The current study was conducted to evaluate the maximum tolerable dose of weekly gemcitabine administered simultaneously with radiation and cisplatin in patients with locally advanced nonsmall cell lung cancer (NSCLC).

Objective: Segmentectomy has recently been suggested as alternative to lobectomy for curative treatment of early-stage non-small cell Lung cancer (NSCLC). This study was performed to investigate if localisation of the resected segment or width of resection margins influence local recurrence following complete segmentectomy of stage IA NSCLC. Methods: Between 1987 and 2002, 49 segmentectomies and 150 lobectomies were performed in patients with pT1pN0cM0-NSCLC in our institution. Indications for segmentectomy were a limited pulmonary function or severe comorbidity. The median follow-up duration was 54 months. Local recurrence was distinguished from secondary primary lung cancer and was defined as tumour within the same lung or in the ipsilateral mediastinum. Segment localisation, width of resection margins, tumour size, tumour type, grading and age were analysed concerning their influence on local recurrence. Results: Local recurrence occurred in 16% of patients with segmentectomy and was significantly more frequent than in patients with lobectomy (5%; p = 0.005; log-rank test). Segmentectomy in the S1-3 region tended more frequently to local recurrence than segmentectomy in the remaining segments (p = 0.08; log-rank test): There was no recurrence following segmentectomy in the S7-10 region (n = 6) or of S4-5 (n = 5). Recurrence occurred in 7 (23%) out of 30 patients with segmentectomy in the S1-3 region and in 1 (12%) out of 8 patients with S6-segmentectomy. Also, resection margins <= 1 cm tended to be associated with local recurrence (p = 0.06; log-rank test). Conclusions: The frequency of local. recurrence following segmentectomy might be influenced by segment localisation and width of resection margins. Segmentectomy within the S1-3 region should be avoided whenever possible. (c) 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Einleitung: Die adjuvante Chemotherapie erzielt eine geringe Verbesserung des Gesamtüberlebens nach Resektion des Nicht-Kleinzelligen Karzinoms verbunden mit einer hohen Komplikationsrate. In dieser Studie soll die Elimination von residualen Tumorzellen im Körper durch eine aktive Immunisierung mit einem Maus Anti-Epcam Antikörper erreicht werden. Nach Abschluss der Randomisation (n=762) im April 2005 werden die Ergebnisse der dritten Interimsanalyse (11/05) im Vortrag dargestellt. Methoden: Nach radikaler Resektion eines NSCLC im Stadium Ib – + IIIa erfolgte im Verumarm eine Immunisierung mit IGN101. Im Placeboarm wurde unspezifisches Impfstoff-Adjuvants angewendet. Primärer Endpunkt ist das rezidivfreie Überleben. Als sekundäre Endpunkte werden die Sicherheit und Verträglichkeit, die Entwicklung der Immunogenität, die Lebensqualität und das Gesamtüberleben erfasst. Die Datenerfassung erfolgt mithilfe von elektronischen Dokumentationsbögen (eCRF-Case Report Form). Ergebnisse: Ergebnisse der 2 Interimsanalyse 9/04 (n=300). 82% Männer, im Median 59 Jahre alt. Es wurden 2 Segmentresektionen, 178 Lobektomien und 118 Pneumonektomien durchgeführt. Das Plattenepithelkarzinom überwog mit 56%. Im Median wurden 15 Lk untersucht, davon waren 2 positiv. Die Stadien waren wie folgt vertreten: IIa: 6%, IIb: 50%, IIIa ohne N2 7%, IIIa mit N2: 37%. Es traten 1498 unerwünschte und 216 schwere unerwünschte Ereignisse auf. Letztere waren in keinem Fall auf die Verumgabe zurückzuführen und in der Regel durch eine Tumorprogression ausgelöst. Die häufigsten Nebenwirkungen nach der Impfung bestanden in lokalen Reaktionen. Etwa 50% der Patienten zeigten eine immunologische Reaktion auf den Antikörper in Form eines signifikanten Titeranstiegs. Diskussion: Die Immunisierung mit IGN 101 ist mit einer niedrigen Komplikationsrate möglich. Die Hälfte der Patienten zeigt eine Immunreaktion auf die Impfung. Der therapeutische Effekt wird erst nach Abschluss der Studie messbar sein.

Background. The advantage of sleeve lobectomy as an alternative to pneumonectomy for preserving lung function is obvious and among other arguments allows operating on patients with lung cancer who would not tolerate pneumonectomy. The purpose of this retrospective, nonrandomized study is to compare the early (30-day mortality) and late (5-year survival) outcomes of both procedures.Methods. The charts of 310 patients who underwent either pneumonectomy or sleeve lobectomy for lung cancer stages I to IIIA from 1987 to 1997 were reviewed. One hundred ninety-four patients underwent pneumonectomy, and 116 patients underwent sleeve lobectomy. Specific operative complications, i.e., anastomotic leakage versus stump dehiscence, perioperative complications, 30-day or in-hospital mortality, and 5-year survival were registered for comparison of the immediate risk of the respective procedures.Results. In the bronchial sleeve lobectomy group, the incidence of anastomotic leakage was 6.9% (8 of 116 patients) and the operative mortality was 4.3%. The incidence of bronchial stump fistulas after pneumonectomy was 3.6% (7 of 194 patients), and early mortality was 4.6%. All but 6 patients (98%) had a complete resection. Overall 5-year survival after sleeve lobectomy was 39% and after pneumonectomy, 27%. The distribution of 5-year survival stage by stage in either group is presented. Sleeve lobectomy, age younger than 65 years, pN0, and stage I are positive prognostic factors for long-term survival. In the multivariate analysis, pneumonectomy is a negative prognostic factor.Conclusions. The indication for pneumonectomy versus sleeve lobectomy depends on the localization of the primary tumor on the one hand, and on cardiorespiratory function, which might be more often distinctly impaired in the sleeve group, on the other hand. This could explain why the mortality in the sleeve lobectomy group was identical with that in the pneumonectomy group. However, both techniques are appropriate treatment modalities of advanced lung cancer or patients with critical functional reserve. Therefore, whenever possible, sleeve lobectomy should be performed. (C) 2005 by The Society of Thoracic Surgeons.

Background Radiofrequency ablation (RFA) is a minimally invasive technique and well established in the treatment of malignant hepatic tumours. This method could also find application in patients with malignant lung tumours who, for functional reasons, have to be excluded from standard surgery. Until now, however, very little data have been available on the application of RFA in malignant pulmonary tumours. Patients and methods From November 2001 to January 2004, eleven malignant lesions of the lung were treated with RFA. The indication for RFA resulted from an inadequate pulmonary reserve and additional severe risk factors. Results Eleven lesions were treated in ten patients with RFA. The malignancies were primary non-small cell bronchial carcinomas (n=9) as well as metastases of non-small cell carcinomas (n=2). Early complications of RFA were pneumothorax, hemorrhagic intrapleural effusion, bronchopleural fistula and pericarditis. Two weeks after RFA, pneumonia appeared as a late complication. No patient's death was related to the RFA procedure. After a mean follow-up of 8.5 months five patients died. Five patients are still alive, two of whom exhibit no tumour recurrence. Conclusion RFA in patients with lung tumours is possible from a technical viewpoint. It is possibly a therapeutic alternative for patients with localized tumours that are inoperable. However, in this series, the morbidity of the procedure -- taking the degree of invasiveness into account -- is high, and the oncological results are unsatisfactory, possibly due to a small cohort of patients.

Successful sequential resection of isolated hepatic and pulmonary metastases of colorectal cancer (crc) has been reported, however long-term results of large series are lacking. Therefore, we retrospectively analysed data of patients in whom sequential hepatic and pulmonary resection for metastases was performed. Patients and Method: From the records of our hospital we identified 25 patients (19.5% of all patients operated for hepatic or 33% for lung metastases due to crc) with colorectal cancer who had pulmonary and hepatic resection for metastatic disease between 1991 and 2002.11 of these had primary colonic cancer and 14 rectal cancer. None of the patients died perioperatively. Longterm results were correlated with the staging of the primary tumour, the number of metastases, disease free interval between primary tumour operation and occurrence of metastatic disease. Results: Five-year survival rate was 33.5% following the resection of the first metastasis. Three year survival after resection of the second metastasis was 39%. The disease free interval was 20 months (mean). Long-term results were clearly influenced by the disease free interval: < 1 year (n = 6) median 50 months after resection of the crc: > 1 year median 90 months (n = 19). Further on R0 resection was important for long-term survival: Median survival was 32.5 (+/- 4.1) months following resection of the second metastasis but only 9.9 months after R > 0 resection. Conclusion: These results confirm that sequential resection of hepatic and pulmonary metastases can be performed with curative intention provided a systemic spread of the disease is excluded. The surgeon's opinion of resectability should be obtained in patients with such metastases before the patient is scheduled for palliative conservative treatment.

Die Radiofrequenzablation (RFA) ist ein minimalinvasives Verfahren, welches in der Behandlung maligner Lebertumoren etabliert ist. Diese Methode könnte auch bei Patienten mit malignen Lungentumoren Anwendung finden, die aus funktionellen Gründen von einer Operation ausgeschlossen werden müssen. Bisher liegen allerdings wenige Daten über den Einsatz der RFA bei malignen Lungentumoren vor.

UNLABELLED:Successful sequential resection of isolated hepatic and pulmonary metastases of colorectal cancer (crc) has been reported, however long-term results of large series are lacking. Therefore, we retrospectively analysed data of patients in whom sequential hepatic and pulmonary resection for metastases was performed. PATIENTS AND METHOD:From the records of our hospital we identified 25 patients (19.5 % of all patients operated for hepatic or 33 % for lung metastases due to crc) with colorectal cancer who had pulmonary and hepatic resection for metastatic disease between 1991 and 2002. 11 of these had primary colonic cancer and 14 rectal cancer. None of the patients died perioperatively. Long-term results were correlated with the staging of the primary tumour, the number of metastases, disease free interval between primary tumour operation and occurrence of metastatic disease. RESULTS:Five-year survival rate was 33.5 % following the resection of the first metastasis. Three year survival after resection of the second metastasis was 39 %. The disease free interval was 20 months (mean). Long-term results were clearly influenced by the disease free interval: < 1 year (n = 6) median 50 months after resection of the crc; > 1 year median 90 months (n = 19). Further on R0 resection was important for long-term survival: Median survival was 32.5 (+/- 4.1) months following resection of the second metastasis but only 9.9 months after R > 0 resection. CONCLUSION:These results confirm that sequential resection of hepatic and pulmonary metastases can be performed with curative intention provided a systemic spread of the disease is excluded. The surgeon's opinion of resectability should be obtained in patients with such metastases before the patient is scheduled for palliative conservative treatment.

OBJECTIVE:Completion pneumonectomy (CP) for malignant disease is generally accepted but controversial for lung metastases. The data available show a high perioperative morbidity and mortality with a poor long-term prognosis. We analysed the postoperative outcome and long-term results of our patients undergoing CP.PATIENTS AND METHODS:Between January 1986 and May 2003, nine patients underwent completion pneumonectomy for lung metastases. This represents 10% (9/86) of all CPs performed and 1.7% (9/525) of all pneumonectomies.RESULTS:One to three metastasectomies in the form of wedge resection (16), segment resection (5) and lobectomies (3) were performed prior to CP. The mean time interval between the operation of the primary tumour and the first metastasectomy was 38 months, the first and second metastasectomy 12 months, the second and third metastasectomy 14 months, and the third metastasectomy and CP 25 months. Six patients had an extended completion pneumonectomy. Operative morbidity and mortality was 0%. One patient is still alive and recurrence-free 9 months after CP. Two patients have recurrent pulmonary contralateral metastases under chemotherapy and six patients died of metastatic disease. Actual survival is 33%, recurrence-free survival (RFS) is 11%. The 3-year survival is 34%.CONCLUSION:Since there was no morbidity and mortality in our series, CP for lung metastases seems to be justified but the long-term survival is limited by the occurrence of contralateral or extrapulmonary metastatic disease. Multiple resections of metastases have a positive influence on survival, but the last step of resection in the form of CP does not seem to improve long-term survival.

Die sekundäre Pneumonektomie (SP) ist anerkanntermaßen mit einer hohen Morbidität und Letalität verbunden. Sie stellt allerdings häufig die einzige Möglichkeit der Heilung dar. Die Ergebnisse folgender SP (n=86) wurden untersucht: Progression oder Rezidiv einer gutartigen Erkrankung (n=6, Gruppe I), Rezidiv eines Malignoms (n=41, Gruppe II) und Komplikation nach Lungenresektion (n=39, Gruppe III). 48 SPs wurden rechtsseitig, 38 linksseitig durchgeführt.

OBJECTIVES:Completion pneumonectomy (CP) is widely known to be associated with a high morbidity and mortality. However, in certain instances, CP offers the only chance for a cure. The results of the following three groups were investigated: progressive or recurrent benign disease, recurrence of a malignant tumour and complication after lung resection.METHODS:Between January 1986 and April 2003, 525 patients underwent pneumonectomy, 86 of these being completion pneumonectomies (16.4%). Six patients suffered from a progression or recurrence of a benign disease, 41 patients had a recurrence of a malignant tumour (local recurrence, secondary carcinoma and recurrent metastases) and 39 patients had a complication after lung resection. Among patients with a complication, the indication for CP was either an emergency or urgent condition. Right CP was carried out in 48 cases and left CP in 38.RESULTS:The overall 30-day mortality was 20.2, 0% in the group with benign disease, 10% in the group with a recurrent malignant tumour and 33.3% in the group with a complication after lung resection. The 30-day mortality of CP was significantly higher (P = 0.014) on the right side (29.8%) than on the left side (7.7%). Differentiation between emergency and urgent indications resulted in 30-day mortalities as follows: 54 and 23%, respectively. This difference is significant (P = 0.002). The 30-day mortality for patients with anastomotic or stump insufficiency was 41% (P = 0.002). Five-year survival of all patients was 28% and in the group of patients with a complication after lung resection 32%.CONCLUSIONS:Lethality of CP remains high, especially after CP for a complication performed in an emergency condition. Possible risk factors are right side of operation, CP performed in an emergency condition and CP for anastomotic or stump insufficiency, either or not involving sepsis. However, considering the long-term survival, CP is certainly justified.

Ziel dieser Arbeit ist es, Morbidität, Mortalität und das Langzeitüberleben nach einer Manschettenlobektomie oder einer Pneumonektomie zu vergleichen. Die Vorteile einer Manschettenlobektomie als Alternative zu einer Pneumonektomie, im Hinblick auf die Erhaltung der Lungenfunktion, zu zeigen. Zu klären ist, ob die Radikalität erhalten bleibt.

Aims: Metastatic breast cancer is a systemic disease. The discussion concerning the resection of lung metastases in patients with breast cancer is controversial.Methods: Retrospective analysis of 25 patients with suspected pulmonary metastases operated between March 1989 and September 1998. Survival probabilities and disease-free survival was analysed using the Kaplan-Meier method and the log-rank test.Results: The median survival rate after resection of lung metastases for the 21 patients was 96.9 months. The disease-free survival (DFS) after resection of lung metastases was 27.6 months. Survival was not influenced by the receptor status, lymph node involvement, number of lung metastases (p = 0.8) or the disease-free interval (DFI) (0.59). DFS was, however, influenced by the DFI. With a DFI of <2 years survival was 8.5 months, whereas with a DFI >2 years it was 36.1 months (p = 0.012). The DFS was influenced, but not statistically significant, by the number of lung metastases (n = 1/n > 1). The median DIPS was 28.8 months with one metastasis and 13.1 months with multiple metastases (p = 0.29).Conclusions: The indication to remove solitary lung metastases in patients with previous breast cancer is supported by these findings. Especially when the disease-free interval is greater than two years. (C) 2003 Elsevier Science Ltd. All rights reserved.

BACKGROUND:Postoperative mortality rates have been published in relation to operative procedure or preexisting pulmonary and extrapulmonary diseases. We analyzed our patients for the effect of the postoperative tumor stage on perioperative mortality.PATIENTS AND METHODS:Retrospective study of all thoracotomies for resections ( n=1281) in primary lung cancer from January 1987 to December 1997. Uni- and multivariate analysis was performed for operative procedure, mortality (30 and 90 days), tumor stage, sex, age, tumor localization, and completeness of resection. Radical resection was achieved in 91.9% of the patients.RESULTS:Overall postoperative deaths occurred in 4% and 7.3% of patients after 30 and 90 days respectively. Depending on the operative procedure the mortality after segmental resection ( n=116) was 0.9% and 1.7%, lobectomy ( n=621) 3.0% and 5.7%, sleeve lobectomy ( n=152) 5.3% and 7.9%, and pneumonectomy ( n=314) 6.7% and 12.5%, respectively. Within 30 and 90 days postoperatively deaths occurred, respectively, in 0.8% and 1.0% of stage I patients ( n=493), 5.4% and 5.4% of stage II ( n=147), 4.9% and 8.8% of stage IIIa ( n=388), 7.2% and 16.6% of stage IIIb ( n=148), 8.9% and 20.5% and of stage IV ( n=114). Multivariate analysis showed postoperative tumor stage to be the factor most closely related to within the first 90 days.CONCLUSIONS:Tumor stage but not type of resection is the strongest predictor of postoperative mortality in these subpopulations.