The surgical management of multiple lung metastases.

From 1970 to June, 1976, 56 patients who had multiple metastatic tumors of the lung were treated by lung resection. Most of the bilateral lung lesions were removed through a median sternotomy so as to avoid staged bilateral thoracotomy. The surgical mortality was 1.8%. A total of 26 patients are alive at 7 to 69 months (estimated median survival, 20.7 months). Patients with tumor doubling time of less than 40 days had lower survival results (median, 9.5 months), compared to patients with tumor doubling time of more than 40 days (median not yet reached). The type of primary tumor, tumor-free interval, number of lesions removed, and presence of unilateral as opposed to bilateral lung metastases did not seem to affect the therapeutic results.

Treatment of inoperable lung carcinoma: a combined modality approach.

Twenty-four patients with inoperable lung carcinoma other than of the small cell type who received cis diamminedichloro platinum (II)-based combination chemotherapy were further treated with all available treatment modalities: radiation therapy, lung resection, chemotherapy, and immunotherapy. There were 2 operative deaths, and 2 patients died 6 and 8 months postoperatively of cardiac causes. Postmortem examination on these 4 patients revealed no evidence of residual tumor. The remaining 20 patients are alive 7 to 33 months from the onset of chemotherapy and 4 to 27 months following lung resection. These results, although preliminary, are encouraging, and further study is in progress.

Lung resection for metastatic sarcoma.

Our experience with lung resection in fifty patients with metastatic sarcoma is presented. Seventeen patients underwent lung resection for solitary lung metastasis and thirty-three had multiple metastases. The overall estimated median survival of the patients was 22.2 months. Shorter tumor doubling time was found to indicate poor prognosis. The tumor-free interval, length of the waiting period, and the number of metastatic lesions removed did not influence the postoperative survival rate. Surgical therapy of solitary as well as multiple metastatic sarcoma of the lung appears to produce acceptable therapeutic results.

Hierarchical organization, integrations in biology and cancer, balance loss, and a question on modernism.

The hierarchical organization of biological processes is considered in the light of universal interrelationships of each and every factor affecting open systems such as human life. The maintenance of health and/or the production of disease are viewed at different levels of biological organization as related to the dualistic concept. The relative effects of environmental versus genetic tendencies in the pathogenesis of "disease" are mathematically formulated as related to time and location. Psychological determinants are considered as cause and as consequence of the onset of somatic disease. The multifactorial aspects of chronic pathology are seen in relation to dominant tendencies in life and in medical sciences, as well as to individual factors. The "non-specificity" of some aspects of cancer as related to "Adaptation" is advanced. Doubts are raised regarding the ultimate value of modern technological achievements and overspecialization per se, as well as on the lines followed by modern trends in the organization of cancer research. Finally, the increasing need for progressive thoughtful integration versus increasing specialization is stressed.

Bronchio-alveolar carcinoma. A clinical overview and bibliography.

Clinical aspects of bronchio-alveolar carcinoma are reviewed through over 1,000 cases abstracted from the literature and 58 new cases. This form of lung carcinoma is more equally distributed among the sexes than other forms, and has a better prognosis when diagnosed early. Suggestions that the tumor has a multicentric origin are seen to have arisen from early experience with advanced cases.

Management of multiple lung metastases.

During the past seven years, 78 patients with multiple lung metastases under went lung resection. Most of the patients with bilateral lung metastases had lung resection through a median sternotomy rather than by bilateral thoracotomies. "Local excision" of the lung lesions was the most frequently used technique in order to preserve as much lung tissue as possible. Sixty-three of the 78 patients received adjuvant therapies following lung resection. Operative mortality was 3.8%. The over-all median survival was 18.3 months. Analysis of the data showed shorter tumor doubling time to be an indicator of poor prognosis, whereas other factors such as disease-free intervals and unilateral vs bilateral metastases did not affect the postoperative survival.

Platinum-based combination chemotherapy in non-small cell lung carcinoma.

A series of 35 patients with advanced non-small cell lung cancer were treated with combination chemotherapy consisting of cis-diamminedichloro platinum (II), Adriamycin, 5-fluorouracil, methotrexate and vincristine. The objective response rate was 37.1% and the overall median survival 52.8 weeks. Notable toxicity was infrequent and reversible. Although the investigators have obtained higher response rates with other platinum-based combination chemotherapies, the present regimen appears superior in that other regimens fail to yield superior survival times while consistently inducing more severe toxicity.

Surgical management of metastases to the lung.

Our experience with 234 patients having resection of metastatic lesions of lung is reviewed. Most bilateral lung metastases were removed though a median sternotomy. Exploration of the contralateral lung with simultaneous removal of all lesions is possible through such an incision, and moreover, it appears to give less pain postoperatively. The over-all median survival time of the patients was 21.4 months, with a surgical mortality of 2.6 per cent. The therapeutic results were analyzed according to various factors. Incomplete resection and the presence of a positive hilar mediastinal node, or both, resulted in poor survival rate of the patients. Generally, the survival rates of the patients were found to be proportional to the disease-free interval and the tumor doubling time. Patients with a solitary lesion and those with two lesions removed had the best survival time. There was no difference in the survival rates of patients with unilateral and bilateral pulmonary multiple metastases. Treatment of metastases to the lung should be carefully planned in consultation with physicians who are acquainted with the natural history of the primary tumor, as lung resection is a part of the multimodal therapy of patients with solid tumor.

Surgical treatment of locally far-advanced lung carcinoma.

It has been our policy to employ radical lung resection as a primary treatment whenever possible in locally far-advanced lung cancer. In order to assess the therapeutic results, a total of 132 patients with locally far-advanced lung cancer who had radical lung resection were reviewed. Postoperative mortality was 10%. A significant difference in survival was seen between those patients receiving no adjuvant therapy, radiation or single agent chemotherapy and those receiving cis-platinum-based polychemotherapy and/or immunotherapy (respective median survivals 14.25 and 25.68 months, P less than 0.05 Breslow test or failure rats). Aggressive surgery followed by effective adjuvant therapy in locally far-advanced Stage III lung carcinoma appears to produce acceptable survival results.