma patients with tolerable complication.

Tracheobronchial reconstructions with bronchoplastic closure: an alternative method in treatment of bronchogenic carcinoma involving the carina or tracheobronchial angle.

OBJECTIVE: Our objective was to summarize our experience with tracheobronchial reconstructions using bronchoplastic closure for airway defects after noncircumferential resections of bronchogenic carcinoma involving the carina or tracheobronchial angle. METHODS: From January 1990 to December 2005, all patients who underwent tracheobronchial reconstructions with bronchoplastic closure for bronchogenic carcinoma involving the carina or tracheobronchial angle were included. The clinical data for patients were collected retrospectively, including demographic characteristics, occurrences of postoperative complications, and survival. RESULTS: A total of 40 patients were eligible, including 23 who had right pneumonectomies, 6 who had right upper lobectomies, and 11 who had left pneumonectomies, associated with lower lateral wall of the trachea resections or with partial carinal resections for centrally localized tumors. The airway defects ranged from 0.5×2 cm to 2×4 cm and involved up to 50% of the airway circumference. Microscopic residual disease was found postoperatively at the bronchial margin in 20% (8/40). Of 40 patients, 2 (5.0%) had pulmonary atelectasis develop, 2 (5.0%) arrhythmia, 2 (5.0%) bronchopleural fistula, and 1 (2.5%) airway stenosis after operation. Thirty-day mortality was 2.5% (1/40). Median survival for 40 patients was 18.5 months with a cumulative survival of 72.2%, 26.6%, and 21.3% at 1, 3, and 5 years, respectively. CONCLUSIONS: Tracheobronchial reconstruction using bronchoplastic closure might be a reasonable option for closing massive central airway defects for advanced bronchogenic carcinoma involving the tracheobronchial angle or carina, avoiding tracheal sleeve pneumonectomy with limited excision of the lateral wall of the trachea or carina.

Bronchial carcinoma after lung transplantation: a single-center experience.

BACKGROUND: Lung transplantation (LTx) remains the best option for selected patients with end-stage lung disease. Long-term survival is hampered by the development of chronic allograft dysfunction, which is the main reason for mortality at 3 to 5 years after LTx. Prevalence of and mortality due to solid-organ tumors also increases and we specifically investigated the development of primary bronchial carcinoma (BC) and its outcome after LTx. METHODS: From January 2000 until June 2011, 494 lung and heart-lung transplantations were performed. Among this population, 13 patients developed bronchial carcinoma at 41 ± 27 (mean ± SD) months after LTx. Of these 13 patients, there were 9 men and 4 women. They were transplanted at a mean age of 59 ± 2.8 years; 8 patients were transplanted for emphysema and 5 for pulmonary fibrosis. RESULTS: Nine of 92 single LTx patients (transplanted for emphysema or lung fibrosis) developed a bronchial carcinoma in their native lung, whereas only 4 of 224 bilateral LTx patients (also for emphysema or fibrosis) developed a bronchial carcinoma (p = 0.0026). At diagnosis, 4 patients had local disease (cT1N0M0 and cT2N0M0), whereas all others had locoregionally advanced or metastatic disease. Five patients were surgically treated; however, 1 had unforeseen N2 disease with additional pleural metastasis at surgery. All other patients (except 2 who died very soon after diagnosis) were treated with chemotherapy with or without radiotherapy. The median survival after diagnosis was only 10 ± 7 months, with a significant survival difference between patients with limited and extensive disease (p = 0.037). The latter had a median survival of only 6 months compared with 21 months for patients with limited stages of bronchial carcinoma. CONCLUSIONS: Bronchial carcinoma, especially of the native lung after single LTx, is a significant problem and the survival after diagnosis is very poor, although patients with limited (operable) disease tend to have better results.

Health-related quality of life in patients with lung cancer: validation of the Mexican-Spanish version and association with prognosis of the EORTC QLQ-LC13 questionnaire.

INTRODUCTION: Lung cancer (LC) is the first cause of cancer-related mortality worldwide and health-related quality of life (HRQL) is a fundamental outcome for evaluating treatment results. Our objective was to validate the Mexican-Spanish versions of the European Organisation for Research and Treatment of Cancer (EORTC) Quality-of-Life QLQ-LC13 disease-specific questionnaire module in Mexican patients with LC; and to explore the possible prognostic role of HRQL data. METHODS: Translation procedures followed EORTC guidelines. Both instruments were completed by patients with LC. Tests for reliability and validity were performed. A subset of patients was administered HRQL evaluations before and after chemotherapy. HRQL was associated with prognosis in chemotherapy-naïve patients. The protocol was approved by the Institute's Ethics Committee. RESULTS: One hundred fifty three patients (mean age, 60.3 years; 84 females and 69 males) completed both questionnaires. Compliance rates were high, and the questionnaires were well accepted. Nine of 10 multi-item scales of both questionnaires presented Cronbach's alpha coefficients > 0.7. Multi-trait scaling analysis demonstrated good convergent and discriminant validity. Patients with better Karnofsky or Eastern Cooperative Oncology Group (ECOG) performance status reported better functional HRQL scores. Different scales in the EORTC QLQ-C30 and EORTC QLQ-LC13 questionnaires were accurately related with clinical characteristics. Functional as well as disease-symptom scales improved after chemotherapy, but treatment side-effects scales worsened in test-retest analysis. Better role functioning and absence of thoracic pain scales were associated with longer overall survival (OS) (p = 0.009 and p = 0.035, respectively). CONCLUSION: The Mexican-Spanish versions of the EORTC QLQ-C30 and EORTC QLQ-LC13 questionnaires are reliable and valid for HRQL measurement in Mexican patients with LC and can be used in clinical trials.

[Lung cancer in adults: Better prognosis of patients aged 45 and under related to good condition and lower TNM stage (a comparative and retrospective study)]. / Meilleur pronostic des sujets de 45ans et moins, atteints de cancer du poumon, lié au bon état général et au stade TNM plus faible (étude rétrospective et comparative).

BACKGROUND: Bronchogenic carcinoma (BC) is a worldwide health public problem with a parallel but delayed development to smoking. The prognosis of BC in young patients is poorly known mainly because of few studies that have looked at this group of patients. The hypothesis of our study is that 'young' patients with BC have a better prognosis than others. METHODS: We conducted a retrospective epidemiologic study of all patients aged 45 and under (n=73) followed for BC between 2002 and 2007 in two hospitals in the central region in France, compared with patients over 45 years random (n=73). We evaluated the clinical characteristics (sex, smoking habits, WHO status, clinical presentation, histology, TNM stage), the management and prognosis of these patients. RESULTS: The median survival of patients aged 45 and under was 13.4 months against 8.9 months for patients over 45 years. In multivariate analysis, age is not an independent prognostic factor (P=0.41) in contrast to the WHO status (P=0.002) and initial TNM stage (P<0.001). There was no significant difference for other clinical characteristics between the two patient populations. CONCLUSION: In our study, the better prognosis of the "young" patient group is not directly related to age but in good condition and lower TNM stage of these patients.

Sleeve resections with unprotected bronchial anastomoses are safe even after neoadjuvant therapy.

OBJECTIVES: Sleeve resection is the operation of choice in patients with centrally located tumours, in order to avoid a pneumonectomy. Most surgeons protect the bronchial anastomoses with tissue to prevent insufficiencies. The purpose of this study is to report on outcome of unwrapped bronchial anastomoses, especially after neoadjuvant chemo- or chemoradiotherapy. METHODS: Between 2000 and 2010, 103 patients [59 years (range 16-80), 40 females] underwent bronchial sleeve resections without coverage of the anastomosis with a tissue flap. We retrospectively reviewed the data for morbidity, mortality and survival, especially with regard to the type of resection, neoadjuvant therapy and stage. RESULTS: Sleeve lobectomy was performed in 88, sleeve bilobectomy in 8, sleeve pneumonectomy in 4 and sleeve resection of the main bronchus in 3 patients. Twenty-seven patients had a combined vascular sleeve resection. Neoadjuvant chemotherapy was performed in 20 and radiochemotherapy in 5 patients. Non-small cell lung cancer (NSCLC) was present in 76 patients (squamous cell carcinoma in 44, adenocarcinoma in 24, large cell carcinoma in 6 and mixed cell in 2) and neuroendocrine tumour in 20 and other histological types in 7 patients. The pathologic tumour stage in NSCLC was stage I in 26, stage II in 26, stage IIIA in 16, stage IIIB in 7 and stage IV in 1 patient. There were no anastomotic complications, especially no fistulas. One patient developed narrowing of the intermediate bronchus without need for intervention. Twenty-four patients had early postoperative complications, including 11 surgery-related complications (air leakage, nerve injury, haemothorax or mediastinal emphysema). The 30-day mortality was 3% (one patient died due to heart failure and two with multiorgan failure). The 5-year survival rate was 63% in NSCLC patients and 86% in neuroendocrine tumour patients. CONCLUSIONS: Sleeve resection without wrapping the bronchial anastomoses with a tissue flap is safe even in patients who underwent neoadjuvant chemo- or chemoradiotherapy. Therefore, wrapping of the bronchial anastomoses is not routinely mandatory.

[Timeline trends in surgery of bronchogenic carcinoma]. / Casové trendy chirurgické terapie bronchogenního karcinomu.

BACKGROUND: The aim of our study was to determine how patient preoperative status and outcomes of resection have changed over last 12 years. MATERIAL AND METHODS: This retrospective study of prospective database included 1412 patients operated from January 1,1998 through December 31,2009. Patient characteristics and outcomes were compared for two time periods (1998-2003 and 2004-2009). RESULTS: We performed 985 lobectomies with 30-days mortality 1.8% and 300 pneumonectomies with 30-days mortality 5.7%. Median of survival of all 1412 patients was 4.3 year and 5-year survival was 45%. The percentage of female patients, lobectomies and adenocarcinoma increased over time, as well as age of our patients. Outcome improved over time, with significant decrease in 30-days mortality after pneumonectomy (8.2% vs. 2.3%, p = 0.029). The overall 3-year survival improved in patients with III. stage (30 % vs. 40%, p = 0.012). CONCLUSION: Our study identified time trends which are in-line with increased incidence of lung cancer among women and with improvement of preoperative evaluation, preoperative and postoperative care

[Comparative survival study between the old and new bronchogenic carcinoma classification]. / Estudio comparativo de supervivencias entre la actual y la antigua clasificación del carcinoma broncogénico.

INTRODUCTION: A new classification of bronchogenic carcinoma has been made by the International Association for the Study of Lung Cancer (IASLC) and published by Frank C. Detterbeck et al in the journal Chest (2009). The Thoracic Surgery Department of the Gerona (Spain) University Hospital has re-staged a series of patients with bronchogenic carcinoma who had attempted curative surgery, with the aim of comparing the survival (survival for T, survival for M, and survival by disease staging) between the old and new classification, and also to determine whether these changes in survival are statistically significant. Another one of the objectives of the study is to see whether there is agreement between the current survival of our surgical series and that published by the IASLC. PATIENTS AND METHODS: Data on 855 patients who had attempted bronchogenic carcinoma curative surgery were entered into a data base. They were radiologically, clinically and histologically staged according to the new and old staging. Survival was calculated according to the T, M, N, and histology stages. A statistical analysis was performed using the SPSS program and the changes in survival between both classifications were analysed. RESULTS: No statistically significant changes were observed in survival (P=.58) with the new classification in stage IIA, but there were statistically significant changes in survival (P=.0001) in stage IIIB. DISCUSSION: The study confirms that the current TNM classification is useful, since it shows changes in survival in 2 histological stages (one of them statistically significant). The survival data of our series now fits better with those provided by the IASLC.

[Bronchogenic carcinoma after lung transplantation: a case report and literature review].

BACKGROUND AND OBJECTIVE: Lung transplantation is an efficient therapeutic option for patients with end-stage pulmonary diseases, but less is known about lung cancer after lung transplantation. The aim of this study is to improve the awareness, diagnosis and treatment of bronchogenic carcinoma after lung transplantation with a case report and related literatures. METHODS: We reported a 65-year-old male with idiopathic pulmonary fibrosis (IPF) who underwent right lung transplantation under extracorporeal membrane oxygenation (ECMO) support in May 2007 in our hospital. The patient recovered smoothly and discharged from the hospital 46 days after the procedure with regular follow-up. Immunosuppression therapy was triple drug maintenance regimen including tacrolimus (Tac), mycophenolate mofetil (MMF) and steroids. RESULTS: Small cell lung cancer in the left lung with multiple osseous metastases was found 13 months after the lung transplantation. Symptoms were relieved a bit by administering chemotherapeutics (etoposide and cisplatin) for 4 cycles. However, the patient was succumbed to his illness within 11 months after the diagnosis of lung cancer. CONCLUSIONS: Lung cancer after lung transplantation has been suggested as one of causes of late mortality with the risk factors such as chronic obstructive pulmonary disease (COPD), IPF, cigarette smoking history and immunosuppression etc. Early diagnosis and treatment are very important to improve the prognosis.

Tracheal carinal reconstruction and bronchovasculoplasty in central type bronchogenic carcinoma.

BACKGROUND AND OBJECTIVE: Because radical resection for lung cancer invading the initial borderline of different lobes and carina is difficult, we tried to analyse the variables of successful tracheal carinoplasty and bronchovasculoplasty to discover a proper approach for appropriate early and long-term results. METHODS: Of 1 399 lung resections for primary lung cancer performed in our hospital from April 1985 to December 2006, 133 underwent bronchoplastic surgeries, including 15 carinoplasty cases and 118 sleeve lobectomy (SL) cases, and 118 pneumoectomy (PN) cases were compared at the same time. RESULTS: Complications occurred in 18 cases, with no operative related mortality. For all patients, the 1 year, 3 year, and 5 year survival rates were 79.8%, 56.7% and 31.2%, respectively. The 5 year survival rate by cancer stage was 69.2% for Ib, 40.6% for IIb, 19.6% for IIIa, and 16.6% for IIIa (N2). CONCLUSION: Selection of cases, clearance of lymph nodes, disposal of the bronchus and pulmonary vessel and replacement or restoration of the superior vena cava are the main factors influencing prognosis.

Palliative high-dose-rate endobronchial brachytherapy for recurrent carcinoma: the University of Louisville experience.

PURPOSE: To determine the efficacy and toxicity of iridium-192 high-dose-rate (HDR) endobronchial brachytherapy (EBBT) for symptomatic palliation of respiratory symptoms caused by endobronchial carcinoma. METHODS: We reviewed the treatment outcomes of 52 patients with carcinoma who underwent HDR EBBT between July 1995 and July 2005 for recurrent tumors at the University of Louisville School of Medicine. The subjective clinical response was assessed by patient reports. The objective response was assessed by bronchoscopy and chest computed tomography. RESULTS: The median actuarial survival measured from the first EBBT treatment session was 7 months. Forty-eight patients (92%) showed improvement in one or more symptoms. The median time to symptomatic relapse was 6 months. Bronchoscopic regression of tumor occurred in 45 patients (87%). Tumor regression as determined by bronchoscopy correlated with symptomatic response. Complications occurred in two patients (one pneumothorax and one fatal hemoptysis). CONCLUSIONS: The results confirm the efficacy of endobronchial brachytherapy in relieving obstructive airway symptoms from endoluminal bronchogenic carcinomas. We demonstrated a low morbidity associated with EBBT treatment and a high objective response (87%) and subjective response (92%).

[Epidemiology of lung cancer]. / Epidemiologie des Bronchialkarzinoms.

Lung cancer is by far the most common form of cancer worldwide and in Germany is now "only" still the commonest cause of death from cancer. The most important single risk factor is smoking but in selected population groups, for example in the professional area, other factors can also play a role which cannot be ignored and open up a corresponding potential for prevention. Effective early detection procedures are at present unknown. The most promising, however, is multislice computed tomography (MSCT) which for this reason is presently being tested for effectiveness in several large research projects. The results are not expected for some years. Until then the early detection of lung cancer with MSCT cannot be considered suitable for routine use but can only be justified within the framework of research studies.

Heart failure, myocardial infarction, lung cancer and death in COPD patients: a UK primary care study.

BACKGROUND: The leading comorbidities and causes of death in patients with chronic obstructive pulmonary disease (COPD) are lung cancer and cardiovascular disease. The aim of this study was to establish the incidence of lung cancer, myocardial infarction and heart failure in patients with COPD in UK primary care. METHODS: The General Practice Research Database (GPRD) was used to identify a cohort of 1927 patients with a first recorded diagnosis of COPD. This cohort was followed for up to 5 years to identify new diagnoses of lung cancer, myocardial infarction and heart failure. Mortality was also assessed. The relative risk (RR) of each outcome in the COPD cohort was compared with that in a control cohort with no diagnosis of COPD. RESULTS: The risk of lung cancer was significantly increased in individuals with a diagnosis of COPD compared with those with no COPD diagnosis (RR: 3.33; 95% confidence interval [CI]: 2.33-4.75; adjusted for age, sex and smoking status). A diagnosis of COPD was also associated with a significant increase in the risk of heart failure (age- and sex-adjusted RR: 2.94; 95% CI: 2.46-3.51) and death (age- and sex-adjusted RR: 2.76; 95% CI: 2.45-3.12), but not myocardial infarction (age- and sex-adjusted RR: 1.18; 95% CI: 0.81-1.71). CONCLUSIONS: Patients with a diagnosis of COPD are at significantly increased risk of lung cancer, heart failure and death compared with the general population. They do not appear to be at increased risk of myocardial infarction.

[Clinical treatment outcome of grade III, non-small cell bronchogenic carcinoma using "whole-body" gamma-knife system].

The results of treatment of 80 patients with non-small cell lung cancer using the Chinese-made "Whole-Body" gamma-knife system were analyzed. Primary focus and involved lymph nodes were exposed. Neither gap between primary focus and involved lymph node or nodes, nor organs of the mediastinum were exposed. Exposure regimens were: STD = 4 Gy (2.5 - 10 Gy) 5 times a week; TTD=48 Gy (27-52 Gy) per primary focus and 4 Gy (3-6 Gy) 5 times a week; TTD = 43.5 Gy (30-52 Gy) per lymph nodes (105.6 - 150 Gy = equ.). Complete response was observed in 27.5% (22/80), partial - 42.5% (34/80). Overall survival was 61.3% among those sick for one year; 41.5%--2 years and 20.75%--3 years (mean survival time--20 months).