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INTRODUCTION: Surgical resection of lung metastases may prolong survival as a part of multimodality treatment. Our aim was to review how the indications and practice of this type of surgery have evolved over time. METHOD: We included in the study all patients who were operated for this indication between 1983 and 2006 in two different surgical departments. A retrospective review was conducted including the following criteria: age, sex, type of primary cancer, type of pulmonary resection, histology of metastases, perioperative chemotherapy. RESULTS: Four hundred and seventy-two operations were performed in 225 men and 145 women: 448 were complete resections (wedge resection: 221, segmentectomy: 47, lobectomy: 148, pneumonectomy: 32), and 24 incomplete resections. Most metastases were from colorectal (n=129), renal (n=73), and sarcoma origin (n=34); the survival rate was 38.5% and 24.3% at 5 and 10 years. The following criteria were markers of poor prognosis: incomplete or large excision (whole lung or lobar excision), size, nodal status, intravascular microemboli. Factors that did not influence prognosis were: disease free interval, location and number of metastases. Prognosis showed a significant improvement since 1998, and with the use of neoadjuvant chemotherapy (77 patients). The survival rate for isolated metastases that were potentially candidates for radiofrequency ablation was 48% at 5 years. CONCLUSION: The prognosis of lung metastases has been notably improved by better understanding of the disease and the adoption of a multidisciplinary approach, integrating recent advances in systemic treatments. The efficacy of other forms of local surgical treatment have yet to be demonstrated.
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Carcinoma/secundario , Carcinoma/cirugía , Neoplasias Pulmonares/secundario , Neoplasias Pulmonares/cirugía , Neumonectomía/tendencias , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma/epidemiología , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/cirugía , Femenino , Humanos , Neoplasias Renales/epidemiología , Neoplasias Renales/patología , Neoplasias Renales/cirugía , Neoplasias Pulmonares/epidemiología , Masculino , Persona de Mediana Edad , Neumonectomía/métodos , Neumonectomía/estadística & datos numéricos , Sarcoma/epidemiología , Sarcoma/patología , Sarcoma/cirugía , Adulto JovenRESUMEN
Mediastinal adenopathies without pulmonary disease may be benign, lymphomatous or the metastases from intra- or extrathoracic malignancy or more rarely metastases with unknown primary site. We observed 507 patients with isolated mediastinal adenopathies: benign, lymphomatous and metastatic disease represented 41.4% (210/507), 26.8% (136/507), 31.8% (161/507) of them, respectively. Management of the latter was the most challenging. Surgery was generally diagnostic, restricted to confirming the metastatic process, because of too numerous and disseminated or unresectable lymph nodes in 84% of patients (135/161). However, radical surgery consisting in lymphadenectomy proved effective in case of mediastinal lymph node malignancy without other extra- and intrathoracic disease. We observed long-term good results in such cases, which also was demonstrated by case reports in the literature. We suggest that including surgery in the multimodality treatment of mediastinal metastatic lymph nodes may be advisable in selected patients.
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Metástasis Linfática/patología , Neoplasias del Mediastino/patología , Neoplasias del Mediastino/secundario , Terapia Combinada , Diagnóstico Diferencial , Humanos , Escisión del Ganglio Linfático , Ganglios Linfáticos/patología , Neoplasias del Mediastino/cirugía , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/cirugía , Estadificación de Neoplasias , Grupo de Atención al Paciente , PronósticoRESUMEN
Induction treatments in non-small cell lung cancer are usually discussed. Long-term survival after surgery and resecability are enhanced in locally advanced cancers. Morbidity and mortality observed after surgery limit the use of these treatments, despite they depend on many other factors: comorbidities in patient, smoking status, cancer staging, and type of surgery. Right pneumectomy enhances this risk more than left pneumectomy or other limited resections allowed by neoadjuvant treatments, especially in case of downstaging.
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Carcinoma de Pulmón de Células no Pequeñas/cirugía , Neoplasias Pulmonares/cirugía , Terapia Neoadyuvante , Carcinoma de Pulmón de Células no Pequeñas/terapia , Causas de Muerte , Humanos , Neoplasias Pulmonares/terapia , Neumonectomía , Complicaciones Posoperatorias , Factores de RiesgoRESUMEN
PURPOSE: To provide empirical evidence on the impact of on-site initiation visits on the following outcomes: patient recruitment, quantity and quality of data submitted to the trial coordinating office, and patients' follow-up time. PATIENTS AND METHODS: This methodological study was performed as part of a randomized trial comparing two combination chemotherapies for adjuvant treatment of breast cancer. Centers participating to the trial were randomized to either receive systematic on-site visits (Visited group), or not (Non-visited group). RESULTS: The study was terminated after two years, while the main randomized trial continued. Of the 135 centers that had expressed an interest in the trial, only 69 randomized at least one patient (35/68 in the Visited group, 34/67 in the Non-visited group). Almost two-thirds of the patients were entered by 17 centers (10 in the Visited group, seven in the Non-visited group) that accrued more than 10 patients each. None of the prespecified outcomes favored the group of centers submitted to on-site initiation visits (ie, mean number of queries par patient: 6.1 +/- 9.7 versus 5.4 +/- 6.4, respectively for the Visited and Non-visited groups). Spontaneous transmittal of case report forms, although required by protocol, was low in both randomized groups (mean number of pages per patient: 1.5 +/- 2.0 versus 2.1 +/- 2.3, respectively), with investigators submitting about one-third of the expected forms on time (29% and 39%, respectively). LIMITATIONS: This study could not evaluate the impact of repeated on-site visits on clinical outcomes. CONCLUSION: Systematic on-site initiation visits did not contribute significantly to this clinical trial.
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Neoplasias de la Mama/tratamiento farmacológico , Oncología Médica/normas , Evaluación de Resultado en la Atención de Salud , Selección de Paciente , Ensayos Clínicos Controlados Aleatorios como Asunto/normas , Antineoplásicos Fitogénicos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Quimioterapia Adyuvante , Ciclofosfamida/uso terapéutico , Epirrubicina/uso terapéutico , Femenino , Fluorouracilo/uso terapéutico , Humanos , Paclitaxel/uso terapéutico , Proyectos de InvestigaciónRESUMEN
In the last 2 decades, major progresses have been made in the management of patients with advanced colorectal cancer (ACC). The modulation of 5-fluorouracil (5-FU) by folinic acid (LV), followed by the introduction of irinotecan and oxaliplatin have significantly improved the outcome of these patients. New strategies consist of oral fluoropyrimidines, and of targeted agents to inhibit cancer signalisation.
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Antineoplásicos/uso terapéutico , Neoplasias Colorrectales/tratamiento farmacológico , HumanosRESUMEN
We report a case of glaucoma induced by doxetaxel therapy for metastatic breast cancer. The disorder recurred during treatment with paclitaxel.