[Multimodality therapy concept in stage I-IIIA small cell bronchial carcinoma. Case follow-up over 15 years]. / Multimodales Therapiekonzept beim kleinzelligen Bronchialkarzinom im Stadium I-IIIA. Fallverlaufsstudie über 15 Jahre.

We analysed our results of multimodal therapy including chemotherapy, radiotherapy and surgery in 150 consecutive patients with SCLC stage I-IIIa operated on in our hospital between 1983 and 2000. Median age: 58 years, stages see Table 2. Patients with proven SCLC had induction chemotherapy prior to surgery. All patients received three cycles of adjuvant chemotherapy, some with additional radiotherapy. Perioperative mortality: 2%. Median survival: 22.4 months. R0 resection was possible in 84% of all patients. Pre- and post-surgery staging differed in the majority of the patients. Rotes of 1-, 2- and 5-year survival were 79%, 47%, and 32%, respectively. A median survival of 22.4 months in multimodally treated LD-SCLC, most of them stage IIb/IIIa appears promising. Randomized studies based on clinical staging procedures are not recommended. Survival data are promising.

[Non-small-cell bronchial carcinoma with pathological N2 involvement: adjuvant radiotherapy versus adjuvant chemo-radiotherapy]. / Nicht-kleinzelliges Bronchialkarzinom mit pathologischem N2-Befall: Adjuvante Radiotherapie versus adjuvante Chemo-Radiotherapie.

Fifty-eight patients, 28 of them included in a German multicenter study, were treated either with radiotherapy (5 x 2 Gy/50 Gy) or combined radio-chemotherapy (cisplatin 75 mg/m2 d1 in cases with pneumonectomy etoposide 120 mg/m2 d1-3) and Ifosfamid 1.5 mg/m2 d1-4, 3 cycles) following surgery in pN2-NSCLC. Metastatic disease or local failure was seen in 24 patients (43%), in the majority with distant metastasis (n = 21), in 4 patients combined local and distant failure. Time to progression (TTP) was 27 to 1172 days, median 244 days. Median survival of the whole group was 873 days (= 29 months), the 3-year survival 49%. Comparing the two groups there was an advantage (not significant) in favor of the combined treated group with a median survival of 1449 days versus 765 days (p = 0.22).

Clinical and radiologic features, lung function and therapeutic results in pulmonary histiocytosis X.

Clinical appearance, radiologic findings, lung function and results of corticosteroid therapy were analyzed in 42 adult cases of biopsy-proven pulmonary histiocytosis X. Symptoms were present in only 64%. Using the ILO classification 1980, the evaluation of chest radiographs revealed all categories of profusion, size and shape of nodules. The characteristic 'ring figures', i.e. thin-walled cysts, in the parenchyma were detected in 78% of conventional tomographies (n = 27) and in all patients examined by CT (n = 5). In patients with early disease, lung function tests (n = 26) including body plethysmography, pulmonary diffusing capacity and ergospirometry revealed that parameters of gas exchange are most sensitive (TL,CO 84%, KCO 72%). Bronchial reactivity to carbachol was significantly higher than in controls (n = 12). Lung perfusion scintigram showed an abnormal, but uncharacteristic pattern in 81% (n = 26). During corticosteroid therapy, no progression was observed (n = 36). 85% of patients with radiographic evidence of progressive disease improved after administration of corticosteroids (n = 14).

Omental pedicle flap used to treat a bronchopleural fistula after diaphragma--pericardio-pleuropneumonectomy.

In a 47-year-old male patient a bronchopleural fistula was apparent 22 days after extended right-sided diaphragma-pericardio-pleuro-pneumonectomy for pleuramesothelioma. The thoracic cavity was infected. Rethoracotomy was performed and the fistula was closed using an omental pedicle flap. The bronchial stump became tight and the cavity fluid became sterile. No abdominal complications were seen. The patient died 8 months later from malignant pericardial infiltration. The ability of greater omentum to revascularize ischemic tissue, to absorb fluid and to resist local infection is proved and used in several subspecialities of surgery. Nevertheless the use of the greater omentum in the management of bronchopleural fistula has been rarely published. The reported case shows that the closure of a large bronchopleural fistula is possible by using the attributes of the omental tissue.