Prospective study of 445 lung carcinomas with mediastinal lymph node metastases
Martini, N.; Flehinger, B.J.; Zaman, M.B.; Beattie, E.J.
Journal of Thoracic and Cardiovascular Surgery 80(3): 390-399
1980
ISSN/ISBN: 0022-5223 PMID: 6251316 Document Number: 161915
From 1974-1978, 998 patients with carcinoma of the lung were treated. All were staged according to the staging system of The American Joint Committee for Cancer Staging and End Results Reporting. Of these, 445 patients had clinically evident mediastinal lymph node metastases. The condition of 204 was considered inoperable at diagnosis, based on histology of oat cell carcinoma, known distant metastases or malignant effusion. Surgical exploration was undertaken in the remaining 241 patients and they were treated by resection and/or intraoperative implantation of radioactive sources. Of this latter group, 161 (69%) had palliative resection or implantation of radioactive sources. The median survival in this group of patients was 9 mo. There were 80 patients who had complete, potentially curative resection of their primary tumor and all accessible mediastinal lymph nodes. The vast majority of these were also treated by postoperative external radiation therapy to the mediastinum. In this group, there were 25 epidermoid carcinomas, 44 adenocarcinomas, 8 large cell carcinomas and 3 oat cell carcinomas. The survival rate was 73% at 1 yr, 57% at 2 yr and 49% at 3 yr. Survival at 3 yr was slightly better in glandular carcinoma (adenocarcinoma or bronchiolar) than in epidermoid carcinoma (56% vs. 44%). There is a select group of patients with mediastinal lymph node metastases who can be effectively treated by combined resection and radiation therapy, with prolonged survival.