1
s31 Indications for, and results of, surgical treatment of bronchopul- monary carcinoma. Roeslin N, Morand G, Wihlm JH, Witz JP. Service de Chirurgie Thoracique. CHU, F-67091 StTasbourg Cedex. Prax Klin Pneumol 1988;42(Spec Iss 1):344-6. Surgical intervention is still the best form of treatment of cancer of thelung.Itmustbeconsideredineverycaseofthisdisease,sinceitoffers the chance of a cure. In this article, the indications for, and the results of, surgery are examined. We concentrated our attention not so much on aglobalanalysisoftheindications,as,ra(her,onadiscussionofthemost difficult of the problems, in particular, carcinoma in the elderly patient, carcinomas involving the mediastinum, the wall of the thorax or the carina, and, finally, the anaplastic carcinomas. The representation of the results needs to take account of the mortality rate of surgery and of exploratory tboracotomy. Tberesultsachievedcontinue todepend upon the histological classification of the tumour in accordance with the TNM stages. But they can also be discussed as a function of the nature and extent of the intervention, with consideration being given to the addi- tional treatment modalities. Transaxiltary thoracotomy revisited. Massimiano P, Ponn RB, Toole AL. Section of Curdiothoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT. Ann Thorac Surg 1988;45:559-60. Transaxilhuy thoracotomy is a well-known but underused approach to both benign and malignant conditions in the chest. The traditional posterolateral thoracotomy affords little advantage over this incision in terms of staging of disease or therapeutic resection. Previous reports have emphasized the wide range of conditions for which this approach is suitable, but advances in the technique and design of stapling devices and routine use of the double-lumen endotracheal tube have further enhanced its indications. We have reviewed 54 consecutive patients who have undergone thoracotomy over a 21-year period. The wide range of procedures performed up to and including pneumonectomy indicates theversatilityoftheapproach. Wenowconsidertransaxillarytboracoto- my to be the incision of choice for most pulmonary and mediastinal lesions and an attractive alternative to mcdiastinoscopy for the identi- fication and staging of chest tumors. Reconstruction of the chest wall after full thickness resection: A comparison between myocutaneous flap and acrylic resin plate as reconstructive techniques. ShibaE, Koyama H, Noguchi S et al. Department ofSurgery, Cenrerfor Adult Diseases, OS&I 537. Int Surg 1988;73:102-6. Thirty-three patients with chest wall malignancies underwent full thicknessresectionofthechestwallandimmediatereconstruclionofthe defects with either synthetic materials (acrylic resin plate, 16 patients) or with myocutaneous flaps (rectus abdominis flaps, 17 patients). Although the acrylic resin plate proved to be excellent for maintaining stability of the chest wall, fivepatients suffered from local skin necrosis, requiring skin grafting, and four suffered from persistent foreign body reactions, necessitating ultimate removal of the plate. The patients receiving myocutaneous flap repair had excellent wound healing, acceptable rigidity of their chest wall, and no foreign body reactions throughout the follow-up period. The 50% post-operative survival time for the entire series was 29 months, suggesting that the procedure is an effect& treatment modality for breast cancer involing the chest wall. Reconstruction with a myocutaneous flap is indicated as long as the chest wall defect is not too extensive. Successful resection of the tracheal bifurcation with rightsided upper lobectomy on account of a malignant tumour in the region of the carina. Hajek M. Chirurgicka Klinikn ILF. 180 81 Praha-Bulovka 8. Rozhl. Chir 1987;66:163-7. Theauthorprescnts a case-history on a successful complete resection of the tracheal bifurcation. After resection of the upper right pulmonary lobe a neocarina was established by the junction of tbe right bronchus intermcdius and the left main bronchus and the thus joint bronchi were connected with the caudal end of the trachea, resected 2.5 cm above the carina on account of an adenoid cystis carcinoma. The 29-year-old female patient is now 6 months after operation and is in a very good condition and resumed her work. The fibroscopic finding in the trachea is almost normal. Chemotherapy A phase II trial of vinblastine, bleomycin, and cisplatio induction followed by dacarbazine and dibromodulcitol maintenance in tbe treatment of metastatic melanoma. A follow-up study of twenty-two patients. Gentile PS, Epremian BE, Seeger J, Hamm JT, Sheth SP. Division of Medical Oncology, The James Graham Brown Cancer Center, Univer- sity ofLouisville School of Medicine, Louisville, KY 40292. Am J Clin Oncol, Cancer Clin Trials 1988;11:666-8. Twenty-two patients with mctastatic melanoma were treated with a chemotherapy regimen consisting of two cycles of induction therapy with vinblastine, bleomycin, and cisplatin, followed by maintenance therapy withdacarbazineanddibromodulcitol. A 17% responserate was noted in this patient group, with a median survival of 40 weeks. Objective responses were limited to cutaneous, nodal, pulmonary, and one adrenal site of metastatic disease. Toxicity was acceptable and was limited to myelosupprcssion and nausea with emesis. Further study appears warranted to define the optimal treatment plan for metastatic melanoma. Randomized Phase II evaluation of iproplatin (CHIP) and car- boplatin (CBDCA) in lung cancer. A Southeastern Cancer Study Group trial. Kramer BS, Birch R, Greco A, Presddge K, DeSimone P, Omura G. Universify of Florida, Gainesville. FL. Am J Clin Oncol, Cancer Clin Trials 1988;11:643-5. Cisplatin-containing regimens have shown activity in both small and non-smallcclllungcanccr. WcthereforeconductedarandomizedPhase II trial of the new platinum congencrs iproplatin and carboplatin in bronchogcnic carcinoma. The overall response rate in chemotherapy- naive non-small cell patients with iproplatin was 3/48 (6%; 95% contidence interval 2-180/o) and with carboplatin 6/50 (12%; 95% confidence interval 525%). The response rates in previously treated small cell patients were O/l6 and l/18, respectively. Overall, neitber agent has pronounced activity in bronchogenic carcinoma. Etoposide and split-dose cisplatin in bronchogenic carcinoma. LauerRC,FisherWB,PcnningtonK,AnsariR,EinhomLH,LoehrerPJ. Departmenr of Medicine, Indiana University, Indianapolis, IN 46223. Am J Clin Oncol, Cancer Clin Trials 1988;11:634-5. The Hoosier Oncology Group (HOG) treated 13 patients with bron- chogenic carcinoma and an innovative schedule of cisplatin and VP-16.

Reconstruction of the chest wall after full thickness resection: A comparison between myocutaneous flap and acrylic resin plate as reconstructive techniques

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Page 1: Reconstruction of the chest wall after full thickness resection: A comparison between myocutaneous flap and acrylic resin plate as reconstructive techniques

s31

Indications for, and results of, surgical treatment of bronchopul- monary carcinoma. Roeslin N, Morand G, Wihlm JH, Witz JP. Service de Chirurgie Thoracique. CHU, F-67091 StTasbourg Cedex. Prax Klin Pneumol 1988;42(Spec Iss 1):344-6.

Surgical intervention is still the best form of treatment of cancer of thelung.Itmustbeconsideredineverycaseofthisdisease,sinceitoffers the chance of a cure. In this article, the indications for, and the results of, surgery are examined. We concentrated our attention not so much on aglobalanalysisoftheindications,as,ra(her,onadiscussionofthemost difficult of the problems, in particular, carcinoma in the elderly patient, carcinomas involving the mediastinum, the wall of the thorax or the carina, and, finally, the anaplastic carcinomas. The representation of the results needs to take account of the mortality rate of surgery and of exploratory tboracotomy. Tberesultsachievedcontinue todepend upon the histological classification of the tumour in accordance with the TNM stages. But they can also be discussed as a function of the nature and extent of the intervention, with consideration being given to the addi- tional treatment modalities.

Transaxiltary thoracotomy revisited. Massimiano P, Ponn RB, Toole AL. Section of Curdiothoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT. Ann Thorac Surg 1988;45:559-60.

Transaxilhuy thoracotomy is a well-known but underused approach to both benign and malignant conditions in the chest. The traditional posterolateral thoracotomy affords little advantage over this incision in terms of staging of disease or therapeutic resection. Previous reports have emphasized the wide range of conditions for which this approach is suitable, but advances in the technique and design of stapling devices and routine use of the double-lumen endotracheal tube have further enhanced its indications. We have reviewed 54 consecutive patients who have undergone thoracotomy over a 21-year period. The wide range of procedures performed up to and including pneumonectomy indicates theversatilityoftheapproach. Wenowconsidertransaxillarytboracoto- my to be the incision of choice for most pulmonary and mediastinal lesions and an attractive alternative to mcdiastinoscopy for the identi- fication and staging of chest tumors.

Reconstruction of the chest wall after full thickness resection: A comparison between myocutaneous flap and acrylic resin plate as reconstructive techniques. ShibaE, Koyama H, Noguchi S et al. Department ofSurgery, Cenrerfor Adult Diseases, OS&I 537. Int Surg 1988;73:102-6.

Thirty-three patients with chest wall malignancies underwent full thicknessresectionofthechestwallandimmediatereconstruclionofthe defects with either synthetic materials (acrylic resin plate, 16 patients) or with myocutaneous flaps (rectus abdominis flaps, 17 patients). Although the acrylic resin plate proved to be excellent for maintaining stability of the chest wall, fivepatients suffered from local skin necrosis, requiring skin grafting, and four suffered from persistent foreign body reactions, necessitating ultimate removal of the plate. The patients receiving myocutaneous flap repair had excellent wound healing, acceptable rigidity of their chest wall, and no foreign body reactions throughout the follow-up period. The 50% post-operative survival time for the entire series was 29 months, suggesting that the procedure is an effect& treatment modality for breast cancer involing the chest wall. Reconstruction with a myocutaneous flap is indicated as long as the chest wall defect is not too extensive.

Successful resection of the tracheal bifurcation with rightsided upper lobectomy on account of a malignant tumour in the region of the carina. Hajek M. Chirurgicka Klinikn ILF. 180 81 Praha-Bulovka 8. Rozhl. Chir 1987;66:163-7.

Theauthorprescnts a case-history on a successful complete resection of the tracheal bifurcation. After resection of the upper right pulmonary lobe a neocarina was established by the junction of tbe right bronchus intermcdius and the left main bronchus and the thus joint bronchi were connected with the caudal end of the trachea, resected 2.5 cm above the carina on account of an adenoid cystis carcinoma. The 29-year-old female patient is now 6 months after operation and is in a very good condition and resumed her work. The fibroscopic finding in the trachea is almost normal.

Chemotherapy

A phase II trial of vinblastine, bleomycin, and cisplatio induction followed by dacarbazine and dibromodulcitol maintenance in tbe treatment of metastatic melanoma. A follow-up study of twenty-two patients. Gentile PS, Epremian BE, Seeger J, Hamm JT, Sheth SP. Division of Medical Oncology, The James Graham Brown Cancer Center, Univer- sity ofLouisville School of Medicine, Louisville, KY 40292. Am J Clin Oncol, Cancer Clin Trials 1988;11:666-8.

Twenty-two patients with mctastatic melanoma were treated with a chemotherapy regimen consisting of two cycles of induction therapy with vinblastine, bleomycin, and cisplatin, followed by maintenance therapy withdacarbazineanddibromodulcitol. A 17% responserate was noted in this patient group, with a median survival of 40 weeks. Objective responses were limited to cutaneous, nodal, pulmonary, and one adrenal site of metastatic disease. Toxicity was acceptable and was limited to myelosupprcssion and nausea with emesis. Further study appears warranted to define the optimal treatment plan for metastatic melanoma.

Randomized Phase II evaluation of iproplatin (CHIP) and car- boplatin (CBDCA) in lung cancer. A Southeastern Cancer Study Group trial. Kramer BS, Birch R, Greco A, Presddge K, DeSimone P, Omura G. Universify of Florida, Gainesville. FL. Am J Clin Oncol, Cancer Clin Trials 1988;11:643-5.

Cisplatin-containing regimens have shown activity in both small and non-smallcclllungcanccr. WcthereforeconductedarandomizedPhase II trial of the new platinum congencrs iproplatin and carboplatin in bronchogcnic carcinoma. The overall response rate in chemotherapy- naive non-small cell patients with iproplatin was 3/48 (6%; 95% contidence interval 2-180/o) and with carboplatin 6/50 (12%; 95% confidence interval 525%). The response rates in previously treated small cell patients were O/l6 and l/18, respectively. Overall, neitber agent has pronounced activity in bronchogenic carcinoma.

Etoposide and split-dose cisplatin in bronchogenic carcinoma. LauerRC,FisherWB,PcnningtonK,AnsariR,EinhomLH,LoehrerPJ. Departmenr of Medicine, Indiana University, Indianapolis, IN 46223. Am J Clin Oncol, Cancer Clin Trials 1988;11:634-5.

The Hoosier Oncology Group (HOG) treated 13 patients with bron- chogenic carcinoma and an innovative schedule of cisplatin and VP-16.