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Background: Lung cancer is the most common cause of cancer death in the world. Nonetheless, public policy organizations have consistently recommended against screening for lung cancer, with the result that [...]

Lung cancer is the number one cancer killer in North America. Currently, screening for lung cancer is not recommended. Therefore, patients will not receive a diagnosis until they present with [...]

Stage IIIB includes patients with T4, any N, M0, and any T, N3, M0. Surgery may be indicated only for carefully selected T4N0M0 patients with or without neoadjuvant chemotherapy or [...]

The treatment of small cell lung cancer (SCLC) has evolved significantly over the past 3 decades. Single-agent and combination chemotherapies given with radiotherapy have greatly improved response rates and median [...]

Lymphoma, mediastinal cysts, and neurogenic neoplasms are the most common primary middle and posterior mediastinal tumors. Lymphoma may involve the anterior, middle and/or posterior mediastinum, frequently as Lymphadenopathy or as a discrete mass. Foregut cysts are common congenital mediastinal cysts and frequently arise in the middle mediastinum. Pericardial cysts are rare. Schwannoma and neurofibroma are benign peripheral nerve neoplasms, represent the most common mediastinal neurogenic tumors, and rarely degenerate into malignant tumors of nerve sheath origin. Sympathetic ganglia tumors include benign ganglioneuroma and malignant ganglioneuroblastoma and neuroblastoma. Lateral thoracic meningocele is a rare cause of a posterior mediastinal mass. (CHEST 1997;112:1344-57) Key Words: cyst; ganglioneuroma; lymphoma; mediastinum; meningocele; neoplasm; neuroblastoma; neurofibroma; neurogenic tumor; schwannoma Abbreviations: HD=Hodkin's disease; MTNSO=malignant tumors of nerve sheath origin; NHL=non-Hodgkin's lymphoma; PA=posteroanterior; REAL=revised European-American classification of lymphoid neoplasms; SVC=superior vena cava., This article will review primary middle and posterior mediastinal neoplastic and nonneoplastic tumors that comprise approximately 50% of all mediastinal masses. Lymphoma constitutes one of the most common mediastinal neoplasms [...]

Primary anterior mediastinal neoplasms comprise a diverse group of tumors and account for 50% of all mediastinal masses. Thymomas are most common and can he locally invasive and associated with [...]

Mitomycin is a chemotherapeutic agent that is used to treat a variety of solid tumors. Pulmonary toxic reactions from this agent can be life threatening. We prospectively investigated the utility [...]

Background. Long-term survival with extensive stage small cell lung cancer is rare. There have been no major advances in the treatment of this stage of disease in the last 15--20 years. New agents with activity against this malignancy are needed. This study was designed to evaluate the efficacy of edatrexate against small cell lung cancer in a Phase II trial. Methods. This was a multicenter cooperative oncology group trial. Patients were either previously untreated or had failed only one prior chemotherapy regimen. All previously untreated patients had extensive stage disease. Patients in whom prior therapy had been unsuccessful had either limited or extensive stage disease. All cases had histologic documentation. Patients received edatrexate (80 mg/[m.sup.2]) intravenously over 20--30 minutes every 7 days. Previously untreated patients with disease progression at any time or stable disease after 6 weeks of treatment were crossed over to treatment with cisplatin and etoposide. The primary end points of the study were clinical response and toxicity to edatrexate. All patients were observed for survival. Results. Eleven previously untreated and 22 previously treated patients were enrolled. A median of five doses of chemotherapy was given to each group. No major clinical response was observed in either group. The median survival time for the 11 previously untreated patients was 9.8 months versus 3.7 months for individuals who had received prior therapy. Myelosuppression and stomatitis were the primary toxicities, and both were infrequent. Conclusions. Edatrexate is inactive against small cell lung cancer. Cancer 1994; 73:1189--93. Key words: edatrexate, 10-EDAM, small cell lung cancer.

Background: Chemotherapy, with or without radiotherapy, results in a 30%-40% complete response rate in small-cell lung cancer (SCLC), but approximately 90% of patients who have complete remission die within 2 years after relapse with chemoresistant disease. Randomized clinical studies of maintenance chemotherapy after complete response have failed to demonstrate survival advantage. However, studies have shown that the human cytokine interferon [Gamma] (IFN-[Gamma] induces immune response in humans, including T-cell activation and expression of class II major histocompatibility complex (HLA-DR) and receptor for the Fc portion of immunoglobulin on monocytes. It has also been demonstrated that recombinant IFN-[Gamma] (rIFN-[Gamma]) induces immunomodulation and has anti-proliferative activity. Purpose: In vivo effects of rIFN-[Gamma] treatment were characterized by flow cytometric analysis of peripheral blood mononuclear cells in patients with SCLC who received rIFN-[Gamma] as maintenance treatment. Methods: After induction chemotherapy and radiotherapy, 100 patients who achieved a complete remission were randomly assigned to receive rIFN-[Gamma] at a dose of 0.2 mg (4 x [10.sup.6] units) once a day, subcutaneously, for 6 months, or observation only. In 31 patients, peripheral mononuclear cells were obtained prior to the study and at weeks 4, 8, and 12 for serial monitoring of immune response. By flow cytometric analysis, we identified the lymphocyte and monocyte populations using characteristic differences in electronic volume and right-angle scatter. In these populations, we determined the mean fluorescence channel after staining for CD14 (antigen expressed on monocytes), CD3 (antigen expressed on T lymphocytes), and HLA-DR (HLA class II expressed by monocytes and activated lymphocytes). To determine the number of Fc receptors per cell, an Fc receptor assay was performed using the monocyte cell line U937 as a standard. Results: At weeks 4, 8, and 12, expression of HLA-DR and Fc receptors on monocytes in patients who received rIFN-[Gamma] was significantly higher than that in untreated patients, and the difference was statistically significant. The number of Fc receptors per monocyte consistently increased during the rIFN-[Gamma] treatment and reached a fivefold elevation at week 12. There was no statistically significant difference in lymphocyte surface antigen expression between the treated and untreated groups. Conclusion: The dose of rIFN-[Gamma] used in this study resulted in immune stimulation in patients with SCLC who had complete remission after induction therapy. The in vivo immunomodulatory activity of rIFN-[Gamma] in such patients is characterized by a strong monocyte activation but no significant alteration in T-cell activation.

Background. In an effort to identify new active chemotherapeutic agents against non-small cell lung cancer (NSCLC), the authors conducted a randomized Phase Il trial to evaluate the efficacy of amonafide or trimetrexate in patients with Stage IV disease. Methods. This was a multicenter Cooperative Oncology Group trial. All patients had advanced NSCLC and were previously untreated with chemotherapy. Patients were randomized to treatment after enrollment. Amonafide was administered as a 24-hour continuous infusion (1600 mg/[m.sup.2]) every 21 days. Trimetrexate (150 mg/[m.sup.2]) was administered intravenously over 30 minutes every 2 weeks. The primary endpoints of the study were clinical response and toxic effects. All patients were observed for survival. Results. Thirty-five patients received amonafide and were assessable. There were no complete responses and two partial responses (6%). Thirty-seven patients were treated with trimetrexate. There were no complete responses and five (14%) partial responses. Myelosuppression was the primary toxic effect observed with amonafide treatment. Trimetrexate was associated infrequently with clinically significant side effects. Conclusions. Amonafide is inactive against NSCLC, and no additional studies with this agent are planned. Trimetrexate has some activity against NSCLC, but its role in the future therapy of this disease is questionable. Cancer 1993; 71:2723-6.

Background. In an effort to confirm the efficacy of mitomycin C against metastatic squamous cell lung carcinoma and to compare the efficacy of single-agent therapy with a combination containing cisplatin, the authors conducted a randomized Phase III trial of mitomycin C alone versus mitomycin C, vinblastine, and cisplatin (MVP). Methods. All patients had advanced squamous cell lung carcinoma, and survival was the primary end point. There were 133 eligible patients who received either mitomycin C alone (n = 64) or MVP (n = 69). The two groups were similar with respect to performance score, disease status, age, sex, and stage. Results. The major objective response rates were 30% (95% confidence interval [CI], 18-41%) and 43% (95% CI, 32-55%) for mitomycin C alone and MVP, respectively (P = 0.1). The median time to progression was 83 days for mitomycin C alone, compared with 119 days for MVP (P 0.026). The median survival time was 114 days for mitomycin C and 163 days for MVP (P = 0.09). The 1-year survival rates were equivalent. Myelosuppression was the major toxicity, and there were significantly greater leukocyte nadirs with MVP therapy (P < 0.001). Conclusion. Mitomycin C has antitumor activity against squamous cell lung carcinoma when used alone or in combination with MVP. The regimen containing cisplatin had marginally increased activity that did not translate into a clinically significant survival advantage. Cancer 1992; 70:2281-2287.

An immune response can reveal cancer. As a normal cell undergoes tumorigenesis, it expresses aberrant protein antigens, known as tumor-associated antigens (TAAs). They are recognized as non-self by the immune [...]

A patient with a previously unsuspected intrathoracic tracheal malignancy presented with symptoms suggestive of asthma and an unusual pattern seen by conventional PFTs. Reduced expiratory flows with a large difference [...]

Outcome in Patients Presenting With Regional Lymph Node Involvement Study objective: Typical pulmonary carcinoid tumors are well-differentiated neuroendocrine tumors that are associated with good patient survival rates, while atypical carcinoid [...]

Detection of small, peripheral nodules is improving ABSTRACT. Advances in radiologic techniques are improving the detection and evaluation of the solitary pulmonary nodule. While past chest films are valuable for [...]

What can you do for your patient after the oncologists and pulmonary experts have delivered definitive care? Follow-up evaluations, screening for recurrence, and relief of complications are just part of [...]

It has been a little over 10 years since the last revision of the staging system for lung cancer by the American joint Committee on Cancer (AJCC). The previous staging [...]

Malignant pleural mesothelioma (MPM) is a disease that is infrequently encountered in the usual pulmonary practice. There are estimated to be 2,000 to 3,000 cases per year in the United [...]

INTRODUCTION: Pure red cell aplasia (PRCA) is an auto-immune mediated disorder with isolated hypoproliferation of the erythrocytes precursors in the bone marrow. It can be associated with thymoma. We present [...]