tailieunhanh - Advanced therapy in thoracic surgery - part 3

hạn người sống sót có nhiều khả năng có một khối u ác tính thứ hai chính hơn là một tái phát của bệnh ung thư phổi tế bào nhỏ, và nhiều người trong số các khối u mới phát sinh trong phổi. Trong trường Đại học Toronto loạt, tám bệnh nhân trải qua phẫu thuật cắt bỏ tại thời điểm của "tái phát" | 110 Advanced Therapy in Thoracic Surgery term survivor is more likely to have a second primary malignancy than a relapse of the small cell lung cancer and many of these new tumors arise in the lung. In the University of Toronto series eight patients underwent surgical resection at the time of relapse following a long disease-free interval after initial treatment for small cell lung cancer. Two were found to have nonsmall cell tumors and both achieved long-term survival after surgery. It is recommended therefore that a biopsy should be undertaken for long-term survivors of small cell lung cancer who develop a new lung lesion. If nonsmall cell pathology is documented the patient should be staged completely and surgery should be considered if the standard medical and surgical criteria for resection that would be applied to all patients with nonsmall cell tumors are met. Summary Combined modality therapy with surgery and chemotherapy is feasible the toxicity is manageable and postoperative morbidity and mortality rates acceptable. Patient selection is important and the results of the LCSG trial indicate that surgical resection does not benefit the majority of patients with limited small cell lung cancer. The chances of long-term survival and cure are strongly correlated with pathologic TNM subgroups and consideration of surgery for patients with small cell lung cancer should be limited to those with stage I and perhaps stage II cancer. Therefore before surgery is undertaken patients should undergo full staging of the mediastinum including mediastinoscopy. Surgery may be considered for patients with T1-2N0 small cell tumors and whether it is offered as the initial treatment or after induction chemotherapy does not seem to be important as has been shown by Wada and colleagues and the University of Toronto 34 If a small cell tumor is identified unexpectedly at the time of thoracotomy complete resection and mediastinal lymph node resection should be undertaken if

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