RESUMO
Bronchoplastic surgical operations by means of invaginated method on 1 semicircle in lung malignant tumors were performed in 124 patients. Of them 116 patients (93,5%) had primary and 8 patients (6,5%) metastatic tumors. There were 94 men (75,8%) and 30 women (24,2%). The average age of patients was 56,4. The lesion of the right lung was observed in 78 patients (62,9%), of the left one in 46 patients (37,1%). Bronchoplastic lobectomies were performed in 98 patients (79%), bilobectomies - 17 patients (13,7%), segmentectomy - 4 patients (3.3%), isolated resections of bronchi - 5 patients (4,0%). All operations were radical. In all cases of lung cancer there was carried out extended inpsilateral lymph node dissection. Complications of different severity were observed in 24 patients (19,4%): pneumonia (4,8%), atelectasis (0,8%), insufficiency of bronchial sutures (3.2%), granulation stenosis of the bronchial anastomosis (1,6 %), chylothorax (0,8%), recurrent nerve palsy (2,4%), heart rhythm disorders (2,4%). Postoperative lethality was 4.8%.
Assuntos
Brônquios/cirurgia , Neoplasias Pulmonares/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Brônquios/patologia , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-IdadeRESUMO
For treatment of metastatic lung lesions there was used the method isolated chemoperfusion of the lung in combination with metastasectomy. The study includes 74 patients with metastases in the lungs who underwent 101 normothermal isolated chemoperfusion of the lung: of these 38 (37,6%) with melphalan and 63 (62,4%) with cisplatin without lethality. In the early postoperative period 1 (1,4%) patient died due to postperfusion lung edema. The period of observation of patients ranged from 2 to 99 months (median 29.3 months). Of 74 patients 53 (71,6%) patients are alive, 2 (2,7%) patients died from causes unrelated to the underlying disease. 43 (58,1%) patients showed progression of disease, what in 18 (41,9%) of them was the cause of death. Repeated appearance of metastases in perfused lung was detected in 30 (40,5%) patients. A 5-year disease-free (in the lungs) and observed survival of patients after isolated chemoperfusion of the lung with metastasectomy was 45% (median 46 months) and 59% (median not reached) respectively. There were established predictors of effectiveness of isolated chemoperfusion of the lung with metastasectomy: DFI> 13 months, ≤5 metastatic nodes in the lungs, the size of the largest metastasis in the lungs ≤20 mm, intralobular location of metastases in the lungs as well as the time of doubling the volume of metastases >64 days for chest computed tomography.
Assuntos
Quimioterapia do Câncer por Perfusão Regional , Cisplatino/administração & dosagem , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/terapia , Melfalan/administração & dosagem , Metastasectomia , Adolescente , Adulto , Idoso , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
AIM: To evaluate results of circular resection and carina reconstruction in patients with bronchial cancer. MATERIAL AND METHODS: Study included 82 patients with bronchial malignant tumors operated for the period from 1998 to 2014. Mean age was 56±1.1 years (range 24-75). There were 75 men and 7 women. Squamous cell carcinoma, adenocarcinoma, dimorphic cancer, carcinoid, adenocystic cancer, small cell cancer and clear cell renal cancer were observed in 66, 9, 1, 3, 1, 1 and 1 patients respectively. Stages IIB, IIIA, IIIB and IV were determined in 5 (6.2%), 45 (56.3%), 28 (35%) and 2 (2.5%) patients respectively. Tracheal carina resection was combined with right-sided pneumonectomy in 62 (75.6%) patients, left-sided pneumonectomy - in 5 (6.1%) cases, right upper lobectomy - in 10 (12.2%) cases. 3 patients underwent carina resection alone. Plasty with bronchopulmonary segment of right upper lobe was applied in 2 cases. Since 2002 primary bronhomyoplasty using m.latiss.dorsi, m.intercostalis and m.serr.anterior flaps has been used in 64 patients. RESULTS: Postoperative complications occurred in 31.7% (26) of patients. In-hospital mortality was 10.1%. Use of primary bronhomyoplasty and head adduction reduced broncho-pleural fistula incidence and mortality (p<0.05). Long-term results in T3-T4N0 tumors were significantly better compared with T3-4N1-2 tumors (5-year survival 41.2 vs. 16.8%, p<0,05). CONCLUSION: Results of resection with carina reconstruction may be improved using primary bronhomyoplasty and is associated with satisfactory long-term results in patients with N0-tumors.
Assuntos
Brônquios/cirurgia , Neoplasias Brônquicas/cirurgia , Neoplasias Pulmonares/cirurgia , Traqueia/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonectomia/métodos , Adulto JovemRESUMO
For treatment of metastatic lung lesions there was used the method of isolated chemoperfusion in combination with metastasectomy. The study included 74 patients (mean age 43 ± 13.4 years). There were performed 99 normothermic isolated chemoperfusions of the lung: with melphalan (39) and cisplatin (60). During surgery there were no lethality outcomes. In the immediate postoperative period it was recorded 1 (1.4%) death developed in 3 days after surgery. The cause of this death was postperfusion lung edema accompanied by increase of signs of respiratory insufficiency. There were following complications after isolated chemoperfusions of the lung: anemia--23 (23.1%), nausea--13 (13.1%), vomiting--5 (5.1%), atrial fibrillation--10 (10.1%), pneumonia-2 (2.0%), pulmonary infarction--2 (2.0%), chylothorax--1 (1.0%), pneumothorax--29 (29.3%), emphysema of soft tissues of the chest wall 73 (73.7% ). Thus isolated chemoperfusion of the lung with melphalan or cisplatin is a procedure reproducible and relatively safe.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia do Câncer por Perfusão Regional , Neoplasias Pulmonares/tratamento farmacológico , Metastasectomia , Adulto , Idoso , Anemia/induzido quimicamente , Fibrilação Atrial/etiologia , Quimioterapia do Câncer por Perfusão Regional/efeitos adversos , Quilotórax/etiologia , Cisplatino/administração & dosagem , Cisplatino/efeitos adversos , Feminino , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Masculino , Melfalan/administração & dosagem , Melfalan/efeitos adversos , Pessoa de Meia-Idade , Náusea/induzido quimicamente , Pneumotórax/etiologia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/prevenção & controle , Enfisema Subcutâneo/etiologia , Resultado do TratamentoRESUMO
The study includes data on 54 patients with pleural malignant lesions (39 with metastatic pleural malignant tumors and 15 with pleural malignant mesothelioma) received treatment using a multimodal approach: maximum cytoreduction, intraoperative photodynamic therapy and hyperthermic chemoperfusion of pleural cavity. A control group of patients with malignant pleural mesothelioma consisted of 21 patients who had undergone only conservative treatment. It was found out that the use two-thoracotomy surgical approach had advantages over standard thoracotomy across IV intercostal space. The use of multimodal treatment was accompanied by relatively low (1.85%) postoperative mortality on the background of a relatively high number (79.6%) of postoperative complications, easily cured in the early postoperative period. The use of multimodal therapy in treatment for metastatic pleural malignant lesions was accompanied by a median of disease-free survival of 11 months and a median of overall survival of 23 months. The proposed multimodal treatment compared with conservative methods of therapy improved disease-free (12 months vs. 7.5 months) and overall (18.8 months vs. 10.2 months) survival. Thus the use of a multimodal approach in treatment for pleural malignant lesions is relatively safe but requires further study.
Assuntos
Quimioterapia do Câncer por Perfusão Regional , Procedimentos Cirúrgicos de Citorredução , Hipertermia Induzida , Fotoquimioterapia , Neoplasias Pleurais/terapia , Toracotomia/métodos , Adulto , Idoso , Quimioterapia do Câncer por Perfusão Regional/métodos , Terapia Combinada/métodos , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/terapia , Masculino , Mesotelioma/terapia , Mesotelioma Maligno , Pessoa de Meia-Idade , Imagem Multimodal , Neoplasias Pleurais/diagnóstico , Neoplasias Pleurais/mortalidade , Toracotomia/efeitos adversos , Resultado do TratamentoRESUMO
There are summarized the foreign and domestic references of recent years devoted to methodology and the efficiency of the use of intraluminal high-dose radiation brachytherapy in patients with lesions of the central bronchi and trachea caused by primary and metastatic malignant tumors. It is presented own experience of applying this method in 207 patients. It is showed that in some patients to ensure the delivery of the radiation source to the area of interest it is advisable to perform firstly endotraheobronhial surgery with recanalization of the lumen of the respiratory pathways. The best is the use of intraluminal brachytherapy with high dose radiation. Palliative intraluminal irradiation of inoperable patients allowed achieving a good immediate results (65-95%), a significant reduction of the main symptoms--hemoptoe (87-95%), dyspnea (75-90%), obstructive pneumonia phenomena (50-85%), and significantly increasing survival median from 1-3 to 9-14 months. Following performance of chemoradiotherapy permitted increasing the survival median up to 15-20 months. The number of complications of intraluminal high-dose radiation brachytherapy was small, usually--pulmonary hemorrhage (2-7%) more likely developing when using large fractions--more than 10 g for 1 session.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Braquiterapia , Neoplasias Brônquicas/terapia , Quimiorradioterapia Adjuvante , Cuidados Paliativos/métodos , Neoplasias da Traqueia/terapia , Adulto , Idoso , Braquiterapia/métodos , Neoplasias Brônquicas/tratamento farmacológico , Neoplasias Brônquicas/radioterapia , Neoplasias Brônquicas/cirurgia , Quimioembolização Terapêutica , Criocirurgia , Esquema de Medicação , Eletrocirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dosagem Radioterapêutica , Radioterapia Adjuvante , Stents , Análise de Sobrevida , Neoplasias da Traqueia/tratamento farmacológico , Neoplasias da Traqueia/radioterapia , Neoplasias da Traqueia/cirurgia , Resultado do TratamentoRESUMO
This review article analyzes data of literature devoted to the description, interpretation and classification of focal (nodal) changes in the lungs detected by computed tomography of the chest cavity. There are discussed possible criteria for determining the most likely of their character--primary and metastatic tumor processes, inflammation, scarring, and autoimmune changes, tuberculosis and others. Identification of the most characteristic, reliable and statistically significant evidences of a variety of pathological processes in the lungs including the use of modern computer-aided detection and diagnosis of sites will optimize the diagnostic measures and ensure processing of a large volume of medical data in a short time.
Assuntos
Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Interpretação de Imagem Radiográfica Assistida por Computador , Tomografia Computadorizada por Raios X , Cicatriz/diagnóstico por imagem , Diagnóstico Diferencial , Detecção Precoce de Câncer , Humanos , Pneumopatias/diagnóstico por imagem , Pneumopatias/patologia , Pneumonia/diagnóstico por imagem , Pneumonia/patologia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/patologiaRESUMO
During the period from April 2012 to December 2014 54 patients aged 29-76 years, 36 (66.6%) males and 18 (33.4%) females, with esophageal cancer underwent minimally invasive esophagectomy as final phase of treatment. Squamous cell carcinoma was diagnosed in 50 patients and adenocarcinoma identified in 4 patients. The disease was staged as follows: IA--5 (9.3%) patients, IB--11 (20.4%) patients, IIA-- (16,.%) cases, III -- (3,.%) cases, IIII --8 (33,.%), IIII -- (14,8%), III -- (1,.%). 37 (68,.%) patients had surgery after induction chemoradiation therapy. Of 54 surgical interventions there were 20 hybrid and 34 minimally invasive operations. 19 (35,.%) patients developed complications, postoperative mortality was 2 (3,.)%. Minimally invasive esophagectomy meets basic oncological principles and leads to tolerable short-term results.
Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Adenocarcinoma/cirurgia , Adulto , Idoso , Carcinoma de Células Escamosas/cirurgia , Quimiorradioterapia Adjuvante , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/terapia , Esofagectomia/mortalidade , Feminino , Humanos , Quimioterapia de Indução , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Estadiamento de Neoplasias , Estudos Retrospectivos , Resultado do TratamentoRESUMO
This review summarizes data dedicated to improving the efficiency of screening of malignant tumors through the use of modern information and telecommunication technologies. It is showed that currently available software solutions in the field of medical imaging is not enough adapted for population screening. So far there is no single standard that defines checking algorithms of data processing at certain controlled conditions. The most expected result will be the organization of information centralized storage, sharing diagnostic data, providing broad access to them, automated analysis and selection of diagnostically significant results through the software. The basic requirements for the development of self-learning systems for intelligent processing array of heterogeneous data through the use of technologies of semantic networks are provided.
Assuntos
Inteligência Artificial/tendências , Redes de Comunicação de Computadores , Diagnóstico por Imagem/tendências , Detecção Precoce de Câncer , Programas de Rastreamento , Software , Algoritmos , Redes de Comunicação de Computadores/estatística & dados numéricos , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/tendências , Humanos , Programas de Rastreamento/métodos , Programas de Rastreamento/tendênciasRESUMO
The literature and our own experience were analyzed in multimodal approach to the treatment of patients with malignant pleural mesothelioma (MPM). Survival and quality of life of patients with MPM who underwent multimodal treatment, according to modern standards, are often limited by the occurrence of local recurrences. The value of a number of local therapy methods is still being explored in order to determine the possible side effects as well as the duration of disease-free survival. Photodynamic therapy and intraoperative hyperthermic chemoperfusion of the pleural cavity are the methods of the local treatment of this disease, applied after surgery. These approaches have been investigated separately in several studies, but their efficacy and tolerability is still not clear. The authors wanted to find the best indications for the use of these methods and to assess the immediate and long-term results.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Quimioterapia do Câncer por Perfusão Regional , Hipertermia Induzida , Neoplasias Pulmonares/tratamento farmacológico , Mesotelioma/tratamento farmacológico , Fotoquimioterapia , Neoplasias Pleurais/tratamento farmacológico , Qualidade de Vida , Adulto , Idoso , Quimioterapia Adjuvante/métodos , Quimioterapia do Câncer por Perfusão Regional/métodos , Intervalo Livre de Doença , Feminino , Humanos , Neoplasias Pulmonares/cirurgia , Masculino , Mesotelioma/cirurgia , Mesotelioma Maligno , Pessoa de Meia-Idade , Cavidade Pleural , Neoplasias Pleurais/cirurgia , Resultado do TratamentoRESUMO
This review summarizes data of publications and meta-analyses devoted ton the use of transthoracic biopsy. It is showed that the method continues to be one of the main ways to diagnose pathological processes in the thoracic cavity's organs, especially tumors of the lungs, pleura, mediastinum and chest wall. Modern methods of navigation trepan-needles can receive sufficient volume of pathological tissue samples for subsequent full morphological study to individualize and optimize treatment algorithms.
Assuntos
Biópsia/métodos , Neoplasias Torácicas/diagnóstico , Toracotomia , Biópsia/efeitos adversos , Biópsia por Agulha/métodos , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias do Mediastino/diagnóstico , Neoplasias Pleurais/diagnóstico , Valor Preditivo dos Testes , Neoplasias Torácicas/patologia , Parede Torácica/cirurgiaRESUMO
An analysis of modern methods of diagnostics such as morphological, immunohistochemical and spectral, which included the bronchoscopy and spectrometry by using reflectance and autofluorescent regime, was made. The data involved the results of prospective follow-up study of 167 patients (620 biopsies). An obligatory spectrometry of suspicious area was carried out before the forceps biopsy. The microslides, which met the requirements of criteria of one of the carcinogen steps (n=201), were subjected to the in-depth morphological and immunohistochemical investigations. The tendency of angiogenesis (CD31 and CD34), proliferative activity (Ki-67), level of apoptosis (P53), EGFR expression were estimated. The sensitivity of combined endoscopic method was 94,74% by specificity 79,95% and high prognostic value of negative endoscopic diagnosis - 99,4%.
Assuntos
Broncoscopia , Neoplasias Pulmonares , Pulmão , Lesões Pré-Cancerosas/patologia , Biópsia/métodos , Broncoscopia/métodos , Broncoscopia/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Imuno-Histoquímica/métodos , Pulmão/metabolismo , Pulmão/patologia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/metabolismo , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Prognóstico , Federação Russa/epidemiologia , Análise EspectralRESUMO
This article presents the literature data review showing an urgency of lung cancer treatment problem in elderly patients, considering that more than 40% patients are in the age category older 65. The opinion on inexpediency of baseless refusal of adequate radical operative treatment performance under condition of patient functional validity is proved. The authors demonstrate their own clinical case of the 91 year old patient with a peripheral middle lobe right lung cancer with metastasises in root lymph nodes pT2N1M0 IIB, whom upper bilobectomy with one-piece methodic ipsilateral mediastinal lymphadenectomy without any complications was made.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias Pulmonares/cirurgia , Procedimentos Cirúrgicos Torácicos/métodos , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patologia , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Excisão de Linfonodo , Metástase Linfática , Mediastino/cirurgia , Estadiamento de Neoplasias , Resultado do TratamentoRESUMO
The article summarizes the experience of anesthetic management in rigid bronchoscopy endobronchial surgery. Induction intravenous anesthesia followed by high tidal-volume mechanical ventilation proved to be more effective, than inhalation anesthesia with injector or high-frequency ventilation, although these methods are safe and effective in patients with compensated respiratory failure. The use of controlled hypotonia with mean arterial pressure of 60-70 mm Hg leads to decrease of blood loss and hypoxemia prevention without impairment of hemodynamics.
Assuntos
Anestesia Intravenosa , Perda Sanguínea Cirúrgica/prevenção & controle , Neoplasias Brônquicas/cirurgia , Broncoscopia , Hipóxia/prevenção & controle , Respiração Artificial , Neoplasias da Traqueia/cirurgia , Adulto , Idoso , Anestesia por Inalação , Broncoscopia/métodos , Feminino , Ventilação de Alta Frequência , Humanos , Hipotensão/induzido quimicamente , Hipóxia/etiologia , Masculino , Pessoa de Meia-Idade , Prevenção Primária/métodos , Respiração Artificial/métodos , Insuficiência Respiratória , Estudos Retrospectivos , Volume de Ventilação PulmonarRESUMO
In 20 primary patients with focal abnormalities on conventional CT we evaluated diagnostic properties of simultaneous double-tracer SPECT. Scintigraphy was performed as a single examination with simultaneous registration of 67Ga and 99mTc-MIBI. Image acquisition was started 48-74 hours after IV injection of 130-175 MBq 67Ga-citrate and immediately after IV injection of 500-740 MBq of 99mTc-MIBI. All images for each agent were classified as positive and negative for primary tumor, N1 and N2 lymph-nodes (LN). According to histology 18 of 20 evaluated patients had non-small cell lung cancer (NSCLC), the other two patients had tuberculosis and nonspecific inflammation. SPECT with 99mTc-MIBI correctly visualized tumor in 18, 67Ga allowed correct visualization in 16 cases. Both tracers were truly negative in a patient with tuberculosis and false positive in a patient with nonspecific inflammation. Double-tracer SPECT was slightly more specific than CT in primary lesions. In 18 patients histological verification of LN status was obtained: NO was revealed in 9 cases, N1 in 4 and N2 in 5 cases. Both tracers correctly discriminated LN-positive and LN-negative cases with 94% specificity. On the contrary, CT was false-positive in 3 and false-negative in another 5 patients. Differentiation between N1 and N2 LN involvement is crucial for therapy planning. 99mTc MIBI and 67Ga revealed N1 in 2 cases and N2 in 4 cases, the diagnosis was later verified by postoperative morphology. In 2 patients SPECT overestimated extent of LN involvement and LN status was changed after surgery from N2 to N1. In 18 patients results of 99mTc-MIBI and 67Ga augmented each other. Accuracy of LN staging by SPECT with 99mTc-MIBI and 67Ga was 83%. CT accurately determined LN stage only in 7 patients, it was overestimated in 7 and underestimated in 4 cases. SPECT with 99mTc-MIBI and 67Ga demonstrated high overall accuracy in diagnostics of regional LN invasion for patients with NSCLC. Diagnostic value of conventional CT was significantly lower. Correct level of LN involvement was determined by SPECT in 83% of cases.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/patologia , Citratos , Gadolínio , Gálio , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Radioisótopos , Compostos Radiofarmacêuticos , Tecnécio Tc 99m Sestamibi , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Gadolínio/administração & dosagem , Humanos , Injeções Intravenosas , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Pneumonia/diagnóstico por imagem , Valor Preditivo dos Testes , Radioisótopos/administração & dosagem , Compostos Radiofarmacêuticos/administração & dosagem , Sensibilidade e Especificidade , Tecnécio Tc 99m Sestamibi/administração & dosagem , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/diagnóstico por imagemRESUMO
The present report analyses the immediate and long-term results of treatment of surgical complications in 998 patients with lung cancer. There were complications in 37,5% of the cases, with a fatality rate of 14,7%. The most frequent complications were as follows: postoperative empyema with bronchopleural fistula (41,3%), bleeding (12,0%), pneumonia (9,8%), pulmonary arteries embolism (8,1%) and heart rhythm disorders (8,1%). Adjuvant and neoadjuvant treatment does not increase the rate of surgical complications as compared to just surgery alone (p = 0,1). Postoperative empyema with bronchopleural fistula requires intensive therapy, affects the quality of life of patients but does not decrease survival rates as compared to patients at the same stages of disease with uncomplicated course (p = 0,001). Timely drainage of pleural cavity accompanied by its adequate sanation does not differ (p = 0,1) from usage thoracoplasty (MS 29,9 months to 33,2 months).
Assuntos
Fístula Brônquica/etiologia , Drenagem , Empiema Pleural/etiologia , Neoplasias Pulmonares/cirurgia , Terapia Neoadjuvante , Pneumonectomia/efeitos adversos , Pneumonectomia/mortalidade , Adulto , Idoso , Animais , Fístula Brônquica/terapia , Empiema Pleural/terapia , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/terapia , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodosRESUMO
A total of 4218 lung cancer patients received therapy from 1965 to 2004. Patients' population analysis shows no statistically significant changes in sex, clinico-anatomical forms or morphological type structure. The first 30 years analyzed showed a gradual increase in the number of patients receiving radical treatment (46.7, 67.2 and 82.4% for each decade), in 1995-2004 this value dropped to 34,0%. For each of the decades studied was evident an increase in the number of patients over 60 years receiving radical treatment. The third decade (1985 to 1994) was characterized by statistically significant increase of 5-year overall survival among patients receiving radical treatment (49.0% compared to 36.2%, 37.6% and 46.0%) mostly due to an increase in I and IIA stage patients compared to other periods (67.9 versus 52.3, 56.5 and 51.6%). The adjuvant tele-irradiation (total focal dose 45-55 Gy, conventional fractioning) in patients receiving radical surgical treatment for metastatic lung cancer with mediastinal lymph nodes involvement (N2) lead to statistically significant increase in 5-year overall survival from 14.7 to 19.7%.
Assuntos
Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/terapia , Adulto , Idoso , Feminino , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/cirurgia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Radioterapia Adjuvante , Estudos Retrospectivos , Análise de Sobrevida , Telemedicina/métodos , Resultado do TratamentoRESUMO
The paper describes the general experience of modern lung cancer treatment methods application. Neoadjuvant therapy was shown to improve the long-term results of stage III patients increasing the 5-year overall survival by 7,8% (p=0,012). The special diagnostic algorithm for treatment results evaluation including autofluorescence spectrometry with 97,1% sensitivity and 88,3% specificity was developed. The adjuvant external-beam radiotherapy in patients with mediastinal lymph nodes metastases was shown to increase the 5-year overall survival (14,7% versus 19,7%) (p=0,01). The combination of endotracheobronchial surgery with chemoradiotherapy allowed to increase the median survival time of patients with inoperable lung cancer to 17 months. Isolated lung chemoperfusion was shown to increase the overall (p=0,019) and relapse-free (p=0,005) survival in patients with lung metastases.
Assuntos
Neoplasias Pulmonares/terapia , Carcinoma Pulmonar de Células não Pequenas/terapia , Quimiorradioterapia , Quimioterapia do Câncer por Perfusão Regional , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Metástase Linfática , Terapia Neoadjuvante/métodos , Estadiamento de Neoplasias , Sensibilidade e Especificidade , Espectrometria de Fluorescência , Análise de Sobrevida , Resultado do TratamentoRESUMO
The locally advanced cancer of thoracic esophagus was treated by induction chemo-irradiation therapy (IHRT) with intraluminal medium dose-rate brachytherapy (IMBT). From July 2009 to February 2012 twenty five patients (mean age 54.3 +/- 1.3 years) were included in the study. The length of the primary tumor was up to 6 cm in 10 pts and more than 6 cm in 15 pts. Induction therapy consisted of three IMBT sessions (7 Gy X 3; q7d) and two cycles of chemotherapy (PF; q28d), 26-31 days later the surgery was performed. Subtotal resection of the esophagus type of I Lewis was performed in 23 pts, transtracheal extirpation of the esophagus was performed in 2 pts.In all the cases 3F lymphodissection was performed. After IHRT in 15 of 25 pts. was obtained complete or partial response, in 10 of 25 pts was obtained disease stabilization. Perioperative complications occurred in 17 (68%) patients receiving conservative treatment, one patient (4%) died of treatment complications. In 6 cases (24%) morphology had shown the complete regression of primary tumor. Thus, the combination of intraluminal medium dose-rate brachytherapy and chemotherapy lead to reduction of primary tumor local spread and can be an efficient factor in improving the results of surgical treatment.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Braquiterapia , Carcinoma/terapia , Neoplasias Esofágicas/terapia , Terapia Neoadjuvante/métodos , Adulto , Idoso , Braquiterapia/métodos , Carcinoma/tratamento farmacológico , Carcinoma/patologia , Carcinoma/radioterapia , Carcinoma/cirurgia , Quimiorradioterapia Adjuvante , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/radioterapia , Neoplasias Esofágicas/cirurgia , Esofagectomia , Esofagoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/efeitos adversos , Dosagem Radioterapêutica , Indução de Remissão , Resultado do TratamentoRESUMO
The paper deals with evaluation of the literature data and our experience with automated quantitative cytometric examination of sputum for diagnosis of lung cancer and, in particular, early one. This novel procedure uses measurement of quantitative indices which characterise tumors-induced alterations. The LungSign computerized system was employed to scan cellular nuclei. The results were evaluated by linear discriminative analysis with the aid of ROC-curves and underlying areas. The procedures were run in 248 cases and its sensitivity was significantly higher that of a standard cytological one (36.6% and 13.3%, respectively; p = 0.033), albeit a slight decrease in specificity (93.7% and 100%, respectively; p = 0.003). Automated quantitative cytometric indices varied significantly in cohorts of patients with confirmed (-0.275871) and false (-1.24990) diagnosis of lung cancer (p = 0.0001).