Survival in 6086 cases of bronchial carcinoma

Primary lung cancer: characterization and survival of 1024 patients treated in a single institution

This report describes the presenting features, smoking history, diagnostic techniques and their yields, histological typing and tumor-node-metastases (TNM) staging for a cohort of 1024 Australian patients with primary lung cancer. It also includes survival data for the group as a whole and for subgroups of patients based on clinical stage, histology, treatment modality and postsurgical stage. Ninety-six per cent of patients had smoked. A much higher proportion of patients with adenocarcinoma had smoked than has commonly been believed. In surgically treated patients, stage, but not histological type or age, was related to survival. Approximately one-third of all patients had such advanced disease that no treatment to the primary site was offered.

Survival of Lung Cancer in East London: A Prospective Survey

Five hundred men and 76 women all under the care of one physician at the London Chest Hospital were diagnosed as having bronchogenic carcinoma and admitted to a prospective survey between May 1966 and April 1978. The survey was completed in December 1984 when all but 19 of the 500 men had died. None was lost to follow up. The longest period of surveillance was 18 years 7 months, the shortest 6 years 8 months. The five-year survival of the group of 500 men was 7.6% (38), and 22% (32) for the 145 patients who had had resections. Of the 78 patients (63 men, 15 women) who had small cell carcinoma, only one survived 3 years; the others died in under 2 years, giving a median survival of 5 months. The median survival of the 21 untreated cases in this group of small cell carcinoma was 2 months.

Fifteen-year follow-up of all patients in a study of post-operative chemotherapy for bronchial carcinoma

The 15-year findings are presented of a double-blind, randomised study planned in 1964 in which cytotoxic chemotherapy with either busulphan or cyclophosphamide prescribed to be given daily for 2 years as an adjuvant to surgery was compared with placebo in the treatment of 726 patients with carcinoma of the bronchus. The two cytotoxic agents administered in this way did not influence survival. At 15y, 8% of the 243 patients allocated busulphan, 9% of the 234 cyclophosphamide, and 10% of the 249 placebo were alive, these being 10% of the patients who had had epidermoid cancers, 12% large-cell, 5% small-cell, 5% adenocarcinomas, and 8% other histological types. The study provides data on long-term results in a large group of patients who were, in effect, treated by surgery alone. Survival was significantly shorter in patients with histological involvement of the resected intrathoracic nodes (log-rank test P much less than 0.001). A finding of particular interest is that the histological type of the tumour did not influence survival in the 390 patients whose nodes were not involved, although, as expected, it did in the 336 whose nodes were involved, the 226 with epidermoid cancers surviving longer than the 57 with small cell carcinoma, the 31 with adenocarcinoma and all 110 with non-epidermoid carcinomas (P much less than 0.001 in each comparison).

Thirty years of surgery for carcinoma of the bronchus

A study has been made of 8781 patients with bronchial carcinoma who were operated on by seven surgeons in England during the years 1949-80. There were 3865 pneumonectomies, 3790 lobectomies, and 1126 thoracotomies. During this period the operative mortality has fallen. Neither the resection rate nor the proportion of lobectomies bears any relation to the survival rate in any series. There has been remarkable similarity between the various survival rates in that the difference at five years was only 1.3% (25.5-26.8%) and at 10 years 4.2% (13.6-17.8%). These figures are reflected in reports published worldwide, where there is also great similarity between the results. If the improvement in operative mortality is excluded, there has been no improvement in the survival rates in the last thirty years.

Clinical indicators of prognosis in unresected lung cancer

A prognosis estimate in palliative treatment for inoperable lung cancer is thought to be of value. Performance status is now recognized as being of major importance, but only recently has been consistently available. We examined other simple information not requiring clinical or laboratory tests that is available in the clinical histories of a series of 1,839 patients with unresected lung cancer. Actuarial survivals at 1, 2, and 5 years were 21.9, 7.8, and 2.0 percent, respectively. The median survival rate was 24 weeks. Squamous cell histology and an increasing interval between the first symptoms and diagnosis were associated with a better prognosis. The number of symptoms recorded at the time of assessment had strong negative association with survival; asymptomatic patients had a two-year survival of 26 percent compared with 6 percent or less with four or more symptoms. A similar discrimination is given by Feinstein's index, which combines information on the number and type of symptoms and on the interval between first symptom and diagnosis. The clinical stage was strongly related to survival. Additional statistical analysis showed that the prognostic value of each of the most powerful prognostic factors, the number of symptoms, and Feinstein's index was little altered by the use of data on stage and histology in addition. The data show a range of median survival of 18 to 60 weeks for Feinstein's indices from 6 to 1, suggesting that the symptom index is useful particularly in the relatively well patients and the performance status particularly in those more ill. The combination may be better than either alone, and it is recommended that such information be recorded for all lung cancer patients.

The role of curative radiotherapy in the treatment of lung cancer

From 1963-1974, 141 patients with lung cancer were treated with curative intent in the A. Maxwell Evans Clinic in Vancouver. The clinical presentation, age and sex distribution, histology, and reasons for surgery not being carried out are examined. The results of this treatment are presented. An attempt has been made to isolate a group of patients who have a better prognosis so that treatment selection can be improved. Hemoptysis, cough, dyspnea, and incidental finding on routine chest x-ray were the most common manner of presentation. Thirty-four percent of the patients were over 70 years of age and 13% were women. The crude overall three- and five-year survival rates were 18 and 10% (19 and 9% in the men, 17 and 14% in the women). Patients presenting with dyspnea had a better survival than those presenting with cough and hemoptysis. Patients with lesions less than 3 cm in diameter had a 28% three-year survival, compared with 14% for lesions greater than 5 cm in diameter. The three- and five-year survival rates in patients over 70 years of age were 23 and 17% respectively. The response to treatment and the survival was better in the patients with squamous cell carcinoma. Twenty-two percent were alive at three years and 12% at five years as compared with 9 and 5% for other histologies. Fifty-four percent of the 35 patients with a complete response and with squamous cell carcinoma were alive at three years, compared with only 8% of the 12 patients with other histologies who showed a complete response.

The sympatomatic treatment of carcinoma of the bronchus using combination chemotherapy

A study was made of chemotherapy for inoperable carcinoma of the bronchus. Only patients with symptoms directly due to the tumour or with evidence of rapid tumour growth were selected for treatment. Half the patients selected in this way responded and in these patients survival may have been prolonged. The regimen chosen caused the minimum of interference with the patient's life and, by relief of symptoms, appeared to offer an improvement in the quality of life.

Radiotherapy for bronchogenic carcinoma

Treatment of carcinoma of the lung to cure or even to prolong survival time to a satisfactory degree is not yet a reality. For squamous cell carcinoma confined to the lung, radical surgery offers the best possibility of cure. When surgery is not feasible in such a case for other than technical reasons (eg, poor general condition of the patient), radical (megavoltage) radiotherapy offers a good possibility of cure. For anaplastic or oat cell carcinoma confined to the lung, cure by surgery or radiotherapy is less likely and there is little advantage of one or the other of these modalities. Once metastasis has occurred, surgery is largely precluded and radiotherapy becomes a measure of last resort that offers a good possibility of relief of distressing symptoms and some hope of prolonging worthwhile life.

Endobronchial carcinosarcoma. A case with osteosarcoma of pulmonary invasive part, and a review with respect to prognosis

A case of endobronchial carcinosarcoma is reported in which a small area of epidermoid carcinoma at the base of the partly necrotic, polypoid part of the tumor was found, and where the pulmonary invasive part consisted of osteosarcoma. To our knowledge such a case has not been published before. In the literature 23 cases of endobronchial carcinosarcoma were found. All but one of those alive at the time of diagnosis were considered operable. The first year survival rate of the reviewed and the reported cases was 36% of all or 42% of the resected cases. The figures for bronchial carcinoma are 33% or 62% of the resected cases. The pre- and post-operative mortality for endobronchial carcinosarcoma was 23%. Because follow-up was too short, the 5 year survival rate cannot be estimated. Features common to pulmonary sarcoma and pseudosarcoma of the upper respiratory tract are also discussed.

5-year follow-up of cytotoxic chemotherapy as an adjuvant to surgery in carcinoma of the bronchus

This report gives the 5-year findings of a double-blind study of long-term cytotoxic chemotherapy as an adjuvant to surgery in patients receiving busulphan or cyclophosphamide for carcinoma of the bronchus compared with a group receiving a placebo. Of 243 patients initially allocated busulphan, 234 cyclophosphamide and 249 placebo, 28%, 27% and 34% respectively were alive at 5 years. There were significant associations between mortality from bronchial carcinoma and histological involvement of the resected intrathoracic nodes and the histology of the tumour. Haematological toxicity, especially thrombocytopenia, was frequent and severe in the busulphan series, and low platelet counts continued long after chemotherapy was stopped.

Post-irradiation surgery for bronchogenic carcinoma

In an attempt to improve both the resectability and survival rates for bronchogenic carcinoma, pre-operative supervoltage radiotherapy was introduced in 1961 and continued for a period of three years. Patients with either a histological or cytological diagnosis were given a tumour dose of 4,500 r over six weeks and then a two-month period elapsed before surgery. A follow-up of cases treated during the period revealed a five-year survival rate of 15·7%. This rate is low when compared with the results achieved at this hospital with surgery alone. This finding is attributed to the harmful effects of radiotherapy which have led to a high bronchopleural fistula rate of 15·5%. A single case of myocardial radionecrosis also occurred. No improvement is noted in the resectability rate. An overall assessment is that radiotherapy has provided no benefits but has in fact greatly increased both the morbidity and mortality rates.