Post-Thoracotomy Diagnostic and Staging Conversion Rates of Clinically Staged I Lung Cancer

Modality of Lung Cancer Treatment in an Unselected Population

The modality of lung cancer treatment was retrospectively evaluated in an unselected population. All the lung cancer cases diagnosed among the residents in a Local Sanitary Unit of Lombardy during four years (1974–1979), were identified. The clinical records of the 235 collected patients were reviewed and on this basis the anatomical extent of disease was retrospectively classified in stages according to the TNM of UICC (1978). The relative frequency of clinical stages resulted 29 % for stage I, 17 % II, 20 % III and 32 % IV. Only 57 % of all the subjects had been treated; 11 % by resection, 22 % by radiotherapy and 24 % by chemotherapy. For the stages I and II the operability rates were 35 % and 26 % respectively, while the resectability rates were 29 % and 17 %. An objective reason of exclusion from surgery was found in no more than a quarter of stage I and II lung cancers, while the remaining (40 %) had probably been excluded from exploration owing to a subjective prognostic evaluation. If compared with similar reports from other countries, these data show a striking defect in the choice of curative treatment for a high proportion of the examined cases.

Incident Lung Cancer Survival. Long-Term Follow-Up of a Population-Based Study in Italy

The long-term survival of an incident lung cancer population was evaluated in relation to clinical stage, treatment modalities and other prognostic factors. The survey was carried out among the residents in the Local Sanitary Unit of Saronno, a highly industrialized area of northern Italy, where all the lung cancer cases diagnosed during the years 1976-79 had been identified and clinically studied. The overall survival of the 222 cases included in the analysis was 32% at 1 year, 10% at 3 years and 5% at 5 years; median survival was 7 months. A significantly better prognosis was associated with surgical resection (32% at 5 years; median, 42 mo), clinical stage I (16% at 5 years; median, 15 mo), and squamous cell carcinoma (13% at 5 years; median, 11 mo). Other factors such as age, sex, social class or cancer symptoms did not affect survival when treatment was taken into account. Our data show that surgical resection is the major determinant of survival, and suggest that suboptimal access to curative treatment, particularly in patients aged 60 to 75 with limited disease, might have compromised the overall survival.

Computed tomography in lung cancer

Computed-assisted tomography produces a cross-sectional image of the body using x-ray absorption measurements. Density differences are much more apparent than on conventional radiographs, although spatial resolution is not so fine. Lung cancer, can be evaluated accurately with regard to size, location, and whether regional or mediastinal lymph nodes are enlarged. Although enlarged granulomatous nodes generally tend to be dense, histologic specificity is not available. Computed tomography is recommended as a screening technique in lung cancer staging for patients whose routine radiographs are normal but whose primary lesions fulfill criteria for mediastinoscopy. If findings on computed tomography are normal, thoracotomy should then be performed; if enlarged nodes are detected, then a biopsy is needed to exclude operability. This strategy presumes that computed tomography has high sensitivity, although it remains to be proven by further experience whether the false-negative rate of computed tomography is an acceptable 10 to 15 percent. Computed tomography has been shown to be of considerable value in optimizing radiation therapy of lung cancer, and in diagnosing pleural complications of the cancer or its treatment.