Intensive Alternating Combination Chemotherapy and High Dose Chest Radiotherapy in Small Cell Lung Cancer

Sixty-nine patients, 32 with limited and 37 with extensive small cell lung cancer (SCLC), were admitted to the present study. Patients with limited disease underwent alternating combination chemotherapy consisting of CAV (cyclophosphamide, adriamycin, vincristine) and PE (cisplatin and etoposide) regimens and concurrent high dose thoracic radiotherapy (6,000 cGy); prophylactic brain irradiation (3,000 cGy) was administered to complete responders. Patients with extensive disease received the same alternating chemotherapy but not radiotherapy. In the 25 evaluable patients with limited disease we obtained an objective response (OR) in 80% with a complete response (CR) in 54% and partial response (PR) in 24%, stable disease (SD) in 4% and progressive disease (PD) in 16%. Median duration of response was 9.5 months for CR and 8.5 months for PR. Median survival was 14 months for all patients with 12% long-term survivors. Toxicity was acceptable. In the 32 evaluable patients with extensive disease we observed 65.6% OR with 18.7% CR and 46.8% PR, 9.3% minimal response and 25% PD. Median duration of response was 7 months for CR and 8 months for PR. Median survival was 10 months for all patients. The treatment was well tolerated. Our study did not show a therapeutic advantage for alternating combination chemotherapy in SCLC and failed to show the use of high dose chest radiotherapy in combined modality for limited disease.

The Treatment of Metastatic Pleural Effusion in Breast Cancer: Report of 25 Cases

We report our experience in the treatment of pleural effusion in 25 patients with metastatic breast cancer. Seventeen patients received initial systemic therapy and in 13 of them local intrapleural therapy was subsequently employed; the remaining 8 patients received local therapy only. Several modalities of local treatment were used: intrapleural chemotherapy with thiotepa and 5-fluorouracil; the production of pleural adhesion by the use of chest drainage alone or associated with instillation of sclerosing agents, such as nitrogen mustard or tetracycline. Of the 21 patients who were subjected to local therapy, 19 (90.5%) achieved an objective response (16 complete (76.2%) and 3 (14.34%) partial). Complete responses were observed exclusively in patients who had pleurodesis. Our data suggest that pleurodesis is the treatment of choice for neoplastic pleural effusion and that the use of tetracycline as a sclerosing agent is the most useful because of its availability, low cost and low morbidity.

Epidemiology of non-gastroenteropancreatic (neuro)endocrine tumours

The widespread availability and reliability of immunohistochemical techniques in the last three decades have allowed researchers to identify cells with common neuroendocrine markers in virtually every organ. As a whole, these neuroendocrine cells form the so-called diffuse neuroendocrine system. Tumours arising from the cells of the diffuse neuroendocrine system are defined as (neuro)endocrine tumours (NETs). NETs have been increasingly described in recent years. However, despite the increase in the number of published papers focused on NET, we still lack adequate epidemiological data, particularly for non-gastroenteropancreatic (GEP) NETs. Furthermore, the real incidence of neuroendocrine differentiation for most sites is not completely known and is probably underestimated. As a consequence, data on the clinical features of many NET subgroups are not well known or confusing. For all of these reasons, we have attempted to evaluate the epidemiology of non-GEP NETs, reviewing the limited data available in the literature.

[Pneumothorax in pregnancy. A review of 16 cases including one of the authors']

Pneumothorax in pregnancy raises several problems especially of therapy. In the present study we report a case observed in our Institution and literature data on 15 further cases. Pneumothorax occurred in 9 cases in the course of pregnancy, in 6 cases during delivery and in 1 case in the post-partum period. Immediate treatment was insertion of pleural drain in 13 patients and bed rest in 3 patients. Surgery was required in 8 cases and was performed after delivery in 5 cases and during pregnancy in 3 cases, 6 thoracotomies, 1 bilateral thoracotomy and 1 sternotomy for bilateral pneumothorax were carried out. Actually a videothoracoscopic treatment, requiring general anaesthesia, is also possible. In all observed cases pneumothorax didn't represent a serious risk for both mother and foetus, for the timely therapeutic measures. Pneumothorax represents an uncommon pathology, usually underestimated in literature, that must be taken into account whenever during pregnancy or the post-partum period a progressive respiratory failure arises.

Mediastinoscopy vs. anterior mediastinotomy in the diagnosis of mediastinal lymphoma: a randomized trial

We selected 95 patients with mediastinal adenopathy and no signs of goiter, myasthenia gravis or mediastinal involvement by other disease. All patients underwent, for screening purposes, transthoracic fine needle aspiration biopsy based on chest x-ray and CT findings. Patients were then subdivided into 4 groups. One group of 22 patients with prevalent anterior mass localization underwent anterior mediastinotomy. One group of 19 patients with prevalent middle mediastinal mass localization underwent cervical mediastinoscopy. Two other groups of 27 patients each with both anterior and middle mediastinum localization randomly underwent anterior mediastinotomy or mediastinoscopy. Fifty-one Hodgkin's and 44 non-Hodgkin's lymphomas were diagnosed in total. In 11 cases (11.57%), median sternotomy (2) or thoracotomy (9) were necessary for establishing the final diagnosis. The overall diagnostic accuracy was 80.43% for cervical mediastinoscopy and 95.91% for anterior mediastinotomy. The statistical analysis performed on all patients showed a significant difference (chi 2 = 5.56, P less than 0.025, df = 1) between the two procedures.

Lateral thoracic meningocele

A case of intrathoracic meningocele is reported, and 95 cases from the literature are reviewed. Thoracic meningoceles are usually associated with neurofibromatosis; nevertheless their etiology remains controversial. The authors postulate the role of spinal trauma in some patients and the origin of the meningocele from an abnormal prolongation of a nerve sleeve in nontraumatic cases. Thoracic meningoceles often are asymptomatic or produce radicular intercostal pain. Spinal computed tomography is the most useful investigation, particularly in the exploration of large meningoceles. Surgery is required in symptomatic cases and usually results in remission of the pain.