Lung cancer : journal of the International Association for the Study of Lung Cancer
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We hypothesized that transoesophageal endoscopic ultrasound guided fine needle aspiration (EUS-FNA) has the potential to be a valuable and accurate new diagnostic technique for mediastinal restaging in non-small cell lung cancer (NSCLC) after induction chemotherapy. The current restaging modalities either have a low diagnostic accuracy (computed tomography (CT) scan of the thorax) or they are invasive, can be technically difficult and are therefore not commonly performed (remediastinoscopy). ⋯ EUS-FNA qualifies as an accurate, safe and minimally invasive diagnostic technique for the restaging of mediastinal lymph nodes after induction therapy in NSCLC. In the future EUS-FNA might play an important role in the mediastinal restaging in NSCLC, particularly to identify the subgroup of down staged patients who benefit most from further surgical treatment.
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Many patients with early stage lung cancer (stage I and II) are curable by surgical resection. In patients with locally advanced disease surgery plays an important role in order to provide local tumor control. Therefore, the aim of all staging efforts in NSCLC must be to identify all patients, who might be potential candidates for a surgical approach. ⋯ With respect to lymph node staging, VATS is complimentary to cervical mediastinoscopy because it helps to stage the lymph nodes in the A-P. window (#5, 6), as well as the lymph nodes paraesophageal (#8) and in the pulmonary ligament (#9). In conclusion, surgical staging methods provide a 100% specificity in combination with a high sensitivity and only a minimal morbidity. Currently, surgical staging is recommended by the majority of scientific societies for the staging of patients with apparently resectable NCSLC.
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A retrospective study was conducted analyzing the clinical outcome and various prognostic factors in patients treated with gamma knife stereotactic radiosurgery (GK-SRS) for solitary brain metastasis from non-small cell lung carcinoma (NSCLC). A total of 72 patients from June of 1992 to January of 1999 were treated. All patients received GK-SRS to a median dose of 18Gy, with 45 patients receiving additional whole-brain radiation therapy. ⋯ In conclusion, patients presenting with a solitary metachronous brain metastasis from NSCLC achieved longer survivals than those with a synchronous metastasis. The tail in the survival curves demonstrates that a prolonged survival may be attained in patients with solitary metastases from NSCLC. This study adds to the growing body of literature that supports the use of SRS in the management of this patient population.