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March 25, 1992, Vol 267, No. 12 >
ARTICLE | March 25, 1992

Recent Developments in the Treatment of Lung Cancer FREE

Albert Y. Lin, MD, MPH; Daniel C. Ihde, MD
[+] Author Affiliations

Reprint requests to Office of the Director, Bldg 31, Room 11A48, National Cancer Institute, Bethesda, MD 20892 (Dr Ihde).


JAMA. 1992;267(12):1661-1664. doi:10.1001/jama.1992.03480120099040
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References

SELECTED CASE A 45-year-old asymptomatic white man with a 60-pack-year history of cigarette abuse presented with an upper lobe pulmonary nodule apparent on the right side on a routine chest roentgenogram. Physical examination was unrevealing. Computed tomography demonstrated an irregular noncalcified mass suggestive of neoplasm. Results of transbronchial biopsy were positive for adenocarcinoma. Evaluation for metastases, including a computed tomographic scan of the head, radionuclide bone scan, and serum liver function tests, yielded negative results. The patient subsequently underwent upper lobectomy of the right lung with curative intent and was pathologically staged as having stage I (T2N0)1 adenocarcinoma of the lung.

The patient did well until 14 months after surgery, when he developed cough, dyspnea, and hemoptysis. A few days later, he noted a right-sided facial droop, clumsiness of the right hand, blurring of vision, and a severe headache. He presented in the emergency department, where physical examination revealed facial

REFERENCES

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Mountain CF.  A new international staging system for lung cancer. Chest . 1986;;89( (suppl 4) ):225S-233S.
2 +
Boring CC, Squires TS, Tong T.  Cancer statistics, 1991. CA . 1991;;41:19-36.
3 +
Cullen JW.  Principles of cancer prevention: tobacco.  In: De Vita VT, Hellman S, Rosenberg SA, eds. Cancer: Principles and Practice of Oncology . 3rd ed. Philadelphia, Pa: JB Lippincott; 1989;:181-195.
4 +
Garfinkel L, Silverberg E.  Lung cancer and smoking trends in the United States over the past 25 years. CA . 1991;;41:137-145.
5 +
Ries LAG, Hankey BF, Miller BA, Hartman AM, Edwards BK. Cancer Statistics Review 1973-88 . Bethesda, Md: National Cancer Institute; 1991;. NIH publication 91-2789.
6 +
MinnaJD, Pass H, Glatstein E, Ihde DC.  Cancer of the lung.  In: De Vita VT, Hellman S, Rosenberg SA, eds. Cancer: Principles and Practice of Oncology . 3rd ed. Philadelphia, Pa: JB Lippincott; 1989;:591-705.
7 +
Martini N, Flehinger B, Zaman M, Beattie EJ.  Results of resection in non-oat cell carcinoma of the lung cancer with mediastinal lymph node metastases. Ann Surg . 1983;;198:386-397.
8 +
Cortese DA, Pairolero PC, Bergstralh EJ, et al.  Roentgenographically occult lung cancer: a ten-year experience. J Thorac Cardiovasc Surg . 1983;;86:373-380.
9 +
Errett LE, Wilson J, Chiu RCJ, Munro DD.  Wedge resection as an alternative procedure for peripheral bronchogenic carcinoma in poor-risk patients. J Thorac Cardiovasc Surg . 1985;;90:656-661.
10 +
Perez CA, Pajak TF, Rubin P, et al.  Longterm observations of the patterns of failure in patients with unresectable non-oat cell carcinoma of the lung treated with definitive radiotherapy: report by the Radiation Therapy Oncology Group. Cancer . 1987;;59:1874-1881.
11 +
Weisenburger TH, Gail M, Lung Cancer Study Group.  Effects of postoperative mediastinal irradiation on completely resected stage II and III epidermoid cancer of the lung. N Engl J Med . 1986;;315:1377-1381.
12 +
Cox JD, Azarnia N, Byhardt RW, Shin KH, Emami G, Pajak TF.  A randomized phase I/II trial of hyperfractioned radiation therapy with total doses of 60.0 Gy to 79.2 Gy: possible survival benefit with > 69.6 Gy in favorable patients with Radiation Therapy Oncology Group stage III non-small cell lung carcinoma: report of Radiation Therapy Oncology Group 83-11. J Clin Oncol. 1990;;8:1543-1555.
13 +
Feld R, Rubinstein LV, Weisenburger TH, Lung Cancer Study Group.  Sites of recurrence in resected stage I non-small-cell lung cancer: a guide for future studies. J Clin Oncol . 1984;;2:1352-1358.
14 +
Rapp E, Pater JL, Willan A, et al.  Chemotherapy can prolong survival in patients with advanced non-small cell lung cancer: report of a Canadian multicenter randomized trial. J Clin Oncol . 1988;;6:633-641.
15 +
Dillman RO, Seagren SL, Propert KJ, et al.  A randomized trial of induction chemotherapy plus high-dose radiation versus radiation alone in stage III non-small cell lung cancer. N Engl J Med . 1990;;323:940-945.
16 +
Martini N, Kris MG, Gralla RJ, et al.  The effects of preoperative chemotherapy on the resectability of non-small cell lung carcinoma with mediastinal lymph node metastases (N2 MO). Ann Thorac Surg . 1988;;45:370-379.
17 +
Lad T, Rubinstein L, Sadeghi A, Lung Cancer Study Group.  The benefit of adjuvant treatment for resected locally advanced non-small cell lung cancer. J Clin Oncol . 1988;;6:9-17.
18 +
Holmes EC, Gail M, Lung Cancer Study Group.  Surgical adjuvant therapy for stage II and stage III adenocarcinoma and large cell undifferentiated carcinoma. J Clin Oncol . 1986;;4:710-715.
19 +
Johnson BE, Grayson J, Makuch RW, et al.  Ten-year survival of patients with small-cell lung cancer treated with combination chemotherapy with or without irradiation. J Clin Oncol . 1990;;8:396-401.
20 +
Osterlind K, Hansen HH, Hansen M, Dombernowsky P.  Mortality and morbidity in long-term surviving patients treated with chemotherapy with or without irradiation for small-cell lung cancer. J Clin Oncol . 1986;;4:1044-1052.
21 +
Einhorn LH, Crawford J, Birch R, Omura G, Johnson DH, Greco FA.  Cisplatin plus etoposide consolidation following cyclophosphamide, doxorubicin, and vincristine in limited small-cell lung cancer. J Clin Oncol . 1988;;6:451-456.
22 +
Ihde DC, Mulshine JL, Kramer BS, et al.  Randomized trial of high vs standard dose etoposide (VP16) and cisplatin in extensive stage small cell lung cancer. Proc Am Soc Clin Oncol . 1991;;10: 240.
23 +
Spiro SG, Souhami RL, Geddes DM, et al.  Duration of chemotherapy in small cell lung cancer: a Cancer Research Campaign trial. Br J Cancer . 1989;;59:578-583.
24 +
Bork E, Hansen M, Dombernowsky P, Hansen SW, Pedersen AG, Hansen HH.  Teniposide (VM-26), an overlooked highly active agent in small-cell lung cancer: results of phase II trial in untreated patients. J Clin Oncol . 1986;;4:524-527.
25 +
Perry MC, Eaton WL, Propert KJ, et al.  Chemotherapy with or without radiation therapy in limited small-cell carcinoma of the lung. N Engl J Med . 1987;;316:912-918.
26 +
Perez CA, Einhorn L, Oldham RK, et al.  Randomized trial of radiotherapy to the thorax in limited small-cell carcinoma of the lung treated with multiagent chemotherapy and elective brain irradiation: a preliminary report. J Clin Oncol . 1984;;2:1200-1208.
27 +
Bunn PA, Lichter AS, Makuch RW, et al.  Chemotherapy alone or chemotherapy with chest radiation therapy in limited stage small cell lung cancer: a prospective randomized trial. Ann Intern Med . 1987;;106:655-662.
28 +
Brooks BJ, Seifter EJ, Walsh TE, et al.  Pulmonary toxicity with combined modality therapy for limited stage small cell lung cancer. J Clin Oncol . 1986;;4:200-209.
29 +
McCracken JD, Janaki LM, Crowley JJ, et al.  Concurrent chemotherapy/radiotherapy for limited small cell lung carcinoma: a Southwest Oncology Group study. J Clin Oncol . 1990;;8:892-898.
30 +
Turrisi AT, Glover DJ, Mason BA.  A preliminary report: concurrent twice-daily radiotherapy plus platinum-etoposide chemotherapy for limited small cell lung cancer. Int J Radiat Oncol Biol Phys . 1988;;15:183-187.
31 +
Ihde DC, Grayson J, Woods E, et al.  Twice daily chest irradiation as an adjuvant to etoposide cisplatin therapy of limited stage small cell cancer.  In: Salmon SE, ed. Adjuvant Therapy of Cancer VI . Philadelphia, Pa: WB Saunders Co; 1990;:162-165.
32 +
Devesa SS, Blot WJ, Fraumeni JF.  Declining lung cancer rates among young men and women in the United States: a cohort analysis. J Natl Cancer Inst . 1989;;81:1568-1571.
33 +
Hong WK, Lippman SM, Itri LM, et al.  Prevention of second primary tumors with isotretinoin in squamous-cell carcinoma of the head and neck. N Engl J Med . 1990;;323:795-801.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Mountain CF.  A new international staging system for lung cancer. Chest . 1986;;89( (suppl 4) ):225S-233S.
2 +
Boring CC, Squires TS, Tong T.  Cancer statistics, 1991. CA . 1991;;41:19-36.
3 +
Cullen JW.  Principles of cancer prevention: tobacco.  In: De Vita VT, Hellman S, Rosenberg SA, eds. Cancer: Principles and Practice of Oncology . 3rd ed. Philadelphia, Pa: JB Lippincott; 1989;:181-195.
4 +
Garfinkel L, Silverberg E.  Lung cancer and smoking trends in the United States over the past 25 years. CA . 1991;;41:137-145.
5 +
Ries LAG, Hankey BF, Miller BA, Hartman AM, Edwards BK. Cancer Statistics Review 1973-88 . Bethesda, Md: National Cancer Institute; 1991;. NIH publication 91-2789.
6 +
MinnaJD, Pass H, Glatstein E, Ihde DC.  Cancer of the lung.  In: De Vita VT, Hellman S, Rosenberg SA, eds. Cancer: Principles and Practice of Oncology . 3rd ed. Philadelphia, Pa: JB Lippincott; 1989;:591-705.
7 +
Martini N, Flehinger B, Zaman M, Beattie EJ.  Results of resection in non-oat cell carcinoma of the lung cancer with mediastinal lymph node metastases. Ann Surg . 1983;;198:386-397.
8 +
Cortese DA, Pairolero PC, Bergstralh EJ, et al.  Roentgenographically occult lung cancer: a ten-year experience. J Thorac Cardiovasc Surg . 1983;;86:373-380.
9 +
Errett LE, Wilson J, Chiu RCJ, Munro DD.  Wedge resection as an alternative procedure for peripheral bronchogenic carcinoma in poor-risk patients. J Thorac Cardiovasc Surg . 1985;;90:656-661.
10 +
Perez CA, Pajak TF, Rubin P, et al.  Longterm observations of the patterns of failure in patients with unresectable non-oat cell carcinoma of the lung treated with definitive radiotherapy: report by the Radiation Therapy Oncology Group. Cancer . 1987;;59:1874-1881.
11 +
Weisenburger TH, Gail M, Lung Cancer Study Group.  Effects of postoperative mediastinal irradiation on completely resected stage II and III epidermoid cancer of the lung. N Engl J Med . 1986;;315:1377-1381.
12 +
Cox JD, Azarnia N, Byhardt RW, Shin KH, Emami G, Pajak TF.  A randomized phase I/II trial of hyperfractioned radiation therapy with total doses of 60.0 Gy to 79.2 Gy: possible survival benefit with > 69.6 Gy in favorable patients with Radiation Therapy Oncology Group stage III non-small cell lung carcinoma: report of Radiation Therapy Oncology Group 83-11. J Clin Oncol. 1990;;8:1543-1555.
13 +
Feld R, Rubinstein LV, Weisenburger TH, Lung Cancer Study Group.  Sites of recurrence in resected stage I non-small-cell lung cancer: a guide for future studies. J Clin Oncol . 1984;;2:1352-1358.
14 +
Rapp E, Pater JL, Willan A, et al.  Chemotherapy can prolong survival in patients with advanced non-small cell lung cancer: report of a Canadian multicenter randomized trial. J Clin Oncol . 1988;;6:633-641.
15 +
Dillman RO, Seagren SL, Propert KJ, et al.  A randomized trial of induction chemotherapy plus high-dose radiation versus radiation alone in stage III non-small cell lung cancer. N Engl J Med . 1990;;323:940-945.
16 +
Martini N, Kris MG, Gralla RJ, et al.  The effects of preoperative chemotherapy on the resectability of non-small cell lung carcinoma with mediastinal lymph node metastases (N2 MO). Ann Thorac Surg . 1988;;45:370-379.
17 +
Lad T, Rubinstein L, Sadeghi A, Lung Cancer Study Group.  The benefit of adjuvant treatment for resected locally advanced non-small cell lung cancer. J Clin Oncol . 1988;;6:9-17.
18 +
Holmes EC, Gail M, Lung Cancer Study Group.  Surgical adjuvant therapy for stage II and stage III adenocarcinoma and large cell undifferentiated carcinoma. J Clin Oncol . 1986;;4:710-715.
19 +
Johnson BE, Grayson J, Makuch RW, et al.  Ten-year survival of patients with small-cell lung cancer treated with combination chemotherapy with or without irradiation. J Clin Oncol . 1990;;8:396-401.
20 +
Osterlind K, Hansen HH, Hansen M, Dombernowsky P.  Mortality and morbidity in long-term surviving patients treated with chemotherapy with or without irradiation for small-cell lung cancer. J Clin Oncol . 1986;;4:1044-1052.
21 +
Einhorn LH, Crawford J, Birch R, Omura G, Johnson DH, Greco FA.  Cisplatin plus etoposide consolidation following cyclophosphamide, doxorubicin, and vincristine in limited small-cell lung cancer. J Clin Oncol . 1988;;6:451-456.
22 +
Ihde DC, Mulshine JL, Kramer BS, et al.  Randomized trial of high vs standard dose etoposide (VP16) and cisplatin in extensive stage small cell lung cancer. Proc Am Soc Clin Oncol . 1991;;10: 240.
23 +
Spiro SG, Souhami RL, Geddes DM, et al.  Duration of chemotherapy in small cell lung cancer: a Cancer Research Campaign trial. Br J Cancer . 1989;;59:578-583.
24 +
Bork E, Hansen M, Dombernowsky P, Hansen SW, Pedersen AG, Hansen HH.  Teniposide (VM-26), an overlooked highly active agent in small-cell lung cancer: results of phase II trial in untreated patients. J Clin Oncol . 1986;;4:524-527.
25 +
Perry MC, Eaton WL, Propert KJ, et al.  Chemotherapy with or without radiation therapy in limited small-cell carcinoma of the lung. N Engl J Med . 1987;;316:912-918.
26 +
Perez CA, Einhorn L, Oldham RK, et al.  Randomized trial of radiotherapy to the thorax in limited small-cell carcinoma of the lung treated with multiagent chemotherapy and elective brain irradiation: a preliminary report. J Clin Oncol . 1984;;2:1200-1208.
27 +
Bunn PA, Lichter AS, Makuch RW, et al.  Chemotherapy alone or chemotherapy with chest radiation therapy in limited stage small cell lung cancer: a prospective randomized trial. Ann Intern Med . 1987;;106:655-662.
28 +
Brooks BJ, Seifter EJ, Walsh TE, et al.  Pulmonary toxicity with combined modality therapy for limited stage small cell lung cancer. J Clin Oncol . 1986;;4:200-209.
29 +
McCracken JD, Janaki LM, Crowley JJ, et al.  Concurrent chemotherapy/radiotherapy for limited small cell lung carcinoma: a Southwest Oncology Group study. J Clin Oncol . 1990;;8:892-898.
30 +
Turrisi AT, Glover DJ, Mason BA.  A preliminary report: concurrent twice-daily radiotherapy plus platinum-etoposide chemotherapy for limited small cell lung cancer. Int J Radiat Oncol Biol Phys . 1988;;15:183-187.
31 +
Ihde DC, Grayson J, Woods E, et al.  Twice daily chest irradiation as an adjuvant to etoposide cisplatin therapy of limited stage small cell cancer.  In: Salmon SE, ed. Adjuvant Therapy of Cancer VI . Philadelphia, Pa: WB Saunders Co; 1990;:162-165.
32 +
Devesa SS, Blot WJ, Fraumeni JF.  Declining lung cancer rates among young men and women in the United States: a cohort analysis. J Natl Cancer Inst . 1989;;81:1568-1571.
33 +
Hong WK, Lippman SM, Itri LM, et al.  Prevention of second primary tumors with isotretinoin in squamous-cell carcinoma of the head and neck. N Engl J Med . 1990;;323:795-801.

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