Long term surgical results of 154 petroclival meningiomas: A retrospective multicenter study.

BACKGROUND: Outcomes of petroclival meningiomas (PCM) (morbidity, permanent cranial nerves deficit, tumor removal and recurrence) are inconsistent in the literature, making it a challenge to predict surgical morbidity. METHODS: A multicenter study of patients with PCMs larger than 2.5cm between 1984 and 2017 was conducted. The authors retrospectively reviewed the patients' medical records, imaging studies and pathology reports to analyze presentation, surgical approach, neurological outcomes, complications, recurrence rates and predictive factors. RESULTS: There were 154 patients. The follow-up was 76.8 months on average (range 8-380 months). Gross total resection (GTR) was achieved in 40 (26.0%) patients, subtotal resection (STR) in 101 (65.6%), and partial resection in 13 (8.3%). Six (2.6%) perioperative deaths occurred. The 5-year, 10-year and 15-year progression-free survival (PFS) of GTR and STR with radiation therapy (RT) was similar (100%, 90% and 75%). PFS of STR without adjuvant radiation was associated with progression in 71%, 51% and 31%, respectively. Anterior petrosectomy and combined petrosectomy were associated with higher postoperative CN V and CN VI deficits compared to the retrosigmoid approach. The latter had a significantly higher risk of CN VII, CN VIII and LCN deficit. Temporal lobe dysfunction (seizure and aphasia) were significantly associated with the anterior petrosectomy approach. CONCLUSIONS: Our study shows that optimal subtotal resection of PCMs associated with postoperative RT or stereotactic radiosurgery results in long-term tumor control to equivalent radical surgery. Case selection and appropriate intraoperative judgement are required to reduce the morbidity.

Quantitative and qualitative analysis of antimicrobial usage in white veal calves in France.

The development of antimicrobial resistance has made it necessary to measure antimicrobial usage in animal production sectors. France is a major European producer of white veal calves, but few data were previously available for that sector, even though these young animals are particularly susceptible to infection and considered as a reservoir of antimicrobial resistance. A cross-sectional study was conducted on 186 batches of French calves to estimate the exposure of white veal calves to antimicrobials and identify the potential risk factors related to antimicrobial usage. An indicator of calf exposure was calculated as a count of the number of antimicrobial treatments per calf. The indicator was based on veterinary prescriptions (products, quantity dispensed and dosage prescribed) and the estimated weight of calves at treatment, using the dates of treatment collected from farm registers. The study showed that calves were exposed to an average of 8.55 antimicrobial treatments (SD: 2.21, range: 2.75-15.86) over the five to six months of the fattening process. Group treatments were predominant (95.8%) and administered by the oral route. The "starting treatments", given during the first two weeks of the fattening period, were administered systematically (to all the calves in all the farms) and accounted for a third of all treatments. Tetracyclines, polypeptides and macrolides were the most widely used antimicrobials, with respectively 4.32, 1.59 and 1.01 treatments per calf. Only rare uses of 3rd and 4th generation cephalosporins and fluoroquinolones, considered as critically important in human medicine, were reported. Despite low variability of exposure between farms, a linear mixed-effects model highlighted a higher variability between farmers (ICC=0.14) or veterinarians (ICC=0.12), than between integrators (ICC=0.06). The number of calves per pen, introduced as a fixed effect in the model, was also significant: calves housed in pens of 6-10 and fed in buckets had on average 2.55 more antimicrobial treatments per calf than calves housed in pairs with the same feeding system. The model also highlighted an increase of 1.48 treatments per calf for farms with more than five percent of mortality, versus those with two percent or less. The present study showed that antimicrobial treatments are numerous in veal calf fattening farms, particularly at the arrival of the animals. Taking into account the development of resistance to antimicrobials, the necessity and the effectiveness of some of these treatments should be re-evaluated.

Rationale for a Minimum Number of Lymph Nodes Removed with Non-Small Cell Lung Cancer Resection: Correlating the Number of Nodes Removed with Survival in 98,970 Patients.

BACKGROUND: The benefit of thoracic lymphadenectomy in the treatment of resectable non-small cell lung cancer (NSCLC) continues to be debated. We hypothesized that the number of lymph nodes (LNs) removed for patients with pathologic node-negative NSCLC would correlate with survival. METHODS: The National Cancer Data Base (NCDB) was queried for resected, node-negative, NSCLC patients treated between 2004 and 2014. Patients were grouped according to the number of LNs removed (1-4, 5-8, 9-12, 13-16, and ≥17). Patients with <10 LNs removed were also compared with those with ≥10 LNs removed. A Cox regression analysis was performed and hazard ratios (HRs) calculated, with 95 % confidence intervals (CIs). RESULTS: Of 1,089,880 patients with NSCLC reported to the NCDB during the study period, 98,970 (9.0 %) underwent resection without evidence of pathologic nodal involvement. Lobectomy was performed in 83.9 %, sublobar resection was performed in 12.7 % and pneumonectomy was performed in 2.8 % of patients. The number of LNs removed correlated with increasing tumor size and extent of resection. On multivariate analysis, increasing age, male sex, white ethnicity, high tumor grade, larger tumor size, pneumonectomy, and positive surgical margins were all negatively correlated with overall survival. The number of LNs removed and lobectomy/bi-lobectomy correlated with improved survival. The removal of <10 LNs was associated with a 12 % increased risk of death (HR: 1.12, 95 % CI 1.09-1.14; p < 0.001). CONCLUSION: Survival of early-stage NSCLC patients is associated with the number of LNs removed. The surgical management of early-stage NSCLC should include thoracic lymphadenectomy of at least 10 nodes.

A rare case study of a retropharyngeal neurofibroma and a brief literature review.

INTRODUCTION: Space occupying lesions in the retropharyngeal space are rare. CASE REPORT: Here, we present a rare case of a retropharyngeal neurofibroma treated surgically through an open cervical approach without any complication. DISCUSSION: Neurofibromas are benign, slowly growing neoplasms that could be associated or not with neurofibromatosis. They are derived from peripheral nerves. Diagnostic work-up should include CT-scan and MRI as well as a biopsy to confirm the diagnosis. Treatment of localized and diffuse neurofibromas is often surgical resection, which may require sacrifice of the nerve. Malignant transformation of these lesions, without association to NF-1, is rare and exceptionally documented in the literature. CONCLUSION: We presented a rare case of solitary neurofibroma of the retropharyngeal space. Complete resection of the lesion was performed without any complication. We also presented a brief review of the literature about neurofibromas.

Technique for reduction and percutaneous fixation of U- and H-shaped sacral fractures.

We describe an early reduction and percutaneous fixation technique for isolated sacral fractures. Strong manual traction combined with manual counter-traction on the torso is used to disimpact the fracture. Transcondylar traction is then applied bilaterally and two ilio-sacral screws are inserted percutaneously on each side. Open reduction and fixation, with sacral laminectomy in patients with neurological abnormalities, remains the reference standard. Early reduction and percutaneous fixation ensures restoration of the pelvic parameters while minimising soft-tissue damage and the risk of infection. Decompression procedures can be performed either during the same surgical procedure after changing the installation or after a few days. These complex fractures warrant patient referral to specialised reference centres.

Assessment of the quality of medical care among patients with early stage prostate cancer undergoing expectant management in the United States.

PURPOSE: Given the increased attention to the quality and cost of medical care, the Institute of Medicine and Centers for Medicare and Medicaid Services have called for performance measurement and reporting. The clinical management of prostate cancer has been outlined, yet is not intended to describe quality prostate cancer care. Therefore, RAND researchers developed quality indicators for early stage prostate cancer. The ACoS (American College of Surgeons) used these indicators to perform the first national assessment to our knowledge of the quality of care among men with early stage prostate cancer undergoing expectant management. MATERIALS AND METHODS: Information from medical records was abstracted for evidence of compliance with the RAND indicators (structure and process). Weighted and stratified proportions were calculated to assess indicator compliance. Logistic regression models were fit and evaluated by hospital type and patient factors. RESULTS: A weighted and stratified total of 13,876 early stage prostate cancer cases on expectant management in 2000 to 2001 were investigated. Compliance with structural indicators was high (greater than 80%) and compliance with process indicators varied (19% to 87%). Differences in process indicators were observed from models by hospital type and comorbid conditions, but not for age, race or insurance status. CONCLUSIONS: Using the RAND quality indicators this study revealed several process areas for quality improvement among men with early stage prostate cancer on expectant management in the United States. Efforts to improve the quality of early stage prostate cancer care need to move beyond the paradigm of age, race and insurance status.

Small-cell lung cancer: prognostic factors and changing treatment over 15 years.

BACKGROUND: The incidence of small-cell lung cancer (SCLC) has decreased over several decades. Sixty-eight thousand six hundred eleven patients with SCLC in the National Cancer Data Base (NCDB) were analyzed to describe demographic, treatment, and survival changes between 1992 and 2007. METHODS AND MATERIALS: Four patient cohorts-diagnosed in 1992, 1997, 2002, and 2007-were examined. Univariate and multivariate analyses were performed to determine changes in demographic and treatment factors and their effect on survival of limited SCLC (LSCLC) and extensive SCLC (ESCLC). RESULTS: The proportion of female patients increased, whereas the proportion of non-Hispanic white patients decreased. Median survival for patients with ESCLC and LSCLC was 6.1 and 12.9 months, respectively, and was not significantly improved between patients diagnosed in 1992 and 2002. Improved survival was associated with female sex, age < 70 years, and receipt of surgery for patients with LSCLC. Radiation therapy decreased the hazard ratio (HR) for patients with stage III LSCLC but not for patients with earlier stage disease. Chemotherapy decreased the HR for all patients with LSCLC. Patients with ESCLC treated with radiation in addition to chemotherapy had better survival than those who received only chemotherapy. CONCLUSIONS: Despite changes in demographics and treatment, the median and 5-year survival rates for patients with SCLC have not significantly improved over the past 15 years. Surgery was associated with improved survival in LSCLC. The benefit of chemotherapy and/or radiation therapy was dependent on American Joint Committee on Cancer (AJCC) stage. AJCC staging information had prognostic and treatment ramifications and should be collected in future studies and databases.

Quantitative analysis and molecular fingerprinting of methicillin-resistant Staphylococcus aureus nasal colonization in different patient populations: a prospective, multicenter study.

OBJECTIVES: To better understand the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection in different patient populations, to perform quantitative analysis of MRSA in nasal cultures, and to characterize strains using molecular fingerprinting. DESIGN: Prospective, multicenter study. SETTING: Eleven different inpatient and outpatient healthcare facilities. PARTICIPANTS: MRSA-positive inpatients identified in an active surveillance program; inpatients and outpatients receiving hemodialysis; inpatients and outpatients with human immunodeficiency virus (HIV) infection; patients requiring cardiac surgery; and elderly patients requiring long-term care. METHODS. Nasal swab samples were obtained from January 23, 2006, through July 27, 2007; MRSA strains were quantified and characterized by molecular fingerprinting. RESULTS: A total of 444 nares swab specimens yielded MRSA (geometric mean quantity, 794 CFU per swab; range, 3-15,000,000 CFU per swab). MRSA prevalence was 20% for elderly residents of long-term care facilities (25 of 125 residents), 16% for HIV-infected outpatients (78 of 494 outpatients), 15% for outpatients receiving hemodialysis (31 of 208 outpatients), 14% for inpatients receiving hemodialysis (86 of 623 inpatients), 3% for HIV-infected inpatients (5 of 161 inpatients), and 3% for inpatients requiring cardiac surgery (6 of 199 inpatients). The highest geometric mean quantity of MRSA was for inpatients requiring cardiac surgery (11,500 CFU per swab). An association was found between HIV infection and colonization with the USA300 or USA500 strain of MRSA (P < or = .001). The Brazilian clone was found for the first time in the United States. Pulsed-field gel electrophoresis patterns for 11 isolates were not compatible with known USA types or clones. CONCLUSION: Nasal swab specimens positive for MRSA had a geometric mean quantity of 794 CFU per swab, with great diversity in the quantity of MRSA at this anatomic site. Outpatient populations at high risk for MRSA carriage were elderly residents of long-term care facilities, HIV-infected outpatients, and outpatients receiving hemodialysis.

[Orbital tumors. Neurosurgical activity]. / Tumeurs orbitaires. Activité neurochirurgicale.

In this chapter, we report the results of orbital tumor management in a few neurosurgical departments and compare it to a Paris neurosurgical department that has developed a close relation with an ophthalmological department. These departments' activity is quite low, treating mainly sphenoorbital meningiomas. Other tumor groups are unequally and sporadically managed.

National Cancer Database report on cancer of the head and neck: 10-year update.

BACKGROUND: We sought to examine the current state of cancer care for head and neck tumors in the United States. We therefore performed a retrospective, longitudinal study of the approximately 822,000 head and neck cancer cases included in the National Cancer Data Base (NCDB) for 1990 through 2004, representing approximately 75% of the estimated incident diagnoses in the United States. METHODS: All cases of head and neck cancer diagnosed and reported to the NCDB during this interval were reviewed, and descriptive statistics, grouped by disease and host factors, were analyzed over time and compared with a prior similar analysis done 10 years ago. RESULTS: Although many similarities persist, several major changes in head and neck cancer have occurred, most notably (1) a decrease in the number of the older-aged patients who have mucosally derived squamous cell carcinomas coupled with an increase in the number of younger-aged patients who have thyroid-origin adenocarcinomas and (2) a decrease in the use of radiation therapy alone for treatment in favor of chemotherapy enhanced radiation therapy. CONCLUSION: Head and neck cancers include a heterogeneous group of tumors whose precise composition changes over time and whose therapy evolves as well. The NCDB is well suited to capture this information and provide both an analysis of the current state of cancer care for head and neck tumors and a longitudinal view over time.

PET-CT as an effective imaging modality in the staging and follow-up of post-transplant lymphoproliferative disorder following solid organ transplantation.

INTRODUCTION: To establish the role of positron-emission tomography (PET)-computed tomography (CT) in post-transplant lymphoproliferative disorder (PTLD) patients, compared to conventional imaging (ultrasonography/CT/magnetic resonance imaging) in relation to its accuracy, sensitivity and specificity. METHODS: 30 patients (26 males and 4 females), with a median age of 49.5 (range 18-74) years, were retrospectively evaluated. In 29 cases, the diagnosis was confirmed by histopathology. Malignant lymphoma was detected in 20 cases, polymorphic lymphoproliferative disorder in six cases, multiple myeloma in two cases and Hodgkin's disease in one case. A total of 49 PET-CTs (13 studies for staging at diagnosis and 36 studies at follow-up as assessment post-therapy) were compared to conventional imaging. Imaging results in accordance with disease status were assessed at a median follow-up of 17.8 (range 1.5-42.2) months post-PET-CT. RESULTS: In 41 of 49 examinations performed for staging and on follow-up, PET-CT and conventional imaging findings were concordant. Compared to conventional imaging, PET-CT showed comparable sensitivity (75 percent vs. 83 percent), similar specificity (100 percent in both modalities) and comparable accuracy (77 percent vs. 85 percent) during staging at diagnosis. PET-CT was found to be superior to conventional imaging modalities at follow-up, with greater sensitivity (100 percent vs. 81 percent), specificity (80 percent vs. 100 percent) and accuracy (97 percent vs. 83 percent). CONCLUSION: PET-CT is an accurate diagnostic tool for staging and for the follow-up of PTLD patients. It represents a good alternative imaging method to avoid contrast-related nephrotoxicity in patients who often develop impaired renal function secondary to chronic immunosuppressive therapy. However, further studies are recommended before considering PET-CT as a routine diagnostic tool in PTLD.

Variations in quality of care for men with early-stage prostate cancer.

PURPOSE: The commencement of quality-improvement initiatives such as Pay for Performance and the Physician Consortium for Performance Improvement has underscored calls to evaluate the quality of cancer care on a patient level for nationally representative samples. METHODS: We sampled early-stage prostate cancer cases diagnosed in 2000 through 2001 from the American College of Surgeons National Cancer Data Base and explicitly reviewed medical records from 2,775 men (weighted total = 55,160 cases) treated with radical prostatectomy or external-beam radiation therapy. We determined compliance with 29 quality-of-care disease-specific structure and process indicators developed by RAND, stratified by race, geographic region, and hospital type. RESULTS: Overall compliance exceeded 70% for structural and pretherapy disease assessment indicators but was lower for documentation of pretreatment functioning (46.4% to 78.4%), surgical pathology (37.1% to 86.3%), radiation technique (62.6% to 88.3%), and follow-up (55%). Geographic variations were observed as higher compliance in the South Atlantic division than the New England division for having at least one board-certified urologist (odds ratio [OR], 9.2; 95% CI, 1.9 to 45.0), at least one board-certified radiation oncologist (OR, 3.3; 95% CI, 1.2 to 9.0), use of Gleason grading (OR, 4.1; 95% CI, 1.2 to 13.8), and administering total radiation dose >or= 70 Gy (OR, 3.1; 95% CI, 1.6 to 6.1). Teaching/research hospitals and Comprehensive Cancer Centers had higher compliance than Community Cancer Centers, whereas racial differences were not observed for any indicator. CONCLUSION: The significant and unwarranted variations observed for these quality indicators by census division and hospital type illustrate the inconsistencies in prostate cancer care and represent potential targets for quality improvement. The lack of racial disparities suggests equity in care once a patient initiates treatment.

Impact of adjuvant radiation on survival: a note of caution when using cancer registry data to evaluate adjuvant treatments.

BACKGROUND: With increasing frequency, studies using cancer registries have evaluated the treatment effect of adjuvant radiation; however, these analyses generally do not include chemotherapy treatment data. Our objective is to evaluate the potential impact the absence of adjuvant chemotherapy data has on the estimated survival benefit attributed to adjuvant radiation therapy. METHODS: Using the National Cancer Data Base, patients were identified who underwent surgery for cancers that often require radiation therapy: breast, esophageal, gastric, pancreatic, and rectal cancer. Cox proportional hazards modeling with and without chemotherapy as a predictor variable was used to assess the impact of radiation therapy on 5-year survival. RESULTS: From 1998 to 1999, 295,206 patients underwent surgical resection for one of five cancers. Chemotherapy administration ranged from 27.5% for gastric to 56.1% for rectal cancer. For cancers where chemotherapy affected survival, the impact of radiation therapy was overestimated in the multivariate model when chemotherapy was not included. For example, radiation treatment for rectal cancer was associated with a 31% decrease in the risk of death in the model that did not control for chemotherapy; however, the addition of chemotherapy to the model resulted in only a 14% decrease in the risk of death associated with receiving radiation therapy. CONCLUSIONS: For selected tumor sites, the administration of chemotherapy is not evenly distributed among patients receiving and not receiving radiation. Survival analyses that do not include chemotherapy administration overestimate the beneficial impact of radiation on survival. Evaluating the effect of radiation on survival retrospectively without adjusting for chemotherapy administration should be done cautiously.

Reported prevalence and co-morbidity of asthma, chronic bronchitis and emphysema: a pan-European estimation.

OBJECTIVE: Comparable population-based data exist at the European level for asthma but not for chronic obstructive pulmonary disease. Data from the World Health Organization's Large Analysis and Review of European Housing and Health Status Study conducted in random samples from eight European cities were used 1) to describe the prevalence of chronic bronchitis and emphysema (CBE) and asthma according to socio-demography, addictions, physical activities and body mass index; and 2) to identify the co-morbidities of these respiratory diseases. DESIGN: A total of 6915 adults filled out a standardised questionnaire on health outcomes, including major respiratory diseases and individual characteristics. RESULTS: Data showed that in the year preceding the survey, 3.3% of individuals had been diagnosed or treated for asthma and 6.2% for CBE. One per cent suffered simultaneously from both. Large variations were observed between cities. Physical activities and never smoking were inversely associated with CBE, independently of socio-cultural differences between the eight cities. Furthermore, both asthma and CBE were significantly related to several non-respiratory diseases, after adjustment for potential confounders. CONCLUSION: Population-based data from eight European cities show that there is a link between chronic respiratory diseases and various non-respiratory co-morbidities that needs further investigation.

The quality of surgical pathology care for men undergoing radical prostatectomy in the U.S.

BACKGROUND: The authors assessed adherence with the College of American Pathologists (CAP) radical prostatectomy (RP) practice protocol in a national sample of men who underwent RP for early-stage prostate cancer. METHODS: Using the National Cancer Data Base, the authors identified a nationally representative sample of 1240 men (unweighted) who underwent RP. For each patient, local cancer registrars performed an explicit medical record review to assess patient-level compliance with surgical pathology report documentation of 7 morphologic criteria (ie, quality indicators). Applying the CAP prognostic factor classification framework, composite measures and all-or-none measures of quality indicator compliance were calculated for the following analytic categories: 1) a strict subset of CAP category I prognostic factors (3 indicators), 2) a broad subset of CAP category I factors (6 indicators), and 3) the full set of 7 indicators. RESULTS: Among a weighted sample of 24,420 patients who underwent RP, compliance with documentation of the CAP category I factors varied from 54% (95% confidence interval [95% CI], 50-58%) for pathologic tumor, lymph node, metastases classification (according to the American Joint Committee on Cancer staging system) to 97% (95% CI, 96-99%) for Gleason score. In composite, RP pathology reports contained 83% (95% CI, 81-84%), 85% (95% CI, 84-87%), and 79% (95% CI, 78-80%) of the recommended data elements measured by the strict CAP category I subset, the broad CAP category I subset, and the full set of 7 indicators, respectively. In contrast to the generally higher composite scores, only 52% (95% CI, 48-56%) and 41% (95% CI, 37-45%) of men who underwent RP had complete documentation in their pathology reports for the strict and broad CAP category I subsets, respectively. CONCLUSIONS: RP surgical pathology reports contained most of the recommended data elements; however, the frequent absence of pathologic stage provides an opportunity for quality improvement.

National survey of non-small cell lung cancer in the United States: epidemiology, pathology and patterns of care.

PURPOSE: To determine the epidemiology, pathology and patterns of care for patients with non-small cell lung cancer (NSCLC) in the United States. METHODS: In 2001 the National Cancer Data Base, under direction of the American College of Surgeons, conducted a patient care evaluation study in 719 hospitals. We collected information on patient demographics and histories, diagnostic and staging methods, pathology, and initial treatment. RESULTS: Information on 40,909 patients was obtained; 93% were smokers. Slightly more than half were older than 70 years; 58.5% were male and 35% had adenocarcinoma. Comorbid conditions were present in 71.8% and 22% had a prior malignancy. A chest CT scan was performed in 92% of patients and PET scans in 19.3%. Mediastinoscopy was performed in 20.3%. 67.2% of patients had Stage III or IV disease. More of the Hispanic, Asian or Black patients than White had Stage IV disease (p<0.01). Treatment was multimodality in a little over 30% of patients. Surgery alone was primarily utilized for patients in Stage I or II. Choice of treatment correlated more with stage and age than comorbidities. CONCLUSION: Our results substantiated the pattern of increasing proportions of women with NSCLC and the increasing frequency of adenocarcinoma. Most patients presented with Stage III or IV disease. Ethnic minorities were more likely to present in late stage disease than Whites. Treatment strategies depended more on stage and age than comorbid burden. Older patients were less likely to receive surgery and more likely to be treated with radiation only or have no treatment.

The Commission on Cancer, American College of Surgeons' response to HIPAA.

The Commission on Cancer is able to continue serving the CoC-Approved Cancer Programs following enactment of a business associate agreement between each of the programs and the ACoS. Worrisome unintended consequences, potentially threatening the value of the products that the CoC provides cancer patients, providers, and families, were not realized because of the Business Associate role that the CoC assumes with each of the CoC-Approved programs.

Limited-stage small-cell lung cancer (stages I-III): observations from the National Cancer Data Base.

The standard treatment of limited-stage small-cell lung cancer (LS-SCLC) has changed over the past 15 years. Standard treatment for LS-SCLC currently involves multiple-agent chemotherapy and early concurrent thoracic radiation therapy. Four patient cohorts (total number of patients, 22,969) diagnosed with LS-SCLC in 1985 (N=2123), 1990 (N=6279), 1995 (N=7815), and 2000 (N=6752) were studied in order to describe demographic and treatment pattern changes as well as 5-year survival rates across cohorts. Women composed 40.2% of patients in the 1985 cohort but represented a significant proportional increase over each successive cohort, representing 50.8% of the 2000 cohort. The proportion of patients aged >or=70 years also significantly increased over time, from 31.6% in 1985 to 44.9% in 2000 (P<0.001). Over these years, the use of chemoradiation as the primary treatment for patients with LS-SCLC increased from 34.6% to 51.9% (from 37% to 60.5% for patients aged <70 years, and from 29.5% to 41.3% for patients aged >or=70 years). During the same time, the use of chemotherapy as the sole treatment decreased from 30.7% in 1985 to 21.7% in 2000. Chemotherapy as the sole treatment was used in 25.9% of the population>or=70 years of age in 2000, compared with 18.3% in patients aged <70 years. The percent of patients for which there was no treatment given did not change significantly between the cohorts (14.3% in 1985 and 13.7% in 2000; P<0.001). The 5-year survival rates and 95% confidence intervals (CIs) for the 1985, 1990, and 1995 cohorts of all ages of patients treated with chemoradiation therapy are as follows: 10.5% (CI, 6.75%-14.25%), 11.88% (CI, 9.63%-14.13%), and 13.3% (CI, 11.2%-15.4%). Between 1985 and 2000 there was a significant increase in the percentage of women diagnosed with LS-SCLC. The use of combined chemotherapy and radiation therapy also increased during this period. This increase in chemoradiation therapy was associated with a decreased use of chemotherapy alone. Despite changes in demographics and treatment during these time intervals, the 5-year survival for patients with LS-SCLC treated with chemoradiation therapy did not increase significantly. These results demonstrate the continued need for the evaluation of new treatments in this group of patients.