Principles of induction chemotherapy for non-small cell lung cancer.

The results of lung cancer treatment have not significantly improved for many years. About 35% of patients with non-small cell lung cancer (NSCLC) are in clinical stage IIIA. Clinically asymptomatic distant metastases occur in the majority of these patients. In such cases only combined treatment offers a chance of cure. In the Chest Surgery Center in Lublin a clinical trial was carried out aimed to assess late results of combined treatment in patients with IIIA NSCLC. Over 700 patients were enrolled in the study. The results of the trial disclosed, that neoadjuvant chemotherapy prolonged life of the operated patients and improved their life quality. However, a question of qualification for this complex treatment and complexity of assessment criteria, still remain to be answered.

[Surgical treatment of advanced lung emphysema. Does it really improve treatment results?]. / Chirurgiczne leczenie zaawansowanej rozedmy pluc. Czyzby nowa nadzieja na poprawe wyników leczenia?

Lung emphysema may be one of the components of chronic obstructive pulmonary disease (COPD). Nearly 60% of patients with advanced chronic respiratory insufficiency with FEV1 < 30% expected, aged > 65 years die within the first 2 years of the disease. The treatment of COPD includes oxygen therapy, lung transplantation and/or lung volume reduction (LVR). The study presents qualification criteria for LVR in reference to oxygen therapy and lung transplantation. Crucial diagnostic features include: CT of the chest with densitometric analysis and lung perfusion scans. Patients with severe but limited dyspnea, disseminated emphysema lesions with fairly untouched areas of normal lung tissue, FEV1% < 30-35%, DLCO < 25% expected, PaCO2 < or = 50 mmHg and PaO2 < or = 50-55 mmHg, appear to be the best candidates for LVR. The results of the study indicate, that in Poland, patients with advanced emphysema, who are treated with oxygen therapy or soon will be qualified this therapy or await lung transplantation might be candidates for LVR. The early results of lung volume reduction are promising and include: decrease in total lung capacity, residual volume and breathing frequency. LVR has been in use for about 3 years and majority of authors still do not possess clinical observations long enough to obtain statistically significant comparison with other methods of treatment. Limited morbidity and low perioperative mortality enable application of LVR even in patients with severe respiratory insufficiency and/or requiring constant oxygen therapy. In conclusion considering all positive aspects of LVR it is necessary to emphasise that for overall assessment of this method a broader clinical material is required including data on duration of clinical improvement.

[Current views on surgical treatment of non-small cell lung neoplasms with metastasis to the central nervous system]. / Wspólczesne poglady na leczenie chirurgiczne niedrobnokomórkowego raka pluca z przerzutem(ami) do osrodkowego ukladu nerwowego.

Non-small cell lung cancer is the most frequently encountered malignant neoplasm. Brain metastases occur in about 30% of patients with NSCLC The recent data from Poland indicate that there were about 6000 patients with NSCLC and brain metastasis in the year 1993. The first symptoms in those patients are usually of neurological nature, because brain metastases have high dynamics of growth and accompanying brain oedema accelerates increase of intracranial hypertension. Although the surgical treatment of NSCLC with brain metastases has been known for 50 years there is still controversy over indications for such treatment and possibility of improvement in results by combining surgery with other methods of treatment. There is good evidence in literature on the surgical treatment of lung cancer and synchronous brain metastasis. In some papers the results of treatment of many hundreds of patients are presented. They show, that thoracic and neurological surgery operations coordinated in time provide a chance to extend the survival time of the majority of patients, and enable even 5-year survival in up to 20% of patients. Polish experience on this subject resulted in only a few publications. Majority of those papers come from neurosurgical centres related to the results of treatment of brain metastases. Patients with single brain metastasis and a resectable primary lung tumour have the best prognosis for radical treatment. Presented study suggests that it is still worth undertaking the combined neurosurgical and thoraco-surgical treatment in patients with NSCLC and brain metastasis.

[Lung neoplasms in patients under 40 years of age. Treatment results in patients qualifying for surgical treatment]. / Rak pluca u chorych przed 40 rokiem zycia. Wyniki leczenia chorych kwalifikowanych do leczenia operacyjnego.

In last decades an increase of new cases of lung cancer has been observed. The global prognosis based on the analysis of the increase rate of new cases envisages that total number of lung cancer patients will reach 2 millions at the end of the XXth century. In Poland alone, the number of new cases can come up to 50,000 a year in the second decade of the XXIst century. Respectively, the number of surgically treated patients with lung cancer increases. In literature, controversial opinions on the results of surgical therapy of patients with lung cancer younger than 40 years can be found. Some authors report unsatisfactory results. The others do not confirm differences due to the age of operated patients. We present our observations based on the clinical analysis of 46 patients below 40 years of age treated surgically because of lung cancer. The aim of this analysis is the evaluation of the long-term results of surgical therapy in this group of patients. This is the first Polish report on this problem.

Powdered diatrizoic acid for radiography of the respiratory tract. Part II. Clinical application.

The diagnostic and clinical value of 41 examinations using insufflation and/or inhalation of powdered diatrizoic acid for tracheobronchography, tracheography, laryngography, nasopharyngography, and sinusography was investigated in 35 patients. Diatrizoic acid was found to be useful when applied by insufflation for demonstration of the nasopharynx, trachea and greater bronchi, especially in patients with airway stenosis and low pulmonary reserve. Double contrast images were obtained with good demonstration of anatomic details and adequate diagnostic value. Visualization of the peripheral bronchi by insufflation was satisfactory only when excessive secretions were not present. The inhalation method was adequate only for visualization of the trachea and main bronchi. The method was found to be safe since diatrizoic acid produced no toxic, allergic or febrile reactions and was given in relatively small amounts without impairment of respiratory function.