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Purpose Lung cancer is an epidemic disease in developing countries. Incorporation of new active drugs in the neoadjuvant treatment of operable patients might lead to improved outcomes. Postchemotherapy mediastinal-based treatment decisions allow for in vivo testing of activity and could help to determine the ideal local treatment. Patients and Methods This phase II trial enrolled patients with documented non–small-cell lung cancer, clinically staged IB-IIIA, and considered candidates for surgical resection. Patients received 3 cycles of neoadjuvant chemotherapy with alternating doublets: cisplatin/gemcitabine; gemcitabine/vinorelbine, and cisplatin/vinorelbine. After neoadjuvant treatment, clinical restaging was performed. Patients without evidence of progression underwent mediastinoscopy. Those with negative mediastinal nodes were taken to surgery whereas those with positive nodes were treated with radiation therapy. Results Between January 2001 and August 2002, 30 patients were included. The median age was 56 years, 66% of the patients were men, 43% of the patients had adenocarcinoma, and 34% had squamous cell carcinoma. Clinical staging was IB in 9 patients (30%), IIB in 7 (23%), and IIIA in 14 (47%). Median tumor size was 6.5 cm (range, 3–11 cm). Twenty-three patients (77%) had clinical response to neoadjuvant chemotherapy. Eight of 12 patients (67%) with N2 disease had clinical downstaging. Twenty-two patients (73%) were taken to surgery. Complete resection rate was achieved in 21 patients (70%). Treatment was well tolerated. Conclusion Localized non–small-cell lung cancer is very sensitive to chemotherapy. Postchemotherapy mediastinal-based treatment decision led to a high complete resection rate, even in patients with large tumors. This strategy deserves further investigation.

RESUMO: Objectivos: Identificar os factores preditivos de risco para o surgimento do segundo tumor primário maligno primário no pulmão. Métodos: Estudo primário, observacional, multicêntrico, retrospectivo, de uma série de casos com 104 pacientes do Hospital do Câncer â INCA/MS e do Hospital Universitário Antônio Pedro. Resultados: Os locais dos tumores primários foram: cabeça e pescoço(56,7 %); entre eles, o mais comum foi o carcinoma da laringe (42,4 %); pulmões (15 %); bexiga (8,6 %); colo uterino (7,6 %); estômago (4,8 %); outros (6,8 %). Sexo masculino 84,6 %. A idade média foi de 56,7±± 10,7 anos, com coeficiente de variação de 18,8 %. Dentre os pacientes, 91,4 % eram fumadores e 92,0 % consumidores de álcool. Regressão logística: local do tumor primário (OR:8,22; IC 95 % - 2,21 a 30,56; p=0,0017); tipo histológico do tumor primário (OR:0,21; IC 95 %: 0,04 a 0,99; p=0,0498); sexo (OR: 0,25; IC 95 %: 0,03 a 1,81; p=0,1711); idade (OR: 0,98; IC 95 %: 0,92 a 1,04; p=0,6318); tabagismo (OR: 2,80; IC 95 %:0,44 a 17,55; p=0,2711) e consumo de álcool (OR:0,76; IC 95 %: 0,19 a 2,95; p=0,6964). Modelo final ajustado: OR do local do tumor primário foi 4,14, com IC a 95 % entre 1,36 e 12,78 e p=0,0123 (p < 0,05). Exactidão do modelo final: 82,69 %. Conclusão: O local do tumor primário foi a única variável preditiva de risco para o surgimento do segundo tumor primário maligno no pulmão.REV PORT PNEUMOL 2004; X (4): 297-303 ABSTRACT: Objectives: The objective of our study was to identify the risks factors for the de development of a second pulmonary primary cancer. Methods: It was a primary, observational, multicentric and retrospective study with 104 patients from the Cancer National Institute and the Antonio Pedro Universitary Hospital, in Rio de Janeiro, Brazil. Results: The sites of primary tumors were: head and neck(56.7%); with laryngeal carcinoma (42.4%); lungs (15.5%); bladder (8.6%); uterine cervix (7.6%); stomach (4.8%); others (6.8%). Male patients represented 84.6%. Average age 56.7±10.7 years, with a coefficient of variation 18.8%.Among the patients 91.4% were smokers and 92.0% were alcohol consumers. Multiple logistic regression model: site of primary tumor (OR:8.22; CI 95% - 2.21 to 30.56; p=0,0017); specific histologic of primary cancer (OR:0.21; IC 95%: 0.04 to 0.99; p=0.0498); sex (OR: 0.25; CI 95%: 0.03 to 1.81; p=0.1711); age (OR: 0.98; CI 95%: 0.92 to 1.04; p=0.6318); smoking (OR: 2.80; CI 95%: 0.44 to 17.55; p=0.2711) and alcohol consumption (OR:0.76; CIIC 95%: 0.19 to 2.95; p=0.6964). Asjusted model: odds ratio of the site of the primary tumor was 4.14,; CI 95%; from 1.36 and 12.78 and p=0.0123 (p < 0.05). Accuracy or the model: 82. 69%. Conclusion: In this study teh site of the primary tumor was the only predictor of risk for the second pulmonary primary cancer.REV PORT PNEUMOL 2004; X (4): 297-303 Palavras-chave: segunda neoplasia primária do pulmão, neoplasias primárias múltiplas, cancro do pulmão, Key-words: second primary lung neoplasms, multiple primary neoplasms, lung cancer

INTRODUÇÃO: Nos últimos anos, a punção aspirativa transbrônquica por agulha vem sendo utilizada cada vez com maior freqüência no diagnóstico e estadiamento do câncer de pulmão, principalmente nos EUA. Entretanto, muito pouco se tem publicado a respeito do método em nosso país. OBJETIVO: Avaliar a efetividade da punção aspirativa transbrônquica por agulha no diagnóstico e estadiamento do câncer de pulmão. MÉTODO: Setenta e quatro punções aspirativas transbrônquicas por agulha, realizadas no Hospital do Câncer-INCA/MS, foram revistas retrospectivamente. Todos os pacientes realizaram tomografia computadorizada do tórax previamente ao procedimento. RESULTADOS: Onze (15%) pacientes tinham massas mediastinais e 63 (85%) massas hilares. Foram encontradas 76 alterações endoscópicas: alargamento da carina principal em 44 (59%) pacientes, alargamento de carina secundária em 12 (16%), compressão paratraqueal em 5 (7%), compressão da parede posterior da traquéia em 3 (4%), e compressão de brônquio principal em 5 (7%) pacientes. O material foi satisfatório para o diagnóstico em 42 (57%) pacientes e em 34 (46%) o diagnóstico foi confirmado. O diagnóstico de doença maligna foi confirmado em 30/34 (88%) pacientes: carcinoma indiferenciado de pequenas células em 10/30 (33%), carcinoma escamoso em 7/30 (23%), adenocarcinoma em 7/30 (23%), e carcinoma não pequenas células em 6/30 (20%) pacientes. Em 4/30 (12%) pacientes foram diagnosticadas patologias benignas: tuberculose em 2/4 (50%) e sarcoidose em 2/4 (50%) pacientes. Não observamos nenhuma complicação com o método. CONCLUSÃO: Nossa experiência em 74 pacientes mostrou que o procedimento é seguro, rápido em sua realização, com mínimas complicações e de utilidade no diagnóstico e estadiamento de pacientes com neoplasia pulmonar. BACKGROUND: Transbronchial needle aspiration (TBNA) with a flexible bronchoscope has been used to diagnose bronchogenic carcinoma for many years in the United States. However, little information on the subject is available in Brazil. OBJECTIVE: To assess the effectiveness of transbronchial needle aspiration in the diagnosis and staging of lung cancer. METHOD: A retrospective review was made of 74 TBNA performed at the National Cancer Institute in Rio de Janeiro, Brazil. a thoracic computerized tomography had oreviouslbeen made of all patients.Eleven (15%) patients exhibited mediastinal masses and 63 (85%) hilar masses. Seventy six endoscopic alterations were detected: enlargement of the main carina in 44 (59%) patients; enlargement of the secondary carina in 12 (16%); paratracheal compression in 5 (7%); posterior tracheal wall compression in 3 (4%); main bronchus compression in 5 (7%) AND BRONCOSCOPY was normal in 5 (7%) patients. RESULTS: Specimens were satisfactory for diagnosis in 42 (57%) patients and in 34 (46%) diagnosis was confirmed. Malignancy was confirmed in 30 of 34 patients (88%): as follows: small cell undifferentiated carcinoma in 10 of 30 (33%); squamous cell lung cancer in 7 of 30 (23%); adenocarcinoma 7 of 30 (23%); and non-small cell lung cancer in 6 of 30 (20%). Four of 30 (12%) were diagnosed as bearers of benign disease: tuberculosis 2 of 4 (50%) and sarcoidosis 2 of 4 (50%). No complications related to the method were perceived. CONCLUSION: This preliminary study of TBNA in 74 patients indicated that this method is safe, easy to perform, with a minimum of complications and useful for the diagnosis and staging of pulmonary neoplasms.

Os linfomas não-Hodgkin fazem parte de um grupo de doenças malignas linfoproliferativas com diferentes padrões de comportamento, de tratamento e de prognóstico. Eles podem comprometer as estruturas intratorácicas, particularmente o mediastino e o parênquima pulmonar, em alguma fase do curso da doença. Entretanto, o envolvimento endobrônquico é extremamente raro, mesmo na presença de doença avançada. Os autores relatam um caso de linfoma não-Hodgkin endobrônquico e fazem revisão da literatura.

OBJECTIVE: To determine the contribution of percutaneous biopsy with core cutting needle in the diagnosis of mediastinal tumors. METHOD: Retrospective review of 22 patients with mediastinal lesions who were submitted to percutaneous core cutting needle biopsy, oriented, but not guided by computer assisted tomography of the thorax, between 1999 and 2002. RESULTS: Percutaneous biopsy with core cutting needle provided adequate material in 18/22 cases, with a total positive sample rate of 82%. In 4/22 cases, the material was insufficient to define the diagnosis (18%). Percutaneous core cutting needle biopsy established a specific histologic diagnosis in 82% of the patients: 8/22 (36%) lymphoma; 5/22 (28%) thymoma; 2/22 (11%) thymic carcinoma; 1/22 (6%) metastatic adenocarcinoma; 1/22 (6%) neuroectodermic primitive tumor; and 1/22 (6%) plasmocytoma. All the patients were submitted to a thoracic X-ray after the biopsy. No complications were found in these patients. CONCLUSION: Percutaneous core cutting needle biopsy oriented, but not guided by computer assisted tomography of the thorax, is an easy and safe procedure which can provide a precise diagnosis in most mediastinal tumors, and can prevent the exploratory thoracic surgery in inoperable or chemotherapy-treated cases.

Aim: To determine the contribution of percutaneous biopsy with core cutting needle (Trucut) in the diagnosis of mediastinal tumours. Method: Retrospective review of 56 patients with mediastinal lesions who underwent percutaneous core cutting needle biopsy, oriented but not guided by computer assisted tomography of the thorax, 1999 â 2008. Results: Percutaneous biopsy with core cutting needle provided adequate material in 49/56, with a total positive sample rate of 88%. In 7/56 (12%) cases the material was insufficient to define the diagnosis. Percutaneous core cutting needle biopsy established a specific histological diagnosis in 88% of the patients: 23/56 (41%) lymphomas; 12/56 (21%) thymomas; 5/56 (3%) thymic carcinomas; 3/56 (2%) small cell carcinoma and 1/56 (0.6%) metastatic adenocarcinoma, metastatic squamous cell carcinoma, neuroendocrine primitive carcinoma, plasmocytoma, teratoma and goiter. All patients underwent thoracic X-ray after the procedure. No complications were found in these patients. Conclusion: Percutaneous core cutting needle biopsy (Trucut) oriented but not guided by computer assisted tomography of the thorax is an easy and safe procedure which can provide a precise diagnosis in the majority of mediastinal tumours and can prevent the need for exploratory thoracic surgery in cases which are medically treatable or non-resectable. Resumo: Objetivo: Determinar a contribuição da biópsia percutânea com agulha cortante (Trucut) no diagnóstico das massas mediastínicas. Método: Revisão retrospectiva de 56 doentes com massas mediastínicas submetidos a biópsias com agulha cortante orientadas, mas não guiadas, pela tomografia computadorizada do tórax, no período de 1999 a 2008. Resultados: A biópsia percutânea com agulha cortante forneceu material adequado para o diagnóstico em 49/56 casos, com índice de positividade de 88%. Em 7/56, o material colhido foi insuficiente para definir o diagnóstico (12%). Este método foi capaz de definir o diagnóstico em 88% dos doentes: 23/56 (41%) linfomas; 12/56 (21%) timomas; 5/56 (3%) carcinomas tímicos; 3/56 (2%) carcinoma indiferenciado de pequenas células e 1/56 (0,6%) adenocarcinoma metastático, carcinoma epidermóide metastático, carcinoma neuroendócrino primitivo, plasmocitoma, teratoma, bócio. Após a biópsia, os doen tes foram submetidos a radiografia do tórax. Não houve nenhum tipo de complicação nestes doentes. Conclusão: A biópsia transtorácica com agulha cortante (Trucut) orientada, mas não guiada pela tomografia computadorizada, tem alto rendimento, esclrrecendo o diagnóstico na maioria dos portadores de massas mediastínicas e pode ser útil, evitando a toracotomia exploradora, nos casos de tumores do mediastino inoperáveis ou de tratamento quimioterápico. Key-words: Biopsy, needle, Trucut needle biopsy, mediastinal/lesions, mediastinal neoplasms, Palavras-chave: Biópsia por agulha, biópsia com agulha Trucut, neoplasias do mediastino, mediastino/lesões

Background: Besides clarifying the etiology of unidentified lymphadenomegaly, puncturing hilar and mediastinal lymph nodes by a flexible bronchoscopic needle is an aid in diagnosing and staging bronchogenic cancer or other metastatic cancers. Objective: Our study had the principal objective to evaluate the positivity of transbronchial needle aspiration (TBNA). Method: We evaluated retrospectively the effectiveness of all TBNA done in 74 consecutive patients. Forty-nine patients were male and the median age was 59. We used Wang-needles, 21-gauge (Bard, USA), and the same technique described for differents authors. Of the 74 patients evaluated, 11(15%) showed mediastinal mass and 65 (85%) hilar mass. We observed 76 endoscopics abnormalities. Results: According to the classification of the specimens, we had 32/74 (43%) unsatisfactory specimens, 34/74 (46%) satisfactory and diagnostic specimens, and 8/74(11%) satisfactory and non-diagnostic specimens. Thirty four (46%) of the examinations were found to be positive out of the total amount of specimens. Of the positive results, 30/34 specimens (88%) contained malignant disease. Small-cell carcinoma was the most frequent finding, with 10/34 cases (29%); squamous cell carcinoma 7/34 (21%); adenocarcinoma 7/34 (21%), non--small cell carcinoma 6/34 (17%); sarcoidosis 2/34 (6%) and tuberculosis 2/34 (6%). Conclusion: Our study indicated that this method is safe, easy to perform, with a minimum of complications and useful for the diagnosis and staging of pulmonary neoplasms. Resumo: Introdução: A punção com agulha através da broncofibroscopia (TBNA), além de ser útil no esclarecimento das linfodenomegalias hilares e mediastinais, é também de utilidade no diagnóstico e estadiamento do carcinoma brônquico e de outras neoplasias metastáticas. Objectivo: Avaliar restrospectivamente a eficácia das TBNA realizadas em 74 doentes consecutivos. Quarenta e nove deles do sexo masculino e com idade mediana de 49 anos. Utilizámos a agulha de Wang, 21--gauge (Bard, USA), e a técnica utilizada foi a descrita pelos diversos autores. Dos 74 doentes estudados, 11 (15%) tinham linfadenomegalia mediastinal e 65 (85%) hilar. Observámos 72 anormalidades endoscópicas. Resultados: De acordo com a classificação do material obtido, tivemos 32/74 (43%) cujo material foi insatisfatório para o diagnóstico; em 34/74 (46%), o material foi satisfatório e capaz de definir o diagnóstico; e 8/74 (11%) nos quais o material obtido foi satisfatório mas insuficiente para se definir o diagnóstico. Da amostra, 34 (46%) foram positivos. Destes, 30/34 (88%) eram doenças malignas. O carcinoma indiferenciado de pequenas células foi o mais comummente encontrado, com 10/34 (29%); o carcinoma escamoso, 7/34 (21%); o adenocarcinoma, 7/34 (21%); e o carcinoma de não pequenas células, 6/34 (17%). A sarcoidose foi identificada em 2/34 (6%) e a tuberculose em 2/34 (6%). Conclusão: O método é seguro, de fácil realização, com pequeno índice de complicações e de utilidade para o diagnóstico e estadiamento do cancro do pulmão. Key-words: Lung cancer, cytology, staging, flexible bronchoscopy, lymph node metastases, transbronchial needle aspiration, Palavras-chave: Carcinoma brônquico, citologia, estadiamento, broncofibroscopia, metástases linfonodais, punção aspirativa transbrônquica com agulha

Resumo: O blastoma pulmonar é um tumor primário do pulmão, raro, de mau prognóstico e que acomete doentes mais jovens do que os portadores do carcinoma de células não pequenas do pulmão. Geralmente, são vistos sob a forma de grandes massas pulmonares, sintomáticas e com metástases para linfonodos mediastinais. Do ponto de vista anátomo-patológico, estes tumores são bifásicos, englobando na sua estrutura componentes mesenquimal e epitelial. Embora infrequente, este tipo de tumor deve fazer parte do diagnóstico diferencial das neoplasias pulmonares. Os autores apresentam um caso de blastoma pulmonar e fazem revisão da literatura.Rev Port Pneumol 2007; XIII (3): 391-395 Abstract: Pulmonary blastoma is a rare primary lung tumor with poor prognosis that commonly presents at a younger age than the non-small cell lung cancer. Classicaly they are large, symptomatic tumors with lymph nodal metastasis and carry poor prognosis. Pathological examination revealed features suggesting a biphasic tumor with mesenchymal and epithelial components. Over 200 cases have been reported so far worldwide since the first description of the tumor in 1945. Authors present a case of pulmary blastoma with literature revision.Rev Port Pneumol 2007; XIII (3): 391-395 Palavras-chave: Cancro do pulmão, blastoma, blas-toma pulmonar, tumor primário do pulmão, Keywords: Lung cancer, blastoma, pulmonary blastoma, primary tumors of lung

18175 Background: The goals of chemoradiotherapy in non-small cell lung cancer (NSCLC) with stage III disease are to achieve local control, for which radiotherapy plays the main role, and eradicate occult distant metastases by chemotherapy. Systemic progression remains a significant cause of morbidity and mortality in these patients. Japanese trials showed that the combination of uracil and tegafur (UFT) improves survival in patients with early NSCLC. The Brazilian National Cancer Institute (INCA) conducted a phase II trial to evaluate the use of adjuvant UFT in patients with IIIB NSCLC treated with sequential chemoradiation. Methods: The eligibility requirements were stage IIIB NSCLC, an ECOG performance status 0 or 1 and normal end organ function. Patients were treated with induction chemotherapy with cisplatin (100 mg/m2 - days 1 and 29) and vinblastine (5 mg/m2/week for 5 weeks) followed by 60 Gy of thoracic radiotherapy. Two weeks after the end of radiotherapy they started a fixed UFT oral dose (400 mg/day), administered continuously for one year if no progression was detected in this interval. Results: Between May 1999 and October 2003, 22 patients were enrolled; 15 were male (68.2%); 65% were white (no patients had oriental ethnicity); 11 were adenocarcinoma (50%), 9 squamous cell (40.9%); the median age was 55.5 years (range: 45–74 years). UFT’s toxicity was manageable with 13.6% of grades 3 and 4 toxicities (mainly fatigue, diarrhea, nausea and vomiting). Two patients discontinue UFT due to limiting toxicity (1 patient due to diarrhea and 1 due to nausea and fatigue). Median time on UFT was 5 months (range: 0.5–12 months). Median follow-up was 13.5 months (range: 6–77 months) and five patients are still alive. The median overall survival (OS) was 14 months (95% CI: 10.6–17.3) and the median progression-free survival was 8 months (95% CI: 3.4–12.5). Conclusions: UFT in this fixed dose schedule was well tolerated, but our results are almost identical to the Dillman′s original report with sequential chemotherapy and radiotherapy in stage IIIB NSCLC (13.7 months OS). Despite our limited sample size these data may suggest that adjuvant UFT do not add any benefit to sequential chemoradiation in this non-oriental population. No significant financial relationships to disclose.

Background The approach to palliative treatment of malignant pleural effusion (MPE) should be individualized because these patients generally have poor survival. Our study aimed to develop a model to identify prognostic factors or survival time in patients diagnosed with MPE. Methods This is a retrospective, descriptive, observational study to identify prognostic factors related to MPE in patients with a confirmed cancer diagnosis. Cox regression analysis was used to determine significant potential prognostic factors with respect to survival time. Survival time was defined as the time from pathological diagnosis to death. Results One hundred and sixty-five patients were included; 77 were men (47%) and 88 were women (53%). The median age was 60 years, and all of the patients were pathologically proven to have MPE. Non-small-cell lung cancer (36.0%), breast carcinoma (26%), and lymphoma (13.0%) were the most frequently diagnosed tumors. The median overall survival of patients from the initial diagnosis was 5 months (range: 1.0–96.0 months). Kaplan–Meier univariate analysis showed that survival was significantly related to the following prognostic factors: ECOG PS (hazard ratio [HR] 10.0, 95% confidence interval [95% CI] 5.96 to 18.50, p